The first week of my trial has been so stressful. The evening of the first day my BS was ok, but it’s gradually rising everyday since. Started in 200’s, then 300’s, now this morning it was in the mid 400’s. I think I’m doing everything right, but can’t understand what’s happening. I’ve been in touch with the sales rep and my CDE. They say it takes time to adjust. We adjusted my basal rate and I/C ratio, and my sugar went down for a few hours last night, but it’s still in the 300’s after a correction 2 hours ago. Does anyone know what’s happening?
Is this your first time on any pump? Are you under the care of your doctor and CDE as you started this trial? Often times medical professionals will start insulin basal and bolus rates conservatively and then inch up from there. To do this well, any medical professional should be closely monitoring your situation. You should be in daily contact with them. Many of today's medical practices do not have sufficient time to properly address a solid pump start.
The short answer to your question is that you're not getting enough insulin. That can be caused by many things, starting with a bent cannula or a poorly absorbing site. Next, your basal rates need to be adjusted so that your blood glucose (BG) ideally remains flat when you don't eat. Have you done any basal rate testing?
Then your insulin to carb ratio (I:C) needs refining. Your insulin sensitivity factor (ISF) is also programmed into your pump. This is the number your BG will fall for each correction unit of insulin that you give.
The best outcome with pump therapy happens when the patient is sufficiently educated to understand how pump basal/bolus therapy works and is willing to take over eventually analyzing daily therapy challenges and making educated guesses about how to proceed. It also means that the patient is willing to frequently check BGs.
I don't know to what extent you have received useful instruction. I fear that you may have been thrown into the deep end of the pool and you're now faced with sinking or swimming.
Have you read either Think Like a Pancreas by Scheiner or Pumping Insulin by Walsh? Good solid education is the base upon which successful pump adoption is built. The pump is simply a dumb tool. Humans need to bring the smarts to power this tool.
Sorry if I've jumped to any wrong conclusions here. I love insulin pump therapy. It is a sophisticated tool when employed with intelligence and a dash of art.
Yes this is my first try on a pump. I’m a type 1 LADA diabetic. I’ve been on MDI of 6 or more/day for years. My A1C is from 8-10 typically. I got about 1hr. Of training and went home pumping insulin. I have been in touch with the trainer and my CDE. I’m seeing her this afternoon. We have adjusted my basal rate and I/C ratio. But conservatively. Thanks for the valuable information. I do feel a bit frustrated, and I hope I can get it adjusted.
No one should have to go days with BGs ranging in the 200s and 300s. I strongly recommend beefing up your knowledge of basal/bolus insulin therapy. The two books I listed are a great place to start. I'd also ask the trainer and/or CDE for daily contact until you can get your BGs in a reasonable range, say nothing above 200.
I've had my eye on the Snap pump since it was introduced. It looks like a good choice. It's on my short list for my next pump.
You have all the needed hardware; you need, however, to build up your software chops!
Pump therapy can restore some flexibility and spontaneity to your life. It's definitely worth the effort. Good luck to you!
Thanks for your help. I will check out the books. As far as the Snap pump goes, it’s easy to use and cartridge changes are easy. But I prefer something with a better screen. I like the Tandem T:Slim because it has all your settings and so much on the home screen. I’d rather not have to scroll through menus to find my info. the T:Slim also has a micro-delivery system where you are never “connected” to 300 units of insulin. That has always been my fear, Being connected to a potentially lethal dose. I guess I’m just nervous about the whole process of pumping.
It sounds like you've already investigated the feature of a few pumps. You're right; not having to scroll up to numbers on the t:slim is a definite advantage. The idea of inputting in a parallel fashion is a better one. The t:slim, however, takes a long time to prime the set when first loading, something like more than 5 minutes.
You needn't worry about the pump accidentally injecting its whole load. I've been on many pumps since 1987; I've never had this happen nor have I ever heard of this happening. The important thing is to never allow a cartridge to be connected to you that is not under the direct control of the pump.
The t:slim has many things to recommend it. As I said before, you are the brains that make this whole thing work. That's where your best investment lies.