Into the Looking glass....pump possibilities?

So, I've been learning from you all for a few months now, and I think my questions are boiling down to this...

The question:
If you have a predictable BG increase of about 150 points per hour, for an interval of a few hours, then how would you treat that on a pump?

Lets say that I, hypothetically, were to take 1 unit per hour as a standard pump basal. If I start exercising and want to increase to 10 units for an hour, then, that's a 900% increase in temp basal for an hour? Can that be correct? How does one manage that? Where does a pump max out on temp basal % increases?

@niccolo, I might be 'coming around,' but I'm having trouble visualizing how my algorithm translates into a pump algorithm. I am somewhat concerned that I never used pump software because my pump wouldn't allow me to take as much insulin as I needed to overcome these endocrine BG spikes. Is that possible? If I needed 10 u of correction, I would just hard dial and deliver 10 u via the pump. Perhaps there's a better way to do that. IDK.

The purpose of the question:
I'm trying to learn how to control my BG when I ski so that I don't become a public health threat and because I want to return to fun, challenging skiing. Last night I went downhill skiing for the first time this season and the data has 'public health threat' written all over it. LOL.

My data:
I'd like to hear from all you pumpers, MI's, and IM injection-ers because I just haven't been able to figure out a good solution. I am trying to collect data on these spikes that I think are coming out of my endocrine system, maybe its adrenaline or liver function. Its something that I can't measure easily. Its hormonal. I might spike 60 points an hour when I wake up, for 4-6 hrs. I might spike 200 points and hour during lower intensity exercise. I've collected enough data, without eating, to know that peaks are not resulting from carbohydrate intake. Its definitively endocrine.

Adding exercise into the equation makes the system enter a land of bizarre-o happenings....I appreciate any perspective you have to offer.

Have you ever had a cgm for diagnostic purposes? Ordered by a dr. you will be blind to the data until the test is done (usually 3 days, but mine butted into a weekend, so I stretched it to 5...the data was enormously useful when i started my pump). With that said, when your dr. gets the data (which you will be able to see afterwards), then said dr. can find out what is going on with you. It's important that the data be blinded to you so that you don't change your routine and habits... My 2 cents, which is all I have :)

I don't have any advice because the only time I ever spike when exercising is when I lower my basal rate too much or disconnect my pump. Otherwise, exercise always makes me plummet.

But in regards to your temp basal question, my Ping stops at +200% (so 4x usual basal, I think). However, if you wanted to take 10u spread out, you could do something like a combo bolus where you extend the entire thing out over however many hours you want (my Ping allows anything from 0.5 to 12 hours). Then you wouldn't have to worry about maximum temp basal rates, and it would still stop when you wanted it (or you could cancel it sooner).

I have never heard of that, but its a great idea. Maybe you can refer me to a clinic that does it. My Doc tells me outright that she has no idea what to make of the data. I don't either. Its messy.

Is that a CGM graph above, and if so, is it accurate? It looks like both times you calibrate the CGM jumps by a huge amount. Are you doing meter tests to see if you are actually spiking and dropping that much?

It lags during large increase/decrease. The CGM is trying to be accurate, but it requires some re-calibration to keep up with the rate of change. Manual BG's confirm the sensor data, although the sensors not doing great.

It's ordered by your dr. through a company that makes/sells cgms. Mine was done through Medtronic. Is your dr. an endo.?

What did you do going into the 150 point increase, if I'm reading your question right?

I get pretty engaged with my pump before I work out. Usually I do lifting/ jumping etc. (T25/ P90X3) in the AM and then run in the evening and mix it up. During "big race" season, I'm in a training group that goes on Saturday mornings, usually following a plan, like 7-8-7-10-8-12-10-14-12-16 miles and so on up to 20. Last summer I also tossed in 50 mile bike rides on Sunday to unwind so I was busy!

I want to be flat and not too high going in and just aim at staying there. Lifting (these are 1/2 hour workouts but can be pretty high intensity...) and anaerobic exercise usually raises me about 50-70 points so I prebolus like .3-.5U, depending on what it's doing and kind of keep an eye on it, whihc might be more difficult in ski clothes. I think the 200% = 200% or double your normal rate of basal, not 4x like Jen suggested. The whole thing you do with a pump is to figure out, roughly, how much insulin you need per input (food/ adrenaline?) and then fix it with a calculated amount. It's usually more sophisticated than "9 units". If it's 9 units to fix 220, it's say 7.2 units to fix 175 or whatever. The pump does the math.

Sure is. I'll ask her next week when I'm in for my apt.

Just sent a message to my clinical trainer asking for a number you could call for setting this up in St. Paul. Not trying to be a sales rep., just know how helpful it was for me to see daily patterns, and when I got the pump, setting up basil schedule was almost spot on from the "git go". The wireless contour gc meter collects downloadable data that was also really helpful recently. I want to photograph, and frame the mealtime bell curves!

Thanks a bunch, Lorraine. I have a cgm, but I don't think I've ever had anybody perform diagnostics on it, I mean, I know my Doc downloads the data and she probably looks at it. But, that might not be what you mean.

I am HIGHLY adjusting my routine and habits when I'm testing the data myself. I'm trying to 'pull the variables' apart so I can see trending in particular ones. Otherwise, I can't even begin to interpret it.

Your two cents is probably worth a lot more than $2,000.00. : )

I think my basal requirements are highly variable when I don't control for behavior. I would like it very much if a pump could fit my basal requirements more closely. I don't know if it can, but it would be great. My Endo is pushing hard for a pump. If someone could fit the basal curve, then I could really, 'let it all hang out,' behaviorally, again. :)

I think I have an old medtronic pump that works with a sensor.

It depends on the pump, but I just checked my Ping and it allows basal rates up to 25 units an hour, and boluses up to 35 units in one bolus. So yes, a pump can easily deliver 10 units over the course of an hour. It only allows up to a 200% increase in basal, though, so you may not be able to do it as a temporary basal, but you can also have up to four different basal programs that you can switch between, so you could set it to an "exercise" program (you'd just have to remember to switch it back after the exercise) or could use a 10 unit bolus extended over an hour (in which case it would stop on its own).

Hi Mohe, need your zip code for someone to contact you or for you to contact.
Sending a friend request to you, if you want to do this privately.

Oh, OK! That should work, then. I see.

I've run a bunch of exercise tests - Downhill skiing I went high. X-country skiing, I went high and then low, with a bit of a delayed reaction that occurred after the exercise was over (it was a real brief session). Today, I am going to X-country ski using downhill skis and see what happens. I think that will make it less aerobic, more anaerobic.

I see what your asking about, AR. That 150 point jump is me re-calibrating the sensor because there is a lot of lag when I'm rapidly increasing/decreasing. Sensor lag is usually a pretty good indicator that I am experiencing a rapid increase/decrease. I was initially low, so I was trying to bump it up. Maybe I over treated the low, but I would have expected all the sugar to be in my blood stream, and readable by the machine, after that time interval. Maybe not, though, now that I look at it. IDK. Maybe this high is partially exercise and partially over treating a low. I can't tell.

I don’t calibrate when my BG is moving. If there’s the potential to have over treated a low, that seems much more likely to have been the cause of a high in my experiences exercising, although I haven’t ever skied.

I think I've done enough testing, of late, to see that exercise often bumps me high, but not all of the time, and often the effects of exercise are delayed, so I find it really difficult to sort out.