I think it’s more that while you’re pumping, you get to know your body a little better when it comes to BG.
Because on the pump, I was in control to the finest detail (you can change the long acting “basal” setting to as little as 0.05 difference). So, becasue I could control my levels so strictly, I learned that I need a higher insulin dosage while I’m sleeping to keep myself from going too high during the night. My sleep patterns raise my BG, but then I’ll crash after about 6 hours of REM sleep. So, this means that I could not use Lantus (because it would try to change my natural sleep patterns) and when on Levemir, it works WITH my sleep patterns and I wake up around the same level of BG as when I went to bed- so long as I inject just before going to sleep.
While on the pump, I also learned EXACTLY how much insulin I needed per carb. Because I could give myself a half of a unit on the pump, I was able to get the ratio down to an exact dosage.
I am no longer on the pump, but my three years with it has helped me immensely in my diabetes control.
At least, that’s why I think it’s the pump and not specifically the training. It was worth the purchase, even though I don’t currently use it anymore.
I was given all of the above information when I moved over to MDI. Actually, when I switched over to MDI about seven years ago I was put through an education session on both MDI and an updated nutritional course. When I moved over to the pump a few months ago I went through another updated nutritional session and spent all day with a pump trainer getting updated on I:C, ISF and all that other good stuff. I found the transition from MDI to pumping fairly easy because it was all more or less stuff I had already been doing.
So…I’m not sure why some people get the education and others don’t. I do have a hypothesis though…I don’t think a lot of people are willing to ask questions and/or are willing to move if they don’t feel like they’re doing well with the doctor they have.
I was diagnosed at 12 and my mom was always really proactive about my care - she asked questions and asked about classes and training. I was always with an endocrinologist too and not just an internist or PCP. As that was my basis of comparison for how quality diabetes care worked (meaning, always ask questions - questions questions questions! and doctors who are willing to mention the classes offered) that is how I treated it once I was considered an adult. When a endo didn’t seem willing to provide enough information I switched even if it meant driving further for appointments. So I guess…ask questions. Ask your doctor why you don’t get that kind of information. If they don’t have an answer for you and aren’t willing to fix the problem then move. And move again until you get someone that gives you what you need to feel like you are in control of your diabetes.
I was on MDI 6 yr prior to getting my pump recently. I was sent home with a kit and a Rx for Insulin. The kit had a syring and pamplet explaining how to give an injection. No one showed me how or even talked to me about it. Luckily, I’d given injections when I was younger and worked at a small town hospital and I’d taken allergy shots. At least I knew what the pamplet was saying. I, of my own accord, called the ADA and asked for literature about eating. That’s it. That is all I learned until I found this site. The first time I knew about carb counting was when I began needing a pump and started my research. The type insulins I was on prior to that were used like your friend’s for the same “Shooting in the dark”. I learned more on this site in 6 mo than I learned anywhere else in 6 yrs.
I have no idea whether I would benefit from knowing my ratios or counting carbs. I don’t do either. The last time I used a food scale was 30 years ago. I am attracted to the simple way of life. When my CGM tells me that my bg is 70 I eat enough to bring it up to 120. I kind of know how much I can eat to do that: almost no carbs and a lot of everything else. My simple way of life has one shortfall: I am not in control of when to eat. I eat when my bg is 70 which gets in the way mostly on weekends and on vacation. I have an endo appointment in a month when I will ask for a pump. I am not good at receiving lectures but I also don’t want to ■■■■ off the endo by being a smart-■■■. I will try my best to get away without ‘education’ and rather read a book and do it myself.
I was very accomplished at carb counting before pumping but I had never heard of the insulin sensitivity factor until I read my pump manual. I had not heard of John Walsh’s "Using Insulin"either. I did not know how to determine the amount of insulin on board when I took two injections less than four hours apart. Those were new features introduced to me while I was preparing to start using my pump. I struggled along without that knowledge and had A1c’s between 5.5 and 5.9 for several years before I started pumping in June, 2007. My A1c’s during my 28 months of pumping have also been in the same range, without any improvement. That is OK with me. Before pumping, my BG testing ranged from 30-180 but with pumping it has been 50-160. My standard deviation has been lowered. That is better but not what I had hope for. I have no more lows that require assistance from another person.
In summary, I agree that there are things I may not have known if I had never pumped insulin. The book “Using insulin” would certainly have taught me those things but I had not heard of it. That book has nothing to do with pumping.
Only way to know if this would be beneficial is to learn ratios & carb counting. This can only help since it’s a far more accurate approach. To me it’s a lot simpler than what you’re now doing. For one thing, it would put you in control of when you eat. Rather than feeding the insulin to prevent dropping, you’d be matching insulin to food.
Thankfully I have a found a very good endo (after firing the first one) and was trained in all that before the pump…becasue my basal needs are soooo very different throughout the day, long acting insulin no matter how we timed it was too overwhelming for my system at times…nasty lows…
so enter pump … made it better–enter CGMS–better still. …symlin even better…A1C not that mcuh better but much more stable bgs now–still sneaky lows occasionally but not so much…so while A1C not significantly improved…control is–as the doc keeps reminding me–as long as <7…the most important thing is stabilty as bigs swings do more damage than slightly elevated BGs–we are still aiming for that <6…but not at the expense of nasty lows (I know not everyone agrees with this philosophy–but it works for us)
I was on Humalog and Lantus prior to pumping so I had to learn my I:C ratio and do all the math in my head. My control was not as tight because I could not do fractions and my basil rate was an average for the day not a specific number. In my case I thought it was good learning carb counting for a while before going on the pump, it made the transition easier.
The pump is a precision tool, requiring consistent simple math.
Before I went on the pump I thought that the pump and counting carbs would make me “feel” more diabetic. Truth is, I think about diabetes a lot more, but the result is that I “feel” less diabetic. Less lows - less highs. THAT’s what sucks about diabetes - not counting carbs.
Yes, I was the same as you too Chrissy! I had bought the John Walsh “Pumping Insulin” book about 3 years prior - when a friend of mine on a pump was telling me to “go on the pump”. I didn’t want to at the time, then an opportunity came for me to test drive a few - and I leapt at the chance - and never looked back since. Having the knowledge I did prior to pumping really helped me transition better. I now feel so undiabetic now, it’s so odd - even when a doctor winces at what my infusion introducer needle looks like (yeap - my GP and a nurse the other day - actually looked grossed out - wierd huh?).
Luckily, with my Animas 2020 pump, I was given a newer version of John Walsh’s book - the first one is now residing at my local library! I felt it best to donate it to them, so someone else could learn how to manage their diabetes well, with a pump or MDI!
In our case, it’s definitely the pump, because the pump allows us to use full strength insulin whereas MDI required us to use diluted insulin. We had been doing MDI for 10 months prior to switching and had a fairly thorough understanding of I:C ratios, carb counting, etc. because with such a little person, even slight variations meant big swings in BG. The ability to vary basal rates over the course of the day depending on activity is a HUGE difference as well. Eric was always, always, always high at dinner time because the Lantus didn’t last him long enough, but we couldn’t up the dose because then he’d plummet overnight. So we had considerable variability in his BG readings till we got more control of that aspect of his insulin usage.
I can see where adult MDI-ers might be able to get away with “eyeballing” and not having a deep understanding of I:C ratios, but it’s just not possible when you’re dealing with tenths of a unit having a huge effect on BG.
To test this you’d have to give the pumper and the MDI’er the same training and then follow them for some period. My hypthosis is that the MDI’er would have better control than before and that the pumper would have better control than before but also better control than the MDIer.
Why? Because the pumper can fine tune the basal delivery, but the MDI’er will take a shot of long-acting insulin (or two) and remain on autopilot between shots.
So, between the pump itself and the education that accompanies the pump, I’d say they both count. But the pump counts a little more.
“I’m curious about why you desire a pump yet don’t feel the need to count carbs.”
I forgot to mention that I am not a MDI’er. I inject 30 units of 70/30 when I get out of bed and that is it for the day. This means that I never have to calculate how much insulin to inject because I don’t inject during the day. Maybe saying that I don’t count carbs was too strong. I look at a meal and say to myself: “If I eat the whole thing I will be high, let me eat half.” By looking at food I kind of know how much of it will raise my bg by 50. I also figure in the time of day. In the morning a lot of insulin is at work and I can eat more. My insulin wears off in the early afternoon. Lunch is typically my last meal for the day. I equated carb counting to coming up with a number, let’s say 50 and putting this number into some formula to give me the units of insulin I need as a bolus. This is not what I do.
I might think that I control my bg but it is actually the other way around. My bg controls me and I roll with the punches. Since I am cutting it so close I must be prepared to always eat within 10 minutes of my bg closing in on 70 because I am not keen on eating glucose tablets. I desire a pump so that I can eat when I want to eat. Or not eat when I don’t want to eat. Right now I am a diabetic between the time I get out of bed and lunch. Then the eating stops and I am free.
I bought “Pumping Insulin” and will inhale it before my first endo appointment. Thanks for recommending this book. I expect that setting up and fine-tuning my basal rates with be fun because my CGM gives me very accurate readings. Then the only other thing I have to figure out is how much insulin I need to cover my small meals. This will bring me up to par. Every gain beyond that will be gravy.
Dave, I have a tendency to be book smart. I tried to explain to my wife why I might be better off not trying the pump. Her answer was: “What is the downside? If you don’t like the pump go back to what you are doing now.”. She used the same rhetoric on me when I could not get myself to try a CGM. Now I think that my CGM is the best thing since sliced bread. I have a feeling that she will be right again. I also don’t expect it to be much work. I only have to translate what I see on my CGM into a language that the pump understands. For example, bg sloping down at night: reduce basal rate at night. I am looking forward to playing with a new toy.
Heidi, I agree that my simple way of life is a very inflexible way of life. This is the main reason that I am attracted to a pump. I don’t think that I will start eating heaps of pasta only because I can. I lean more towards Dr. Bernstein’s “Law of small numbers”. I will shoot for an A1C of 4.9% with no lows and a standard deviation of 20. I hope my endo does not freak out. I am in for an adventure and I am looking forward to it.
The word simple has so many meanings. My simple bg control causes me to be inflexible. I can see your point of equating inflexible with not-simple. Maybe I am trying too hard to avoid finding a bathroom and shooting up. With a pump I will be able to ‘dial-a-shot’. This might be a small difference to some but for me the ‘finding a bathroom’ thing is a deal breaker. I can see the benefits of keeping my bg stable and occasionally bolus/eat. This is what I am determined to do with a pump. Carb counting and the other technicalities will not hold me back.
I wish I had a good answer. This is what I started out with 36 years ago. I didn’t know that there was anything better which works with one shot in the morning.
Dave, let me know when you get private messages, expressing dismay at me constantly throwing my numbers in other people’s faces.
I am not dead serious about A1C 4.9%. For me it is always a wake-up call when I sit in my PCP’s waiting room and overhear conversations about all kinds of deceases. None of them caused by bad A1C. These patients are not even diabetics. When leaving the good doctor’s office a truck might run me over, totally ignoring my good A1C which is supposed to protect me from all evil. Even I am not a number.
