It just keeps getting better

wow, am I frustrated now…

I have yet to see this damned thing perform a bolus that seems to do what a bolus should… you know that whole “lowering your blood sugar” thing

I’m pretty sure I am ketotic now… got all the fun symptoms tiredness, thirst, cranky (more than normal), a little nausea now and again.

And guess what? my CDE is out of the office until Friday. I called into my doc’s triage nurse, hopefully I’ll hear back soon. I am getting to the point where I am about to send this damn thing back. I’ve been on it less than I week and I can see a hospital trip peeking over the horizon, be my first one in over 20 years (how many of you remember the days when all the various type of insulin came in bottles exactly the same shape, size, and color? I do, and the really hot female EMT that took me to the ER… ah those were the days)

We adjusted my carb ratio from 1:15 down to 1:10 yesterday. Even if I don’t eat when I do a bolus, my sugars still go either go up or come down very little. I’m just not seeing the behavior I would expect to see. Hell, at this rate,I’ll be out of my monthly supply of test strips by the 15th.

I’ll quit complaining now and just sit here and be cranky

Hey, Scott. I’m really sorry that you’re having an awful time with your new pump. The transition can be hell. I hope you get it ironed out with your CDE soon.

In the meantime, I have a couple of suggestions. Maybe one or two might help. First of all, when are you doing your pre-meal bolusing? Even on a fast-acting insulin, bolusing 20-30 minutes before a meal is a great suggestion for lowering your sugars. Your body is reacting to no longer having that background insulin in the form of whatever you were taking before. Now it’s getting such small infusions as basal. Your body can get used to it, I promise.

Have you considered that your correction factor or your duration of insulin activity may not be set right? I enthusiastically recommend the book Pumping Insulin by John Walsh. It’s the most richly detailed troubleshooting guide for pumping I’ve ever seen. Wish I’d had it 8 years ago when I got my first pump!

Also, I imagine the stress is going to be pushing you higher. We all know that, right? But telling a stressed out person to de-stress is like trying not to hyperventilate when you’re already short on breath.

Feel free to be cranky. When I’m having technical malfunctions, dealing with doctors and insurance on the phone, etc., I’m a downright witch.

Hi Melissa,

Thanks for taking the time to reply

The timing is a good suggestion, but the biggest problem is that I can bolus and NOT eat and have my sugar levels increase. I’ve ordered the Walsh book, should be here later this week.

I need to talk to my CDE about the duration and sensitivity, hopefully my dr’s nurse will call back soon

Hmm… Then honestly, I bet your basals are set too low. That shouldn’t happen. I would expect your CDE to tweak them when you meet.

Scott, My doctor just reset all my basal rates. Now I am experiencing the same thing (for me only in the afternoon/evening). So I figure that my basal rate is too low then. I think that Melissa is right that is likely the case. The same thing would happen with injections if you weren’t taking enough of your long acting insulin (Lantus, Levemir, etc).

Your pump is only as good as the settings that are in it!! So you have to get your basal rates right. If you just started on the pump, then you will need to do basal testing. That means fasting and not bolusing for at least 6 hours and seeing what happens to your blood sugars. They should stay level. If they are climbing up, then your basal is too low. If they are dropping then your basal is too high. The book, Pumping Insulin, explains how to do basal testing really well. Once your basal rates are set right, you will be a much happier pumper (really it’s amazing!)

But the road there can be frustrating because you need to figure out the right settings. One thing that might help is to see if you can get a trial CGMS even for 3 days. It makes basal testing even more useful. Hopefully you can get your settings adjusted soon!!!

I hope by the time you get this, you are feeling a whole lot better! Two of our most knowlegeable members here have given you some great advice. The only thing I could add is: if you feel nausea or other symptoms of ketoacidosis, check your ketones. It’s also a good idea to drink plenty of water. See if you can get a scrip for more strips per month. My doctor had to write a letter to the ins company saying I needed to test 8-10 times a day. At the very least, while you are getting used to your pump, you are going to need to test more. The first two days I had my pump, they had me in the hospital and tested me every hour on the hour for 48 hours (made for a bad night’s sleep). Now this was 17 years ago, so things are probably different now. I also remember being tired and cranky the first couple of weeks on the pump.

Don’t give up, Scott. Keep in touch, I know things will be looking better soon!

Thanks everyone… here’s the latest installment…

Last Friday, I called medtronics because they had shipped the wrong reservoirs. First guy I talked to wanted to charge me for them, even tho they shipped the wrong ones. Finally get to talk to someone in Returns who says I will have the correct ones on Tuesday. Still haven’t received them by Wednesday, so I call back… guess what? no record of the return. Let’s just say that this is been less than a pleasant experience and my impression of Medtronics is not a good one. The lady I spoke to today there was really appalled at the situation and has it taken care of, I just got the return label and it’s been about half an hour.

So while I’m frustrated, I call my Medtronics rep and explain to him what has been going on. He offers to get me hooked up with one of their trainers and calls the doctors office. About half an hour after that, the doctor finally returns my call from this morning. We do indeed increase my basal rates and lower my carb ratio from 1:10 to 1:8. I also took a normal injection of Humalog to get my sugar levels down. I am drinking a ton of fluids, not sure if I am going to be able to drink enough to avoid some IV fluids tho. The last time I was ketotic like this, I was getting over the flu, took me several days to stop spilling

I guess I am really uncomfortable dropping a manual injection into the middle of the settings changes, seems like it will just make it a cluster to figure out and things seemed to be jacked up enough all on their own.

Thanks for the tips and support kids, I appreciate it even if I am old and cranky

Hey Scott!

I’ve been pumping about seven years, and I’ve been where you’re at, too. Don’t worry too much about the manual injection of insulin. Sometimes I have to do that even now when I have some sustained high that I can’t account for. Just be sure to not OD in your desire to get your sugars down and start feeling better. That being said, I’ve noticed that sustained highs can take longer (and more insulin) to come down than post-meal highs. No background insulin to carry some of the weight. Once you’re in target range and feeling better, you’ll be able to start seeing if it’s the basal setting or the I:C ratio that needs additional tweaking.

It DOES take some tinkering, but you and your trainer/doctor will figure it out. Sorry to hear your experience with Medtronic has not been great thus far. Promise it’s not always like that!

Hang in there and hope you get to feeling better!

CaseyK

ok, got sugar level down… a little too down, down to 65… got it back up to 90 and then did the bolus wizard and ate lunch… time will tell

Hang in there Scott. There is a learning curve to the pump just like there is to the shots. Once your basals are set correctly you will see a huge difference. And of course you are always having to tweak your basals for various reasons as well. Another idea for you is until your basals are set correctly you can do a temporary basal for more insulin when you are running high. Not only do I correct, but I also usually do an increase in my basal for an hour if I can’t get it down with the first correction, of course if I start running low I will do a decrease for a while until it stabilizes out.

Scott, right now I’m going through a similiar process to yours - after 38 years of injections I started using a pump two weeks ago. I’m starting to finally see consistantly good BG values except for the 3AM - 8AM time slot.

As I’m sure you know that hardest part is to tweak a little and wait. Until you get repeatable patterns you can’t have any confidence in your changes so stick with it and in a couple of weeks you should be through the tough part (at least that’s what I keep telling myself). :slight_smile:

I’m going into to see the Medtronics trainer in the morning, she recommended that I use a steeper angle on the inserter than I been trained to use. My sugars were once again at 200 at two hours post lunch bolus, so I am hoping changing the angle will get me better absorption.

Wow, John, we’re pretty much in the same boat here, it’s good to see you having some success!

Thanks again everyone for the support, it’s been frustrating few days