Hi! I just started pumping 4 days ago, and I have some general pumping questions, and some specific questions about the animas ping, as well as some other questions.
I’m a late life Type 1 diabetic diagnosed at 20, and coming up on 20 years of diabetes. I’ve been doing MDI Lantus/Humalog for a while now, not very successfully due to lack of dietary willpower, and have been hovering in the mid to high 8 A1c’s for years. I’ve been using the Dexcom CGM for about a year now.
Recently (Feb), to lose some of my extra 40 lbs and to prepare for going on the pump, I switched to a low-ish carb diet. As hoped, the strict diet has had a dramatic effect on my bg control, and my understanding of how to control it. I can’t imagine having starting pumping before the diet. In fact, as expected, my recent excellent (for me) control has been upset quite a bit by starting the pump.
I understand that we all have individually specific needs and mine will be different than yours, and that you are not giving me medical advice. With that in mind please answer with your personal experience/general understanding. thanks.
My CDE and Animas Pump trainer thinks my ratios are aggressive. Do they seem extreme to you?
Perhaps the higher percent of calories from protein due to my diet is accounting for the ratio being/seeming more aggressive?
Is it unusual (or bad?) for basal to be only 25% of total? (P.I. says 40-60%. why?)
I eat 6 small meals during the day, which means lots of overlapping bolusing. Perhaps this is masking basal usage? (once i dial in night/morning I'll skip some afternoon meals, but .8 did seem about right last time i tried)
I have a morning spike even if bg was great all night while i slept.
With my recent diet, I really dialed in my lantus for my sleep time at 12u, and it was perfect but would spike as soon as I got up. This makes my mornings awful (for no fault of mine!) and can affect the rest of the day.This is one of the reasons I got on the pump.
This morning I measured it: at 8a till 9:30a I went from 100bg to 200bg, despite the basal increase at 6a. to try and help with this. I just let it rise without treating and it leveled off at 200. This is the first time i've measured it that specifically, but it agrees with my historical feel of this spike.
Would you try to cover this with a more aggressive basal, earlier basal, both, or a bolus? It seems almost like i ate 5-10g of carbs at 8a (I didn't) so maybe it should be a bolus? But I assume if you don't eat anything, then you should be tuning your basal, not your bolus.
I often get stinging/burning with bolusing, even for 2-3 unit boluses.
I've read some people feel this is due to humalog, but i've been injecting that for 10 years with no sting/burn. Although I didn't feel this with the saline.
Perhaps it is depth? My needles went twice as deep (12.7mm) as my infusion set (6mm). It isn't painful enough to make me switch off the pump, but i definitely don't look forward to it.
Maybe it is just the current site, and when i rotate to a new one it will be different?
Pump infusion sets are supposed to be changed every 3 days. Do you typically follow this, or stretch it longer? How long?
With dexcom, the sensors are for "1 week" but I leave them in as long as possible, 2-3 weeks. I am one of the lucky ones because my current insurance fully covers it, so i don't leave them in to save money. I just want to avoid extra holes and not use up rotation sites so quickly, and keep an accurate one going as long as possible.
I disconnect for showers. Do you worry about the connection site needle (at end of tubing) touching something? It seems reasonably protected by the plastic tabs.
Animas questions
I got the animas for the remote meter, but find I hate to use it. The entry of carbs, bg, and insulin is either painfully slow or zips by too fast to be useful. Is there some secret here that I'm missing? The pump interface goes up slower, but is so much more predictable that it is actually useful, and I prefer this to the meter. I would even prefer to have to set each digit individually (ok, blink, up arrow x times, ok, stop blink, next digit etc...)
Neither seem to simply enter in the insulin they just calculated for you as a starting point!??!?
tudiabetes questions:
What is the difference between a forum and a group?
I’ll answer the items I feel capable of
I have a teen son, so things are a LOT different for him. His basals are 1.7 - 1.8 and his I:C ranges from 1:15 to 1:9.
So I’ll leave it to others to comment on that since it is so different for a teen vs an adult.
But for the stinging - have you got your insulin delivery speed set to SLOW? In the setup, you can choose slow or normal. A lot of people complain about the normal delivery speed causing stinging.
When J first started pumping, I had to do all of his boluses as combo boluses also. I did them for .1 hour (6 minutes) to avoid the stinging sensation. After a month or so, he got used to it and I could use normal bolus.
We typically leave sets in for four days, just to stretch our supplies. I’m always thinking of what happens when he is to old for his current insurance, so am building a stockpile. He has autism and other issues, so we are not sure if he will ever hold a full time job (with insurance). It’s a constant worry.
yes, the Ping remote is slower. I find I don’t use it much anymore. It is handy for when we are in the car, though. I can bolus J for food while in the drive through line and if he is high and asleep, I don’t have to dig for the pump.
Yes, it doesn’t have the “act” button like medtronic. You do have to dial up the amount it suggests.
I’ve got lots more information about the Ping, Multiclix, and the Accucheck Compact Plus (all the items we use) on my blog if you are interested. http://type1anautoimmunething.blogspot.com
Congrats on your new adventure in pumping! I want to encourage you that it’s normal to have a period of time where things aren’t great when you’re first starting on your pump. It takes some time to fine-tune all your rates and that good stuff. It took me a good couple months when I first started to feel like I got some normalcy. But I LOVE the pump and I wouldn’t ever want to go back to MDI.
As far as your rates go, I would recommend testing them–starting with the basal rate. If your basal rate isn’t correct, you’ll never know if your I:C or Correction is correct. If you don’t have it already, I would recommend getting “Pumping Insulin” by John Walsh. It has great info about basal testing and all things pumping.
everyones measurements for the pump will be different. Your sensitivity factor is different from mine. I am 1:80. And I’ll try to answer the questions as well
I change every 2 days as by day 3, the insulin is causing more pain than the other days. And yes its the humalog. I dread to bolus because of the humalog. I am hoping to switch to novolog. And I felt the burning when I was on shots too. But it wasn’t as bad as it is on the pump. I also rotate as well and no matter where I put it, it stings!
When I disconnect for the showers I am not worried about the tubing at all. I leave it on top of my pump so its safe.
I use the meter because when I download the info I have more info for my team. I just like using the meter. I check my sugar levels with it so I might as well use it for the bolusing, etc. It may change over time once I am at the levels I want to be, etc.
Forum is general questions where a group is specific. At least this is what I think.
you know if you download the pump, it also downloads all the info in the meter as long as you have them set to “talk to each other”. If you can bolus from the meter, they are talking and you only have to download the pump to get all the meter info too
For your morning spike (before eating, I assume), I would definitely ramp up my basal earlier than 6. I calculate about a 3 hour lag time for basal effect so if your numbers are jumping that much between 8 and 9:30 you want to catch the rise. I would send it higher around 5AM. You might have to play with it for awhile to see how that works and to see if you should divide your basal rates into more “time zones” depending on the results you get during the rest of the time. You definitely seem to have significant DP. I don’t have DP, so you might want to do a separate post on the main board and see how other people handle this. I know some people do “correct” (bolus) first thing in the morning when they have rises like that before breakfast. I’m assuming you include a correction bolus with your breakfast to counter the high starting point, but if you are doing a lot of correcting (Walsh says correction should only be 8%) than you might want to look at your basals and see if you can do some more prevention.
Those forumulas of ratio are just that, formulas. They don’t work for everyone. What counts is what works for you. But in general, people who eat less carbs tend to be balanced in the other direction. My guess is your basals need some working. It also seems a bit unusual to have that big a difference between your basal rates, but again, what works is what works!You say you eat 6 small meals which definitely will influence your bolus. I hope you take into account your IOB so you aren’t “stacking” insulin. You don’t mention, but if you are having lows, then that could certainly account for some of that “extra” bolus and you might want to keep better track of the IOB.
Yeah, the Ping can be annoying with that speed moving. And it would be nice if they entered in the amount recommended and you could just up or down it from there, but from what I understand Animas is all about safety. I had never thought to use the pump itself to work around this, so I’m going to try and see if I prefer it. I guess every pump has its drawbacks and everyone dislikes that difficulty of controlling the numbers.
I’ve been on my ping for a little over 2 months and am just now having stable numbers. I definitely agree there is a learning curve!
Even though there are separate forums, many of us have our settings such that we read all the newest posts. With groups you have to be subscribed (and also can get e-mail notification). I use the forums for topics that I want a variety of responders. If it is specific to the Animas, (or, in my case LADA), I will post there. Btw you are not a “late adult onset” in the scheme of things. I was diagnosed at age 58 (though I was misdiagnosed originally as type 2 due to age).
I call it Dawn Phenomenon too, but mine is more like "wake up" phenomenon. It doesn't seem to really start until i wake up, although i did see it start to rise at 5am once.
I increased from .8u/h to 1.2u/h basal at 5am last night. My bg still got to 200, but started out at about 130-140. So I think it helped. tonight I'm going to go to 1.6. It seems weird my sleep time vs. morning time basal rates would be 4x. I also am moving the .4u/h nighttime rate to start earlier at 8pm, as i seem to go low in late evening, even if i eat w/o bolusing.
Yeah, i do correct along with extra for breakfast. I try to wait till it is coming down to eat.
Thanks for the heads up about stacking. I have always tried to mentally account for this with MDI (although i didn't know what it was called) and now with the pump I accept its IOB recommendations. I have had some lows, but they are much less than before my diet and better control.
wow, 58. ok, i guess I'm late juvenile onset then. :>
still confused about groups vs. forums. I see a pumping group. is there a pumping forum too?
I have no idea how I got to this age, Amy. I didn’t really “grow up” until somewhere in my 40s, so middle age definitely snuck up on me!
Yes, there is a pumping forum, dx, click on the “forum” and “group” tabs on top and you can see all the forums and groups. That’s ok, I’ve been on here for over two years and it confuses me too!
Sounds like you are on the right track, poco a poco as we say in Spanish, little by little. Definitely ask on the main board about DP. There are lots of people who have experience dealing with it. (I’m lucky I don’t have it, but I do have more carb sensitivity in the morning as many of us do! Hang in there. I think it really takes time to benefit from the pump’s capabilities. I feel like I’m only scratching the surface after 2 months!
