New Pump User

I know it’s frustrating, but I really encourage you to stick with the pump and I think you will see it pay off. Try different infusion sets (again, try an angled one), and expect to have wacky results until it all comes together, which I think it will. It’s a much more precise way of dosing insulin which is why I think it can lead to strange results compared to what people are used to when first switching from MDI, but will lead to much better control and the ability to eat a large variety of foods while staying in control (and without other people seeing you pulling out a needle) once you master it.

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So odd you didn’t get a trainer. I had no choice but to have one. Maybe there is not one near where you live??? Why don’t you ask Tandem to send you different sets to try? The contact detach (steel needle) is what I switched to and it doesn’t bend. I felt like I was starting over with the pump but now I love it. It does take a lot of trial and error. How about asking Tandem if there is a trainer within driving distance of you? It would make a big difference if it’s possible.

Perfection is unattainable for probably 99% of Type 1s. If perfection was so easy, we wouldn’t have forums like this. Besides carbs and activity, there are another 6,782 variables if I’m counting correctly, and they all conspire against perfection. It’s called … life. If my nurse educator said she wanted perfection, I’d ask her if she had other patients who had achieved perfection, and if so, perhaps she could arrange an international speaking tour, because there are a great many of us out here who would love to see a few seconds of perfection in our diabetic lives and would appreciate any tips.

But you can aim for “good enough” or “pretty darn good” or “great!” or even “that’s amazing! maybe my meter/pump/CGM is broken” – one perfect test, a pretty nice morning, a whole day or night with no extreme, inexplicable highs or lows. Try not to get overwhelmed and frustrated by the erratic numbers that result from … life … because then you get angry at your diabetes, and that solves nothing. By all means say to your nurse, “Not now.” It’s YOUR diabetes; rein it in on YOUR terms. Make a change that makes sense to you and your nurse, then see how it affects your results over a week or even two. If it makes no difference or causes another problem, you can easily reverse it. It’s not going to kill you.

As for counting carbs, I count just about everything if it’s more than 3 or 4 g carb. But it’s an individual thing, and trial and error. I find at breakfast that 1 tablespoon of peanut butter (3 g carb) does not affect my BG at all, whereas 1 teaspoon of my favourite marmalade (also 3 g) definitely will.

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@Scott_Eric has made some great suggestions for you.

I have never experienced the pooling you described, so I reiterate the idea of trying some different infusion sets. I also use an angled set; they have worked well for over 18 years. I do also wonder if you might be hitting areas where you have scar tissue from your MDI days.

I also want to recommend giving Gary Scheiner @ Integrated Diabetes Services a shout/call/email. Gary truly “gets it” and has a vastly wide range of experience helping new pumpers successfully.

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HI there thanks for reply. Canada sounds great and would love to visit someday! A sugar of 40 while exercising is pretty low! That’s about the lowest I’ve ever gone, and weirdly didn’t even feel it. I got like a weird thought that I should check my sugar and bolted. It’s tricky when low sugar symptoms mimic exercise symptoms (sweating, hunger etc). I agree with exercising with as little IOB as possible and relying on just the basal. Have tried that, with the same type of exercise for same amount of time and sometimes it’ll go down, sometimes up, sometimes up a lot and sometimes not budge. That’s also SO frustrating like any aspect of this disease to not KNOW OR PREDICT WHAT AND WHEN it’ll do what…UGH!! It makes it nearly impossible and like hitting 200 moving targets :confused: Thank you for your ideas though I’ll keep them in mind! I’m getting more feedback here than my doctors/nurse.

Agree also that carbs act diffrently too (and for me depends on what I’m doing right before or after a bolus dose, which can make it work harder from any activity) …Like if I take a small walk , even just strolling or walking at a normal pace for 30 mins after a meal (which is what a person should be able to do like if I were at a job/school and was walking, without it being considered “Exercise”? And my bs went down an extra 100 pts that I didn’t take insulin to cover. Tricky stuff. :confused: I have tried the extended bolus like you said for fatty foods etc and sometimes it helps bs not spike and others its like I didn’t need to split the dose (even with the same food as a previous split that bs were ok with the split)…Do you extend your bolus for the same % over the same period of time every time you have the same fatty food, say pizza? How do you estimate your dose and timing of dose?

What kinds of problems did the t-90 set give you? Did you get pooling/mis-absorbtion like me and your bs’s went either way high or low? Since you are lean, did you hit muscle? What would the insulin do if it were absorbed in muscle? I’m about 5’6" and 160lbs…not exactly lean so not sure which set would be good.

Did you get diagnosed at a young age? I was 10 and it’s been hell ever since, especially the last 5-10yrs or so…It seems nothing helps me whereas other diabetics find things that work for them…and if somehting ‘works’ for me one day or give a ‘decent’ result…the next time it’ll be a 180 degree result…I just have had enough of this and def have the ‘diabetes burnout’ as they say? I asked my dr. to maybe talk to a psychologist specializing in diabetes/health to get out my frustrations but where I go (supposedly a top notch place) doesn’t have those programs anymore! :confused: Has anyone here ever gone to talk to someone? Or how do you vent your frustrations/worries/anger with this disease? I’ve no real family/friends to speak of or talk to :confused:

Hi there,

Thanks for your response. Yes I agree that ‘perfection’ isn’t a word we or doctors should use! Otherwise we wouldn’t be diabetic if our sugars could be ‘perfect’! I read in a diabetes magazine that doctors should sort of broaden their horizons on what a ‘good’ blood sugar is?! They shouldn’t expect it to be in or near ‘normal’ range all the time, as that can become very tricky and the article siad that for people to have sugars like that, often times that comes with many episodes of real hypoglycemia, (not fun!) and then after a while you may not feel it coming on! That is dangerous, for people living alone too. And yes I think you mean the 15,999 variables in life? It is quite intimidating when all you do is get reprimanded for high bs’s when you have to sort of keep em high because you have a history of BAD crashing at rapid rates :confused: THey don’t really listen to the individual much it seems and place you in a broad category of everyone else and just look at you and go ‘your sugars are high’…Yes an international speaking tour of ‘perfection’ would be great!! My nurse educator is so into being well controlled and she’d say she has perfect patients to show me. My mom was almost ‘perfection’ with a good a1c, BUT she had LOTS of low sugars like in the 40’s where I’d have to run and get her juice.

I agree where ‘good enough’ or for me even ‘decent’ is the best you cna shoot for right now. I’d aim for one good bs reading like you said, or a whole day with no extreme low or high…because that is what i’ve been dealing with …Not lows b/c I’ve had to keep it so high for a long time with random , inexplicable rapid drops of like 20-30 points a minute!! I’d have to run and go eat stuff, so then it never really got ‘low’ but still this has caused a lot of PTSD I think and even though I"m on pump now (the crashes were on shots it seems), the minute my bs starts to go down, I still get taht panick if its dropping fast. I told my nurse it’ll take me a long while to get used to the pump and that maybe it’ll SLOWLY get bs down.

Thank you for your advice, I try not to get overwhelmed by the erratic numbers and never used to as much as this but its hard b/c it seems the more I try to be ‘good’ the more it backfires. And I can’t take a lifetime of this…my diabetes has stopped and limited so many things I’ve tried to do in life and the daunting idea that this is for life is overwhelming. I’ve had it 20 yrs but since I’ve never really done ‘well’, it seems like 60yrs…I never talked about it growing up but now its hitting me hard at once, the physical and mental anguish together. ANother website I saw for diabetes asked a question “What is something you’d do different if you didn’t have to manage sugars/have diabetes”…and ALL the answers were mostly the same…EAT, EXERCISE AND JUST LIVEE!!! “Not having to plan out everything you eat, do, not do, insulin to take, how much and when and then dealing with the unpredictable aftermath” was the main consensus. SOrry for the novel here, have just never been on a blog before or gotten much feedback about life with diabetes!! I appreciate you time and responses! Good day to you! :slight_smile: By your username, you like the beach?

I was hitting blood vessels almost every other time I inserted a 90-degree set, causing occlusions and inconsistent absorption even when I didn’t get an alarm. I think I have had that problem once or twice with the angled set but otherwise they work much better. I would call Tandem and see if they will send you samples of all their different sets. Try them all and see if any work better or more consistently for you. As for extended boluses it’s really just trial and error and it isn’t the same every time. For something like pizza I will take about 50% of the carbs up front and the other 50% over 2.5-3 hours. This usually works reasonably well but I still have to adjust sometimes after, and sometimes I can get a spike 6-8 hours later. The CGM makes it easy to correct if that happens at least.

I was diagnosed at 19. In a way I’m lucky because my dad has had it since he was 15, so I was very familiar with it and it wasn’t something shocking for me. I probably always figured there was a good chance I would get it and was never too worried about it since my dad never developed any real complications and it never stopped him from doing anything. I also did not have to be a kid with it, which I’m sure was difficult for you. I went on a pump very quickly since my dad always said he would go on the pump if one of his kids were diagnosed, so we started together right away and it’s all I know. In saying all that, it’s never easy and I still have a lot of the problems you are talking about. I know what to do to minimize lows during sports/exercise, but I still have them almost every time. I bring Gatorade or glucose tablets and devour them - that’s my best advice really!

I felt very burnt out last year, and had for the last few years to be honest. I was exhausted all the time, was constantly going high and low, and I think I blew a couple of job interviews because my blood sugar was way too high during them causing me to be lethargic and cotton-mouthed the whole time. I was sick of it all just like you are. I made a change though and I started reading this forum and everything I could about diabetes, food and insulin. I re-learned everything and learned I never really knew a lot to begin with, even though I thought I did. I bought a CGM and realized my basal rates and carb ratios were way off, and that stress/anxiety has been causing me to run high blood sugars on the job for years, making me exhausted all day. I made changes in my diet, but without going low-carb, and learned how to dose more appropriately for the foods I like to eat. Lastly, I read Sugar Surfing by Stephen Ponder and changed my mindset, realizing I am never going to just dial in a dose and expect great results every time; every time is different and requires action to get close to right. A psychologist is probably a great idea, but you’re also taking good steps by reaching out on this forum. I recommend you get a CGM if you are able to and keep reading and learning as much as you can.

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Hi there Scott_Eric,

Thank you for your recent reply, Been busy but will respond soon as I prob have more q’s! Take care! One question I have right now is if using the tandem t slim, can where the leur lock and tubing meet ever come loose? What if it does while wearing the pump, how can you tell and how will it affect insulin delivery? Was told never to touch that area once you change your pump, taht initial tightening of the two tubes is it for 2-3 days…but am constantly yanking on that area by accident but don’t want to tighten it b/c they said that could push any built up insulin out into the body as a delivery? Am nervous about that

I’ve been using luer lock pumps for over 25 years and this has never happened to me.

Where do you usually wear it? I clip mine to my waist. There’s never any pressure on the tubing where it meets the connection.

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Hey sweetgal88, I’m not the best person to ask because I use a Medtronic pump and it doesn’t use luer lock connectors. I’ve never had a problem with them coming loose, I’ve even had my pump fall and dangle from me and everything still worked after. The worst that ever happened was an old girlfriend’s cat chewing on the tubing in the middle of the night - luckily my blood sugar didn’t go too high before I woke up and realized! My suggestion is if you think the connector needs tightening, disconnect your pump from you, tighten the connector, shake the end of the tubing that connects to you in case any excess insulin dripped out during tightening, and then reconnect.

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@sweetgal88 - Yes, the luer lock can come loose. As @MarieB said, it’s extremely rare, but … it has happened to me exactly twice in 18+ years of pumping. Similar to what @Scott_Eric suggested, I had to detach the tubing from the infusion set and re-prime the tubing because when the luer lock begins to open, it introduces air into the connection.

I only discovered the problem because my BGs went unexpectedly high. One of my trouble-shooting steps when that happens is to disconnect the tubing from my infusion set and bolus 0.1 or 0.2U, watching t see the drops of insulin come out of the tubing @ the connection interface. When I didn’t see insulin come out, I looked closer at the luer lock and saw that it was loose.

I can’t emphasize enough how minor this has been,

also, I know I sort of absent-mindedly touch my pump during the day, and the area of the luer lock. I also check my cannula site - alarm bells go off in my head if it’s wet. And make sure you know what insulin smells like (who doesn’t?). If you smell that smell, check every connection.

I had my luer lock come loose once while I was sleeping. Woke up with high Bg’s and tubing full of air bubbles. Only once in 17 years of pumping but one time too many.

Thanks for response!
So if it did come loose, the result would more likely be high bg’s than it going low? I suppose it’d go low if you tried to re-connect the luer lock to the tubing while it’s connected to your site? Then the built up insulin could push through into you?

So you’d disconnect from site, re-tighten the luer lock, then re-prime the pump with how many units, just a few drops? How do you re-prime it without changing cartridge? Sorry, prob a dumb question but am new to this. Thanks for the info!

Yes, the result is almost always going to be high BGs because the insulin leaving the pump is at best only partially getting delivered into your infusion set. Unless I’m not understanding your question, there is no “built up insulin”. Reconnecting (aka re-tightening) the luer lock while the tubing is still attached to your infusion set is just going to give you air in the tubing, starting at the luer lock/pump interface. Over time, that air will be delivered in place of either basal or bolus insulin (or both), resulting in more high BG results.

Since I am not a Tandem user, I don’t know how the priming works, but I would prime as though I were attaching a brand new tubing. On my pump, I watch the last bit of air travel up the unattached tubing and out of the end that attaches to my infusion set, then I stop the priming, attach to the infusion set and turn the pump on.

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I also have never heard of this.
I also would do everything @YogaO said.
Whenever I get an occlusion, which happens occasionally, I detach the tubing from the cannula and do a prime until I get a fair amount of insulin droplets - works almost every time.

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Thank you for your post and info! Will keep this in mind as I’m so new to the pump!

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Scott_Eric,
Thanks for your reply, good to know! So if it ever came loose, you suggest to disconnect from the site, tighten the leur lock, then just shake the end for excess drips…would you re-prime the tubing to get air out?

To your previous response…sounds like you were having the same problems as me with the t-90 set! I’ve tried the t-30 twice which worked well 1st time, then not good the 2nd…

Thank for ur info on splitting boluses for fatty foods…Will try your method…seems like I’ve tried everything for all foods, and nothing works the same twice, so I practically never know what to do so my sugars are all over the place. …Do you use the same insulin:carb ratio for all TYPES of carbs? What about a combo of carbs? I’ve noticed that when i eat something like a piece of toast alone with nothing w/it, my bs’s will be ‘ok’ next meal…either not go up much or go down just a bit…But when I have a pc. toast WITH something else like an omelet or cream cheese on the bread, or almonds, bs is much higher at next meal, and goes higher and also doesn’t come back down :confused: Ever have this? I try splitting dose for this
but this doesn’t work either…Don’t want to increase dose much b/c am technically still eating same amount of carbs? …Different combos of foods with carbs or combo of types of carbs make my sugar all over the place…How can you adjust for this when even a similar combo of foods never gives the same same result twice?? SO frustrating :confused:

I would - if the luer lock was completely off, you’re going to have air in there.

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Hey sweetgal, I do experience the same issue with you if I eat toast with something else for example. What I will do is bolus for the entire amount of carbs up front, and then extend an additional bolus of about 0.4 to 1 unit (depending on what I am eating with the toast) over 2 - 3 hours. I find with combo boluses it’s not as simple as just spreading the same bolus you would normally take up front over time. I find I still need a lot of insulin up front, but then more later. So for example if my carb ratio is 1:15 and I am eating toast with an omelette, I would bolus 2 units for 30g of toast right away, and then extend a bolus of 0.8 units over 2.5 hours to cover a rise I know from experience I am going to get later. I wouldn’t just extend the 2 units over time as that wouldn’t be enough up front for me.
Again though, it’s trial and error and not always the same. Having a continuous glucose monitor makes it a hell of a lot easier because I can see if my BG is rising after a meal and make adjustments before it goes to high, or if it is falling and cancel the extended bolus before I go low.

As for your question about using the same carb ratio for different types of carbs, I think you’re onto something for very fast-acting and fast-digesting carbs, but the answer isn’t simple. For example, if I were to eat fruit by itself and bolus for the full amount, I would likely go low soon as it digests since it’s such simple sugar and digests quickly but would still have hours of active insulin left. I think the strategy is to eat these types of carbs with or following a meal with something more substantial, or bolus less than the full amount of the carbs (so use a higher ratio like you are asking) but pre-bolus early enough so that there is enough active insulin to prevent a big spike. For example, if I would normally bolus 1 unit for an apple and eat right away or within 10-15 min of bolusing, maybe I would bolus 0.6 units, wait 25-30 min, and then eat. Someone with better knowledge of food nutrition and biology can give you a more knowledgeable answer I’m sure, but let me know if any of this works!