Hi all I just started using omnipod and dexcom. I have been t1 diabetic for 18 years this march. I have always taken shots,this new regimen has been hard on me. I have been running high when I was taking shots so that is why I decided I needed a change. Now I have had more low's even with the dexcom because they came out of nowhere fast.
I think my carb ratio is off, so I end up going dangerously low and then freak out and end up going really high. My diabetes educator told me to be patient and I am but I am beginning to think this is a lot different than I thought.
I have seen great bg readings but I'm not understanding counting for my meals, she has me on a 1:6 ratio and I crash if I'm already at say 130. Tonight I was 110 and my bolus was 15 units and I knew that seemed high but I thought i would be eating a lot of carbs. I will call educator tomorrow and tell her what happened tonight and just keep working at it.
my basal is 1.6 an hour for most of the day and during sleep it goes to 1.65 because I was going high a lot. I hope this get's easier, I haven't been this nervous of taking insulin since I was diagnosed in the 90's and that was cause I didn't like needles, not for fear of going low. Any good reading material you recommend that can bring the whole picture together so I can grasp it as a whole and not just pieces here and there?
Think Like a Pancreas - by Gary Scheiner. It's a little outdated in the technology he talks about but it all applies and will help you with the pump SO much! I would guess you need a more variable basal rate, which he teaches you how to figure out. Another one that many people love is John Walsh's Pumping Insulin. I didn't like that one as much but different people like different ones. :)
Good luck - it gets easier and you will learn to adjust based on your activity level and other thing which really gives you much more freedom in the end.
Thank you I appreciate it, I will look into those books. I think I need to see a nutritionist as well because I obviously don't know my food's well enough. I have been burned by pizza twice now, my educator gave me a carb book and it says for 2 pieces it's 90 carbs, for my i:c it's 1:6 that gave me almost 15 units when I was already at like 110, I dropped like a fly. Not cool and that is the stuff I need to learn. This happened twice to me today, once at work and that was really bad because I am a service tech for a company and drive and use tools etc... Got to get it down quick, I thought I was doing good then boom out of nowhere two really bad low's which resulted in terrible high's for hours. Thanks again
Gadget freak I had issues with counting carbs or at least what food had what amount of carbs. I used my fitness pal. It was/is wonderful. You put in what food you would like and it tells you what the calorie,carb,fats etc… It also is a diary that you could take to the doctor. Congrats on the pump it is scary at first but soon you will be more comfortable. Another way of finding out carbs in foods is calorie king. Both books natasha recommended are great.
I'll give another "Be Patient" to this. It's amazing how long it takes to get a solid line on your control with changes like a pump and the CGM. It does mess with your metabolism, and the CGM will really look odd for months before you begin to see some reason on it's moves and changes. Be vigilant with you data and talking with your Doctor and Diabetes Educator on your numbers. In time you'll gain the low feelings back, and start to feel much better overall.
Pizza is a very tricky thing to bolus for also. Most people have to split the bolus, so they give maybe about half of it before eating and take the other half a little later or do an "extended bolus." With high fat/high carb foods like pizza, pasta, and Chinese food, the spike from the carbs hits much later than you're expecting, so giving that much insulin up front can definitely make you go low very fast!
i n my opinion i would keep the bg a little higher to prevent bad lows.....then readjust the basals & bolus ratio as needed talk to your endo & nurse educator & dietitian
just be patient & it becomes second nature
Every single pizza is different, we use a scale and can do pretty well by weighing it. You can also look it up if it is a chain. We always use a combo bolus for things like pizza, and it sounds as if that would be a very good idea for you. We give 50% up front and the rest over 3 hours. It works well for higher fat meals and pasta also. Seems to me that your ratio is off, especially if you know that is more insulin than you would have taken when you were on shots for that meal. It really shouldn't be much different, not sure how they came up with your ratio? My daughter uses a different ratio for different times of day. You should be in contact with your pump trainer to discuss the problems, especially the lows.
Thanks everyone really, So when I counted the pizza carbs it was 90 for 2 slices according to my book, well when I bolused it gave me 15 units based on my bg, it's automatic easy setup. So within 40 minutes I was at 46 almost out of it, second time yesterday that happened to me. I talked to my educator and she had me lower my basal but what I am finding is after I recover from the low, I'm in the 400's for the next 14 hours. I am still trying to correct and lower my bg from that last low. I haven't eaten anymore carbs and my sugars just won't come down. I know they are coming down but not a lot. I don't know why but it seem's like I'm more sensitive to novalog through the pump than when I shot it. Sound's crazy but I used to take 20 units with no problem and not go low to 46, I have a lot to learn. I just want to stop the rollercoaster ride, it's been awful so far. Funny thing is besides eating that pizza I have been eating really good and I'm still high most of the day.
Most people find that they use less insulin overall with a pump, so what you are seeing isn't crazy at all. The nice thing about doing combo bolus is that if you end up going a bit high, you just cancel it out and give the remainder right away. Just look to see what is left, cancel the extended bolus and give yourself that amount as a regular bolus. If this is happening because of the food, lowering your basals is just going to keep you too high. Try to be patient, pump starts are never easy, but worth it in the end.
MaryMary I just went on omnipod 4 days ago so I'm in touch everyday and we are adjusting. They used a scale to come up with my ratio, it's a very common equation and I'm sure you have heard of it but I'm at a loss for the name of it. Basically took my total daily dose and calculated from there.
I was doing fine first 2 days but I wasn't eating much and it seem's now I'm high then low then back up. I have to learn when this insulin is actually working, I understand the insulin on board feature and love that but I still got burned with a bad low because I think I entered too many carbs for what I ate. I had papa ginos and they state 45g per large slice so I entered accordingly and bam within an hour I was very low, and I actually ate an extra slice and a piece of a sub. So I think that is why I'm still fighting this high, I freaked out and had juice when I was low and a banana so now hours later I had way too many carbs in my body. I need to learn the difference in types of food and how they interact. I wasn't doing any kind of meal planning when I was doing shots this last year I just knew what too take and I was getting by but not like I should of been doing. I just don't know how sensitive I am to insulin when it come's to basil, the amount seem's so small to me but my nurse educator assured me that 1/10th of a unit when pumping can make a big difference so I listen and hopefully will learn.
I'm not sure I understand extended bolus vs regular bolus, I am going to look at my manual for the pod. I only know of the bolus when I test my bg and it will ask if I am going to eat and I either say yes or no and it adjusts accordingly to what my carbs I enter are and what current bg is.
The extended bolus sound's different from what I am doing, My bolus goes right into my iob on my pod. God I have so much to learn, when they said be patient I was so ignorant of what I need to do. I didn't think it was going to be like this, I get it but trying to find what pieces of the puzzle go where is what i'm struggling with, i knew this was going to be tough because I didn't keep good record before i started on pump.
The extended bolus starts from the same place when it asks if you're going to eat. After you dial in the number of carbs and hit "enter" and then "confirm," you can look at the bottom of the screen. There's a new option that shows up that says "extend." If you hit that, you can tell it the percentage of the bolus that you want delivered right then, and then tell it how long it should spread the rest of the bolus out. This will definitely be helpful for pizza, as this is probably a big reason you're going low. The fat in pizza really slows down the spike from all those carbs, so all that insulin is hitting before your body has really digested all of that. This is why you go low pretty quickly and then go (and stay) really high later, and for a long time. So it's very possible that you need all 15 units of insulin, you just don't need them all at once at the beginning.
It really does take a lot of experimentation and testing, unfortunately. Good luck!
That was very easy to understand, Thank you!!! I was just looking at the manual online for that, good timing. Nobody showed me or told me about that feature. I have been working with a nurse who is a diabetes educator and when I finally went live on pod a rep came out to show me some things as well. I think the pdm is amazing and I understand how to maneuver around it's my body I'm struggling with understanding. Thanks again
Do I need to do anything special to change the triple a batteries? I'm looking online and don't see anything. Nobody every told me I have to do anything, just checking I'm down to nothing showing in battery window
It's kind of odd that your battery is that low after just a few days. I would jot the date down so that you can keep an eye on whether it might be a problem with the PDM.It should last a couple of weeks or more. You don't lose any history by changing out both batteries at once. You just don't want to do it when you are using an extended bolus. They don't usually tell you about the extended bolus feature right away unless your reason for starting on a pump is partly due to the problems that you are having now. Extended bolus is one of the biggest reasons for my daughter to be on a pump. For higher carb or higher fat meals, she battled lows like you did and then highs for many hours later. That never happens anymore.
MaryMary I should have stated that I was using the Pdm with saline in the pods to get used too them, so I have actually had it for a month but didn't go live with insulin until Tuesday last week. I talked to my Diabetes educator and she actually told me that they had that extended bolus featured turned off, because I am trying to understand it all and asking questions, trying to be in tune with everything she said to absolutely use it. I can see how that would help, she said especially at holidays or an event where you are kind of grazing all day it really helps too. Learning something everyday with this and as much as I hate having the roller-coaster ride happening it's really helped me with learning the features or I should say reiterating how to do them and with all the help you good folks have given me I am grateful. I truly appreciate it, I stay in good contact with my Diabetes Nurse but there is no replacement for experience and others who have the same equipment with real life experience, we are all different but the way the unit works is the same. I wouldn't have known about the extended bolus as early as I did if not for coming here. Thank you
Edit:When I was using it with saline I was basically just following the bolus calc and pressing confirm, I wasn't really learning how to use the pdm, once I went live whole new ball game:)
So I'm wondering if I need to change my i:c rate, I am having another terrible low and that's the only thing I can figure. I actually took 6 units less than the pdm wanted to give me. Why is this insulin hitting me so hard, it's not new? I was taking shots of novalog before pump and would take 20units no problem if it called for it. Now I look at 10 units and I'm practically on the floor out. This is bloody scary stuff and I feel like it's up to me to find out what I need for insulin but my diabetes educator and the rep said don't worry we will keep you a little higher at first. Well I'm high all day for bg but at meals I'm crashing 30 minutes after I eat, is that probably form i:c rate being to much? I am 1 unit for 6 carbs, that sound's to much to me. What a terrible feeling not knowing if i'm going to drop, i'm watching my dex with two down arrows and it's dropping so fast and they say to wait 15 minutes before eating or checking again. I'm sorry I panic when this happens, probably why I'm high all day.
