I count a manual injection correction bolus as being active over a four hour window. Are you doing the same on a pump? Food bolus, I only count as active for 2 hours, which can lengthen out a little, too, I think. It depends. The guys are suggesting that window might be shortened on a pump because the small pulses of insulin that a pump delivers get absorbed better by the body.
I'm a little confused, mohe; you say you find the pump calculations unhelpful. Didn't you program the formulas into your pump yourself? It is calculating doses based on the I:C, ISF and basal rates you have determined. If they are not "helpful" then that means you need to tweak those programmed formulas.
Nope, I didn't. I think my Doc prob did, but I found them unhelpful. I don't really use just arithmetic to calculate that stuff anymore, so a calculator isn't really gonna help me, does that make sense? I see the idea of using a pump as a calculator as a drawback of the pump. It only serves to limit me and doesn't really provide for the flexibility of using intuition and some of those more nuanced things that I account for when I'm calculating my dosages. Does that make sense?
I'm mainly asking about the pump, I guess, because I think I see where some benefit can almost definitely be reaped from programming in multiple basal rates that are time dependent. I'm seeing pretty consistent patterns there. They aren't totally time dependent, more based on when I wake up or when I exercise - they are event dependant, does that make sense?
Nope, not really..lol. The whole point of having a pump is to have the flexibility of being able to program it for varied basal needs, I:C needs and ISF. It isn't just a matter of doing arithmetic for you; it's a matter of tailoring your insulin doses to your actual needs.
If you are finding, as you seem to be saying, very unpredictable results with your blood glucose, then you need to re-input different data. Ever heard the tech saying, "garbage in/garbage out?" If your doses are inaccurate, your results will suck. Yes, we all use intuition in dosing, and account for nuances of our activity, food, etc, but we do that on top of our correct dose formulas not instead of them!
If you go through your history and see patterns as you mention, of when you go high and when you go low, then you can go "back to the drawing board" and program your I:C (plural, many of us have different ones for different times of day), ISF (ditto) and basals (definitely ditto) to meet your actual needs, including variables such as exercise and time you get up. (Many people have different weekend basal patterns, and even ones for monthly cycles). That is what a pump is good for. Only you know this information, your doctor can at best only make a very general guess. That's why things aren't working well!
Do you think they would let me, sorta 'get my feet wet with the pump?' I mean, make an adjustment into using the pump for basal insulin only and 'try that on for a few weeks,' while still using manual injections for meal bolus. I think that would help me a lot and spread the risk a bit. I'm happy with the meal bolus doses and I'm very familiar with their behavior, but I don't think I will be able to apply changes to both aspects of the system at once. It's intellectually too difficult. If I could break the process into two pieces, then I have more confidence in being able to make a successful transition. Does that make sense? Do you think they would allow me to do that - I would need two Rx, one for pump insulin, and one for syringe insulin, which might be hard to get. Doc would prob have to over-ride something with the insurance co. ????
No one can MAKE you use all the functions of a pump, but there's a steep learning curve however you do it and I would think that especially with a CGM and a dr/pump trainer you trusted to guide you right, you'd be a lot better off just jumping in with both feet and getting it all tweaked at once.
You'd use the same insulin in your pump and syringe, presumably you're injecting humalog or novolog for meals, and you'd just put that in the pump, no extra prescription needed.
It doesn't really sound like you want a pump though, if you don't trust it, aren't interested in most of its functions and generally want to use it as a syringe, I wouldn't bother with it. A pump, although a welcome change for many, certainly isn't for everyone and when things go haywire, the $h1t can hit the fan a lot faster than with injections. If you aren't feeling mentally adept to tackle a huge project (learning to effectively use a pump), I would vote to stick with your syringes because although not perfect, they're a lot simpler and it sounds like basal aside, you wouldn't gain any bolus advantage with a pump. Thats my two cents at least....
It isn't a matter of a doctor "letting you" do something or not. It is your health and your body and even your pump. Doctors can be great advisers and supports, but in the end most of us find we know a lot more than they do about how Type 1 affects us on a day to day basis.
You do have the right idea of figuring out basal doses first and then working on bolus and ISF. In fact, that is the suggested procedure (have you read Using Insulin by John Walsh, it is very helpful). But most of us do this by using our pump and just figuring out and tweaking one thing at a time. Since you're happy with your meal doses, basically you could just stay with the I:C's you are currently using and work on tweaking the basal.
But if you decide to do it literally one part at a time as you said, you don't need two prescriptions. What people have been telling you is that the pump only uses one type of insulin - fast acting. So whether you are using Apidra, Humalog or Novalog that is the same insulin you would use for your pump (basal) and your syringe (bolus). The only time you would need two insulins is if you wanted to do your basal by shots which would necessitate a long-acting.
I think you’re confused. A pump can deliver a big 12 unit correction just like a syringe can. It might take the pump a few minutes to deliver all that insulin, but that shouldn’t matter much. A pump can also be programmed to deliver an extended bolus, but that’s only used when it’s desired, eg to cover a high-fat meal. A pump trickles basal insulin into you, effectively the same as Lantus which crystallizes below the skin and then is slowly released, the key difference being that the pump gives you more control over your basals.
Duration of insulin action is a biological function of how your body processes the insulin, not how it’s delivered (though a bigger dose, delivered by either pump or syringe, will absorb proportionally slower). Your body doesn’t know what device delivered the insulin, or for that matter whether it was delivered with food or not.
I would like to take meal bolus via syringe and just work with a pump on basal. I will insist on having back up Lantus in case of pump failures or suspected failures. I can't spend days trouble shooting those.
Niccolo, they are saying it does matter how its delivered. Better, more rapid absorption from the tiny pulses of insulin that the pump delivers. I think that might be true. See the DrBB and iJohn comments on page 2. I think my meal bolus will require adjustment when I deliver them via a pump, thats why I'd like to just keep delivering meal bolus via syringe for a while, while I'm adjusting the pump basal settings. I don't think I can do both at the same time, while adapting to a new tool.
It might not matter much, I agree, but I don't know for sure. It is reasonable to think that the medics give IVs, as opposed to syringe medications, most of the time when they want something to work rapidly. I think there's something too that. It crystallizes, huh? That's strange.
iJohn, Agreed that it is insane. I believe that we are always playing cards with a deck of NOT 52 cards. Everything about playing cards with dynamic systems is difficult. That's why I sorta like the way that some of the guys are ping pong-ing the BG around in between control limits without really diving in too deep about what causes a particular pattern. I don't know if that would work for me, but it seems to work for them. Its a very different paradigm than I am using. Here we go again with this song, Startler Bros. I'm just trying to break something complicated that I don't really understand into managable pieces and relate it back to things I understand.
I don't think that I will end up delivering pump dosages that are identical to syringe dosages. I think that if you changed over to syringe delivery tomorrow, the dosages wouldn't exactly be additive, or identical, to what your delivering on a pump. Do you disagree with that premise? I'm really just speculating.
Oh oh, I know this one! I just recently (not quite due to choice) gave up my pump and am back on injections and ITS NOT THE SAME! A 5unit bolus of humalog doesn't behave identically when delivered via pump vs syringe, although my experience is N=1, the syringe bolus is slower to start, and lasts longer with less of a peak than the same 5u bolus via pump. I've had to adjust both my carb and correction ratios slightly, as well as my insulin duration so that I'm not always stacking and crashing. Its not a big difference, but its enough that the first couple weeks back on injections were pretty roller-coaster like and not in the places I expected them to be!
I think your speculation on this point is spot-on, at least as far as my experience played out!
The guys explained it to me in the post, otherwise I would have been mixed up on this point. I did the same thing on a pump, during the last go around, before returning to syringes. I crashed and burned, mostly, I think, from stacking and not adjusting the dosages from manual injection.
I got an interesting vote for "split the basal 60/40 and remain of manual injection." I think that's the most simple solution for the most fundamental problem - varying basal needs. I think that's gonna clear things up. If I identify a need to split again, then I move to a pump.