I have tried using a pump a few different times during the course of this disease which I was diagnosed 15yrs ago. Contrary to most people I have very rarely been able to get good consistent numbers while using the pump.
Recently I decided to give it another shot. I REALLY want this to work. I’m working with a great Endo and Diabetes educator but I’m starting to get really frustrated.
For Reference here are what my numbers look like.
Basal .60/hr goes up to .85 in the am to counter Dawn Phenom.
Insulin to carb = 10
Correction = 40 mg/dL/U
My basal seems to be okay although it does rise very slightly throughout the day. The problem is when I bolus. It seems like it takes a long time for the insulin to absorb, if at all…
For instance this is today:
1:12 am 206 Bolus Correction of 2.65 (pumps suggestion)
4:04 am 208 (Where did that 2.65 go?) Bolus 1.9 (pumps suggestion)
8:41 am 176 Bolus 1.9 (pumps suggestion)
9:50 am 157.
If I override the pump and go for more insulin it usually works better but I’m told that my Correction Factor looks about right and I shouldn’t need much more than that. My Doctor has really discouraged me from doing that becuase she doesn’t want me to drop too low.
Also, if I eat, even 35 or 40 grams, I bolus about 15min. before eating, my BG will shoot to 230 or so before starting to slowly come down. When I was I was on MDI if I waited 15min to eat I would be in danger of have low BG.
I am so bummed about this whole thing. I really want it to work but I think there is something wrong with the way my body absorbs insulin form the canula.
Does anybody have any similar experience or some advice?
It appears that your insulin delivery is impaired somehow. That correction at 1:12 this morning should have moved that number lower.
Where did you insert the infusion cannula? Did it hurt going in? Does it hurt now? When you injected during your MDI regimen, what part of you body did you use? Is it possible that your injection sites may be worn out and not effective for pump infusion? You might try infusing into new territory. I’ve found the “love handle” area on the side above the hip to be a good place to find fresh tissue. I’ve even used the area around on my back adjacent to the love handles to be an excellent site. But you have to be able to operate with your line of sight blocked a little.
Don’t give up on the pump too quickly! Work on one thing at a time. Write stuff down so you can come to some valid conclusion moving forward. Consider your correction factor, insulin to carb ratio and basal rates to be nominal starting points that will likely need to be changed by your experience.
Have you read Think Like a Pancreas by Scheiner? It will help you become your own expert on dosing insulin. Endos and diabetes educators are not always the ideal resource for these changes. An informed and motivated patient makes these kind of adaptations best. Also keep in mind that you are not working to find the perfect formulas for insulin dosing. These things change and the ability to change with them is the single best skill to acquire. Diabetes is a moving target.
Thank you so much for getting back to me on this. I really appreciate your input.
It doesn’t hurt now but I remember when the bolus was being delivered last night it did hurt a little. The site is on my love handle and I have really good tissue there, no scaring. I feel like all of my sites have potential to be really good.
I have been taking a ton of notes and sharing with my educator, who is also on a pump. It’s funny that you mention Think Like a Pancreas becuase I have the book but haven’t read it yet. I wanted to give my Endo and educator a chance to work on this. I really need to read it though. Thanks, I will do that.
Any idea on why the same amount of insulin from a needle acts way different than getting it form the pump?
@J_Slice - We have issues that appear similar. Overnight corrections when also over 200 seem to absorb the insulin like a sponge.
However similar amounts of insulin during the day or under 200 have entirely different effects.
Based on our cgm, I am seeing that it takes about 4-1/2 hours (during the day) for a bolus to completely finish its work from time of bolus to time of flat graph on cgm.
Our I:C and correction factor and general basal appear similar to yours except for the DP, we have an almost 50% basal increase. It seems excessive but the cgm data supports it.
Basically, my opinion is the overall approach for the correction factor is flawed in that there is no mechanism in the pump to take into account the impact of the BG on the ratio. We do not find it to be linear. The ratio itself changes at high BG (over 180~200). So, if the BG is 250 and the pump says to dose 3 units, I might bump that to 4 or if the cgm still shows a rise, bump it to 5. And with the cgm if it was a bit too much then we will catch it on the downside before it gets out of control on the low.
That’s great insight! I have noticed that, just never put it together quite like that.
I don’t know if this is right but when I was MDI I would overshoot the correction and catch it with something on the way down. My Endo got pretty upset at me for doing that with the pump…
You mentioned the “Think Like A Pancreas” book. You might also want to read the “Sugar Surfing” by Stephen Ponder.
I picked the Ponder book up recently from a recommendation on the forums.
Don’t be surprised if your Endo doesn’t like the idea of “surfing”. ha ha ha
But in the end - you have to decide what works best for you.
Interesting observations. I’ve been thinking I needed a much more aggressive correction factor for nighttime. Sometimes I’m convinced I’m bolusing water, whereas during the day I can see the CGM heading downward in about an hour.
I also wonder if the lack of activity comes into play.
@Terry4 has often mentioned he finds a short walk after dinner very helpful.
At nightime lying down in bed is perhaps the reverse true? The absolute lack of movement perhaps stiffles the action of the insulin?
So could there be two factors at play working against the insulin? Complete lack of physical activity coupled with very high BG?
Which pump? I had trouble with (suspected) variable delivery rates via Medtronic. Have had significantly better performance from Dex.
Thanks for the suggestion, Sugar Surfing, I just ordered it. As far as activity goes, I like to exercise and do a lot of hiking. During a 3 day backpacking weekend I have to cut my insulin by half so it makes sense that when I’m just warm Jelly laying in bed sleeping that my metabolism just isn’t working very hard at all…
I honestly don’t think the pump model has anything to do with it, but I have been on a few Medtronic Pumps and now I’m on an Omnipod. I have had pretty much the same complaints with all of them.
Just for reference I also use a Dexcom CGM, which I love and will never get rid of…
While Omnipods do a great job for many people, you should be aware that a small percentage of us had problems with absorption, failed infusion sites, and a pattern of occlusion alarms. I tried for five months to successfully adopt the Omnipod but I couldn’t make it work. I’m not saying your pump is the source of your troubles but just be aware that some people before you have had similar problems with the Pod.
Reading the suggested books will pay you back in many ways. You need to become the leading expert on your diabetes. Doctors and educators only see you for short visits about four times per year. They don’t have nearly the same opportunity to learn your glucose metabolism like you do. Plus, they have no “skin in the game,” a factor that can really focus your attention.
I read your first post and immediately thought to myself, “I bet he/she is using an omipod”.
I kept reading and eventually found toward the bottom that you are indeed using omnipod.
The shorter “one-size-fits-all” cannula doesn’t work well for some. You may have to try different spots to find a place that works well.
Also, pinch up your skin and a bit of fat when you are hitting the activate button. Try to get the cannula situated well.
This is possibly significant, since you’re using the Omnipod. For me, there’s almost always an inverse correlation between feeling the initial cannula insertion or boluses and the quality of BG numbers. If the insertion is almost unnoticeable, I’m sure to (mostly) have predictable numbers. If I wince or make funny noises when the cannula goes in, numbers will probably not be great.
Adding to what @Eric2 says, when you apply the pod, don’t just press down the adhesive around it but give the whole pod an aggressive rub to make sure all the adhesive under the pod and around the cannula area sticks to the skin. Pinch up and press down slightly on the cannula end of the pod to prevent bounce-back and relax – you don’t want tightened muscle under the cannula when it inserts.
What insulin are you using in your pump?
I have heard a lot of people say one insulin doesn’t work as well as another, so the problem could be the insulin.
Also, how often are you changing your infusion set? I have heard of a surprising number of people going four, five, and six days on a set. I used to go four until I noticed day four was always a very bad control day.
I will definitely pay more attention when I’m putting a new set in. I knew that people have strong opinions about which pump is best I just never knew there was a consensus with omnipod. I had a Medtronic with Enlite CGM and had a terrible time with the CGM and Medtronics customer support. Although, I heard there new system works much better…
I use Humalog and change my Pod every two to 3 days…
I wouldn’t go so far as to say there’s a consensus. Some of us are positively evangelical about the Omnipod. As @Terry4 diplomatically says, “a small percentage” of Omnipod users experience absorption problems. I’d hazard a guess that a similar percentage of users of the other pumps (all variations of the same model) at some time had similar problems, but it’s possible for them to switch to different styles of infusion sets. I don’t have records to back it up, but when I used other models of pumps in years past, I had periodic absorption issues.
It’s my impression from reading here, and as @Terry4 also notes, people who have absorption issues also tend to have a lot of occlusion alarms. Is this your experience? (For the record, in nearly a year of podding, I have never had an occlusion or other alarm. Perhaps I’m one of the blessed. Perhaps it pays to be evangelical.)
I have never had an occlusion alarm.
I actually have a Minimed 530G also. I’m tempted to set it up and do a comparison.
Yeah, it was absorption problems with the Animas Ping/Inset 30 combination that drove me to try the Omnipod so that I could access more pump real estate. But I had uneven success with the Omnipod and finally gave up when I had one too many pod alarms.
I returned to the Animas Ping and experimented with some new infusion sets. I found that the simple 90 degree 6 mm soft cannula did the trick for me. I used that combination for about four years before I switched to my current rig of an old Med-T 722 pump and the Silhouette infusion sets. I’ve had very dependable luck with them, too.
I’m a big believer in doing the experiment, logging the data, and choosing what’s right for you!
Experiments are great!!!
Especially when you share/post the results.
I don’t quite understand what you mean by this sentence. Do you mean you are increasing your basal during the day, or find that you are going high? I wouldn’t be too quick to discount the basal. If your basal is too low for what you need, it will respond like you have noted; that is, a correction won’t lower you the way you think it should. It’s also correcting for the shortage of basal. I know, another variable is just what you need! Hang in there!