I did a fasting exercise to test the other day. I was at about 110 when I went to bed at 830pm and by 12pm the next day I was up to 145. I know that’s not perfect but I don’t think it’s terrible either.
I like to think of my pump basal profile as a platform to launch boluses. If the platform is sturdy and strong, the entire bolus can be spent on nutrition. With weakly set basals, the basal platform is squishy and the bolus first must backfill for the insufficient basal insulin. Basal/bolus is the ying-yang of insulin dosing. They are complementary forces.
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I have been pumping for over 11 years. I would say it worked flawlessly in the first few years and then I started to have site issues. I used to leave sites in way too long and didn’t rotate enough, so I contributed to the problem. I switched from Medtronic to the OmniPod for almost 4 years and had absorption issues and inconsistency that I ignored or put up with until I got a CGM and got more serious about my control. I went back to my Medtronic pump late last year and found it to be much more reliable and consistent. However, I was having non-stop site issues over the last few weeks to the point where I put my pump in a drawer and tried MDI for a few days. The first thing I noticed was how much faster the insulin absorbs after a bolus, just like you are saying. I decided to order metal infusion sets for my pump (called the “sure T”), which looks and inserts just like a 6mm pen needle, with no plastic/teflon cannula. I’m only on day 2, but so far the insulin absorbs just like MDI! When I take a bolus I see the numbers start to drop on my CGM almost immediately, and I have had to adjust all my ratios/rates to keep from going low. This is the best absorption I’ve ever had on a pump and I only hope it lasts. If you are able to try a tubed pump with a metal infusion set I highly recommend it, it may just solve your issues!
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@Eric2 @beacher I appreciate your thoughts and explanations. I’m pretty new to pumping (Omnipod as well) and I’ve noticed that I like having the pods on my legs best (outside of the upper thighs). The easiest insertion (barely feel it), least noticed once on and best BG results.
I’ve often wondered why I prefer that location over all others (back of the arms, abdomen, love handles) but hadn’t thought of it the way you’ve both stated it… it must be the place that works best for me based on the Omnipod cannula. It’s starting to make sense to me!!
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There are many good suggestions here. I only have one thought to add. For me, insulin resistance plays a big role in bringing bg down from anything over 200. Once I get down to 140-150, the insulin seems to work better. I’m sure not everyone has this same story, and maybe the numbers are different. I discovered this after many replay episodes of trying to bring down the numbers. What can I say? We are all our own science project. You will figure this out.
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Hey how are the Sure-T’s working so far?
I have to confess I’ve been trying MDI for the last few days. Tresiba just became available in Canada; I got my hands on some and thought I would try. The sure t was working great until out of nowhere my blood sugar skyrocketed to 15 after a meal I know it shouldn’t have, and I couldn’t get it down. I suppose I could’ve just tried to move it but I’d like to see how MDI goes for a while since I’ve never really tried for long. My brother is t1 too and loves the sure Ts so far after trying them on my recommendation. When I go back on the pump I will try the sure T again.
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You have been getting some great suggestions as always. Everyone here has so much knowledge and more importantly experience.
My two cents worth here is pre-bolus, pre-bolus, pre-bolus! This is really the main reason for my post meal spikes. And I know they say 15 minutes but there is so much that goes into this. How high is your blood sugar before the meal? What are you eating high carb, high fat, high protein, complex carbs etc? What kind of exercise and when? Oh the joys of diabetes.
And cents number 2 here, metal infusion sets were the answer for me also. After losing some weight the teflon cannula were always bending. Insulin absorption has been great since switching.
Everyday is an experiment. Keep good records and patterns will show themselves. And if you need a lot more insulin later in the day or earlier in the morning, that is what is right for you. Good luck!
I use a tslim X2 pump now and it got my A1C under 5.5%. On MDI I was just under 7%.
I am happy now but it took a lot of learning to ignore advice and find what worked. Listening to current advice would make my A1C lucky to be under 10%. Most advice is designed to raise your glucose and keep you from adjusting things!
I had one nurse educator actually tell me that once set everything should work fine! I have found that as my pancreas turns on and off my doses all vary in proportion. So if I change a basil I change carb and insulin factors too. I’ve never seen this suggested but it is required for me. And my doses have varied at times over a 3 to 1 range in a matter of a few weeks. Handling these changes would not be possible for me without my CGMS.
That is all I do since I am not a low carb eater. I still find my boluses for food are around 20% of my insulin use.