Hi - my husband has been a pump user for a while now. He watches his carbs, gets exercise almost every day, tests regularly, and tries to get plenty of rest (though he has sleep problems). Despite all of this his blood sugars are pretty up and down. I know that no 2 diabetics are the same and that everyone handles this differently. I also know that he has a psychological issue that keeps him from taking as much insulin as he needs because he has had 2 bad lows as a teen where he passed out.
I would love to know what tips you have and how I might be able to help him get his blood sugars better under control. I know that he has to be the one to make the changes but if there are things I could do I would be willing to try. It's hard for me to see him struggle through this.
If there is a lot of fluctuation and he has a fear of lows then he may be having a cyclical problem – eg. he’s going low (or lowish), over-correcting with glucose/food, going high, over-bolusing, going low…and on and on.
Beyond getting the basic stuff optimized (basal rate, insulin:carb ratio, insulin sensitivity factor), one key may be to treat lows more gently if he has a tendency to over-correct. I used to have the same fear and would treat lows too aggressively and end up high leading to the above cycle. A lot of CDEs go for the 15 x 15 rule (15g glucose, wait 15min, test). But 15g of glucose for a mild low (like 60-69) may be too much if he isn’t crashing fast. I usually only take 1-2 glucose tabs (4-8g) for something on the border. The key (and the hardest part) is to wait and see before adding more and more food or glucose. This (along with lower carb and optimized settings) has made a huge difference for me! But, given his past experiences, I think this will be TOUGH for him.
And I know I don’t have to tell you that bringing this up when he IS low is not a good idea:)
I don’t know if he has the book Pumping Insulin by John Walsh, but that if he would read that so he has a good grasp on getting the basic stuff optimized that Tom mentioned.
I also treat my lows the same as Tom - I treat something in the 60s with 1 or 2 glucose tablets and increase the further I drop.
Other than encouraging him, there is not a whole lot you can do. If you do the grocery shopping, try to make sure you have healthy food choices for him.
I am new to pumping so can’t really offer much advise there, but I notice that I seem to have absorption areas in certain areas - maybe he has those problems also so try to pay attention to where he has sets on the days he is high versus days he is low to see if there is a pattern.
