@Nan, I would encourage you to take @Robyn_H’s suggestions to heart. There are very few doctors who are expert in making pump setting changes and who also have enough time to follow up with pump patients like you on a daily basis until a working solution is found.
I’ve worn a pump for 35 years now. It wasn’t until I took full ownership of my glucose management (9 years ago) did I learn enough to manage my pump myself. I was someone who tried to manage his best but was missing some of the fundamental knowledge that pumps require. I therefore trusted my doctor to make various setting adjustments four times per year.
I soon realized that my doctors didn’t know nearly as much about managing pump settings as I thought they did. In fact, I remember realizing that I was the only one with sufficient motivation and time to become the expert that I needed. Clinicians simply do not have the time to actively manage pump settings for a few hundred different patients.
Pump settings are a target that moves. If you don’t move when your body’s requirements change, you will get left behind. Diabetes is dynamic, not static. When diabetes changes, you must follow or your glucose health will degrade. This is a case where the pump wearer is the only logical person to assume the role of diabetes owner and then make competent and rational changes as and when needed.
Your situation perfectly typifies the biblical notion that it’s much more important to teach a woman how to fish rather than to directly feed her fish! If you choose to rely on your doctor to step into this role, it may never happen and you may realize too late that the doctor is not as competent at pump management as you had thought!
I know you are a few years older than me, Nan, and I understand we can be frightened with what our advancing years mean to our ability to manage glucose levels. Our brains, however, are like muscles; if you work it, it will get stronger. If you challenge it less and less it will become less capable.
If you don’t think that you can take this task on alone, perhaps you could find a competent coach (or diabetes educator) who could work with you as much as you need to learn how to manage your diabetes better. Communicating through an app as part of a continuous remote support system is what you likely need.
Just realize that you need this person to demonstrate the ability to successfully work with people like yourself and to be available as often as you need it – as often as every day. Diabetes doesn’t take a day off and neither does the requirement to manage it!
Unfortunately, identifying someone with that competent skillset is not easy. There are plenty of people who like to think they know about managing insulin treatments well, but they don’t. It helps if this person lives with diabetes themselves and uses a pump.
You might look into hiring Integrated Diabetes Services to help you through this. The founder of IDS, Gary Scheiner, has T1D himself and has written several books about managing diabetes. Also working at IDS is Jennifer Smith, a dietitian who also lives with T1D.
Sorry if I’ve just raised more questions than I answer! In summary, I think you should commit to learning more about identifying and setting basal rates as well as identifying and setting appropriate correction doses. See if your doctor can recommend someone to work with you. You can do this!
These new skills, however, are not something that comes automatically or quickly. You do have to do the work. But then you will find satisfaction and confidence in these newly improved skills and quality of life.
