Where to go after PUMP therapy?

Hello All.

I would like to start a discussion as to where to go after pump therapy?
As a type one diabetic for over 25 years, I have seen the ups and downs.

I'm manically focused on trying to eat properly and exercise. Over the last few years my perception is that when I pump insulin, I do not see noticeable changes in my bg levels often. I have changed basal settings and increased bolus patterns. I do not know if I have scare tissue as I don't see it or feel it. It seems that sometime when I insert a new infusion set I get mixed results. A few days of the week I get good results and the others poor, It is almost like a unit of insulin will decrease my bg by 100 points. Other days it will only move 25 points at best. Because of this inconsistency, I can't develop a pattern of treatment. My eating habits are the same time(s) a day with mostly good food (low carb) at that. I use the MIO set and have tried sure T with the same results.

My endo are just keep testing and make the necessary corrections.
I'm toying with the idea of starting to use a Humalog pen to bring down highs fathers than my pump. This seems counter intuitive or is it not?
I have been described as of muscular build. Possibly using my arms could help?

I also have a CGM. It works well but I still have the same problem.

Any Thoughts?

Thanks.

Are you using the same areas for your infusion sets? Arms, legs, hips, bum are all good sites.

I alternate as much as I can. I do not use my arms as I have not figured out how to do it with tubing etc. I believe I'm not using the same sites... How does one know? I might give a week or two between sites I believe.

I start outside my belly button about waist high and zig zag up and down going toward my back moving only and inch or bit more from current site. Then go down several inches (high buttock area)and zig zag back forward. Next I move to upper hip on same side and zig zag downward on my outer thigh until my tubing is not long enough. After I finish one side I switch to the other using the same pattern. I can go a really long time before reusing a site. Back of arms are for vacation.

I do large corrections with a syringe. Why I started pumping was to get better control over my basal insulin and after close to a decade of pumping I still have very few problems with my basal insulin. It seems that most of my variability comes from the bolus insulin, my absorption of large bolus's seems to be very un-reliable so I have lost faith in my pumps ability to correct any big BG swings that have drifted above the 200mg/dL mark,...for me it's a large dose so it's easy to deliver with a syringe and I'm not the least bit bothered by injecting insulin....the new syringes are a blessing.

Interesting. What syringes do you use?

A sensitivity of 100 points VS 25 points on other days is quite strange. I think you should focus on this inconsistency and its root cause (pump failure, scar tissue etc). In your situation I would ask the endo for a pump vacation. Some days on MDI with a modern basal insulin like Levemir will give you the information you need. Important is to inject the Levemir every 12 hours to get good basal coverage. I hope you will get better results soon.

Curious. Why do you think large corrections are better handled by stand along injections? It is almost a contradiction in terms.

I know I need to titrate my correction bolus if I have rather high rogue numbers. Say I am at 180, I will do my usual correction dose plus 10%. If it is above 220, its is usual dose + 20% etc. That works very well for me. It is as though the sensitivity to insulin decreases when I have rogue high numbers. My Cozmore used to do that for me, but now I have to do the math in my head.

I use the 1/3 cc BD with a 31g 6mm needle. Some of my infusion sets work great but many times buy day three my insulin appears weak but using a syringe has confirmed many times that my insulin is full strength. I believe for me it’s a scaring or rejection problem. I have no interest in going back to a basal insulin like levemir I think it was the best of the basal insulins but it never gave me night time BG I could trust like my pump does…YMMV

I seem to get more reliable results from a syringe when doing a large correction…again JMHO