Would you take a pump vacation if you were me?

I have been on a pump for ten+ years and a CGM for four. I am quite OCD about my readings and was recently told by my endo to "back off" and let my blood glucose remain a little higher. I reduced all my setings: C/I ratio, basals, and bolus amounts. Did really well for a while and now everything is wacky. CGM has been unpredictable: sometimes it is spot on, sometimes meter readings are 50-60 points higher or lower than the readings.

I have been taking a lot of correction boluses and have strictly followed my settings for both correction and meal.

Today I downloaded onto Carelink to try to find a pattern. Carbs per day are pretty steady. One morning I will be 94 at wake up and the next I willl be 193. I am just all over the place. The only really great thing is that I have actually slept through the night.

Anyway, I have been quite down about this and my husband suggested a pump vacation. It would mean 7 shots per day (at least) and most of them would be less than 5 units at a time. I average about 16 units per day and the basal is about 10 of that amount. Of the other 6, probably 3 of it has generally been correction. I do eat low carb.

Opinions? Also, I am leaving on an extended vacation in two weeks.......


Do you think that disengaging from the gizmos will allow you to get more stable controlwise? I am never sure about that as I went from R/NPH to pumping in 2008 and I'm sure I do better w/ the pump than that. I've never had Lantus/ Levemir. I had some weird issues w/ DP this spring, that would NOT go away and only just seem to be getting back to smooth at night. I'm still counting 120-130 as "spikes" so it's not way out of control but it has driven me nuts with on ongoing set of "tests" for like 6-8 months. I still find it easier to do tests like that with a pump/CGM than I think I would with shots/ meter reports.

Is the issue you're having with the pump itself? The CGM? Do you feel the need to "back off?" Sometimes, endos have told me that I was "testing too much," but in reality I knew I was testing exactly the amount that I should be. I think you have to decide yourself whether you really need a break from the pump/CGM or maybe a new endo. Was the intensive/OCD testing you were doing previously working?

I agree with MBP that only you can tell if you are "burnt out" on the CGM and/or pump. Personally I have no desire for a CGM because I think it would feed into my obsessiveness and make me more stressed. But that is just me.

I also agree with the question about if the pump itself is making you stressed out? I personally don't see anything obsessive about a pump but mainly see it as the standard of care.

Having said all that it does sound like you need a reevaluation of all your numbers at this point. If I were you that's what I'd put my energy into. Keep the pump as it is the best way to tweak basals and accurately dose. then do basal testing or simply look for problem areas and patterns (which is how I do it). Then tweak your basals based on the results and then go on to reevaluate your I:C carbs and ISF. If you are doing a lot of correcting than something isn't right. Things change for whatever reasons and if I were you I'd go "back to the drawing board" for my settings rather than continuing to follow ones that aren't working very well or throwing out the very tool(s) that can help you do that.

If you are emotionally burnt out I would recommend a different type of vacation: Either a literal vacation or a series of self-indulgences such as the old perennial shopping, time spent with nurturing people and whatever things give you special pleasure and are relaxing. D is hard work, we have to compensate with "hard play"!

Oops! Just saw that you are leaving on an extended vacation in two weeks! In that case I would work on my numbers for those two weeks and then plan to relax and enjoy and if it isn't perfect, well that's life(and type 1)!)

I absolutely LOVE my pump. This has nothing to do with pump or cgm burnout. Zoe is correct. I need to reevaluate.

I actually did three things today:
1. disconnected my CGM. It has been a wild ride and I think I may do better without it for a while.
2. Took a correction dose with a syringe. Have not done that in YEARS AND YEARS.
3. Moved the new insertion set to new real estate on my bod. Maybe I am too scarred up after 50 years in the most comfortable places. Nervous about this (on my thigh) but am willing to try.

My blood glucose looked like rick rack this morning. After wigging out for a while, I decided to try new things. We will see.

I do not want to give up the equipment. It is a part of me and when it doesn't work, I don't know what to do.

I do basal test, but how do I recalulate the ratios?

Trial and error, trial and error! If you are seeing lots of highs with say 1:10, try 1:9 for a few days and see if the 2 hr pp's are more in line. Also try different #'s for the different meals if you don't have that already.

If there is a diabetic crying board, I am on my way. I just tested at 196.

I can't tell you what to do as everyone needs to make there own personal decisions on dosing. But I have had months where I swing like a pendulum and its freaking maddening.

My solution was what I called the ground hog day affect; I try to do the same thing every day for a few days in a row. I mean everything; activity level; sleep pattern; and same boring food; zero change as much as possible. I let my numbers run slightly higher and I sit down for 20-30 minutes at some point during each of these days and look over my CGMS and insulin logs in detail to see where I am tanking and spiking.
By eating the exact thing every day at the same time it gives me the ability to see the same boluses for the same food a few days in a row. It also gives me a pretty good understanding of my basal rates. When I was tanking and spiking in the middle of the night it had to do with either my before bed snack or I needed to adjust my varying basal rates while I sleep. I have 3 different rates I run during the night; as I am susceptible to the dawn phenomenon.

The more variables you can hold constant the easier it is to see where your errors are. Remember as with anything your mileage may vary.

I am really afraid to eat. Everytime I put food in my mouth, my blood glucose jettisons through the sky.

I have seven really fine tuned, through basal testing, basal rates. They just seem to have gone haywire.

Hmm, if it's eating, I usually figure it's the bolus ratio, turn it up a notch or two and try again? If it's fasting, then I adjust the basal rate. I had a patch in the spring where stuff got off and I pretty much said "%$#& it" and turned everything up across the board. Recently, perhaps motivated by running more over the summer or whatever, I've turned things down across the board but I don't hestitate to turn everything up a bit if the numbers are off. 196 isn't that horrible, it seems sort of equal to maybe 1-2G/U so if you make an adjustment and see things fall into place, or even move in the right direction, I would score that as a huge "Win"?

Maybe cut the carbs and eat more protein for the time being. Anything overly processed can cause me to spike pretty easily too. Sounds to me like your basals may need minor tweaks. Weigh your portions if you have too. I have a scale in my kitchen and I have taken it with me places on occasion.

Remember if you skip a meal and you sugar still rises; that is a sure sign that your basal rate is not sufficient; if you bottom you might have a bit to much basal.

Every time the weather changes or my weight gains or loses 5 lbs I have to repeat these usual experiments.

The only thing worse than what you are going through right now is staying low all the time. Good luck!

You have posted on this before, AC. I admit that trying not to be OCD about this is really hard. You are a numbers guys, as I am. I appreciate your advice.

I recently made changes (not major at all) and they worked for a while, then collapsed. I am so afraid to make any more changes, unless I know the reason, such as steroid scrip (not in years) where I just did a temp.

Hate to say it, but I had some homemade chicken stock for dinner and it was great. No carbs.

The weird thing is that I am a trained cook/chef and love to play in the kitchen. Am eating less and less, but gaining weight....

I was thinking too (sorry for back and forth, but I'm BBQing...) that I used to have more basal rates but I noticed that a lot of them were "boosts" around mealtimes and, eventually, I ditched them and went with post-prandial= bolus and fasting= basal. The insulin is the same, but I think that it makes it easier to interpret?

Good point AR could be necessary to do a dual wave or delay part of the dosage till x time after meal and set a bolus reminder. I am puzzled by all the corrective boluses though....

I'm sorry, Spock, I can hear the frustration in your voice. The hardest thing about this disease is when we feel we have no control; when everything we know to do either has no effect, or the opposite of what we expect. I just re-read your initial post where you said the doctor suggested you let yourself run a little higher and you cut lots of doses. That this worked for awhile then went wonky. You never said why the doctor made this suggestion. Did he feel you were being too obsessive? Do you agree? I could be totally offbase on this but sometimes when we do what the "experts" suggest, even when it's counterintuitive, it just doesn't work. If being too OCD is an issue for you, then perhaps the goal isn't to "run your numbers higher" so much as make peace with a certain modicum of control and let go of perfection? (an impossible goal!). As the saying goes, "that's an inside job". If none of this resonates, that's ok

I've never pumped since I have always seen more down-sides than up-sides to pumping (at least for me), but that said, I wouldn't recommend a pump vacation as a way to improve control. If anything, it would just be introducing more variables and would seem to make control harder simply because it has been so long since you've done MDI. I just got back from vacation to Central America (thus my new picture), and in my experience a vacation will certainly throw some new variables at you (changes in exercise, in eating, etc). I would stick with what you know and tune it as best you can. And enjoy your vacation - life is short.

Hope you had a good time in Central America, Jag. I lived in Guatemala for two years and miss it greatly!

Any chance it could all be hormonal ?

I am going through the same thing, and I think it is the overuse of the same sites for my pump. I find lately my basal settings are not working again. I am really thinking about a pump vacation as well, but I HATE SHOTS. NPH and R is how I started but once I changed to Lantus and humalog I did okay. I feel like any form of insulin delivery is just okay even if I low carb. It is a crap shoot every day and that is what is frustrating. Also for me hormones play a huge part in my insulin needs.

Thank you. It was amazing. I uploaded a couple pictures for you that I took (in Nicaragua) if you want to get really homesick.

Luckily I have absolutely no interest in eating low-carb, because I don't think it would be possible there.