This morning I had an appointment with my diabetes nurse, Alice. As I mentioned in my previous post, I had several issues to discuss with her. Fortunately, she had time for it. Actually my appointment lasted almost 75 min! We agreed on a few changes to be tested and some habits of mine that I should try to change. The latter is going to be the hardest task as these habits are actually a question about remembering to make some changes that I haven't been used to give much thought to. An example is the use of temporary basals on the pump. This is a function that I have only used occationally, but certainly could turn out to be an advantage on some of my longer bike rides. I haven't been use to pay attention to insulin delivery just prior to a bike ride, because when on injections, I would usually just reduce the last meal bolus before a ride. This I still tend to do, but especially on days when I am low around dinner time and want to take a ride after dinner, a temporary reduction in the basals is likely to prevent hypos during or just after the trip. I will have to work on remembering this.
Alice also suggested that I should pay more attention to, and make use of, temporary basals on soccer game days and the following nights. In the light of that last serious hypo on the night following the last game of the spring season, this may be a good idea. Because I have been using additional Lantus shots on the game days, I have a pattern of much lower basals coded within my pump for these, but I may need to run a temporary lowering of those even so.
As we discussed the issues around soccer games, we also discussed the possibility of wearing the pump during the game. I haven't been very fund of the thought of this, but because of the BG-difficulties I have been having during games, I think it may be worth at least to try it. I got a neoprene case for the pump during sport. It is designed to be worn in a belt, but it should be fairly easy accustoming it for using a clip or something like that in stead. The best place to place the pump during a game seems to be under my arm, so maybe I can just slip it into my sports bra without any clip or other things to hold. I will try it out and see what will work the best.
To eliminate the BG drop that I tend to see in the late afternoon/around dinner, we decided to start with a reduction in my basal during these hours. If this doesn't work we will take a look at the insulin-carb ratio. Alice pointed out that most people, especially doctors - and mine is no exception - refuses to believe that 0.05 U changes can make any differences, but her experience with pumping tells her they certainly do. She encouraged be to make such a reduction in all the basals, if not now then when I had gotten the around-dinner-hypos under control. She had also seen my last A1C and didn't fail to comment upon that ;-) (remember, she would like to increase it to 6.0 %).