Wednesday, July 12, 2006

Changes

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 %).

3 comments:

Scott K. Johnson said...

I'm no soccer player, but I know it can be rough.

I think that location, under your arm, will probably work well for you. I used to wear my pump there too, using an elastic band thing, and it was very comfortable.

I think that you will enjoy some of those advanced features of the pump (temp rates, basal schedules, etc) as you become more comfortable with it.

I really think with your knowledge of the metabolism, along with your already tight control, you'll be able to get very impressive results. Give it some time, don't try to learn it all right away - just as it becomes comfortable to you.

Scott K. Johnson said...

Er, I meant to add that I used to wear my pump there during basketball.

Chrissie in Belgium said...

I definitely think you should give it a try to keep the pump on while you play soccer, but do remeber to temporarily reduce the basal rate AND adjust the previous meal bolus. You must work with both the amounts and timing. For me it is important to decrease the basal rate BEFORE the actual exercise. This is all a balancing act. You have to see a pattern of when the bg fall and when they increase in relation to the exercise. I will often have less need for insulin during the beginning half of the exercise and will often need MORE insulin after exercise. The tricky part is working with the delayed reaction time of the basal rate. Another difficulty is knowing how anaerobic/aerobic the exercise will be AND how stressful it will be. For me this is really difficult to judge. I have found that if I push myself during a 3-4 hour walk, bg will rise the following 12 hours, although they practically always drop during the first 2/3 of the exercise. If I walk leisurely for the same time period the bg will tend to decrease in the following 12 hours after the exercise is completed AND of course fall during the exercise. However if you are taking a "new walk" it is very hard to judge how much is uphill versus flat! It always seems so WRONG that faster walking increases my bg....... This is just really hard to accept! Sometimes it doesn't work as you planned and there you are with bad tests. Do to the large degree of uncertainty I always am very restrictive about pre-emptive dosing. For me it is easiest to adjust a bit in advance and then further adjust with correction boluses or coke when you see what has happened. But how do you do all this in the middle of a soccer game! Of course my husband usually says I try to draw the line too close. However he doesn't have to live with the terrible way I feel when the bg goes to high. Other people are more concerned with just the hypo side! I must deal with both sides. How you deal with exercise is really an individual thing that must be tested. I have such small levels of basal that I cannot decrease it too much, because you need insulin to get sugar into your cells so you have energy to move. If one has a larger hourly basal rate , one has more to work with!

Yes, the doctors are so dam picky - not only are high HbA1c's bad, but then once you have a good level they tell you it is too low! Mine don't like under 6 either ;-)