Monday, July 10, 2006

Fairly good BGs

The last couple of weeks have been fairly good BG-wise. The majority of my readings have been in target, and the outliers haven't been that far out. I have only had a few low lows (below 2.9 (52)), but I still have a fair amount of readings in the 3.0-4.0 (54-72) interval that I would like loose. I can just accept such readings if they are fasting, first-thing-in-the-morning readings, but they usually aren't. Rather, they seem to cluster in the hours around dinner.

My last HbA1C (3 weeks ago) was 5.7 %, and I would actually have been happy with that if it wasn't because I know that it covers the severe rollercoaster rides that my BG has taken in the 3 months that I have been trying to adjust to pumping. The aim for even testing pump therapy was actually to even out the swings and reducing the number of lows to eventually increase my A1C to 6.0 %. In these months I have had more readings above 15.0 (270) and certainly many more below 2.0 (36) than I can ever remember having in such a short period of time when on injections, at least when using Lantus. I have had two episodes of severe hypoglycemia where I lost track of my actions and needed help from others. Of course I had times of erratic control when on injections, especially the last couple of years that I used Insulatard (NPH) as the basal insulin, but compared to the 2.5 years using Lantus before trying out the pump, I sort of feel that the change to the pump has been a change to the worse. Or at least a change with MANY issues to be solved before being the advantage it was meant to.

I have an appointment with Alice, my diabetes nurse, on wednesday and before that I am trying to write down all the pros and cons of the pump that I can think of. So far the cons lead (12 to 7), although I have a feeling that in the end it will be rather close. I think that I will constantly find new advantages and disadvantages as long as I use the pump, so for now I am just trying to get an overview. In the meantime I hope that Alice will have the time to go through my readings with me. I think that I see a few pattern here and there, and I would like her evaluation of these as well as any suggestions on how to avoid them.

I have a feeling that either I will have to change the settings of my insulin-carb ratio in the afternoon and possibly early evening, or I will have to enter less carbs than I am actually going to eat in order to avoid all the readings below 4.0 that I tend to see at this time of day. It is a bit difficult to figure out though, because I can have a reading of, say, 6.2 (112) mid afternoon at the time where I usually have a snack to keep hunger away until dinner. If I then test 1-2 h after the snack, before I head home from work, I may be at 7.8 (140), which would actually suggest that the carb and insulin calculations are ok, but another 1-2 h later, before dinner, I am likely to be below 4.0 (70). I do have a 9 km bike ride home between the last two reading, and this of course is also likely involved in this drop, but I don't really know how to get about it. I have heard that reducing the basal rates doesn't really have an effect untill an hour later, but I haven't played with that yet. In general I haven't been good at remembering and using the possibility of reduced basal rates when I bike (I also like to go for longer bike rides just for the exercise and fun of it). Maybe it is because I haven't been use to having to speculate too much about adjusting insulin for biking when I was on injections. I would usually only reduce my dinner bolus in the summer because I usually go for my bike rides after dinner. Only rarely have I had to also reduce the basal dose during summer, and when it was needed, only 1 u was cut off. So in order to get as much benefit of the pump as it enables you to, I guess I have to change my way of thinking from the conventional MDI-linked way of action to the CSII one.


Scott K. Johnson said...

Hi Heidi,

It can be a frustrating transition, going from MDI to the pump - and like you say, seems to be for the worse rather than better.

It will take some time to work out all these variables and fine tune the delivery, but stick with it - I believe you will be able to achieve super control once you get it all worked out.

One of the nicest things with the pump is the ability to decrease or increase that basal rate for select periods of time. Like you say, there is some delay in that change and when you'll actually see the impact, but it is a useful feature.

Again, stick through the rough periods and continue to work through the problem areas. I really think you will do very well on the pump.

If you have questions, feel free to contact any of us, or simply post them on your blog.

Take care!

Heidi said...

Thank you for the encouraging comment, Scott. Even though I was not too enthusiastic about the idea of going on a pump, I was determined to at least give it a chance and work with it. It is frustrating though, to make a change that your medical team has been able to convince you will be a change to the better, and this just doesn't show within the first 3 months.

How long did it take you to balance things when you started pumping?

Scott K. Johnson said...

Who says I'm balanced?


Really though - it took months to get the basics fine tuned, and then every time a new scenario or circumstance comes up, it's trial and error all over again.

The pump is really the best tool for the job (that job being delivering insulin), but it doesn't necessarily make the rest of diabetes management any better.

Heidi said...

Scott, you know what I meant! ;-)

Anyway, it is nice - although still a bit annoying, I think - to know that apparently it takes quite some time to get things settled when changing to pump therapy.

I guess that when it comes to control, I have never been that patient. Even though I know that is not the way things works, I always like to see just tiny improvements right away when I make changes.