Tag: ACCU-Chek

Week 3 with an insulin pump

Tomorrow will mark my third week with an insulin pump. I had originally meant to blog my daily or weekly experience with the Accu-Chek Combo but I just did not have the time. I had too many work and home life activities.

My first week was the best. Even though I had a lot of hypo episodes I felt more free. My first weekend with the pump I was able to eat pizza; something I have not done in a while. Eating pizza was like giving my blood glucose a ride at Great Adventure1. With the mutli-wave bolus feature of the Combo I could eat pizza and not worry too much.

My second week was hell. At least that's how I would characterize it. As I worked with my certified diabetes educator (CDE) to adjust my basal rates, I experienced multiple daily hypoglycemic episodes. Some occurred during the day and some at night. Thank goodness for the Dexcom G4! We adjusted my basal rates and bolus ratios so many times that I have no idea what my insulin/carb ration is. It was just all too overwhelming.

This week I am taking it a bit more in stride, although I did start off the week in a bit of a huff. I wanted to get some useful data for the CDE so I decided that on Monday I would eat the same thing for all my meals that day. I had Trader Joe's Steel Cut Oatmeal for breakfast, lunch and dinner.

My BG pattern for the day resembled the ride pattern for Kingda Ka. It went straight up and almost straight down. I was hypoglycemic -- in the 60s -- most of the day. I refused to treat the hypo. I wanted the CDE to see the pattern and sucking down glucose would have meant throwing out the results. The CDE yelled at me when I should her my data later that night but she admitted that the data was useful. My basal rate was too high. We made some adjustments.

Yesterday I went back to eating my normal breakfast, lunch and dinner but my numbers were not much better. I still got a post-prandial hypo after breakfast and lunch but dinner held steady. I went to bed with a BG near my target of 100 and woke up this morning with a BG near target.

This morning I adjusted my breakfast regimen. I took my bolus and waited 20 minutes before eating. My BG did not rise as quickly and dropped into the 80s before lunch.

I don't know how to interpret all this data. I'm hoping the CDE does. Trying to find patterns and trends with so many variables is a daunting task. Unfortunately, I'm a Mac and most diabetes medical devices are Windows. I have no way to download and chart my data. That's a real issue for me. I think if I could look at the data from my CGMS combined with my meal and insulin delivery data, I could find some patterns to inform my diabetes management.

Next Saturday I am scheduled for an early morning fasting blood glucose test. I will use that opportunity to fast until noon. Hopefully we can get an idea of what my BG does in the morning. I don't want to do this more than once. The CDE wants me to do another one for lunch but that will have to wait for another weekend. Fasting during a busy work day would leave me miserable and exhausted.

One thing I am still trying to figure out is where to place my pump. My biggest challenge is going to the bathroom. Placing the pump on my belt loop works only so long as my pants don't drop around my ankles. I've had a some situations where the pump tubing was very taught.

I've received several suggestions via the forums on tudiabetes.org and elsewhere. None of them seem practical for me. One suggestion is to strap the pump to my lower leg or my waist or chest neatly hidden under my clothing. I think this would be uncomfortable and the strap would become and irritant. One of my client's offices has security scanners. At least one a week I am at that site, placing my computer bag on a conveyor belt for scanning, removing metal objects from my pockets, and of course setting of the scanner alarm with my insulin pump. It's a lot easier to deal with when the pump is visible. I also don't see how strapping my pump around my chest and under my clothes does not leave a visible bump under business clothing. I'm usually wearing an undershirt, a long sleeve dress shirt, wool pants and if it's Winter, a sweater. I dress like this guy, except I'm not as handsome and don't wear a tie.

Screenshot 2014 03 22 15 25 50

I'm looking forward to Week 4. According to some of the people on the forums on TuDiabetes.org it can take up to 6 weeks to fine tune my insulin pump. As long as I see progress, I won't be as frustrated.

  1. Great Adventure is officially Six Flags Great Adventure ↩

Insulin pumps may not be the best thing for me

I am beginning to feel that an insulin pump isn't right for me. It's been almost two weeks since I started using my insulin pump and I still have no clue if my basal and bolus rates are correct.

I have worked with a certified diabetes educator (CDE) from Roche to get my basal rate set. The first few days were challenging. I got a lot of hypos, requiring lots of treatment with smarties. The CDE considered the data unreliable since treating hypoglycemia doesn't allow us to see how low I would have gone with the rate and how much we should scale back. Of course I can't allow my BG go too low since the complications are immediate. I started using the pump in the middle of the week1 and I had a family event on the weekend2 so doing the "skip-a-meal" test wasn't something I thought I could do.

We tried for the next week but the results were mixed. It was also a very busy week3 at work. I had a number of back to back meetings all week but I tried to eat pretty much the same thing every day. I still had a lot of hypoglycemia but we thought we had made progress on the midday basal rate. We just needed to work out the basal rate for breakfast and dinner.

We modified a number of things including insulin/carb ratios and basal rates for different times of the day and I had fewer hypos that week. But I now had more hyperglycemia.

The CDE recommended I add some fibre to my fruit/vegetable blends. She thought the blends had too much sugar and not enough fibre. She also recommended drinking milk to add a fat to help slow digestion. I don't drink milk. I don't like it and I don't feel well afterwards. I was also advised to have my morning coffee later in the day instead of at breakfast. Somehow coffee might be raising my blood sugar in the morning.

On Roche's site one of the benefits of using a pump is stated as thus:

Plan your life, not your insulin scheduleAccu-Chek

The more I modified my diet and lifestyle to make the numbers works the more I became disenchanted with the pump. My normal breakfast is a blend of spinach, flax or chia seed, and berries or other fruits in a Vitamix. Total number of carbohydrates is about 17-20g. The flax, spinach and chia seed add healthy amounts of fibre. I don't eat eggs, toast and bacon for breakfast. I'd probably throw up if I did.

My lunch is usually a sandwich; a few slices of deli meat, low-fat cheese, lettuce, some may or mustard, between two slices of multi-grain bread. About 40g or carbohydrates. My wife insists on cooking dinner but I will occasionally eat a Trader Joe's packaged meal. A cooked meal may include one serving of brown rice or quinoa, vegetables, and organic fish or organic chicken. The only other meat we eat is grass-fed organic meat but we do that occasionally. We rarely eat out.

Does that sound like the a diet that needs to be modified? Do I really need to chuck my Vitamix and starting eating shit for breakfast? Do I really need to skip a meal and pop and aspirin for the resulting headache while listening to my stomach growl?

Does it make sense that went to bed with a BG of 101 on Saturday night and woke up with a BG of 140? Does it make sense that I went to bed Sunday night (last night) with a BG of 140 and woke up with a BG of 65 on Monday? Does it make sense that I ate the same things for breakfast on Sunday and Monday (this morning) and yet my 2HR post-prandial BG on Sunday was 140 and now (Monday) my BG is headed below 80?

Accurate carb counting is critical for getting the most from your pump.Excerpt From: John Walsh, PA & Ruth Roberts, MA. “Pumping Insulin.

The only way I know of to get accurate carb counts is to eat prepackaged processed foods. Surely this can't be a good thing! I am beginning to think the entire diabetes medical industry is full of shit. Am I supposed to stop eating home made meals unless I weigh and measure every ingredient and then compute nutritional information? Can I now only eat home cooked meals that come from a recipe book that includes nutritional information? Do I only eat at fast food and chain restaurants that have nutritional information available? Are all the local restaurants verboten? Explain to me how a pump fits in with my existing lifestyle or do I need a new one?

I feel the way I felt when I was just diagnosed. I feel like I don't know my body. I don't feel like I have control of my diabetes. I spend more time thinking about my diabetes with the pump then I did when I was on multiple daily injections. I find myself constantly checking the CGMS to see if I am headed for a hypo so that I can set a temporary basal. I find myself testing more often because I started to doubt the CGMS. I feel like I spend more time planning my insulin schedule than my life.

We have been unable to get anything sorted out in the almost two weeks since I started using this pump. Nothing makes sense to me anymore. I have lost control and that is pissing me off. I am disappointed. I am back where I was eight years ago when I was first diagnosed.

But, not wanting to be accused of not given pumping a chance I have decided to give it one more week before I call it quits on the insulin pump. I have set the range on my CGMS to between 80 and 200 so that I won't get "buzzed' by my CGMS in the middle of meetings and the middle of the night. Today and tomorrow, I will eat the same EXACT thing for ALL my meals. On Wednesday, I will skip breakfast. On Thursday I will skip lunch. And on Friday I will skip dinner. Hopefully I won't throw up from eating the same thing for every meal. Hopefully the hunger headaches won't affect my work. Hopefully I can get some restful sleep.

If we don't have a reliable set of observations to work with and we can't get my life back, then I am done with pumping. I will send this unit back to Roche. I will not change my diet and lifestyle to suit this device. It seems to me that is the antithesis of the supposed benefits.

I've read that a lot of people do well on the pump but I think and insulin pump may not be the best thing for me.

  1. My endo wanted to be present during the procedure and was booked for weekends. ↩
  2. A pizza party for my nephew but I expected his Dad and I would also want beer. ↩
  3. I am consulting on project with a very tight spring deadline. ↩

I got an insulin pump!

I just got my first insulin pump. This morning I worked with a rep from Roche to setup my ACCU-CHEK Combo. I'm anxious and excited. Anxious because using and insulin pump requires more care than using insulin pens. I've used insulin pens for almost eight years. Change is sometimes scary. But I'm excited to be starting a new chapter of my diabetes management system.

I had a week before today to get comfortable with the combo glucose meter. This device is incredible. I love being able to enter my meal carbs after taking a reading and getting bolus advice. I love that I can control my pimp right from the glucose meter.

I have a dexcom g4 CGMS and now I have two devices to help me manage my diabetes. I'm so excited!