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. 

On a good day

It's mornings like the one I just had that I wish I had more of. Morning's filled with inspiration and creativity and excitement. Then later, the creativity is used up, at least for the day, and I feel a bit down.

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It's mornings like the one I just had that I wish I had more of. Morning's filled with inspiration and creativity and excitement. Then later, the creativity is used up, at least for the day, and I feel a bit down.

Been talking to myself forever, yeah. And how I wish I knew me better, yeah Oceanlab

So now, I'm feeling quite low. Emotionally low. Sigh! My emotions today are like my blood glucose (BG) this week. My BG would go high (highs in diabetes management are not a good thing) and then a few hours later go dangerously low (lows aren't good either).

Bhavna kept telling me it was because of the pizza. I kept saying it wasn't. She was right. Every time I've eaten pizza this week my BG has been on a roller coaster. Cheese fat covers high glycemic dough delaying the action of the insulin. So my BG three hours after eating begins to rise rapidly to well over 300. Then an hour later, the Novolog kicks in and my BG is headed to the floor.

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I often wonder how much diabetes affects emotions. Do changes in blood sugar affect emotional state? I know hypoglycemia makes me short tempered. But what emotional state does hyperglycemia cause? Are the changes in emotional state caused by the change in blood glucose of "worsened" by it. Sigh!

So what does a good day with diabetes look like? Ha! Who knows?! For me it would mean that my BG at breakfast was under 100 and stayed that way all the way through lunch and dinner and finally bed time. Yeah! I wish. Some days my BG swings between 86 and 100. Those are great days.