Insulin pump update

I have received a couple of e-mails from fellow insulin pump users asking for an update. I am about a month into using an OmniPod wireless pump and doing very well, according to my health care providers. Here are some finer points I’ve picked up:

– Don’t schedule changes in basil rates. As I’ve stated, pump therapy replaces long-acting insulins such as Lantus and Levemir by releasing small amounts of short-acting Humalog throughout the day. This is better than the long-acting insulins because they tend to peak and decline constantly, causing high and low blood sugars almost unexpectedly. Since Humalog lasts only four hours, those peaks and declines are less noticeable. That

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Don't do this.

said, I originally set scheduled changes in my basil rates (the rate at which the steady stream of Humalog is released) to accommodate my schedule: when I know I’m most active at work, for instance, my basil was set to decline. Likewise, when I knew I’d be doing nothing, my basil was set to increase. However, I learned this is a bad idea because a.) no one’s schedule is exactly the same every day and b.) my body has become “less sensitive” to rate changes as time has passed – something my doctor said is normal. Instead, manually reduce basil rates temporarily according to activity/eating levels.

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This is the way to go.

– Patience is a virtue. I demand results. Instantly. This has been particularly true when it comes to the pump. I am determined to have it be like an electronic pancreas and my blood sugar to be perfect all of the time. Therefore, if I have a high or low, I’m tempted to make changes in my rates the next day. But it’s important to make sure there’s actually a trend before doing so. As stated, I’ve learned it’s not unusual for one’s body to respond to pump therapy once it starts. Consequently, what might cause a low or high blood sugar one day may not do so a few days later. Adjusting basil or bolus rates based on one number could lead to trouble down the road. I noticed one day my blood sugar was 175 two hours after lunch. That’s too high. So I increased my basil before that time the following day and was low. Chances are, my blood sugar would have been fine the following day if I’d stuck with my original rate – especially since it was doing fine prior to the high reading.

-Be realistic. This goes along with my patience issues. I never want to see any blood sugar higher than 120. Ever. But that is stupid because I am two things, among others: human and diabetic. I’m going to eat foods that aren’t whole grain rice and raw apples and I’m going to have days when all I do is watch football on the couch. Of course I’m going to have a high reading from time to time. Since the effects of stress, fibers in foods and other factors on blood sugars is practically unpredictably, it’s impossible to be perfect.

– The arm is the best place for a pod. I say this now, but I’ve never tried my legs, which I know is an option. But the thought of sitting and wearing pants knocking my pod out of place has kept me from trying my legs. And I’ve already had a pod come off my stomach. So my arms – specifically the fatty part on the underside of one’s bicep (forgive me for not knowing the proper names for these body parts) – have been my site of choice. I never sweat there and rarely bump into anything with it. So far, as long as I’m careful putting on/taking off my shirt and make sure I don’t brush into door frames, the three-day pods haven’t moved. Also, I’ve done some biking with a pod on my arm and everything’s been fine.

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This is a used pod. That little plastic tube needs to stay in my flesh constantly in order for insulin to be delivered.

– Speaking of biking, I’m having a bit of an issue adjusting my basil rates to accommodate. My first time mountain biking with the pump didn’t go so well. I started with a blood sugar of 130 after reducing my basil by 90 percent 30 minutes prior and was down to 75 after 20 minutes … and I wasn’t riding hard at all. I ate a protein bar and suspended my basil rate completely. Twenty minutes later, I was 74. So I ate 54 grams of carbohydrates in the form of Swedish Fish candy and returned to my car. By then – an hour after the 74 blood sugar – I was up to 130. A half hour later, I resumed my normal basil … and was 400 (yes, 400) two hours later. After discussing this with my doctor (it scared the crap out of me – 400 is ridiculous), we decided I should try reducing my basil at least an hour (as opposed to half an hour) prior to riding. It’s possible it takes longer than others for a change in basil rate to affect me. Considering reducing by 100 percent (no insulin in my body, in other words) had nearly catastrophic effects, a 90 percent reduction might even be too much when I’m riding. Frankly, though, I’ve been a little scared to give it another shot. Falling too low in the woods or spiking too high afterward could lead to my death.

– Don’t be cheap with insulin. Each pod lasts three days. Each can hold 200 units of insulin. Since I don’t use 200 units of insulin in three days, I started putting less in each pod. Why I did this, I don’t know, as my insurance buys the stuff anyway, but I worked my way down to 120 units in one pod. Well, as luck would have it, I ended up needing more insulin than expected during that span and had to change pods after two days. In the long run, this cost much more money for me and my insurance company (not that I give a damn about those guys) since a month’s worth of insulin is $150 and each three-day pod is about $60. I’ll leave the math to you, but it doesn’t take a genius to see it costs much more to waste pods than insulin.

Hope my this helps someone.

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