Quote:
Originally Posted by nashscan  I started pump therapy yesterday. Before that, I was taking 12 units of lantus at night, and an I:C ratio of about 1 unit per 8-12 carbs, depending on how active I was. It kept me from spiking much at all after meals, and my blood sugars were kept within 30 points from bedtime to sunrise.
My new CDE now has me taking .65 units/hour, which comes out to 15.6 units/day basal. She's got my carb ratio of 1 unit/11 to 13 carbs. I'm spiking up well into the 200's after meals, and my increased basal is very slowly bringing down these high post meal sugars over a period of hours.
I've e-mailed her about this, and she replied if the blood sugars stay high like this over the next few days, she wants to increase my basals. I really really don't think that's the answer. I feel I need to be more aggressive with my bolus, and ease back on my basals. I e-mailed her again and she said
"the way pump therapy works, the basal rate controls blood sugar
overnight and to some extent, between meals. The meal boluses control
blood sugar for the first 2-3 hours after eating a meal. People often
need significantly more or less insulin over night compared to daytime
hours."
Well, yeah. Mmhmm. What do I do? I REALLY REALLY don't think more basal insulin is the answer! |
I had a similar kind of "fuzzy logic" applied when the pump doctor was apparently trying to help me work out my doses. Actually, in my case it the opposite, (boluses doing the work of basals) but the result was similar, confusing the role of one over the other. I spent 2 weeks in phone conversations every second night requesting to put up my basal and discussing the reasons and evidence why I should (they insisted every decision went through the doc). These "conversations" would run to 30 minutes she was so concerned at me upping basals and so insistent on upping boluses which I knew would give me major lows. It was simply a brick wall.
After 3 weeks I went ahead and made the change with instant improvement and relief. I felt it was unfortunate that I had to go directly against her advice but very relieved at the improvement. At that point the contact had turned to email. I emailed her to tell her that I finally did up my basals and the good, trend bucking results, and was careful and appreciated her help and appreciated her support (I was supposed to get another 2 months of contact). I never heard from her again. Personally that was upsetting and disappointing but in the end I don't think she was any use at all and was severely obstructing my control (I say that sadly).
Sorry for the digression there nashcan, but it seemed to be pertinent. Hopefully you can stick to your guns and at least "get permission" to "try" a higher I:C and not up what sound like already aggressive basals. I'm hoping your DE turns out to be far more reasonable than that endo, if you just state yor case firmly.
But I wanted to describe what sometimes does happen in this situation - and if you are like me of course you want to have a productive relationship with your team and you don't want to go renegade at all - but at some stage if you don't get joy cutting across incorrect assumptions and attitudes about the pump and this blocks your way to finding control, you may not have the luxury of a choice. Best of luck in this tricky time.
