Doctor Visit - The Good, The Bad, and The Ugly

[JediSkipdogg]

The good news is that for the first time in about 5 years my cholesterol is under 100. My LDL was 88 and my HDL was 42.

The bad news is that in eating healthier to obtain those numbers my A1C has risen. It was a 7.6 this time. Also the highest in about 5 years. Seems I can't win but then again instead of eating McDonalds all the time I've been eating like McAlisters and other sandwich shops. The problem is many of them don't have nutrition info so it's alot of guestimating.

The worst part though is the change to Apidra hasn't helped at all. I still appear to be having the dreaded insulin coming out from around the canula on occasion. I believe it was xMenace that gave the advice of using tape under and over the infusion set. I have done that but I still see/smell/feel insulin bubbling out from around the set. The doctor looked at my stomach and asked how ofter I change sets and I mentioned every 3-3.5 days. I can't go over 3.5 days cause then my cartridge is out of insulin and I hate just changing one part and not the other. SHe thinks I'm just a slow healer and that may be part of the problem as when she counted "spots" on my stomach, I had almost 3 months worth showing still.

I do think part may be the fast infusion of the Animas pump and I'm hoping in the next 6 months they will come out with a new pump, but so far I've heard nothing. They did offer to let me try out a "Pod" for a few days though but said I should ask the company first. They said their trainer had the same worries as I've had about it and most were turned around except the trainer did leave the PDA at home one day and "couldn't eat" in a sense. That would be my biggest problem.

She also suggested maybe I take a pump break with summer coming up. I said that's a possibility but would be hard with my basal pattern. She said she'll do some more reasearch for me to find out why I am having set problems and at my next appointment we could come up with a solution to solve it all. That was my doctor visit today. One of the longest I've had in a while, but also one of the nicest. And it wasn't with my endo, but her CNP.

[notme]

Always something huh Jedi? I am glad you got your cholesterol down without medication. I wish I could do that. I can't seem to make a difference even with diet. I don't eat any fast food at all. I do have 1/2 and 1/2 in my coffee and I suppose I should give that up.

Have you thought about giving your stomach a break? Maybe use the back of your arms or backside? It is awkward, but I have done it. I can leave my sets in longer than recommended, so I don't think I have the healing issue at all. I did get in infection for the first time in three years on my last set. It has left a nasty bump and I guess I need to get more religious about set changes in three days.

I know I could not take a pump break. My blood sugar and A1C was terrible before pumping. I just couldn't get a good basal pattern down and Lantus was a pain.

Maybe it is time to call Cozmo and MiniMed and give them a try as well as the pod.

Good luck

[JediSkipdogg]

Have you thought about giving your stomach a break? Maybe use the back of your arms or backside? It is awkward, but I have done it. I can leave my sets in longer than recommended, so I don't think I have the healing issue at all. I did get in infection for the first time in three years on my last set. It has left a nasty bump and I guess I need to get more religious about set changes in three days.

We talked about that and she asked if I had tried anywhere else. I explained that I tried my thighs once and had the greatest absortion there, however the sites seemed to swell up really fast and became extremely uncomfortable after the first day. I tried that 4 times, different spots, both legs and the results were all the same.

She then mentioned maybe my upper butt. Problem there is absortion was terrible. That is also where I wore a 3 day CGMS on two prior occasions and could never get it to last more than 2 days.

I just don't see how the heck the arms are possible. I guess mainly my issue is how to contort (sp??) my body to insert it and if the tubing would be a huge issue running down my shirt and annoying me.

Again, I'll take some suggestions on this, lol.

I know I could not take a pump break. My blood sugar and A1C was terrible before pumping. I just couldn't get a good basal pattern down and Lantus was a pain.

My issue would be my basals increase significantly in the evening. So around 3 pm I'd have to add a shot of NPH to get the peak to cover my evening peak. So I'd be on Lantus, NPH, and Apidra (or one of the rapid actings.) I'd think I could do it for a month then I'd be so annoyed with it I'd go back to pumping. I just can't imagine giving up pumping.

Maybe it is time to call Cozmo and MiniMed and give them a try as well as the pod.

Good luck

I'm due for a new one after January 1st of next year, however I was hoping to wait it off as long as possible mainly because of the 20% out of pocket. That amount is a vacation for me. Also, of all the current pumps out there, they all suck. LOL So I'm hoping one of them will reveal a new pump soon with some decent changes, maybe all the ones we've been talking about on here for ages.



Oh, I forgot to add earlier, that although my cholestrol is down, my **** weight is up. I'm just over 200 lbs again and I have no idea why. It's like with eating healthier I'm eating more.

[BlueSky]

... I do think part may be the fast infusion of the Animas pump ....
It sounds like you are having absorption problems. Aren't you able to spread the bolus infusion out on the Animas pump? I had the boluses delivered over 3 minutes with the Cozmo to improve absorption, and it seemed to work very well.

If you need to take a pump break and are concerned about matching variation in your basal requirements, consider combining Lantus with NPH and/or regular. While it isn't ideal, you can get a much better match this way than using Lantus alone. ;)

[JediSkipdogg]

It sounds like you are having absorption problems. Aren't you able to spread the bolus infusion out on the Animas pump? I had the boluses delivered over 3 minutes with the Cozmo to improve absorption, and it seemed to work very well.

That is my biggest complaint about the Animas. Besides that I love the pump. The Animas has two infusion speeds, what they consider fast and slow. The ONLY difference that I can recall is the "slow" setting adds a 1 second pause between each unit and the fast just gives it all at once. Basically, you want to give a 5 unit bolus on the Animas, you get it all in under 10 seconds on fast, and maybe 15 seconds on slow.

I'd prefer it given over a 1-2 minute period. My peeve with the MM is that you can't slow it down, it's just slow.

I'm not sure what the Omnipod is and if that's a changeable setting or not.

[Penny]

Kevin, I really reduced my cholesterol this time too, but my A1C went up. I hardly ever have fast food, but I was trying to lose weight too (the onemore/last time :( ). I cut fat and tried to reduce the amount of Novolog I was using...... I had some idea it was keeping me from losing weight, but it didn't help. All I got from 3 months of this routine was my lower cholesterol and a 7.4 A1C. I felt better with the lower A1C, and my cholesterol was already pretty good .....so I am going back to the way I was before. Sorry about the pump problems, but I sure get tired of this MDI.

[Huckleberry]

Jedi,

Can't you just give your bolus as a combo over .1 hour ( 6 mins)?

It seems that may be the best way to control the rate.

Best of luck

[Eddy]

The good news is that for the first time in about 5 years my cholesterol is under 100.


Excellent. :)


instead of eating McDonalds all the time I've been eating like McAlisters and other sandwich shops. The problem is many of them don't have nutrition info so it's alot of guestimating.


Post-DX, I've limited myself to two or three restaurants, with a few exceptions. Testing 1- and 2-hr post helps me figure out their foods. Buffet portions still pose a challenge (and I'm frequently a unit or two off), but it gets easier with practice.


SHe thinks I'm just a slow healer and that may be part of the problem as when she counted "spots" on my stomach, I had almost 3 months worth showing still.


This could be exacerbated by BG, causing a vicious circle. I was a slow healer pre-DX. Even now, when my BG gets "high enough", my skin takes on a nasty, pasty appearance and feel... and I'm less likely to feel a shot.


She also suggested maybe I take a pump break with summer coming up. I said that's a possibility but would be hard with my basal pattern.


If you choose to try this, note that it need not be all-or-nothing. You could pump half your normal basal, then inject the balance using Levemir/Lantus to "get the feel" without going to the hassle of a basal change.

Note re Levemir: Novo's printed materials indicate that smaller doses act faster. I found this to be true, although the effect was so small as to be insignificant.

If you do go MDI, I'd humbly suggest Levemir for your primary basal. It's shorter-acting than Lantus, allowing you to set night/day basals. Variability supposedly (and in my experience so far) is less than Lantus.

You then could "fill in the gaps" with N, or even R.

Or, perhaps a half-basal-via-MDI approach would do the trick. *shrug*

Hopefully you find something that appeals to, and works for, you...

[Gary_W]

Jedi,

Can't you just give your bolus as a combo over .1 hour ( 6 mins)?

It seems that may be the best way to control the rate.

Best of luck

I was about to say the same; not used it in anger myself for obvious reasons so not sure if this will help you?

Sorry to hear you're having problems :(

[JediSkipdogg]

I was about to say the same; not used it in anger myself for obvious reasons so not sure if this will help you?

Sorry to hear you're having problems :(

I can, but when I have the "bolus around the canula problem" it comes out on even the first unit of insulin.

I truely hope in the next pump Animas does slow the bolus down and make it a customizable obtion for the user. Basically, do what the Cozmo has had for ages and I'll be a continual user of Animas. If they don't change, I may have to seriously consider looking elsewhere.

[xMenace]

Maybe try wearing your pump for basals only.

How's the exercise level? That may help too.

[JediSkipdogg]

Maybe try wearing your pump for basals only.

It works great there. My doc today suggested I try changing my basals thinking that is the problem and I said those are perfect or near perfect. I do have a few problems going on with those though...

1...a) If I wake up at 9 am my basals are perfect.
1...b) If I sleep in till 11 am, my basals make me go low.

Which do I do? I'd say both 50/50.

2...a) If I wake up at say 9 am and eat at 9 am, I have a 1:6 insulin/carb ratio.
2...b) If I wake up at say 9 am and eat at 12 pm, I have a 1:15 insulin/carb ratio.
2...c) If I wake up at say 11 am and eat at 12 pm, I have a 1:6 carb ratio.

Essentially I have to give 1:6 for the first meal unless a long enough period of wake has passed for the ratio to raise to my norm.

How's the exercise level? That may help too.

I'll get back to you on that one in about 3 months. Well, maybe after next week since it's suppose to finally warm up in this **** city. Last night one would think we were still in winter.


I generally wake up around 10:00 am and have a small snack using my 1:6 and then eat lunch around 12:30-1:30 using my normal 1:19.

[Eddy]

1...a) If I wake up at 9 am my basals are perfect.
1...b) If I sleep in till 11 am, my basals make me go low.

2...a) If I wake up at say 9 am and eat at 9 am, I have a 1:6 insulin/carb ratio.
2...b) If I wake up at say 9 am and eat at 12 pm, I have a 1:15 insulin/carb ratio.
2...c) If I wake up at say 11 am and eat at 12 pm, I have a 1:6 carb ratio.


I'm curious what would happen if you awoke in the middle of the night, had a snack, and went back to sleep. i.e., how much of the variation is due to time since eating, sleep duration, time of day.

[JediSkipdogg]

I'm curious what would happen if you awoke in the middle of the night, had a snack, and went back to sleep. i.e., how much of the variation is due to time since eating, sleep duration, time of day.

That's what I've wondered too because there's some times when my dinner ratio can vary from 1:10 to 1:19. I haven't exactly worked on timing that one out though but when I was on day shift here at work I'd eat lunch at 11:00 am and then no dinner quite often till 6 or 7 pm and many times I needed the 1:10. But if I at lunch late and then had a snack when I got home from work it would be the 1:19.

It makes me think I either need to eat more often or eat less or just eat and pray that it works out.

A CGMS would be perfect to fully help figure that out but...
1) My insurance denied me numerous times and told me that they need evidentiary proof from a long term study of the effectiveness of the device.
2) I feel I'd have a hard time finding a spot to put one with my current pump problems without losing valuable infusion site spots. Granted the arm might not be bad for that, never tried there for CGMS. But problem A exists.

[Eddy]

That's what I've wondered too because there's some times when my dinner ratio can vary from 1:10 to 1:19. I haven't exactly worked on timing that one out though but when I was on day shift here at work I'd eat lunch at 11:00 am and then no dinner quite often till 6 or 7 pm and many times I needed the 1:10. But if I at lunch late and then had a snack when I got home from work it would be the 1:19.


It almost sounds like you're stacking boluses when eating frequently. What do your postprandials do for each of the above patterns?


It makes me think I either need to eat more often or eat less or just eat and pray that it works out.


Eating the "right" amount also is tricky. If I don't eat enough, I go hypo. If I eat too much, I gain weight.

A big (200+ g CHO) lunch will hold me until late the next morning, possibly with an evening snack. BG trends are surprisingly smooth.


A CGMS would be perfect to fully help figure that out but...
1) My insurance denied me numerous times and told me that they need evidentiary proof from a long term study of the effectiveness of the device.


Hmmmm. I wish I could help you there. It seems logical and obvious that a CGMS would help one identify one's bodily patterns, and adjust accordingly. Better control leads to better long-term health, and fewer complications.

Oh... wait... I just answered my own question: Forget (more polite than another word beginning with same letter) control concerns, label someone as high risk, and jack premiums. Why focus on long-term prevention when there's an opportunity to increase cash flow now?

[Gary_W]

I can, but when I have the "bolus around the canula problem" it comes out on even the first unit of insulin.

I truely hope in the next pump Animas does slow the bolus down and make it a customizable obtion for the user. Basically, do what the Cozmo has had for ages and I'll be a continual user of Animas. If they don't change, I may have to seriously consider looking elsewhere.

I just played with the .1 setting (advantage of not being plumbed in yet) and it does work in a really weird way.

I told it to do a 5u combo bolus. I set it to 0% up front and 100% over the extend period. So logic would tell you that it puts it in gradually over the 6 mins.

Not so.

It whacked in the first 2.5 units immediately (4 seconds between each unit as I have it set to slow) then put in the other 2.5 units on the stroke of minute 3... What on earth is that all about? The only reason I can think of to do a .1 combo bolus is to combat issues like yours / stinging. In its current form, this feature appears useless...

For the sake of experimentation, I've just told it to do the same 5u bolus over 30 mins (the next timescale available after .1). Again, it was nothing up front and 100% over the extend period. It did nothing for 3 mins then put in a 0.5u bolus. Same at the 6th min. I am guessing it's going to do that for the rest, but I'm going to bed :)

I seem to recall reading that the 2020 puts in basal every 3 mins. I am guessing that 3 min delivery intervals is the best it can do, and it will put the 'extend' in within those 3 minute chunks. If I'm right on all the above then the best you can do is set delivery to 'slow' to get the 4 second gaps and do the .1 extend which will at least cut the bolus in half. Not ideal by a long shot, but the best you've got at present.

Gary

[JediSkipdogg]

Gary, you found the flaw with the Animas. Yes, that is how it works which is in a sense useless. As far as I know all pumps give a basal every 3 minutes. So whatever one's basal rates are per hour it divides by 20 and gives that every 3 minutes.

What the Animas does is exactly as you described and gives it with the 3 minute incrememts. I'm sure a combo/extended/dual-wave on the MM and Cozmo would act in the same way.

The biggest feature I like with the Cozmo is that you tell it how long to give a bolus over and it does that evenly. That is really beneficial because then it's given over a period of time evenly and not all at once. You can set how long you want it to be set. The MM is set at just slow at I believe (without pulling out my manuals) at 1 or 1.5 units per minute.

[kgm0612]

Congratulations on getting your cholesterol levels down. I'm sorry you couldn't do the same with your A1c. Hopefully it will be lower the next time!

Karen

[Huckleberry]

Kevin,

When I first replied I just assumed the 2020 would give that bolus evenly over six minutes. Thanks, Kevin, for doing the research.

Would it help to give your bolus over 30 mins., and maybe a little earlier before you eat? That would certainly give you a much smaller increment each time.

[JediSkipdogg]

Would it help to give your bolus over 30 mins., and maybe a little earlier before you eat? That would certainly give you a much smaller increment each time.

I've been doing that but the problem is there I go high faster and have to wait 30 minutes for the insulin to catch up since I do that maybe 5 minutes before I eat. I've tried doing it earlier and I just simply go low. That does work though for the most part besides sending me higher than normal to begin with.

[Funnygrl]

Can you try changing your infusion set more often, or maybe a different kind? Are you rotating as much as possible- arms, butt, thighs, arms, etc?

[Michael R Zeigl]

[FONT="Fixedsys"]What the Animas does is exactly as you described and gives it with the 3 minute incrememts. I'm sure a combo/extended/dual-wave on the MM and Cozmo would act in the same way.

Actually, MM uses a constant .05 delivery stroke, and varies the time between to calculate an extended or 'square' bolus. If I want to give 5 units over 30 minutes it uses 20 strokes per unit X 5 = 100 strokes. Every .3 minutes it will give a .05 delivery. If I want to give 5 units over an hour, it will give .05 units every .6 minutes. I agree that when doing a normal bolus, it has one speed, which is slow. It takes time for an extremely resistant type 2 using large amounts of insulin to give a meal bolus. For most type 1's this is not an issue.