[Subby]

Originally Posted by Eddy

Here's to hoping that you have indeed removed the proverbial gravel from your shoe. Wouldn't it be something if that's all it took? Wow.

Originally Posted by Kendall

Congratulations Subby!!! I am so glad that you seem to have found some answers. I hope it keeps working for you. I know from lots of your previous posts how inconsistent things seem to be for you even with tons of work. Keep us updated on how things keep going.

Thanks guys. I am in a very strange emotional place right now, it's like two huge states superimposed on each other.

One state recognises with a wry shrug how prosaic and boring this discovery (if really true and lasting, and I feel it probably is) really is. I find myself berating myself for bothering to bore my girlfriend's ear with it (she was enthusiastic that I was excited, she understands it has ramifications, but it still it seems pretty dry and uninteresting - even to me). This part of me almost wants to laugh that I bothered to post about this in detail.

The other part is just shellshocked. Floored. My poor insulin response has been the bane of my daily health for so long now. So many endeavours have failed to provide improvement, so many hours, days, months of my life have been spent trying to prevent or deal with the consequences of my hourly fluctuations caused by insulin not working properly. A huge chunk.

It might seem weird, but that unpleasant hourly struggle feels like a part of my very being by now. Now that it might actually be mostly resolved with a little whimper like this actually makes me feel a bit lost and bewildered. I'm not sure if I feel cheated, the gauntlet has been thrown down for so long. I sure got the feeling I'll have a lot more energy and brain space for other things. This is going to have to settle for a bit. And of course it needs further testing before I fully trust it.

Apologies for going on so much, the prosaic part of me is again chastising me for such self indulgence.

I'll post again about the more practical side of this that people might hopefully learn something useful from, rather than my vague ramblings.

[wastcougr]

Subby,

I TOTALLY understand what you're saying! I'm so happy for you that you could experience something like this! I thought I was the only one who was so violently inconsistent with numbers, but I see I'm not alone. And, I had a stellar day these last 24 hours so I can relate to your exuberience! Congrats again, and keep it up (or down as the case may be)!!!!!

[Eddy]

Originally Posted by Subby

Apologies for going on so much, the prosaic part of me is again chastising me for such self indulgence.

None needed. Something like that, though so "small" in one way, is huge. I've followed your posts, wondering how I'd deal with such unpredictability... all the while glad that I've thus far not had to. We're all thrilled for you.

[Subby]

It keeps working so I'm begining to believe it's real And I'm calming down now, it feels like a new dawn for me. I hope others might benefit from looking at this issue. I've tried to search on the web to find any supporting info but no luck. I looked through the material on the Bernstein website but couldn't see a particular reference to trapping or pooling - any ideas where you might have seen that Bluesky? It may be that it's part of Bernstein general take on the IR/absoprtion issues that occur with higher numbers.

It's interesting that the two sites I've used since starting have been far less solid, and without insulin "springing out", when I removed the set. That seems further evidence that some local trauma and physical trapping was occuring for me, that is alleviated by the slow release.

Eddy, you're right about slow delivery being a feature of the pump! But here's where it gets hazy. This is what I've been doing: Dual bolusing, but trying to keep the "instant delivery" portion to below 3u per couple of hours. I don't know if this is avoiding the problem or still causing it, at a lesser level. At this stage I need to rejigger my I:Cs seeing as they were based on the skewed action I was getting before, and get more experience under my belt before I can comment on what my real threshold for instant delivery is.

Sadly you can't control the rate of instant delivery with the MM (I believe on other pumps you can) so I have no way to diagnose whether a release over say a minute or 4 minutes, would alleviate the problems equally well.

[Subby]

So here's the lowdown: if you are seeing some or all of these symptoms:

- getting poor absorption, especially with the onset of a bolus, typically shown by constant postprandial spiking and regular long delays in insulin action
- your insulin needs are on the higher side (ie, typical boluses/corrections upward of 6 or 8u)
- you find you get big lumps under your skin directly from a bolus, insulin tends to spill out of your sites when removing sets,
- (if pumping) you might find that, thinking back, dual or square waves tended to be really successful compared to normal boluses!

Then this is something that might be worth investigating.

On the pump, you can go dual or square for a number of meals to see if things markedly improve. It's important to start with a clean slate and go "all out" with it for a while because I believe once the problem occurs it may create a bottleneck.

On MDI, you can do the same by trying and keep each delivery to a minimum. You could reduce your dose by eating less, but a more convincing test will be eating normally but splitting up your dose into smaller chunks and injecting separately, as Bluesky mentioned. I can't vouch that this will address these issues in the same way a sustained delivery does, but it seems worth a go for diagnosis at least.

Either way remember to look for an improvement in evenness and consistency over the meal period, rather than sudden magic good numbers. If this method does radically alter your insulin response like it did mine, chances are your settings are out and so you might initially be riding high, but the proof will be in the radical decrease of spiking.

[BlueSky]

Subby, it is great that you are getting good results from this. I definitely got the 7 unit injection limit from Bernstein, but it could have been from one of the CDs or teleseminars. Reference to the "pooling effect" may have come from elsewhere. It was somethuing I immediately related to as I have observed it in myself. This is going back some years, though.

When I trialled the Cozmo, I immediately started using the ability to infuse a bolus over 5 minutes. And when I gave the pump back, the improved absorption was one of the features I missed the most. I am surprised the other pumps don't have this feature. Although a 30 minute square wave bolus would achieve a similar effect. You just may have to get into the habit of bolusing a bit earler.

The other thing people on MDI can do to improve absorption is to use longer needles. I have started doing this, and it definitely makes a difference.

[Jan B]

Subby,

I'm so happy for you I'm almost in tears. Well, now I am. Blue Sky has helped me more than he knows, and Bernstein too. I believe only another diabetic can understand how thrilling a revelation like this can be. However, I'm sure your girlfriend is happy that you are happy!

[Eddy]

This thread is useful enough that it probably should get stickied...

[Gary_W]

At the time this thread was very active, I had nothing useful to say so didn't.

Yesterday, I changed a site a day early as I was having no joy getting my BG down. Worst day since going on the pump. I was a little high in the morning. After lunch, I went sky high and pretty much stayed there.

It was the first time I'd used my right arm as a pump site. At the start of yesterday, it started to sting slightly when the insulin went in. Being stupid, I stuck with it. If this happens in future, I'll change the site.

When I finally changed, I took the site off and sure enough I had a little hard raised area of insulin. It's still a little bumpy now a good 24 hours later after I changed it.

Today, I've fought hypos all day. I am wondering if that nice little bundle of correction bolus's (is that the correct plural or is it boli?) has now decided to come and bite me.

I don't have large insulin needs. Most days I'm on around 30u all in, and that covers my basal and 200-250g of carbs.

I'm glad yours is working for you better now, Subby. I'd not really had this before on the pump; I've certainly had some sites working better than others but nothing like this... I feel for you as it isn't nice....

Gary

[MarieD]

Great news Subby!
Since being diagnosed 3 years ago I too have suffered high readings post meals, especially after lunch when I have my highest carb intake. I'm going to follow your example now and see if the split bolus will work for me too. Fingers crossed