[shiftzor]

Well I went in there with a quest for apidra and a pump. I left with nothing, they gave me lots of information I already knew and we discussed lots of things. Due to my low (9units) TDD they have referred me to the chief and are unsure if I am even a type 1. I have already had the debate with my friends that "type 2" is better somehow, I swiftly corrected them. I can say that at my endo cares, she even worked out my correction factor for me, at least someone gives a sh*t in this world. I don't really know what to make of it, I had another blood test they are checking usual + other stuff to discover my type (c-petite etc). I have dropped from 66kg to 62kg which they are also worried about, doesn't bother me as I know I have been eating less/stress from exams/lack of exercise less muscle mass. I would love to say honey mooning but they seem to believe it can't be because I have had the big D for 2 years. I am tempted to override them on the apidra by going to my doctor who will change me over or wait to see the chief. Pumping looks unlikely as I don’t fit their criteria which they were also worried about, bless their cotton socks. I can’t decide if I should work out 3 times a week or 2 times a week. Does anyone have any answers? Other than 42

[BlueSky]

Originally Posted by shiftzor

... I can’t decide if I should work out 3 times a week or 2 times a week. Does anyone have any answers? Other than 42

I find that, if I am working out, I need to do it at least every second day. Otherwise, changes in insulin sensitivity become disruptive. But you may have a completely different experience. Try it out and see what works best for you.

[Subby]

I don't have any concrete answers like 42, but you seem to be in one of those half-way places with your diabetes that I think tend to occur time to time. Wanting to be progressive with your diabetes yet finding caution/resistance/inaction from the medical fraternity can be so frustrating.... and by this I am not blaming them, rather its a state of mind thing that I think can occur even if all parties are being reasonable (or of course if there is a discrepancy or problem, as well). The docs may be right to question your T1 status. I gotta say, T2 may be no picnic either , but to have such low insulins reqs (whether you are T1, T2, or Terminator3) aint all THAT bad a thing! I am quite jealous. I'd love to drop mine from 100 to even say 80, and I'm not particularly overweight or unfit. Anyway as to what you "are", a bit of waiting with what they come up with diagnosis wise? Again, not much fun, but if NOT a T1 it's hardly a cause for unhappiness, true?

About the Apidra... what's your reasoning to push onto it? I might have missed a thread or two about it, you can point me that way. You may be being perfectly proactive to want to get onto it. I know I was very keen until I resolved big absorption issues another way, now it's a little more background for me than before. Be interested to hear your situation.

I'd like to hear more on the actual arguments as to why you should pump or not! I am one of those people who like to really hunt down a reasonable take on things, very practical arguments when it comes to diabetes... rather than take this or that line (ie that pumps are automatically suitable)... feel free to unpack it here.

[shiftzor]

Apidra has a faster peak and is out of your system faster. The point of this is because i like my 100g+ of carbs which I find myself still high at the 2 hour/2.5hour mark. Hopefully the peaking early will solve this, I have spoken to others who say it does make a difference and I am all for trying it. My endo was going on about absorption rates it’s just unfortunate I can’t go for a run before every meal

My Reasoning for a pump:

Meal flexibility – smaller unit increments and increase different portion sizes of meals
Corrections – mistakes with my tdd/carb counts are usually difficult to fight off
Reduce hypos – reduce the yoyo effect of high->low->high
Better meet my basal needs i.e. morning Dawn phenomena
Adapt faster to insulin changes – i.e. stress
Improve my control during sport, i.e. less hypos
Lower insulin doses – I think the lower the better personally
I am willing to put in the work required and I test frequently enough
Lantus doesn’t always last me the full 24hours especially at low doses
No more Lantus – difficult to prove if it really effects my mood or not (feels better on a low dose)
Require a reduced basal rate in the afternoon

Meh the type issue don't bother too much, type1/1.5/2 etc I am still going to be on insulin nothing is going to change. Just going to keep fighting on and see how things go.

[SueM]

This page is interesting go to the bottom of the page and read the new guidelines the appeal does not apply to you
Diabetes - insulin pump therapy if you have lots of hypos then you can have a pump

[Subby]

Well, you sound like you have great reasons and have thought it through very well, for both Apidra and more specifically the pump. As a pumper I can also vouch that the majority of your points are most likely to be borne out - not that you need more validation from us, just the doctors.

I don't have the time right now to go through the page SueM posted about. But if it does quote hypos and an issue, and you have a lowered basal requirement in the arvo... maybe this particular problem can be used to your advantage.

I know that I had a similar problem with Lantus. I would be basically OK from 7am to 12am, then go high, then hypo massively from 3 - 6pm. The way I would deal with it was to test test test to try and get to hypos before they were severe, then often drink between 1 and 2 litres of juice per day to deal with the lowered basal reqs. Since I micro managed with these kind of techniques, on paper it looked like there was not such a problem. The energy I poured into maintaining my BG on MDI was extreme.

I suspect you might be in a similar boat, you put in lots of effort to manage where others just doing the absolute baseline therapy, would just be at the mercy of worse control, and for their doctors the issues are clearer.

Perhaps you can approach the doctors with the idea of a "protocol test", that cuts out a lot of your "compensatory" control, so they can really assess how much MDI is failing you currently. I know that's not automatically a practical or easy or even particularly safe suggestion, but it may be an avenue worth exploring.

I was lucky that they were happy for me to pump, but cutting out my micro-management (ie, 12+ daily tests, alternating daily between needing excessive carbs/needing to virtually fast, skipping meals, 1 to 3 hour pre-bolusing on a case by case basis, etc etc) and really revealing how base line MDI was failing me, was going to be my next approach if they quoted HBA1Cs and "how well I coped" as reasons for not getting the pump.

This is just the train of thought that comes to me, apologies if it's not much use to you.

[jacobsam622]

Originally Posted by shiftzor

Well I went in there with a quest for apidra and a pump. I left with nothing, they gave me lots of information I already knew and we discussed lots of things. Due to my low (9units) TDD they have referred me to the chief and are unsure if I am even a type 1. I have already had the debate with my friends that "type 2" is better somehow, I swiftly corrected them. I can say that at my endo cares, she even worked out my correction factor for me, at least someone gives a sh*t in this world. I don't really know what to make of it, I had another blood test they are checking usual + other stuff to discover my type (c-petite etc). I have dropped from 66kg to 62kg which they are also worried about, doesn't bother me as I know I have been eating less/stress from exams/lack of exercise less muscle mass. I would love to say honey mooning but they seem to believe it can't be because I have had the big D for 2 years. I am tempted to override them on the apidra by going to my doctor who will change me over or wait to see the chief. Pumping looks unlikely as I don’t fit their criteria which they were also worried about, bless their cotton socks. I can’t decide if I should work out 3 times a week or 2 times a week. Does anyone have any answers? Other than 42

Yeah it sounds like you might be a type 2 you know the more undesirable type I want to see you try and set me straight.