Jump to content
Diabetes forums
  • Welcome To Diabetes Forums!

    Registration is fast, simple and absolutely free so please, join our community today to contribute and support the site.

Archived

This topic is now archived and is closed to further replies.

luckharm

My doctor wants me to go on a pump because of repeated BS lows of 60 or less!!!!

Recommended Posts

luckharm

I have been on insulin (Humalog and Lantus) for 4 years.  My endocrinologist is very concerned about the lows that I have about once per week (they are usually in the 50s).  He says the lows are worse than the highs and he now wants me to go on the pump and BS monitor to help control this.  I looked into this and personally, I do not want to do this.  This means two devices attached to my skin at all times.  The whole idea repulses me and I want to stay on the insulin pens.  I am afraid of my next appointment because he will push me to do it since I still get lows.  My A1C hovers around 7.0 and I have never passed out because of lows.  I do get the shakes and I always carry sugar pills which do the trick if I am experiencing a low.  Has anyone else been through a similar situation?  What did you do?

Share this post


Link to post
Share on other sites
jwags

If your HbA1 c is 7 with frequent lows, I would imagine you have lots of highs too. Is there a way you can tweak your diet so you use less insulin to eliminate the lows.

Share this post


Link to post
Share on other sites
GretchO

Do you know what's causing the lows (i.e., too much basal, mismatch between bolus insulin and carbs consumed, absorption rate issues)?

 

I didn't want to go on a pump but you couldn't pry it from my cold dead hands now. For me, it's infinitely more flexible. As far as CGMS + pump goes, you can use the CGMS to get all your pump settings in order (it's very helpful with basal testing) and then just use it when you need it.

Share this post


Link to post
Share on other sites
luckharm

Sometimes the lows happen for no reason.  Two nights ago, I was 149 at bed time and I woke up at 2:00AM at 47.  The next night I was at 159 at bed time and woke up in the morning at 226.  Does not make any sense. Sometimes, I can explain the lows.  I like to go on long walks ( 5 miles or longer).  If I am close to 100 at the start of the walk, I can hit a low in the middle.  I do try to compensate by making sure my BS is at 150 or above before I head out and of course,  I always carry my sugar pills with me.

 

Gretchen,  since you are on the pump now and love it, let me ask you a few questions.  

 

What do you do with it when you sleep?

How about swimming in a pool?

If I wear a dress, how do I carry it?

Can I use the insulin in my Humalog pens or do I have to get new vials of insulin?

 

Anything else you can share to help me make my decision would be helpful.  Thank you so much.

Share this post


Link to post
Share on other sites
pat593

I have similar issues and tried the CGM for a week.  Amazing.  I too do not want to go on a pump and was worried about the CMG.

 

Try it for a week before making any decisions about a pump.  I was able to watch in real time what was happening and adjust my insulin appropriately.

 

The most amazing feature for me was to watch the arrow trend up - down - or stable. 

 

I only used it for a week but after the 1 week trial, I feel lost without it.  A very different pattern emerges when looking at over 250 readings a day versus 8 or 10 finger sticks.  And the DEXCOM has a wonderful software program that you can plug your remote into and get pages of reports.  I'll try to attach one below.

 

My biggest fear with trying a CGM was having something attached to me.  The device gets stapled in and does pinch a bit at first.  By the end of the first day, I completely forgot the device was attached to my body and I showered and swam as usual.  I kept the remote in my cell phone case and kept it close.

 

For me, I had no idea my bs had so many highs at night or that too much protein caused a delayed spike.

 

I urge you to try the continuous blood glucose monitor first.

CGM Sept Trial.doc

 

 

 

 

Share this post


Link to post
Share on other sites
GretchO

What do you do with it when you sleep?

How about swimming in a pool?

If I wear a dress, how do I carry it?

Can I use the insulin in my Humalog pens or do I have to get new vials of insulin?

 

Anything else you can share to help me make my decision would be helpful.  Thank you so much.

 

I clip it to my PJ bottoms, I flip flop a lot but I've never felt it. At least it doesn't bother me enough to wake me up. You can also let it float free...lay it on the bed beside you and flop around all you want. If you wear PJs with pockets you can probably stick it in a pocket.

 

I detach it when I go swimming, though I've forgotten and gone swimming with it on. You can detach for up to an hour, but should try to compensate for the basal you didn't get while it was off. I'm pretty active when I'm swimming, though, so the activity compensates for the lack of basal. When you detach for a shower you don't need to do anything unless you take really, really long showers. For showers I just detach, I don't suspend it.

 

I stick mine in my bra if I wear a dress. I don't wear dresses that often. When I wear a skirt or pants I clip it to my waistband. I don't care if other people can see it. I've worn it like that for 7+ years and I've had two people comment on it. Both were Type 1s. One said "I have that same pump." The other said "I have an Omnipod and I love it."

 

I've never used a pen so don't know how you can get the insulin out of the pen cartridge. I've always used vials. I imagine you can take the insulin out of the cartridge with a syringe and inject it into the pump reservoir, but I'm not certain about that. I'm sure someone here has done it before and can explain.

 

Pumps are definitely a lot of work...you need to get your basal rates set, and the best way of doing that is by basal testing. CGMS, if it works well for you, is really helpful for this. Once you have your basal rates set you can focus on I:C ratios and your insulin sensitivity. Most of this should already be worked out for you if you're doing MDI. Adjustments will have to be made if you go on a pump, but there are ways of figuring out how to make the changes and a good CDE should be able to help you get started.

Share this post


Link to post
Share on other sites
rubidoux

One low per week in the 50's and your endo is concerned??? I think that would be a very good week for most t1's on pump or MDI. I think when I'm at the top of my game I have lows less than that, but that's only bc I eat a tiny amount of carb and have a total daily dose of 10-12 units. If I was eating carbs and using a more substantial amount of insulin I'd probably have at least 3 or 4 lows per week.

Share this post


Link to post
Share on other sites
GretchO

One low per week in the 50's and your endo is concerned??? I think that would be a very good week for most t1's on pump or MDI. I think when I'm at the top of my game I have lows less than that, but that's only bc I eat a tiny amount of carb and have a total daily dose of 10-12 units. If I was eating carbs and using a more substantial amount of insulin I'd probably have at least 3 or 4 lows per week.

 

Agree....

Share this post


Link to post
Share on other sites
GrammaBear

My CDE is happy if I have less than 3 lows a week.  I was also concerned about starting the pump, but I really like it now.  I have the Medtronic Revel 723 and the Dexcom Gen4 system.  Medicare and insurance paid for the pump, however Medicare does not pay for the Dexcom - so that is "out of pocket" expense for me.  btw......Dexcom doesn't have a remote.  It has a transmitter which fits into a little plastic device that holds the sensor wire (which is very, very small).  That transmitter sends signals every 5 minutes 24 x 7 to a 'receiver' which you carry on your person.

Share this post


Link to post
Share on other sites
mom24grlz

Sometimes the lows happen for no reason.  Two nights ago, I was 149 at bed time and I woke up at 2:00AM at 47.  The next night I was at 159 at bed time and woke up in the morning at 226.  Does not make any sense. Sometimes, I can explain the lows.  I like to go on long walks ( 5 miles or longer).  If I am close to 100 at the start of the walk, I can hit a low in the middle.  I do try to compensate by making sure my BS is at 150 or above before I head out and of course,  I always carry my sugar pills with me.

 

Gretchen,  since you are on the pump now and love it, let me ask you a few questions.  

 

What do you do with it when you sleep?

How about swimming in a pool?

If I wear a dress, how do I carry it?

Can I use the insulin in my Humalog pens or do I have to get new vials of insulin?

 

Anything else you can share to help me make my decision would be helpful.  Thank you so much.

Ashleigh also loves her pump and would never voluntarily go back to injections.  So i'll answer your questions also. Ashleigh wears an animas ping, which does have tubing.

 

-Ashleigh just lays her pump beside her on the bed when she sleeps

-We disconnect when she swims or takes  a shower. Water causes her to go low, so we don't have any issues of going high from missed basals.

-When wearing a dress Ashleigh either puts the pump in her bra or she has a pump pouch that goes on her upper thigh.

-Yes you can use your humalog pens to fill up a pump cartridge. Just remember to not push air into the pen like you would do with a vial of insulin. We use novolog but have filled up a pump cartridge with both pens and vials of insulin. 

Share this post


Link to post
Share on other sites
mom24grlz

oh and i would be happy if Ashleigh only had 1 low a week!  Last week we had 2 lows, which is actually pretty good (a 50 and a 45). 

Share this post


Link to post
Share on other sites
Uff Da

Is there some health problem you have that would make hypoglycemic episodes more dangerous for you than for the average diabetic?  A heart condition, I understand, makes hypos particularly dangerous, but there may well be other conditions that warrant unusual vigilance.  If you don't have some such condition, I think your doctor is being unusually cautious.

 

My own PCP is among the unusually cautious ones, also.  She nearly freaked out when my BG was 59 at my May blood test.  I pretty much ignore her on diabetes related things, though, as my endo now handles my diabetes again and he'd seen my printout of BG test just a few days earlier with several lows a week highlighted in yellow so they were obvious, yet he didn't say a word about it.  There was a period where I was having lows almost every day this summer.  I reached the conclusion that it was primarily the variability of the impact of exercise (yard work) from day to day that was causing my calculations to often be off.  I ended up reducing my basal by just one unit a day as well as making a concerted effort to run my numbers just a little higher to get my hypo awareness back to a better level.  The result is that I've had only eight lows since September 1, six of which were in the 60s, the other two in the 50s.  Yet my A1c yesterday still came in at 5.9, so I'm not complaining.

 

I wouldn't want to go to pumping, either.  If after getting your questions answered you still feel that way, it may be that you can analyze your situation to see if you can't fine-tune your diabetes management routine.  Maybe do some more basal and bolus tests to make sure your doses are still right on.  Possibly some more tests to better define how much certain exercise or foods affect your BG.  Maybe try to eat a more consistent carb level from day to day or meal to meal, so dosing might be easier.  Or analyze your records to see if there might be something else affecting your BG.  But if your endo expects a type 1 to be able to maintain an A1c of less than 7.0 without having any mild hypos, I think he is dreaming.

Share this post


Link to post
Share on other sites
luckharm

Thank you all for all of your helpful advice.  To answer Uff Da's question, the only other condition that I have, that would make hypoglycemic episodes more dangerous is age!  When I asked my endo about his concern for the lows and why they were so "bad" he said that there have been recent studies that for someone my age (64) the lows can lead to mental problems  such as dementia and forgetfulness.  Thank God, I have not experienced any of those symptoms yet.  I think for now, I am going to try and hold off on the continuous BGM and pump combination and try to better control my lows with a stricter regimen.  I am comforted by the fact that my body tells me when I am below 60 by very specific and distinct symptoms, so I can compensate right away.

 

​Living with diabetes is not easy, but at least it's a disease that can be controlled.  Whenever I get a little depressed about my condition, I think about people with MS or ALS or cancer who might not have a treatment option.  Thanks again for all the good suggestions.

Share this post


Link to post
Share on other sites
Uff Da

I wonder what studies your doctor was referring to.  I've done a fair amount of searching online for information using search term combinations like "research hypoglycemia danger" specifically because my PCP almost freaked out about my having a BG of 59 the day of my blood test. But I have yet to find anything that convinces me that mild hypos present a serious problem except possibly triggering a heart event for someone with a heart defect of some kind.  There does appear to be evidence that serious hypos, those which land one in the ER or at least require the assistance of others outside the hospital setting, can be damaging.  But it seems to me one shouldn't jump to the conclusion that mild hypos cause the same problems as those that land one in the hospital. 

 

Here is a link to the article "Association Between Hypoglycemia and Dementia in a Biracial Cohort of Older Adults With Diabetes Mellitus" which appeared in JAMA last year.  Again, though, they only studied severe hypoglycemia.

 

http://archinte.jamanetwork.com/article.aspx?articleID=1696172&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=ArchivesofInternalMedicine%3AOnlineFirst06%2F10%2F2013

 

One of the things I intend to ask my endo at my appointment next week is if he knows of any research indicating dangers of repeated mild hypos in addition to hypo unawareness. I'm not willing to pay $50 or $60 dollars for some of the research articles, and only access the free ones online.  But he may have access to information I don't.

Share this post


Link to post
Share on other sites
aggie168

Sometimes, I can explain the lows.  I like to go on long walks ( 5 miles or longer).  If I am close to 100 at the start of the walk, I can hit a low in the middle.  I do try to compensate by making sure my BS is at 150 or above before I head out and of course,  I always carry my sugar pills with me.

You already heard various good reasons above. Using a pump means a lot of hard work. You can find 50 yes reasons why you should and 50 why you should not. Bases off you above statement, I will explain one in the following way...

 

I am about to go on a "5 miles or longer" walk. I just checked my BG and it is "close to 100". I will lower my basal setting on my pump by setting a temporary basal of 50% for the next 4 hours. I know this will compensate for my body's extra insulin sensitivity due to the walk. That way, I am less likely to go low during and after my walk. I checked my BG halfway through the walk and I am at 105. That looks good. I checked my BG immediately afterward, it is 110. That is good, I do not need to eat any of those chalky sugar pill to bring my BG up. Yippee, I do not have to ingest another 30 calories from the sugar pill that will add to my total daily food intake and just end up as extra pounds around my belly.

 

Note, the above paragraph is fictional .... :)

Share this post


Link to post
Share on other sites
Uff Da

Just to show how different doctors interpret some of the same issues, I had a talk with my endo about hypos today.  I asked if there was any known consequence of mild hypos and he said no, the issue was with serious hypos.  He wasn't at all concerned about the number of hypos I'd been having.  Of course he was happy that I'd solved the problem to the point that I reduced my hypos to only eight during the month of September with none lower than 52, but he viewed the much larger number I'd had previously as nothing out of the ordinary for a type 1, even though I'd had a few lows even into the 30s over the summer.  My last A1c was 5.9, and he did say he'd probably be more comfortable if it were a little higher, as long as it stayed below 6.5.  He thought my control was stable enough that he thought seeing me every six months would be fine.  So it is definitely a case of a different doctor, a different opinion.

 

By the way, I'm age 73.

Share this post


Link to post
Share on other sites
luckharm

Uff Da,  Thank you so much for your report.  It does make me feel a lot better about my lows.  My endo can have his opinions, but in the end, I have to make the final decision on what is best for me.  I am going hold off on the pump for now.  By the way, I have been super careful and have not had a BS reading below 70 for over 2 weeks now!  Yeah!

Share this post


Link to post
Share on other sites

×

Important Information

By using this site, you agree to our Terms of Use.