Replies to This Discussion

Permalink Reply by Brian (bsc) on September 18, 2012 at 10:16am

While I agree with Melitta that early aggressive insulin management is important, I don't feel that the moving to the pump immediately is necessarily good. I think the primary reason that your pancreas burns out is glucotoxicity and that occurs when blood sugars are over 140 mg/dl. If you can maintain tight control with meds and MDI, then you should do fine. I'm in no hurry for a pump. It is more complicated, more expensive and it builds up scar tissue faster. But if your blood sugar is well controlled (< 140 mg/dl all the time) then I don't think there is a compelling reason to move quickly to a pump. Just my opinion.

ps. And a pump despite it's precision and accuracy, still cannot compensate when your own insulin production surges and wanes.

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Permalink Reply by Melitta on September 18, 2012 at 1:01pm

Hi Brian and Shawnmarie: In people with autoimmune diabetes, the primary reason for beta cell loss is the immune-mediated destruction of the beta cells. A lot of people talk about the glucotoxicity that occurs when blood glucose is over 140 mg/dl, but I believe that all of the studies that look at that phenomenon were done on people with Type 2 diabetes (i.e., no immune-mediated beta cell destruction). I agree with Brian that insulin pumps are complicated, cause scar tissue (and really attractive fat pods, too!), and expensive, but again, the researchers who have achieved the best results in prolonging the honeymoon have done it via intensive insulin therapy using a pump.

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Permalink Reply by Shawnmarie on September 18, 2012 at 2:06pm

The idea of "fat pods" definitely does not make me want to sign up too soon for a pump!

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Permalink Reply by Melitta on September 18, 2012 at 2:21pm

Within one month of going on my first pump, I met John Walsh (author of "Pumping Insulin") in person at an International Diabetic Athletes Association meeting. At the time, I had so little body fat it was hard to find a place to insert the cannula. John took one look at me and informed me I would end up with fat pods at the insertion sites. I have viewed it as the price I had to pay, and I don't know if it happens to everyone (they may not be visible on those with more fat). So I completely get "not wanting to sign up too soon" but I would say it has been totally worth it to me to be on the pump. BTW, John Walsh also gave me some great advice and basically solved a basal rate pump problem I was having--the man is a genius when it comes to pumps!

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Permalink Reply by HPNpilot on September 18, 2012 at 2:15pm

Fat deposits (lipohypertrophy) at insulin injection sites can occur with MDI or with a pump. A good rotation schedule in either case can reduce the chances. It's one of the reasons that the infusion site is recommended to be changed at least every 3 days.

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Permalink Reply by dandmanz on December 3, 2012 at 3:29am

I'm 6 weeks into being a type 1, my doses have been reduced nearly every week, humalog is now at 4 units in morning and lunch and 5 units at dinner, lantus has increased from 12 units to 16 units. I'm basically eating what i want within reason which is great. no idea how long this honeymoon will last but I'm making the most of it. going for my 1st endo visit in a week so will hopefully have a better understanding of whats going on

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Permalink Reply by jims on January 21, 2013 at 1:27pm

Strictly from outside, I would say your pancras is doing a great job kicking but and only requires a small boost.

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Permalink Reply by Tabacblond on March 20, 2013 at 6:06am

How did you come up with your ratios? Mine are still off since November 2012, my DX. I've counted TDD with 10 sums and it seems to be 1:21, but that according to 500 rule. Since I am honeymooning this is not an exact. I need to count TGA as well because protein and fat set me off. I don't get this. So frustrating.
Mine dosages are 4 at night Humulin NhP, 4 nhp +4 novorapid morning, 3-4 lunch and 4 novorapid at dinner. This what I came up with myself. Hospital sent me home with 12 8 8 8 based on the food they've served :-(. Next day I had many lows.

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Permalink Reply by Spock on March 20, 2013 at 6:31am

After 50 years, my total basal per day on the pump is7.95 and my IC ratio is 1/18. I average about 10-12 total units per day. Not much, but I maintain A1Cs of 5.1. Every body is different. When I was diagnosed, I took well over 100 units per day....different insulin and regimens. But stability and diabetes are not two words that go together in my experience.

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Permalink Reply by Prince on April 29, 2013 at 6:11pm

Well when I was diagnosed (back in January of 2012) I wasn't even on insulin for the first five months...until I got a C-Peptide and a GAD antibodies test. Basically, within that time frame (or sooner) my pancreas was completely dead (no insulin no nothin). I was total T1 in a very short period. So my doctor put me on 15 units of Lantus per night and started me on a bolus regimen (I use pens so I just adjust my whole I:C ratio according to meals)...
Recently, I went down on my Basal (11 units now)due to my being very insulin sensitive and dropping too low in the night. Again, I'm not honey mooning at all.
So I guess it depends on the person and how you react to insulin. I'm a physically smaller fellow (I'm around 5'6 and 128 pounds) so injected insulin goes through me really fast.

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