Replies to This Discussion

Permalink Reply by nel on May 26, 2009 at 9:35am

probably cannot totally relate , however I think as pump users we all go/went through simelar events. We are also awere, that stress works counter productive in keeping our BG's in check .This is where my pump nurse came in and she suggested to put on the calender the day I wanted to unplug ( 2 weeks from my upset day ) ; almost 9 years later now and I still pump : I use Novorapid as well . I have read that some use Apidra ; it is recently available in Canada .
I still use needles , when I am high ...just comes down faster. I was told, that it is better to use several needles with smaller amounts of insulin , rather than one needle with say 50 units .I have gone without a meal , due to high BG"s and wanted to bring them down before I ate ( bolussed ) ...Have you done fasting tests with the help of your manager in order to set basal rates ? Do you have the book : Pumping Insulin by John Walsh ??
Hang in there, off for my morning walk !!

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Permalink Reply by Anthony Holko on May 26, 2009 at 10:35am

Dear cathy.

I hope I am not usurping my rights as a so called type 2 but I can really relate to your problem as most type 1s cannot. My belief is that diabetes should be classified not by the old inadequate system but by how dead your pancreas is and how insulin resistant you are. You not only have a dead pancreas as the type 1s do but also a bad case of insulin resistance. This is the nightmare case in diabetes

What to do about insulin resistance?

1) I have found and many if not all types of diabetics agree that EXERCISE helps insulin resistance. Also there was an interesting article refered to in diabetes self management web site that said German reseachers found that people that take 1000 mg of vitamin C and 400 units vitamin E these are anti-oxidant vitamins that you would think would be wondeful, NOT SO. Taking the vitamins undid completely the beneficial effect of exercise on insulin resistance.

We do not know what causes insulin resistance but some people suspect infection with some agent and possibly the free radicals that are mopped up by the vitamins are needed by the body. This is of course speculation and the preliminary results may be overturned in a more extensive study but for the moment we should heed it. Since it is summer and there are natural fruits and veggies you can safely eat I would forgo vitamins for now.

How much exercise? As much as your body will stand without falling appart. do like Nel Peach train for 1/2 marathon or something more modest.

2) since you need 2 units of insulin to cover 1 gram of carbs. this is an absurd amount and you are caught in the insulin carb death spiral. Injecting more and more insulin will kill you. You have to go on a NO CARB DIET ASAP. and maintain this till you straighten your situation out.

3) Medications? There are very few out there that help insulin resistance. Metformin does miracles for some diabetics. Adding it to an insulin regime is certainly possible. some people have gastro issues with it. I don't but taking it makes me go comatose after 3 weeks probably poisoning the liver. But otherwise it is all right does reduce the need for insulin which is a must in your case.

The great Dr. B prescribed avandia for Richard on this web site to combat his insulin resistance. He is a type 1 that developped resitance some time back. I took avandia without insulin many years back and it did dink all except damage my pocket book give the illusion to my doctor that he was helping me. But with insulin I could be good. I was thinking of trying again, I think there are issues with heart attacks but in a desperate situation such a risk may be justified.

4) a hypocaloric diet. this I found to be a real winner. Just eat a hundred calories or more, less than you expend in the day. this slight starvation does marvels with the resistance.


That is all that is factual. Now for some wild speculation. I wonder if a pump is worst than MDI for a diabetic with insulin resistance. Heresy again? Possibly. but go to Wiki and read insulin oscillations this is food for thought. with a steady dose of insulin us the resistant saturated our receptors. Makes you wonder why this is not and issue for type !'s without insulin resistance but then again they do use small amounts of insulin than we need to control our BG.

My heart bleeds for you and I wish I could offer some simple solution. Best of luck.

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Permalink Reply by Anthony Holko on May 26, 2009 at 1:38pm

Dear Cathy.

Let me know what is your total daily dose of insulin divided by you body weight in pounds? what was your TDD/ body weight when you were on injections?

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Permalink Reply by Cathy on May 26, 2009 at 2:35pm

Before the pump on was on a sliding scale.

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Permalink Reply by Anthony Holko on May 26, 2009 at 2:55pm

That does not matter how much insulin did you use per day then and how much do you use now? find out from the pruchases if you do not have a log. Does not have to be perfectly accurate.

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Permalink Reply by Unicornzzz on May 26, 2009 at 10:55am

I can relate I had a problem like yours. I would start with a call to the doctor to let them know what type of problems you are having. They may be able to offer suggestions. Have you seen the doctor since you have been placed on the pump? Since you did not have good results on the Novolog pre-pump the doctor may need to change the type of insulin. You should be using less insulin on the pump than you did before the pump.

Have you tried disconnecting from the pump and just doing a injection to see if it is possibly the infusion set or the pump? Have your tried other infusion sets in the past. If not call the pump company and let them know about your problems. Have them send you samples of other infusion sets.

My problem was that I had worn my cell phone to close to my pump and it messed up my pump. I had to have my pump replaced and now it works beautifully.

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Permalink Reply by Sarah on May 26, 2009 at 11:38am

I'd suggest trying a different insulin in your pump - you might have better results with either Humalog or Apidra, and it's hard to say for sure since it's really different for everyone. If you are very insulin resistant, it also may just be that you haven't found out the basal rates and I:C ratio that is right right for you.. sometimes that process can take a few months, just 3 weeks into it may be too soon to expect "perfect" results - there are some people who have been pumping for much longer that still find it to be a BIG challenge. Don't get too caught up in "how much" insulin you need to keep your #'s where you want to.

Secondly, I know Dave suggest it may be an infusion set issue - and I would tend to agree. You may find over time that there are some sets that just don't work well for you, for me any straight-in set is bound to give me trouble, and it only took me a couple of months to decide that even though they were easier to insert, I just couldn't use them. I used mostly angled sets when I was pumping - they were MUCH less prone to having issues. Some people find the exact opposite to be true. Some people find that the shorter cannulas are better (even if you aren't thin, it doesn't matter, as the actual thickness of your skin doesn't vary with weight) and others find that the longer ones are better. The good thing is that there are tons of options, so you can keep trying different ones until you find one that works with your body.

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Permalink Reply by Gordon Paul Jones on May 26, 2009 at 12:30pm

Cathy,

I' m sorry to hear you're having so much trouble, but hang in there.

My first thought was a bad vial of Novolog. Have you tried a different one?

At first, things were crazy for me too. My endo had me testing eight to ten times a day, including midnight and 3am. With my Minimed 522, I can upload all of my pump data to a website where my endo can read reports that don't even make sense to me. At first he was calling me with minor adjustments every few days.. I'm on three or four different basal rates right now. Things have gotten much better but he still checks my stats every other week and has someone call me with small adjustments and behavioral suggestions, i.e how long after bolusing to wait to eat.

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Permalink Reply by Karen on May 26, 2009 at 12:45pm

Maybe Novolog is not the right insulin for you. There are other fast acting insulins, and hopefully you can find one that will work for you. I would ask the doc for a new rx since you said the Novolog provided no results when you were injecting it. I'd try different insulins before I 'blamed' the infusion set itself. I'd also suggest maybe finding some other site areas, there could just be absorption issues. I hope you find a resolution and can get your bg's down. Those numbers need attention!

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Permalink Reply by Karen on May 26, 2009 at 2:06pm

Um, ok. But since the OP said "I use novolog an have been injecting it previously with no results either. ", I just think it's entirely POSSIBLE and perhaps even LIKELY that she might not do well on Novolog. I'd try another insulin, and I'd try it by needle or pen.

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Permalink Reply by Justin Berry on May 26, 2009 at 6:33pm

I have to go with Karen on this one Dave. It sounds like Novolog just isn't right for her. I use Humalog and have been doing great so I have no reason to change. It is entirely possible that she has had a few kinked cannulas. But she said that she's been on the pump for 3 weeks now. I doubt that every set has gotten kinked. Possible, absolutely. Likely, not really. I'd change insulins first and try them out with a needle or pen.

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Permalink Reply by Sarah on May 26, 2009 at 8:01pm

I don't know about that.. the last batch of quicksets I used while pumping, ever darn one kinked on me within 36 hours.. I was using both the 9mm and 6mm, and had the same problem with both, didn't matter where on my body I put them. It's what solidified my decision that they just wouldn't work for me.

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