Never asked for help before, but I finally realized I could use it. Just joined up. Here goes:

Have always had a problem getting A1C below 8.4 Last A1C was 9.2 in November.
Diagnosed 15 years ago. Started Type 2, then migrated to insulin about 12 years ago.
Been on Minimed pump for 5 years now (moved to Revel 523 last year) using Novolog insulin. Running CGM about 1.5 years. Find that my insulin peak time is hours 2-3 post bolus.
Test myself many times per day (8-12) depending on physical activity, pump readings, etc.
Am physically fit (workout 5-6 times per week cardio running, biking and elliptical) and understand carb counting, proper nutrition including low glycemic carbs and portion control.
See Dr and CDE in NYC regularly, plus work with another CDE remotely who is also a type 1 pumper.

Honestly, besides convenience, being on the pump has not improved my BGs.
Despite my best efforts, vigilance and intense focus on trying to control my diabetes, I still cannot find the right handle on getting consistency in my BG readings to the point where my A1C shows it. So far, being on the pump is like my golf game. Flashes of brilliance, but consistent mediocrity!

Does anybody have insights based on personal experience how to turn this around. It am frustrated and not sure where to go from here. Tx

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Replies to This Discussion

BGs are up and down.
Dr (CDE really) makes some tweaks to basals and suggests giving them a try. I always feel like its hit or miss then back to the drawing board for another cycle of the same.

I used to have an A1c of 9.3 but with testing at least 6 times a day and doing all of the things that you are apparently doing, I managed to get my latest A1c down to 5.7. You don't mention whether or not there's been any tweeking of your settings based upon your numbers throughout the day. This is what helped me.

Wow. Congrats on the latest A1C! Lots of tweaking to basals across the day, but still not seeing the desired results.

Could you go into detail on how you tweek your settings? I am trying to get comfortable doing this but not sure how to go about it.

Lori

There are many areas this could touch on Lori, but I was specifically talking about the daily basal rate settings with the 1st priority being the overnight timeframe since its about 1/3 of the day.
Getting the basals right across the board is the first step in good control from what i understand. If you go to bed with you BG in your target range, if your basals are set correctly, you should wake up within 20-30 points of your bedtime BG.
To do this you need to test the basal rates using a replicable process. There is a really good website for this at www.integrateddiabetes.com go to pump users and select basal testing or reach it directly at
http://www.integrateddiabetes.com/p_basaltest.shtml
This was developed by Gary Scheiner a type 1 pump user CDE who wrote Think Like A Pancreas which I find very helpful.
Based on the test results, you can make small changes to your basal settings (tweak) and retest until you achieve the desired results. You can do this with your endo or CDE to start with, then eventually learn how to do it on your own when you are comfortable with this. Once you complete the overnight test, you move on to breakfast, lunch and dinner timeframes.
Keep in mind one test is not really enough, you typically need two or more to rule out variables that may skew the test (eg, not feeling well that day, more stress han usual, etc).

After basals are good, then you would move on to test / tweak insulin:carb ratios and sensitivity settings. Hope this helps - Doug

I've been a diabetic for 21 years, on the pump for 12, and CGM for 3. My 5 year old was diagnosed about 30 days ago. Every once in a while, I find I have to "start over." I start over by first figuring out if my basals are correct by doing 4 to 5 hour fasts and just watching my basal rates. However, I don't rely on the CGM for my basals, I actually check my blood sugar with a finger prick during the fasting. For example, I wake up, don't eat (pending a decent blood sugard when I wake up) and just check my blood sugar every hour until lunch when I do my usual food/bolus. The next day, I may decide to eat breakfast but check my post lunch basal rates by not eating lunch, etc. I make sure to check my basals as long as I have not eaten and have not taken a corrective bolus. If I am checking my nightime basals, I do not eat dinner and set the alarm every hour. Once I am confident that my basal rates, including nightime rates are good, I then start checking my ratios to determine if those are correct. I have found that if I don't fast, I have a hard time making sure my basal rates are correct.

First things first, best of luck with the transition for your little one. On the positive side, he/she has seen you taking care of your diabetes forever so a lot of it will hopefully seem normal. My younger brother was diagnosed with Type 1 at 8 yo over 35 years ago and my parents were clueless, let alone the limited technology that was available to support being diabetic that makes our lives easier (imagine sterilizing needles or peeing on a stick for an ball park BG test).

I think you may be right about pressing the "reset button" on my pump settings. I have done many basal tests over the past several years covering the 24 hour day, but things do change. In fact, I did a basal test yesterday after breakfast. I have been having problems going low 1-2 hours after meals, dinner especially, since I increased the time I have spent working out. I have also been cheating the bolus wizard because my carb ratios seem to be set too low (eg, giving 8 units to cover 45g carb rather than the 10 units the pump calls for,etc.). I set my pump to run 85% of normal basal and tested every hour from 12 noon to 7pm. My BG was really consistent during that time from 97 to 125 while fasting. Only difference is that my CDEs typically want me to eat and wait for the bolus insulin to wear off before basal testing.

Thanks Packers fan.

Super bowl or bust! Little uncomfortable with my defense though..... Good luck with everything!

Well, I just ave 6% , still on MDI-Insulin Pens for quite a few yrs now
Maybe one of these Ideas will help

1. I would depend on these Dr.'s , they just don't have the many Hours to devote and it can take yrs of qtrly appointments to Maybe dial things in

2. Starting with the Basics... Have you got and used the Books?
> THINK LIKE A PANCREASE
> USING INSULIN by John Walsh

3. Basals? I 1st dial what My Basal will Keep my Overnite BG's down first..w/o driving me Hypo over nite. Once I can Figure out How many units to take at Bedtime that will keep my Bedtime BG from going Higher, that is the magic #.. Then I have to have the right Bedtime # and that takes all the way back to My Dinner Bolus to get that..Or Have to take a Correction Bolus if above 100 at bedtime.

4. If I am Above 175 at bedtime.. I not only take a CB, but I also Set my Alarm for 3 hrs to wake up , test and be ready to take another CB..

5. So I would assume, you should be doing the same thing, until you figure out what your overnite Basal should be..
A. Strive for a 100 at bedtime
B. Set alarm for 3-4 hrs and test and be ready to take a CB.
C. After 2-3 Nites , Increase the Basal and just keep doing that until your dialed in for over nite Basal

6. I test B4 meals, but I also Will test 2 and 3 hrs after.. Have to know what your 2 hr BG should be, Not to go Hypo by Hr. #3, but Not to Be too High at Hr #2 to Be too High By Hr #3. My Magic 2 hr # is 120 and by Hr #3 it's btwn 90-110

7. Know your SF ( Sensitifity Factor) to take CB's .. and I have different CB ratios I take for Hours #2 and #3.. ( 3 hrs is my Fasting # too ) Novalog runs pretty much out by Hr #3..for me.So I have a 2 hr CB and a 3 Hr CB.. The 2 hr is alittle Less , since that is stacking on my Bolus I took.., thus alittle less than what my 3 hr / Fasting Is..

8. Little Surprise.. But I have to take even More When taking a CB if I have at or above 200 pts..My SF # is Less, thus I end up having to take an ave of 2 units More than what my 3 hr CB is.. Otherwise? It won't come down..Might as well inject Saline../water

9. IF I DON'T KNOW THE TOT CARBS? I DON'T EAT IT! My I:CR is 1-5, and Every 1 unit treats 15 pts. So , If I am 5 carbs short than what I ate? I'm going to be at least +15pts higher accross the board.. In Most cases? When I guess? I ave 10 carbs short and that's another 50-75 pts on the old BG's

While that may not Be a Big deal, but if you have Been Dilligent and have been having a Good Day ave 100's and then get a Big Fat 150? Can ruin the whole day..
Since It's not just that 1x , 150, it's going to take another 2-3 hrs to take a CB and Get it back down.. And of course, risk Hypo's doing so..

R U Very Active? That's another Problem.. Drives your BG's UP/Down Like Crazy.. Guess what? Until you get things Dialed in for a Normal, Calm, Controled Envirment? Forget the Activities for now.. Those take added Precautions and Prep to do them right..

R U On a Type 2 Meal Plan? Low Carbs? Why not? Best start, you can always Increase the Insulin and carbs Later.. But Higher Carbs Makes the Fats store up and take Longer to Digest.., thus Longer Higher BG's..

Well, those are just my Openers.. Hope you got something out of them..
And if you can't Get 6% A1c's? Give me that Pump, since your Wasting it..

Thanks for the great specific advice Dennis. Much appreciated!! Clearly you have taken a very methodical approach to each aspect of your control to get an A1C of 6. I need to and will do more of this.

You are right about the Drs. I have been through 5 endos that did not get it. They had limited time and kept taking a scatter shot approach to helping me get better control. Changes often made me go hypo and I started to get fearful of taking too much insulin and losing control. Found a better team now.

I did read the Think Like a Pancreas Book by Gary Scheiner a few years back, but should re-read it now since I am much more focused on getting better control. I exercise a lot and despite it being good for you, it does often throws a monkey wrench into my control.

Have been implementing some of the suggestions that you have and they are starting to help stablize / bring down my BGs (eg, focusing on overnite control, eating less carbs (about 30-40g /meal), etc).

Will start doing another round of basal testing (overnight first) next week to confirm settings are accurate.

Keep the suggestions coming. And when I am ready to give up the pump and sensor, you will be the first person I contact.

You must upload your pump readings at least every two weeks and allow your doctor or educator to access your account. He or she can then analyze your readings and then tell you how to modify your basal and bolus infusions to correct the problems you are having. You should also keep a diary of your food intake and send that to your doctor or educator every two weeks to match with your pump readings. Once, you are back under control, you should not have to keep the food diary anymore, but you should still keep uploading your pump readings and have them analyzed every two weeks. This is what I do and I have been very successful in keeping at my target goal for HbA1C.

David is correct! If you have a smart phone, download the App "Glucose Buddy." You can then have your logs emailed to you, print them out and take to your doc/educator. I'm finally getting back on track after the holidays and it shows: BG mostly in the 100s. I note carbs and meal on the notes part of the App, so doc has the information he asked me to keep. I've been T1 35 years; on pump 15 years, but my A1C still hasn't gotten below 6.9. I also workout at gym (Anytime Fitness) and follow a sensible 1200 calorie eating plan. Good luck!!

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