Thanksgiving Eve
My mom arrived yesterday for her week long visit! I'm so excited! We've got a long list of things we want to do and tomorrow we'll just be cooking, eating, and watching football. I'll give my little pump quite a workout, I'm sure.
This post will be sort of all over the place, but since I only really post at work, I need to share some things before the long weekend.
First of all, I witnessed the miracle that is blood sugar control with an insulin pump on Monday. Here's what my readings looked like:
7:00 a.m.- 85 mg/dl
11:30 a.m.- 84 mg/dl
5:00 p.m.- 85 mg/dl
7:45 p.m.- 78 mg/dl
9:30 p.m.- 115 mg/dl
There is NO WAY to achieve this kind of control, without hypos, on injections. Even with the pump, these days are few and far between (as verified by my string of low 200s yesterday!) But still, I was so impressed with my pump and encouraged to eat healthfully and low carb as I did this particular day.
Next, I wanted to respond to Scott's question in his comment to yesterday's post. When I first starting pumping, I set my "duration of insulin action" to 3.5 hours. During the first few weeks, I kept running into a situation where I'd test 2 hours post pradial and be high. I'd want to correct, but the pump said not to correct due to "insulin on board." Then, two hours later, I'd still be high. My rationale was that my "duration of insulin action" was set too high. I moved it down to 2.5 hours. When I asked John Walsh about this situation he responded that the problem was due to underbolusing for the meals, not the duration setting. Duh! He also explained that having an accurate setting for your "duration of insulin action" is important when testing basals. Otherwise you might think your basal rate is too high or low, when really those issues are due to bolus insulin. Interesting.
Now my setting for insulin action is 3 hours. A little on the low side, but its working for me. Also, if I'm high and I'm pretty sure I'll need to correct, I can override the pump's suggestion, something I wasn't too comfortable with when first starting the pump.
Finally, on the eve of Thanksgiving, a few things I'm thankful for:
This post will be sort of all over the place, but since I only really post at work, I need to share some things before the long weekend.
First of all, I witnessed the miracle that is blood sugar control with an insulin pump on Monday. Here's what my readings looked like:
7:00 a.m.- 85 mg/dl
11:30 a.m.- 84 mg/dl
5:00 p.m.- 85 mg/dl
7:45 p.m.- 78 mg/dl
9:30 p.m.- 115 mg/dl
There is NO WAY to achieve this kind of control, without hypos, on injections. Even with the pump, these days are few and far between (as verified by my string of low 200s yesterday!) But still, I was so impressed with my pump and encouraged to eat healthfully and low carb as I did this particular day.
Next, I wanted to respond to Scott's question in his comment to yesterday's post. When I first starting pumping, I set my "duration of insulin action" to 3.5 hours. During the first few weeks, I kept running into a situation where I'd test 2 hours post pradial and be high. I'd want to correct, but the pump said not to correct due to "insulin on board." Then, two hours later, I'd still be high. My rationale was that my "duration of insulin action" was set too high. I moved it down to 2.5 hours. When I asked John Walsh about this situation he responded that the problem was due to underbolusing for the meals, not the duration setting. Duh! He also explained that having an accurate setting for your "duration of insulin action" is important when testing basals. Otherwise you might think your basal rate is too high or low, when really those issues are due to bolus insulin. Interesting.
Now my setting for insulin action is 3 hours. A little on the low side, but its working for me. Also, if I'm high and I'm pretty sure I'll need to correct, I can override the pump's suggestion, something I wasn't too comfortable with when first starting the pump.
Finally, on the eve of Thanksgiving, a few things I'm thankful for:
- My loving and supportive husband, Dennis
- My wonderful mom who among many other things, taught me to sew, so that I can alter my pockets to better accommodate my pump.
- The great people at ADA, JDRF, TCOYD, etc. who work hard on behalf of people with diabetes.
- The O.C. because it keeps me inspired and sane!
- My professors at SDSU who encourage and push me to be a better historian.
- My faith and our favorite little church in Old Town.
- Gravy at Thanksgiving!
- My insulin pump and the very friendly and helpful folks at Smiths Medical.
- The community of Barrio Logan and its heart in Chicano Park, which has motivated me and provided me a wonderful place and people to study.
- Football, especially when the Dolphins are winning.
Mostly I'm thankful for my life, and for peace, health and happiness.
Happy Thanksgiving Everyone!
posted by Kelsey @ 10:12 AM
7 Comments:
At 11:37 AM,
mel said…
I have my IOB set to 2 hours, no issues here with corrections. I've never heard of it being any longer than 2 hours. What type of insulin is it?
At 12:13 PM,
Kelsey said…
I use humalog.
All the books and "experts" say it should be 3-4 hours.
Whatever works though :)
At 2:35 PM,
Scott K. Johnson said…
Thanks Kelsey!
And excellent BG's by the way!
My insulin duration is way long - and maybe I'm wrong with it. I've not yet read the new "Pumping Insulin" book, which I believe may address it.
I've done some testing, starting with a higher than target reading, take a bolus and see how long it takes before my BG's stop dropping. I use that time for my duration of insulin action. Maybe I'm wrong about that. For me, it's a whopping 5:30. Yep.
This is, of course, dependant on my basals being set correctly.
I do have the nagging feeling that I need to re-examine all that stuff.
I used to have real nagging lows after a day of (I think) stacking boluses. I haven't had that trouble since pushing my IOB out a bit.
At 11:03 PM,
Chrissie in Belgium said…
I too set my humalog duration time for 3 hours. In Walsh's Pumping Insulin 3rd edition he points out that usually 30% is used the first hour, second hour and third hour and the remaining 10% through the fourth hour. Since the last tail bit is so small I later changed the duration time to just 3 hours b/c it can easily be influenced by other factors and it is easier to think through in my head what will successfully balance the bg values. It is important to not forget that the duration time is very significantly influenced by your exercise and activity and for some people stress, slow digestion, etc etc etc.... The more active you are the faster the insulin is absorbed. Therefore you can vever truly to 100% rely on the pump"s calculations. If one logs, one sees patterns and these patterns help you decide when to "adjust" the pump recommendations, ie when to give a correction bolus even when there remains IOB. If you continually see that at a particular time bg will not drop even though there remains IOB you learn to give a small correction bolus anyhow. Or take a walk! So logging helps. Sometimes these patterns are NOT explained by incorrectly set basal levels. Keeping variables as simple as possible helps so that you can more clearly eliminate some "causes" for an unexplained bg variation. Often it is better to "take a walk" or get some other exercise as soon as one sees a beginning increase in bg. It is really important to get the bg value down as soon as possible b/c the longer you wait the harder it is to get down. Each person reacts differently so it is important to learn how your own body functions.
Me too, I LOVE my Cozmo pump, but I also think you can never to 100% follow all its recommendations. Blood sugar values are influenced by so many factors - currently all of these factors cannot be built into out pumps. Some days are just bad absorption days, some days bg values are influenced by stress. Some days you have to temporarily decrease the basal rates b/c you will not be sitting still for a moment. Experience and past logging tells you this, not a message from your pump! Furthermore I know of no pump where you can change you correction bolus ratio depending on the bg value. It takes more insulin to reduce a bg from 250 to 200 than it does from 130 to 80, although both are a drop of 50! I have heard that the new Cozmo pumps may allow you to do this, set up different ratios. But even then it is kind of hard to turn this into a fullproof mathmatical calculation, due to other influencing variables. Totally love the pumps - but don't forget to use your own head and what passed experiences have taught you.
At 2:25 PM,
Lili said…
Happy Thanksgiving!
At 5:28 AM,
Johnboy said…
Hey, Kelsey. Glad to hear of your excellent day!
I just pushed my setting out to 3:15 from 3:00 just for kicks, becuase I have seemed to need less insulin lately. I reasoned based on Walsh's book that I was on the low end also and might as well do this before messing too much with rates.
I do a lot of 2 hour post-prandials, so I'm afraid the only way I could stick around 85 all day would be if I overbolused and was scrambling afterwards not to go low. ;-)
Happy Thanksgiving!
At 3:56 PM,
art-sweet said…
Wow - great sugars! My IOB is 4 hours, with humalog, for what it's worth.
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