Adapting to an Insulin Pump

Forum for Addisons and diabetes related issues.

Adapting to an Insulin Pump

Postby MMatt » Tue Apr 29, 2008 6:18 am

I am new to this site. I have Schmidt's Syndrome (Addisons, Type I diabetes, hypothyroidism, and vitiligo (loss of skin pigment). After 39 years injecting insulin 4+ times a day and being comfortable with that routine, I have recently switched to an OmniPod insulin pump (it is infrared rather than having tubes). The device works fine, but I am finding it very difficult to adjust the basal and bolus rates. I am increasing getting frustrated and depressed and I don't want to give up, but I don't know how to get a handle on this new routine. Have others found the switch from injectins to an insulin pump difficult and do you have any tips? One of the hurdles is that life is not routine. I have days I work and sit at a desk, days I run around, days I exercise. Every day is so different how is a person ever able to figure out all the profiles (basal vs bolus)? Your feedback would be greatly appreciated.
MMatt
 
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Re: Adapting to an Insulin Pump

Postby SueM » Tue Apr 29, 2008 10:36 am

Hi Mat, buy the book pumping insulin by John Walsh if you do not have it.
Also set up temp basal rates so you can have ones for work days rest days etc, also contact your diabetes educator that's what they are there for.
You need to sort your basal out 1st if that is not correct then everything else is wrong.
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Re: Adapting to an Insulin Pump

Postby gkardel » Tue Apr 29, 2008 10:47 am

Matt,

The Omnipod is a cool device. No infusion set tubing and the automated install of the infusion set is sweet. Once the pod gets smaller I'll definitely consider this one.

How much input did your doctor have in setting up your basals and carb and correction ratios? It can take some time to get these dialed in. Common practice is to start the patient on a very conservative routine to minimize risk of lows and then incrementally bump up the insulin levels. Your total daily dose(TDD) on injection therapy and your height and weight can be used as inputs into determining your initial basal routines. Basic assumptions also exist for how much of your TDD should be allocated to basals and how much to boluses. The general pump rules are used to guide your initial setting and then you and your doc need to customize the routines to fit you. As Sue said above, a good book to get educated on this is Pumping Insulin.

Did you get any info/training on carbohydrate counting from your doc? This is another important aspect of pump therapy.

As far as adjusting to varying daily routines, the pump definitely has a big advantage over injection therapy. I have three different basal routines: one for my 'standard' most common type activity day, another for days with longer more intense activities, and another for days when I'm less active. I also use the temp basal feature to handle periods that don't fit into these basal routines like when I'm sick or doing super intense and long duration exercise.

With injection therapy, you can adjust your long acting insulin, but you're impacting a big chunk of time when you do this. Once you take that dose, you're committed and can't go back and modify things. The pump allows you to create your own custom long acting insulin that fits you.

The other thing to look at is how the cortisol replacement meds (hydrocortisone/prednisone) you're taking for Addisons are impacting your sugars. You really want to minimize how much of these meds you take. Take the minimum amount that alleviates your Addisons symptoms. This will minimize chances for side effects and the impact on your sugars. The pump also is much better than injection therapy at countering the impact that HC and prednisone has on sugars.

Glenn
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Re: Adapting to an Insulin Pump

Postby MMatt » Tue Apr 29, 2008 11:02 am

Thanks Sue and Glenn for your responses. I do have John Walsh's book and a few others. It may seem odd, but I don't have a diabetes educator. I had a trainer from the pump company for 3 hours 1 day, but all she did was show me how to use the device. She would not address the insulin adjustments. I do go to an endocronologist, but she is in private practice and I don't think she really is setup to handle helping patients on pumps. I've had very little input from her. I've faxed a few of my tracking charts to her and then a week later I hear back. It seems to me you almost need someone every day to bounce off situations and ideas with, at least in the beginning when you are learning. Anyway, I have been reading and I have met with a Nutrionist to make sure that I'm counting carbs correctly. I have tried to address the basal rates, but I drop so low all the time I have to stop the tests and start over. On the flip side I am also seeing a correlation between stress and high blood glucose. The stress of trying to figure it all out is driving my BGs up high. It's just crazy, very low and then very high, no stability and it has been 2 months. I long to go back on insulin injections, which is not suppose to be the case . I think I am a reasonably intelligent person, but geesh this has been a mountain to climb. I did fine for 39 years and only switched to the pump because it got such good press. Could the Addisons be complicating the situation? The OmniPod works great. There have been a few "pods" that were bad, but the company replaced them right away. I will digest what you described Glenn about the steriod issue. Thanks for the feedback.
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Re: Adapting to an Insulin Pump

Postby gkardel » Tue Apr 29, 2008 1:12 pm

Doesn't sound like your endo is set up very well for implementing pump therapy. It's definitely not right to just give the patient a pump with no specific guidance. You should ask your endo if she has a diabetic educator to hook you up with or you can try to find a new endo that's set up for pump therapy.

Glenn
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Re: Adapting to an Insulin Pump

Postby zashes11 » Mon Jun 23, 2008 11:34 am

Matt,

There is an insulin pumpers forum that is very active with lots of advice form Omnipod users.

http://www.insulin-pumpers.org/

They can help you with very practical pointers on using what ever pump any pump as there are 5000 members and we all use different pumps.

Judy
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