
May 23, 2002
Daily Care, Insulin Pumps
Question from Akron, New York, USA:
I have had diabetes for 44 years, and went on a pump about a month ago. I am trying for a glucose range of 100-160 mg/dl [5.6-8.9mmol/L], but I am everywhere except between those ranges! I have read Pumping Insulin over and over, and I am very careful with what I eat, yet I can not even out my blood/glucose readings. I have changed my basal rates so much that I am feeling like a yo-yo! I range from 23 to 177 mg/dl [1.3 to 9.8 mmol/L] in the morning, and then an hour later I am at 233 mg/dl [12.9 mmol/L], and one-half hour later down to 36 mg/dl [2 mmol/L]. If someone can help me, I would appreciate it!
Answer:
I empathize with your frustration. It can be a very frustrating process. However, I would raise several points that may be issues preventing you from reaching your goal:
Do you have problems with gastroparesis? When this occurs, there is significant mismatch between insulin and glucose after the meal.
Do you have problems with skin at the subcutaneous infusion sites?
Do you leave your sets in too long?
Are you matching your food intake with the insulin you receive? We recommend most of our patients use carbohydrate counting to have a system of approximating insulin requirements for food eaten.
Are you giving too many high blood sugar boluses between meals?
Is your physical activity causing too many lows? If so, plan for it by decreasing insulin dose. You can exercise at a similar time each day to help keep a more regular routine.
Are you on medications that antagonize your blood sugars?
These are just a few things to think about. You really need to see your physician or diabetes care team to review additional issues that will interfere with your progress.
JTL