# problems - help needed!



## Lauras87 (Sep 10, 2013)

ughhhh i'm having a really **** time today with my pump.

its the second day of waking in the high teens, i've corrected via a standard bolus which still hasnt brought me down to normal range just to around 14 or 15.

so put a TBR on of 90% to try & get my bloods down by lunch i was 4.6

tested now as i feel really unwell & i'm in the 20's so put another TBR on.

i changed my cannula this morning but dont know if i should change everything again or what to do.

i have no air in the tubing or leaking from my cannula site even tho its slightly red around the area.

my nurse said that because i'm waking high to put my basal up 0.10 units an hour between 10pm - 7am (i'm hoping to do a test tonight or tomorrow)

but feel fed up as i dont have the same control i had on MDI & I know its early days but arghhhhhhhhhhhh


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## m1dnc (Sep 10, 2013)

Keep cool Laura, these hiccups are not unexpected in the first week or two.

Were you on Lantus before the pump? When I started mine it took nearly a week for it to clear my system and for that first week I thought I was doing really well. When it finally left me I started getting high figures like you and I gradually tweaked the basal up to compensate, as you have been advised by your DSN. 

Don't do anything too drastic with the basals - it takes a day or two to see the effect of any change.

Have you checked for ketones though? Keep a close eye on these while you're trying to get under control


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## Lauras87 (Sep 10, 2013)

m1dnc said:


> Keep cool Laura, these hiccups are not unexpected in the first week or two.
> 
> Were you on Lantus before the pump? When I started mine it took nearly a week for it to clear my system and for that first week I thought I was doing really well. When it finally left me I started getting high figures like you and I gradually tweaked the basal up to compensate, as you have been advised by your DSN.
> 
> ...



i was on lantus (59 units split)
i know about the drasticness, am thinking of upping it 0.10% as i feel so poorly with my high bloods.

had no ketones all day & try i dont!

trying not to panic but its hard


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## everydayupsanddowns (Sep 10, 2013)

You have my sympathies Laura - you won't be the first to have a few "chuck it out of the window" moments in the early weeks/months. I had more 20's in the first year on a pump than I ever had on MDI I think! But now... another year further on - my control has never been so good and the pump wins hands-down for Quality of Life for me even when my D is playing silly beggars.

Just to check a few things from your post...

Not sure what you've been told, but my DSN has told me that if high (especially if really high like 13-14+) to do first correction via pump. Then if there is not decent downward movement within 1 hour - 1.5 hours to do a set change and correct by *pen or syringe* so you know for def that it has gone in.

Where you say you set a TBR of 90%... do you mean 190%? TBRs can do down as well as up and I'm on a different pump, but if I set 90% it's because I want LESS basal, not more. On the Veo TBRs range from 0% (no basal at all) to 200% (double your basal)

In terms of basal tweaking I'd be tempted to change by 10% increments unless the alteration you want to see is very minor. 

Hang in there - the first few months are hard work, but it is an investment that will pay off big time in 6 months - 1 years time.

Keep going!


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## Lauras87 (Sep 10, 2013)

everydayupsanddowns said:


> You have my sympathies Laura - you won't be the first to have a few "chuck it out of the window" moments in the early weeks/months. I had more 20's in the first year on a pump than I ever had on MDI I think! But now... another year further on - my control has never been so good and the pump wins hands-down for Quality of Life for me even when my D is playing silly beggars.
> 
> Just to check a few things from your post...
> 
> ...



I do my correction via the pump but it seems to barely drop me (aka will drop 1-2mmol)

I've not been told to do a set change or use my pen (I carry my pen anyway)

I did a 90% increase - just tested & only 13.9 from 20+

I'm just worried about being told off for using/ordering too many cartridges (I use a lot of fast acting & a cartridge just goes into 3 days compared to others who get 6 days out of it (I know everyone is different))

Sorry just feel a bit panicky about failing/not getting the most out of my pump


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## Hanmillmum (Sep 10, 2013)

It's very early days for you Laura, don't get too anxious about using your products if you need to, you won't get told off by anyone 

Have you considered looking at your correction/sensitivity ratio too, may need a tweak now you're pumping to get on top of those highs?

Keep at it, it will be worth it, promise


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## Lauras87 (Sep 10, 2013)

Hanmillmum said:


> It's very early days for you Laura, don't get too anxious about using your products if you need to, you won't get told off by anyone
> 
> Have you considered looking at your correction/sensitivity ratio too, may need a tweak now you're pumping to get on top of those highs?
> 
> Keep at it, it will be worth it, promise



I know but it's just I'm worried about when the hospital get the bill.

My new sensitivity is 1 unit for 2.5mmol compared to MDI of 1 unit to 3mmol.

Thanks, I'm sat with my basal ratios for 10pm - 7am


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## Pumper_Sue (Sep 10, 2013)

Hanmillmum said:


> It's very early days for you Laura, don't get too anxious about using your products if you need to, you won't get told off by anyone
> 
> Have you considered looking at your correction/sensitivity ratio too, may need a tweak now you're pumping to get on top of those highs?
> 
> Keep at it, it will be worth it, promise



Everything except the basal needs to be left well alone until the basal is sorted to many adlib adjustments will mess everything up.

Laura needs to start a basal test tonight and test through the night to see exactly where she is rising then do the suitable adjustments. Then retest to see what needs tweaking.


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## Lauras87 (Sep 10, 2013)

Pumper_Sue said:


> Everything except the basal needs to be left well alone until the basal is sorted to many adlib adjustments will mess everything up.
> 
> Laura needs to start a basal test tonight and test through the night to see exactly where she is rising then do the suitable adjustments. Then retest to see what needs tweaking.



I'm hoping to do one tonight Sue (just hope I don't sleep through my alarms )


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## Lauras87 (Sep 10, 2013)

Ok I've checked what I get now between 10pm - 7am & it's 15.95 units

I don't see how I can increase as my DSN said by 0.10 but if I do 10% ill have 17.53 units.

Hmmmm let's see what my test shows up


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## everydayupsanddowns (Sep 10, 2013)

Are all your time blocks the same Laura?

Between the hours suggested I would write down my current u/hour then increase by 10%

So 0.50u/hr would become 0.55u/hr and so on... (Though your doses are prob quite different!)


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## Lauras87 (Sep 10, 2013)

everydayupsanddowns said:


> Are all your time blocks the same Laura?
> 
> Between the hours suggested I would write down my current u/hour then increase by 10%
> 
> So 0.50u/hr would become 0.55u/hr and so on... (Though your doses are prob quite different!)



Nope, from 10pm -3am I'm in the 1.something range then from 3am til 9am I'm into the mid 2.'s

I've calculated them all for if I need to change, just waiting til 10pm before I go to bed to start basal testing


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## HOBIE (Sep 11, 2013)

In a couple of weeks you wont know yourself. A few pushes of buttons & sorted. Takes quite a bit tweeking though in the first month.  When you do get sorted & want that bag of chrisps/food etc. Its not a performance with syringes & needles.


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## trophywench (Sep 11, 2013)

Who gives a .... how many cartridges you use Laura?

Of course they won't query it, and in any case if they did, your pump will show that you are using all that insulin, won't it?

I also recommend the correction by pen or syringe after the first attempt yields not much of a result - if it works then it means it is a site issue - which may just be because you need a different length cannula or something rather than not having any actual 'decent' sites.


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## AJLang (Sep 11, 2013)

I'm just worried about being told off for using/ordering too many cartridges (I use a lot of fast acting & a cartridge just goes into 3 days compared to others who get 6 days out of it (I know everyone is different))

Sorry to hear that you are having a difficult time but it will get easier.  My cartridge is usually empty after three days


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## Pumper_Sue (Sep 11, 2013)

trophywench said:


> Who gives a .... how many cartridges you use Laura?
> 
> Of course they won't query it, and in any case if they did, your pump will show that you are using all that insulin, won't it?
> 
> I also recommend the correction by pen or syringe after the first attempt yields not much of a result - if it works then it means it is a site issue - which may just be because you need a different length cannula or something rather than not having any actual 'decent' sites.



In my old pct there was a super cow who hated being got he better of. IE I got pump funding and she tried to stop it plus the renewal of the pump.
Being such an *itch she decided to do an audit on exactly how many cartridges and cannulas I used.
Only problem for her it just proved I used less than the average.
My pct had said to use the cartridges twice if getting through more than 1 every 6 days.
Which I find odd as told off for using mine for 10 days at a time.

As Laura has just started pumping TW, then it's more than likely just a basal issue not a site issue.


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## Lauras87 (Sep 11, 2013)

I know but just worried that ill get told off for using too much but I know everyone is different.

I was naughty last night & upped my basal by 10% as per what my nurse had said from looking at all my levels since tuesday. 
Im struggling to wake up every 2 hours but at 2.30 I was 3.8 so I know the base figure was wrong & 10% is too much but I woke this morning at 6.7 - yippeee!!!

I'm hoping I can actually wake up tonight, 3 nights of sleeping through my alarms isn't good when I need to do this to help myself


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## HOBIE (Sep 11, 2013)

You can see how adaptable it is already  Wait till you get into the proper functions   Keep at it & it will pay off


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## everydayupsanddowns (Sep 12, 2013)

Hope your test went well last night Laura


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## Lauras87 (Sep 12, 2013)

everydayupsanddowns said:


> Hope your test went well last night Laura



Was fine til 2 then woke up at 5.3 then started raising
Woke up at 7 & am 14.4


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## Pumper_Sue (Sep 12, 2013)

Lauras87 said:


> Was fine til 2 then woke up at 5.3 then started raising
> Woke up at 7 & am 14.4



So did you test between 2 and 7 AM so you know when the rise started?

There's no point in getting mad about it, all that is happening is your body needs more insulin at a certain time. Your job is to find out where that rise starts and then decide what time you are going to increase your basal from to counteract the rise.
The pump is only delivering what you have told it.


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## everydayupsanddowns (Sep 12, 2013)

Pumper_Sue said:


> So did you test between 2 and 7 AM so you know when the rise started?
> 
> There's no point in getting mad about it, all that is happening is your body needs more insulin at a certain time. Your job is to find out where that rise starts and then decide what time you are going to increase your basal from to counteract the rise.
> The pump is only delivering what you have told it.



Odd that Laura woke to 6.7 the day before though... when as far as I know the only adjustments made were around the 10pm-2am time.

Would be good to get a couple of 'detailed' sets of results though to see if you can see a pattern emerging in some kind of reliable way


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## Lauras87 (Sep 12, 2013)

i started rising from 2-4am (i know i dont have the dawn phenomenon)

from looking at it, between 12 - 2 i start dipping so was thinking of knocking back 5% & see if that helps at all

my time blocks from 2am - 7am have been put up by 10%

have stayed high all day & gone higher so going to put a TBR on as i'm getting cranky

my current ratios are

10pm - 11pm = 1.50 u/h
11pm - 12pm = 1.45 u/h 
12pm - 1am = 1.45 u/h
1am - 2am = 1.55 u/h
2am - 3am = 1.75 u/h
3am - 4am = 2.10 u/h
4am - 5am = 2.40 u/h
5am - 6am = 2.70 u/h
6am - 7am = 2.70 u/h

then from 7am - 8am i go to 2.20 u/h then drop down into the 1.something units

i only have 1 basal profile set on my pump


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## trophywench (Sep 12, 2013)

To prevent the dip at 12 midnight, reduce the base rate from 10pm or 11pm at the latest.

To counteract the rise from 2am, increase the base rate from 12 midnight or 1 am at the latest - no good doing it at the same time your BG changes, that is what is called locking the stable door after the hoss has bolted !

I found that (the required time-lag) quite a hard one to get me head round properly, and do 'automatically' - despite the fact that when you think about it, it's sensible!


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