# Unhappy :(



## Lauren (Jun 12, 2013)

For the last two days I have been having major issues and I don't know what to do. Tuesday morning I was ok, woke up slightly on the high side (11.0), did a correction bolus, had a banana for breakfast (20g) and bolused for it; started work at 8am with my TB on 75% which usually works; had a flapjack mid-morning  but bolused for this (it was a small, biscuit-sized one so I estimated 20g), got to lunch at 11.45am, my BG is 29.9. I freaked out and started worrying my pump had failed or something, checked the tubing and cannula and it all looked fine so I did the correction bolus my pump suggested, skipped lunch, and tested all afternoon, my BG came right down within three hours, and then I went very, very low, to the point where my head started spinning and I felt very faint. My sugars would not go back up so I ended up eating about 65g in fast and long-acting carbs. Got home at 5pm, still low. Once I got my BG up I changed my cannula, using a new vial of insulin which is a different batch from the old vial, and put it in a different place as I was worried about the insulin not working properly in my old site. Ate a huge meal before bed and felt much better.

Woke up at 3am this morning, BG was 3.3 so had 15g juice. Woke again at 5.30, BG is 12.1, did the suggested correction bolus. Got to work, had a banana for breakfast (25g), then put TB on 75% again. Felt ok all morning, had a viscount biscuit (10g), bolused for it, got to lunch at 11.45 - BG is 17.3. Ate my lunch today, bolused for this alongside the suggested correction bolus, half an hour later BG is 20.8. Panicked a bit and did 5 extra units. BG came down slowly, then my BG went low again, although not surprising today given that I bolused those 5 extra units. Had 45g in carbs, then had 10g more on the way home and suspended my pump for about 2 hours. When I got home my BG was 4.1 and out of desperation and also because I was so fed up I ate a KitKat chunky. It helped me feel better about the situation anyway  

I don't know what I am doing wrong but clearly something is happening here. Has anyone else had any problems like this? I am not the greatest pump user ever and my BG is rarely under control all day but never ever to this degree, it usually stays between 3 and 11. I am actually frightened. It is going up and down so much I feel I have little control over it. At the moment I am in the process of registering with a new GP surgery in a different county to where I used to live and don't have a Diabetes clinic, so I have no-one to talk to about this, otherwise I would be straight on the phone to my DSN.


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## novorapidboi26 (Jun 12, 2013)

Are you putting a temp basal on because of your activity at work..?

This may be too much of a cut in basal, if in fact you need it at all.....

Sorry if you have explained this somewhere else......

it looks like you are yo yoing up and down.......

when was your last basal test......?


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## Lauren (Jun 12, 2013)

Hi novorapidboi 

Usually I put a TB of 75% on my morning shift and 55% on my afternoon shift, this usually keeps me around 5 while I am at work. This usually works fine.

I don't really do basal testing because I find it difficult to fast, my BG will just keep rising and rising until I eat, even if I have a lot of insulin to counteract it.

How long do you have to do a basal test for? I could probably last until about 12 or 1pm without eating. I would probably have to correct though.

I also had a day like this last Saturday when I wasn't working. I am so confused!


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## Pumper_Sue (Jun 12, 2013)

It sounds to me as if you need to check your basals.
I would also query your carb counting for the banana and flap jack.
There's a sticky at the top of the forum regarding basal testing take note and do some 

Give your DSN a ring she wont mind Also have you purchased the book pumping insulin by John Walsh?


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## Northerner (Jun 12, 2013)

Lauren, I can't comment regarding the pump, but it might be an idea to be really boring with your meals for a few days so at least you have one less factor to consider. Stick to the same meals, and keep carbs to a minimum so your doses are more accurate (I find more carbs = more insulin = more uncertainty). Hope you can get to the bottom of things


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## Lauren (Jun 12, 2013)

Hi Sue,

No I haven't bought that book but it looks as if it might be something useful to have around.

The bananas are large so that's why I did 2 and 2.5 units of insulin and the flapjacks were small, about the size of a 'nice' biscuit but quite thick, so I estimated 20g. I am usually accurate with carb counting so I'm thinking they were roughly right. 

I have a feeling my basals and possibly my insulin to carb ratios are off. But I can't ring my DSN because I don't have one atm


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## Lauren (Jun 12, 2013)

Hi Northerner, thanks, that is good advice. I will stick to the same meals.


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## Pumper_Sue (Jun 12, 2013)

Lauren said:


> Hi Sue,
> 
> No I haven't bought that book but it looks as if it might be something useful to have around.
> 
> ...



Yes you do have a DSN, just ring the one you were seeing before. You will still be on her books until you have a new one.

The banana was probably more like 45 carbs. They are very carby. Weigh one and work out the carb value  FlapJack was more like 30+ carbs and again very dense and carby. That sort of mix is a complete no no unless you sort out your combination bolus delivery.

Bottom line is the pump will only deliver what you tell it. As you have not done any basal testing this means one big mess.
It's not the insulin or cannula.
The buck stops with you ie you have to make the pump work for you by programing it to suit your needs. 
As you are going to a new clinic and money is so tight this clinic could turn round and say you are not using the pump properly and have no control we wont fund it.
So 1st things first read the sticky and do your basal tests. Do not change anything else until you have done them.


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## Lauren (Jun 12, 2013)

Hi Sue, good point, I will contact my old DSN 

I think I will stick to my usual carb-counting as I have discussed all the things I eat regularly with my dietician and she seemed ok with the amounts I am giving, plus I have a feeling it would have affected me before this week if it was the carb-counting.

I will definitely be doing the basal testing though. Thanks for the advice


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## Pumper_Sue (Jun 12, 2013)

Lauren said:


> Hi Sue, good point, I will contact my old DSN
> 
> I think I will stick to my usual carb-counting as I have discussed all the things I eat regularly with my dietician and she seemed ok with the amounts I am giving, plus I have a feeling it would have affected me before this week if it was the carb-counting.
> 
> I will definitely be doing the basal testing though. Thanks for the advice



If you have discussed with your dietician then perhaps ditch her? A large banana is about 51 carbs
http://nutritiondata.self.com/facts/fruits-and-fruit-juices/1846/2
If you are not counting carbs correctly then again you wont have any control of your diabetes.
I would in your shoes go right back to basics.
Weigh everything and work out the carbs. From the banana size you say you ate, that works out an under dose of 2.5 units of insulin.
I would also suspect the same with the flapjack


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## Redkite (Jun 12, 2013)

Hi Lauren,

What a horrid couple of days!  You were quite right to change the cannula after the first day, if nothing else it ruled out one possible problem.  My son has had the odd day where his levels have swung from very low to very high and on each occasion I suspect the cannula was lodged in muscle (he is very skinny!).  Once you've had a topsy turvy day it can have a knock on effect before things settle down, ie. you have to restrain the impulse to overcorrect highs and/or overtreat hypos.

If you can basal test then great.  If this would be difficult, I'd suggest you increase your between-meal testing.  Maybe don't set a temp basal tomorrow morning, but check your BG level a couple of hours after breakfast and at that point make a decision about snack/TB etc.  then check your level again an hour later.  That way, if you are rising, you can catch it sooner, and perhaps be back in single figures by lunchtime.  If your corrections are dropping you too fast, you need to reduce your correction factor.  A ballpark figure is 100/TDD (total daily dose of insulin).

P.S. For bananas we find a good way to estimate the carbs is to say 1 gram of carb for every 1cm of length.


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## Lauren (Jun 12, 2013)

Hi Redkite, thanks for your advice 

I will definitely increase my in-between meals testing. I'm going to test loads over the next week or so and stick to basic meals so I know roughly what my levels are doing when. Hopefully I'll get it sorted in the end 

Thanks for the tip re bananas! Just measured one in my fruit bowl and it is 22 or 23cm, so I know for tomorrow


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## Lauren (Jun 12, 2013)

Pumper_Sue said:


> If you have discussed with your dietician then perhaps ditch her? A large banana is about 51 carbs
> http://nutritiondata.self.com/facts/fruits-and-fruit-juices/1846/2
> If you are not counting carbs correctly then again you wont have any control of your diabetes.
> I would in your shoes go right back to basics.
> ...



Hey Sue, just followed your link and I don't know if you realised, but the carbohydrate amount is for one cup of mashed bananas. If you choose one medium-sized banana from the drop-down list the carb amount is only 27g, which sounds a little more than what I was bolusing but about right. Just thought I'd point it out because I wouldn't want anyone reading this to overdose when eating bananas!


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## Pumper_Sue (Jun 12, 2013)

Lauren said:


> Hey Sue, just followed your link and I don't know if you realised, but the carbohydrate amount is for one cup of mashed bananas. If you choose one medium-sized banana from the drop-down list the carb amount is only 27g, which sounds a little more than what I was bolusing but about right. Just thought I'd point it out because I wouldn't want anyone reading this to overdose when eating bananas!



Sorry my mistake. 
Also are you aware the riper the banana the higher the carb content? 

Your no 1 priority though is your basal testing. Start with one section at a time and take a week to do the one section. Once you have the nights correct work on the day time basal. Make sure you have plenty of hypo stuff about as things can and will domino once you start to change things.
It will be frustrating just remember Rome wasn't built in a day


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## Lauren (Jun 12, 2013)

Thanks Sue I will definitely follow your advice  I shall stock up on hypo stuff and start testing in earnest. So glad to have you lot to talk to about this!


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## Phil65 (Jun 13, 2013)

Lauren said:


> Hi Redkite, thanks for your advice
> 
> I will definitely increase my in-between meals testing. I'm going to test loads over the next week or so and stick to basic meals so I know roughly what my levels are doing when. Hopefully I'll get it sorted in the end
> 
> Thanks for the tip re bananas! Just measured one in my fruit bowl and it is 22 or 23cm, so I know for tomorrow



Lauren, just to add .....your basal testing is crucial, a pain....but crucial. I don't know how often you test but for me to be confident I have got it right....I test before meals and 2 hours after....if high 2 hours after eating I correct, 1st thing in the morning and last thing before bed .....so at least 8 times a day.


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## Julie.reid1906 (Jun 13, 2013)

Hi Lauren

If you have an iPhone then I recommend getting an app called carbs & cals. It's brilliant for doing your carb counting. I also use my fitness pal, this has a lot of branded food item and their carbs.

If you are gonna do the fasting thing to check your basals, try only missing one meal per day.  You can still have something to eat as long as its carbohydrate free. I like slices of cold meat which keep me going, it's fine as long as you don't over do it.

I have been on my pump for a year and I have crazy periods like you. It's horrible  maybe you have a bug though. I also fine the changing weather really affects me.

Hope you can get some control back soon

Julie


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## Pumper_Sue (Jun 13, 2013)

Julie.reid1906 said:


> Hi Lauren
> 
> 
> If you are gonna do the fasting thing to check your basals, try only missing one meal per day.  You can still have something to eat as long as its carbohydrate free. I like slices of cold meat which keep me going, it's fine as long as you don't over do it.
> ...



Hi Julie, it's stated by many including the bigwigs of pumping that you must not eat protein whilst fasting.(many find that protein raises blood sugars) Fasting used to mean just that fasting  It's now been decreed that SF jelly can be used. It's always advised to skip only one meal in the day as well. Others have worked it very well by changing the times of meals.


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## Lauren (Jun 13, 2013)

Phil65 said:


> Lauren, just to add .....your basal testing is crucial, a pain....but crucial. I don't know how often you test but for me to be confident I have got it right....I test before meals and 2 hours after....if high 2 hours after eating I correct, 1st thing in the morning and last thing before bed .....so at least 8 times a day.



I am pretty big on testing  I wake up at 5am every day and I test then, then I go back to sleep and test when I wake up again, then 2 hours after breakfast, before lunch, two hours after, before dinner, two hours after and before bed and sometimes again later if I didn't go to bed when I first thought I would. I also test if I feel unwell or a bit odd and also before and after exercise. I probably test eight - ten times a day.

I am definitely going to work on my basal testing, I am going to do it tomorrow as I have a day off and don't have to worry about dying at work lol.


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## HOBIE (Jun 13, 2013)

Thats being T1 !  I dont thing there is any hard & fast rules at times. A few weeks ago i had 1 & half days of cold systems went sky high & expected to have proper cold but dissapered ?  Just shows how much you can ajust with pump


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## Lauren (Jun 13, 2013)

HOBIE said:


> Thats being T1 !  I dont thing there is any hard & fast rules at times. A few weeks ago i had 1 & half days of cold systems went sky high & expected to have proper cold but dissapered ?  Just shows how much you can ajust with pump



I'm so glad it's not just me! I think I must have a bug or something, my levels have been better today than they have been, I adjusted my TB to 85% in the morning and it was 8.9 at 9.30 and 6.5 at 11.20, but then in the afternoon went really low again  Better then they were though. I have four days off now and I intend to start sorting these basals out  Plus appointment with new GP on Monday to get my new pump clinic sorted


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## Lauren (Jun 13, 2013)

Julie.reid1906 said:


> Hi Lauren
> 
> If you have an iPhone then I recommend getting an app called carbs & cals. It's brilliant for doing your carb counting. I also use my fitness pal, this has a lot of branded food item and their carbs.
> 
> ...



Just added this app on my phone and it is amazing! Plus there are quite a few other free health and fitness apps which look good  Thanks Julie!


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## HOBIE (Jun 13, 2013)

Good luck Lauren   Days off what are them ?


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