Toast for breakfast is really hard. It’s easier with Fiasp. You could also try a superbolus, where you suspend your pump for 1-3 hours and take the corresponding amount of basal as a bolus combined with your breakfast bolus, to give you more insulin up front for the spike and less later on to keep from dropping low. I used to do this a lot and it usually worked.
When I started out my insulin:carb was 1:15. Then after a couple years it was 1:10. Then 1:8. Now it’s around 1:5. In my view the most important thing is just to take the amount of insulin that my body requires to keep a good BG level. I also set the CGM limits tight, 85 and 130. I really don’t get any more alerts than I did with broader levels, because the CGM prompts me to fix my BG excursions early so they don’t get way out of range and need heroics and a long time to get back in range.
If you have time for a long pre-bolus you can get away with less insulin. If you don’t have that time, just take a bigger bolus and be prepared to take more carbs later to catch the falling BG. Which you already know because you said you used to do that. The CGM is the most important tool for that. Have you heard of “sugar surfing?” There’s a book by that name that Steve Ponder wrote, and it seems that lots of CGM users figure it out on their own.
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Just to simplify things and rule some stuff out, do you have access to a pen or syringe?
How about tomorrow morning doing a bolus with a pen or syringe, using the same amount you are using now with the pump, and see if it acts differently than the pump. Only change that one thing - using a pen or syringe instead of the pump.
Keep everything else the same. All your basal and IC ratio and insulin and all the other stuff, keep all of it the same. Only change the delivery mechanism for your breakfast bolus, from pump to syringe.
By only changing one thing it is easier to rule things out.
The purpose of this would just be to check if it is an absorption/infusion issue, or a IC or insulin issue.
I would try that as a first step before you start adjusting dosing amounts. You may want to try it a few mornings until you are confident it either makes no difference or makes some difference.
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So here’s where I’m at:
- I just had a pod change. Having used Flonase on the skin prior to pod application was AMAZING! My skin has never looked that GOOD after removing a pod and I had no bleeding or absorption issues. I went ahead and put hydrocortisone on the skin after removal although I don’t know that the site actually needed it.
- I have switched from Humalog to Novolog in this pod that I just started. I was able to get a prescription for the Novolog and went ahead and got it filled.
- I am going to try Novolog for a few weeks and then start on birth control in a few weeks to see if that stabilizes me more week to week.
- I have started my paper logging of everything again like I did on shots. It helps my apprehension when I see Dexcom down arrows bc I know I can look at my log and feel less stress that it’s going to “run away” on me. Just not doing pre-low anxiety treating to stop a descent has moderated so many of my highs.
- I’m paying better attention to how many cups of coffee I’m having in the morning and that has helped so far. Coffee had become a blind spot of mine as far as forgetting about caffeine and blood sugar (or not caring, I guess). Wednesday and Thursday morning were trainwrecks even without coffee, but I’m oddly stable today. I’ll take it.
Thanks everyone! You guys are helpful and inspirational!
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Cool that you got some NovoLog to try. That was fast. Let us know if it seems more stable over 3 days.
And for your own records, pay attention to site differences. I notice that I need more insulin when it is placed on some areas of the body. Slight differences are fine with me, as long as they are predictable.
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Wow! That’s amazing progress in a short amount of time!!!
Go you!
One thing that came to mind while I was thinking about your thread and looking at EH’s pod stuck to his upper shoulder this morning was the fact that it works on the areas that are lean. He’s not super lean like some folks here (and yourself) but it still works on areas that seem like it wouldn’t.
Another thing that someone once mentioned was using an ice pack prior to installing the Dex. I wondered if it would work with the pod? Ice makes it less likely to bleed.
And the food thing when high…dude, a woman’s gotta eat. I feel like @Eric’s suggestion of doing an injection with a syringe or pen needle is smart. And eating lower carb and high protein works best for us. Don’t skip eating though - our brains need food. 
The caffeine thing is an issue or factor for us too. Of course, the first five years of endos and CDEs said it was impossible and didn’t make a difference. But it does! Lol!
Keeping track makes sense and will help reveal your patterns quicker. We alternate between keeping track aggressively and not. Photographing the food is an easy way to track it on the fly, then record later. Otherwise we’d go crazy. Gotta use The Force sometimes and not sweat it.
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T1 Allison, unfortunately I don’t have anything to add to the conversation but I’m going from MDI to Omni Pods next week and after reading through this thread I now wonder if I making the right decision?
I’ve heard going to any type of pump is a difficult transition but a general question, Integrated Diabetes Service, is that through your Dr or some group you found on your own?
I’m a L.A.D.A. Diagnosed 2 years ago at 49 years old and I’ve been on a wild ride for about a year now. Until then I had really good control but it gets harder every day.
Do you ever regret moving to a pump?
I’m also concerned about weight gain because since becoming T1 I’ve gained way too much weight and nothing I do helps to get it off. I have a couple other autoimmune diseases and one my med was recently changed and I have put on even more weight. I’m the heaviest I’ve ever been and before diagnosis I was in the best shape of my life.
I am really confused and was kind of looking forward to getting on a pump but as I mentioned, after reading this thread I’m second guessing my decision 
Hi John!
I’m sorry to hear about your difficulties. We all have a lot of layers to our challenges, it appears!
First: Integrated Diabetes Services is a FANTASTIC group of all T1D Certified Diabetes Educators based in Pennsylvania. And when I say “T1D CDE”, I mean that every one of them in the practice actually has T1D themselves. I just signed up for a three month retainer with them last week to help me through this spell of challenges I’m facing. I worked with them for a three month retainer back in 2014 to help me get established on the insulin pump and that is the ONLY reason it’s been successful for me. My endocrinologist’s office is not equipped to serve diabetics intensively and I do not trust their trite judgement since they do not live this disease and are frequently unaware of the tips and tricks that make these systems truly function in our daily lives. Gary Scheiner is the founder of IDS and he wrote “Think Like a Pancreas” and I’ve done several consulting sessions with him. He and his team are the nicest, most knowledgeable team I’ve ever worked with. They do not run their billing through your insurance, so you pay out of pocket and then submit to insurance…but they give you the invoice with the appropriate medical coding to make it easier. I cannot recommend them enough. I’m about to email them my blood sugar logs after this post for collaborative review.
I do not regret switching to the Omnipod. I tried it for a few months in 2006 when I was a new diabetic. But my doctor’s office at the time also completely lacked proper support. The diabetes educator really had limited knowledge of pumps and diabetes. I gave up after a month or two due to skin issues and being overwhelmed. The Omnipod pods were also much larger back then and I am very skinny person, so it was too challenging without the proper resources to help me through it.
I’ve been using Omnipod this time since 2014 and it has definitely been a net positive by a wide margin. My current challenges with it are:
- Skin allergies (hopefully Flonase on the skin will keep working like it has been)
- Apprehension at trying new areas for the pods…but I’m getting motivated to try a new spot at my pod change tonight
- Absorption issues with Humalog. I’ve changed to Novolog and as of today (Day 3 on this pod), the absorption issues seem (fingers crossed) to be resolving.
Overall, I’m coming off of a Diabetes Burnout phase so some of my challenges right now have more to do with the mental balancing of it than the technical aspects.But it’s a mix of both.
The two best things I’ve done are (1) work with IDS and (2) join FUDiabetes. Seeing other people’s challenges, tips and recommendations are inspiring me to be braver and bolder with my self-care. It’s already helped me so so much.
Good luck! I’m having to be patient with trying new things and seeing how they help (or don’t). Fortunately I seem to be having a lot of “wins” right now. I hope you have some “wins”, too! Get a good team (IDS in my case) and take it one step at a time! I’m rooting for you (and for all of us, myself included)!
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Hey John, making the Pump vs MDI decision is always worth giving consideration. If you have specific questions, we have many Omnipod users here, as well as many MDI adherents. Both believe their choice is working the best for them, so I don’t think you can make a wrong decision.
With that said, once you get the pump dialed in you give yourself the ability to easily delay meals, tailor a few different basal profiles a day to more closely match your needs, and the freedom to choose to eat more easily without giving yourself a second meal shot.
Dialing in a pump took us 3 weeks to a month, so don’t expect it to go swimmingly right off the bat. For what it is worth, we are very happy with our pump.
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@Chris and @T1Allison THANK YOU FOR THE INPUT!!
When I was diagnosed it was at my PCP office and she referred me to the Endo in their system. I went to 3 appointments with her and when it took me having to make 4 phone calls to get my prescriptions sent to Express Scripts (mail in pharmacy that saved me close to $2000 year 1). I found it ridiculous that my PCP seemed to be better informed about T1 then this Endo and I finally got fed up and talked to my wife about it and decided since I live 50 miles from the Premiere Diabetes Hospital in the world, Joslins, I’m going to call for an apt. I got really lucky because when I called my now Dr had just posted a cancelation and I jumped on it and was in the office within 10 days.
At the time of diagnosis I just accepted a new job so went to my “friend” I was going to work for to tell him about the T1 and that we should push off the start date until I get my s@&t together he said not necessary, come over and get started and take the time you need. We’ll, 5 months later I wound up in the hospital for 4 days, I come back and get an early morning phone call telling me that my commission sales position is being eliminated. So at almost 50 years old, with multiple autoimmune diseases I found myself out of work for the first time in my life and finding anything even in the ballpark of what I was making turned out to be the case. 11 months I stressed out and finally landed a job but it requires 16 hour work days and a lot of traveling. The reason I bring this up is my Dr @joslin wanted me to go to a pump but being out of work and even with insurance it would have been almost $2,000 out of pocket and I couldn’t afford that at the time.
I did the pump intro class back then but I’m going Monday for an eye appointment, nutrition apt and pump training. Plus I have the added advantage of Insulet being about 60 miles from me.
I have to run out to a chiropractor appointment, I’ll continue my response when I get back but thank you again for your responses, it’s very much appreciated 
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Oh, John, I’m so sorry you’re going through all of that! That’s A LOT on anyone’s plate!!
My track record with endo’s is not a good one, although probably fairly typical for an adult T1D. I hope that Joslins works well for you!! I had an endo fire me as a patient mid-pregnancy b/c I took more insulin for skillet potatoes (carefully measured out and in moderation!) than the Insulin:Carb ratio that she told me to use. She sent me to a dietitian in my second trimester bc she was just sure that I must not understand food. The dietitian said she’d never met with anyone as knowledgeable about carb counting and meal planning as me, and the dietitian apologized for not being able to teach me anything new at the end of that appointment! After I didn’t gain any weight for two weeks mid-pregnancy (b/c my endo only wanted me to eat like seven carrots for lunch and two pieces of bread and string cheese, What the Heck?), she fired me. That was awesome.
All of that is to say:
- You take care of you. It can be hard to figure out which doctors are actually good ones who know what they are doing and which ones are misinformed _____ (I’m keeping it clean here), but you’ll be able to tell early on.
- Research as much as you can on your own and advocate for yourself.
- Do not be afraid to stand your ground or switch doctors. But I am hopeful that Joslins is AWESOME.
- I’ve fired two endos in 12 years. One in the first month of diagnosis.
- I’ve been fired by one endo.
- You’ll start to learn what works for you and it may run counter to convention. That’s okay. See No. 1 above.
Changes are hard and you have a lot of them happening right now, all overlapping each other. You got this!!
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Wow, this is unbelievable! Call me crazy, but no Endo will ever “direct me” what to do with my sons D-Management. Until they live under my roof and live my life and the frustrations that come along with living with Diabetes they will only ever “recommend”…but at the end of the day his mom and I will decide what to do because WE care the most for our son. Any person (caregiver or someone with D themselves) with Diabetes knowledge who cares to learn are much better capable of making the right decisions for their lives because no one shoe fits all patients. Endo’s often times have cookie cutter responses for patients, but each person is an individual who has specific needs for their own management. I would laugh at my Endo if they ever told me I MUST do this, or that. Then I’d quit them before they had the chance to fire me. 
Anyone who is a member of FUD (imho) is either on the road to becoming fully competent for self-management or will eventually reach that bar because there are some superstar scientific minds in this community who understand diabetes far better than any Endo UNLESS that Endo happens to also be Diabetic and live with it as well as treat it in others.
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@John_T1D,
There are advantages and disadvantages to both pumps and MDI. And each pump has advantages and disadvantages. It depends on which things are most important to you. Start a thread and we can offer advice based on our experience.
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Welcome @T1Allison! This is a very interesting thread, and I’m looking forward to reading more of your posts. Sounds like you have a great plan, and there have been lots of excellent suggestions in this thread.
Coffee can definitely have an impact on my bg levels too. I’ve noticed that certain coffees I buy have more of an impact than others. Also, I drink my coffee (with almond milk) before I walk to work in the morning, and this helps tremendously. The walk is about 25 minutes, decent pace. I can see my bg levels begin to trend up before I leave, and then the trend turns around and declines slightly (without any bolus). I’m not sure what your morning schedule is, but it may help to do a little bit of exercise or even an active chore not long after coffee.
I love coffee, so not having it is simply not an option!
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@John_T1D I am currently using the Omnipod and I love it. I moved to a pump (Animas Vibe) around 3.5 years ago after doing MDI for 42 years, and I was also nervous having read a lot of threads online about difficulties with the pump. I told myself that I did not want to go through my entire diabetic life having never tried an insulin pump, so I bit the bullet and did it. I did not regret it for one minute. I recently moved from the Animas Vibe to the Omnipod and I am liking it even more. Keep in mind that people tend to post when they are having issues that they need advice on, but they don’t post when they are not having issues. Do what is right for you, but just know that I am using the Omnipod and I am very happy.
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@ClaudnDaye You are not wrong about this. @T1Allison I am pretty lean and muscular and I put the pods on my arms, lower back and legs (upper and lower thigh). I do both directions, so that gives me 16 rotation sites. I have not had any problems with any sites being uncomfortable. I would love to find more sites (the more rotations the better!).
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This was me just now trying to find the best new spot to try on my low back…I’ve never put a pod there.
It was also me trying to figure out if I had sprayed enough, not enough or too much Flonase on the skin that I could barely see. Time will tell!!!
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Ha!
I did try there once, and it wasn’t that comfortable. It got squished against the backs of chairs, and I found myself having to awkwardly sit at an angle. Much better was sort of midway around the back, if that makes any sense. If you picture a top-down view of your back against a seatback, there’s a narrow V-shaped space before the curve of your back meets the chair. Putting a pod snug in there, where chairs don’t bother it, is perfect. Unless you’re double-jointed everywhere, a second pair of hands helps!
Me too! I’d find it far, far easier to return to MDI than to go back to a tubed pump.
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Pumping can seem a bit fiddly by comparison with MDI, but for me a pump has 3 advantages. First, I always have insulin with me (in the pump) so I can take some whenever I want. Second, I can set a basal profile that varies hugely throughout the day to match my body’s requirements (I need 0.15u/hour in the afternoon and 0.95u/hour at 3am.) Third, I can set a temp basal (like 120% if I need extra because of stress or illness, or 50% because I’ll be fasting for most of a day.) That said, in my view a CGM is more important than a pump.
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That’s my concern, I have no idea what temp Basal or Basal profile even is
I’m worried I will get so distracted at work that I don’t pay attention and wind up either crashing or going crazy high. I also put on weight once I was diagnosed and I’m not used to having all this weight on me, I hear people tend to gain when they start pumping. I’m sure everyone is different but with the luck I’ve had the past 2+ years, I’ll be one who gains. I don’t even look at myself in the mirror I hate having extra weight on so badly but cannot lose anything.
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