"New" to Omnipod and Pumping: 4 years in and I feel like I'm missing something

[Beacher]

@Eric

It takes practice to know exactly how aggressive

Practice and, sometimes, sheer blind luck. It also helps to have a CGM. Before a CGM, I was afraid to be aggressive with my corrections, or else I’d crash, overtreat, and end up right where I started. Now it’s easy to keep an eye on things and head off a low.

The other day after I changed my pod I steadily rose, hitting 293 after four hours, despite activity and several over-corrections. I changed the pod again, hadn’t a clue when or whether my earlier corrections would ever work, so bolused 3 U, then felt that wasn’t enough and bolused another 2. Within an hour I had my first-ever double down arrows, and after another three hours leveled out around 105. I told my partner it was just a good guess, and he said no, it was intuition based on years of experience. His version sounds better, but I still think it was just a good guess.

[Eric]

@Beacher

Practice and, sometimes, sheer blind luck.
…
I told my partner it was just a good guess, and he said no, it was intuition based on years of experience.

[Millz]

Ah, yes wise advice…“patience Grasshopper”! Finding the right Balance is important!

[T1Allison]

Okay…relearning things that I knew to be true about my body during 7 years of MDI prior to these last 4 years on a pump…

This rule of thumb: “If your blood sugar is level, your basal level is correct. If you are level too high, you need a one time correction dose to bring you down to a lower point at which to stay level.”

Yeah…my body looks at that rule, throws its head back, and laughs and says “hold my beer, that’s not true”.

My blood sugar can stay level at 180, 200, 220, 240…and a correction dose might bring it down…for 45 minutes. If I don’t have enough basal, it bounces right back up to the higher version of level.

Temporary basals are my answer. Case in point:
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Yesterday, I needed +20% all day long based on my hormones. This temporary basal expired at 7PM, I didn’t hear the beep or forgot to reset it or whatever, and went to bed (with snack IOB) and stayed level at 150. Very level at 150. I woke up at 4AM for whatever reason, looked at my graph, and thought hmmm…maybe I should take a unit. Then I realized, oh sh!t, my temp expired last night. So I restarted it at +20% (and did not take a correction dose) and it came down to rest at 113 or so the rest of the morning. And quickly. Correction doses almost never work that fast for me.

When on Lantus, I knew as my hormones ramped up each cycle I had to add Lantus. My doses were 13/14/15/16 through each month. And it wasn’t bc my bg was climbing…it was bc it’d get “stuck”. Once my numbers got “stuck” at 170 or 180 for a day or two, I’d add a unit of Lantus and I’d start over back around 100.

So I’ve been told I’m wrong about this by doctors and CDEs, but I don’t care. My body laughs at convention. And this is a big mental block I’ve had for the last four years for how hourly basal rates are “supposed” to work and how you are “supposed” to not need extra basal if you are high and level. Whatever. Not true in my case.

[Eric]

@T1Allison

So I’ve been told I’m wrong about this by doctors and CDEs, but I don’t care. My body laughs at convention. And this is a big mental block I’ve had for the last four years for how hourly basal rates are “supposed” to work and how you are “supposed” to not need extra basal if you are high and level. Whatever. Not true in my case.

In general, you will do much better not listening to those people, and just doing what you know works for your body.

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A conversation happening somewhere, right now…

@Any diabetic

So CDE, can you tell me about your background and experience with diabetes?

@The CDE

Well, I passed the CDE test, for which I studied several weeks. That means I am certified. I am a certified diabetes educator!

@Any diabetic

Impressive. Have you ever taken insulin? Have you ever adjusted your insulin dosing? How frequently do you test your BG and make basal adjustments?

@The CDE

Here is my certificate on the wall. And let me reiterate - it took several weeks.

@Any diabetic

[T1Allison]

So I’m writing this for my own reference as much as anyone else’s. Continuining w my observations of insulin resistance due to hormones and finding the magic basal rate for the day…this morning I was level at 115 w +20% basal for hormones. I was super nauseous and unsettled at 4AM and didn’t want to risk a low depending on what might happen next, so I cancelled the temp basal and it floated up and leveled at 150 which is what I wanted for the conditions. So it seems to me that on the right days of my cycle, +20% equates to an average level drop of 35 points. I’ll keep watching and reporting back…but it also seems to be true that once I’m more than 25% off w my basals (which is EASY to do as a woman in my experience), I get pegged at 200 or 220 and no correction bolus is going to bring that down in a meaningful way unless it is rage-bolusing that leads to tanking and rebounding. The stuck lines at 200 and 220 due to hormones are crazy flat for me no matter the correction dose or if I eat food. It’s just stuck. I’ll copy and post this on my Hormones/Basal Rates thread for consistency.

The thing that keeps interesting me on this topic is how it flies in the face of what we’re taught…even by “Sugar Surfing”…that if you’re level, then all you need is a correction dose if you’re too high. That’s not true in my female body during weeks 1/3/4 of each cycle. It does work in week 2 when hormones are benign.

[bkh]

@T1Allison

The thing that keeps interesting me on this topic is how it flies in the face of what we’re taught…even by “Sugar Surfing”…that if you’re level, then all you need is a correction dose if you’re too high.

I have observed a BG phenomenon that I explain to myself thus: if my BG is over 160 for more than a half hour, I become less sensitive to insulin, so I need larger correction doses to bring down a high. It can take 3x or 5x the “usual” correction dose to get a response if I’ve been significantly high for a while.

Now I’ve had some folks agree with me that this is real and they experience it too. I’ve had other folks suggest that the problem isn’t insulin resistance, it is that I’ve eaten some slow-digesting protein or fat that is continuing to digest and feed extra glucose into my bloodstream. I say that both of these cause sustained highs at times, but for me the insulin resistance caused by a high is the main one. In any case, “If your BG is too high, you need more insulin” (as taught to me at the outset by my CDE.)

[docslotnick]

I have taken a 35u correction dose at 1am when I was 250, only to have my Bg at 245 at 7am. I can only chalk that up to high blood sugar insulin reststance.

[T1Allison]

Totally agree. And when a double or triple correction (or both in succession) do nothing for two week hormone stretches, but they do work during other times of my hormonal cycle, I have to examine other forces and factors.

My goal is to get to the point where I can identify when to pull the basal “lever” and by how much, and when to pull the correction bolus “lever” and by how much. My future quality of life depends on it.

It seems to me that as my progesterone increases significantly in the second half of each cycle, it is the gatekeeper that blocks all insulin action. Experience dictates that if I don’t keep it in check with increased basal all day long, correction boluses ain’t getting past the gates.

[T1Allison]

I’ve left a message for my endo’s nurse asking for a Rx for Humalog pens and ultra-fine mini pen needles today. I hope I can get those today from my pharmacy. (I already have Lantus pens.)

After the fourth site failure or pod failure in a row, I think it is time for a pump vacation.

Wish me luck. I haven’t been on shots in four years but hopefully my heightened understanding of my basal needs through the day will assist my success on shots.

[Scotteric]

Honestly I prefer MDI to the OmniPod. My recommendation is to get a pen that doses in half units, use Regular insulin for when you would use an extended bolus on your pump, and try different basals, not just Lantus. I like Levemir because I can adjust my dose every 12 hours for example and take more or less as necessary (more like a pump), but others love Tresiba.

[T1Allison]

Would you, or anyone, be so kind as to give me the quick and dirty on Lantus vs Levemir vs Tresiba? Lantus is all I’ve ever used on shots. My former endo off-handedly suggested switching to Levemir when I was in my second trimester with kiddo #2, but I wasn’t willing experiment with my care plan when organ formation was involved. Especially since I seemed to be the most knowledgeable one about my diabetic pregnancy at the time. Well, I WAS the most knowledgeable one about my diabetic pregnancy at the time.

Ultimately, for the last four years I feel like I’ve been trying to carve the David out of a heap of butter that’s been sitting in the sun while I’m wearing oven mitts. I need different tools. I think that is pretty clear.

[Scotteric]

The beauty of Levemir is that it lasts 10-14 hours on smaller doses, so you can split the dose and take different amounts for day and night without overlap. For example if I ate a lot for dinner and know it will digest slowly, I will take more Levemir that night. If I know I will have a stressful work day I will take more in the morning, and less weekends or days I am more active. The downside is having to take 2 shots, but I think the flexibility is worth it and at least on Tresiba couldn’t find a dose on one shot per day that worked for me.

[T1Allison]

Thank you. That is very helpful.

[T1Allison]

How precise are you about your levemir spacing? Do you have any “uh oh” moments if they are taken 10 hours apart one day and 12 hours apart the next day?

[Eric]

@T1Allison

Would you, or anyone, be so kind as to give me the quick and dirty on Lantus vs Levemir vs Tresiba?

Here are some posts I did, comparing Lantus and Levemir:
lantus-and-levemir-comparison
basal-insulin-strength-or-duration

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As Scotteric says, Levemir does not last as long. Is that good or bad? It depends on how you will use it and what you are looking for.

What I like about Levemir is that it is kind of like a pump, you can adjust your basal quickly. When using Levemir, I do it twice a day and can take different amounts all the time, so it is like a basal you can adjust. If I want to change, I only need to wait 12 hours and I can change. You can’t do that as easily with Lantus or Tresiba.

The duration depends on dose. For me it is 12 hours, but for you it may be longer or shorter.

I could give you an estimate of duration for you, but I’d need to get personal and ask how much your basal is and how much you weigh.

Or you can look it up here:

A double-blind, randomized, dose-response study investigating the...

Here is the important sentence:

RESULTS:
Duration of action for insulin detemir was dose dependent and varied from 5.7, to 12.1, to 19.9, to 22.7, to 23.2 h for 0.1, 0.2, 0.4, 0.8, and 1.6 units/kg, respectively.

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That sentence is horribly confusing.

So I tried to simplify it here . I think this is an easier way to view it:

Dosage amount (units / kilogram)	Average duration
0.1 units/kg	5.7 hours
0.2 units/kg	12.1 hours
0.4 units/kg	19.9 hours
0.8 units/kg	22.7 hours
1.6 units/kg	23.2 hours

By the way, make sure you convert your body weight to kilograms!

[Eric]

@T1Allison

Do you have any “uh oh” moments if they are taken 10 hours apart one day and 12 hours apart the next day?

I do think Levemir quits much more abruptly than Lantus, which kind of fades off. I mentioned that in one of my posts, I don’t recall which one.

[T1Allison]

Thank you for linking to those posts! I’m in the weeds w kids today. Hope I’m not breaking forum etiquette!

140 lbs/12 units would be my starting Lantus dose…so not sure how that would go on Levemir.

[T1Allison]

By the way, my husband bought a sack of potatoes so we can shoot my potato gun this weekend for stress relief. My gun is named “Eleanor Roosevelt”.

He’s currently rigging up Eleanor in the backyard with some sort of rope/string/something to use it to get a dangling dead limb (“the tree branch of certain death”) out of our oak tree.

At least I’m doing something other than chasing leaking sites and blood sugar this weekend, that’s all I can say!

[Eric]

@T1Allison

140 lbs/12 units would be my starting Lantus dose…so not sure how that would go on Levemir.

I will take a guess that 2 doses of 7.5 units of Levemir, taken about 12 hours apart would be a good place to start.

Also worth mentioning, you can do 7 and 8, or 6, and 9, or whatever works for daytime/nighttime variation you have in basal needs.