Three months pumping and really frustrated

[Michel]

@Chris

As my son has approaches 15, he is pulling away from his mother and I in a predictable way.

I know this is coming. I figure we will adjust his goals as you have, it seems to be the right way to proceed.

We do need to find a way out of our present unsettled circumstances.

[Eric]

@Michel

He is but unfortunately he is not getting that problem every day

If he is above a certain number when he wakes up, he should take a small bolus. If below the number, he should not take it. That’s a simple thing. It’s the same if you are on a basal insulin or a pump.

Things don’t work the same every day. They never will. There are reasons for it being different. But you can’t expect them to always be the same.

[Michel]

@ClaudnDaye

Reading this makes me very afraid for Liam and the years that lie ahead for us.

I think I made a very significant mistake to start with. I was overconfident that we would be able to deal with everything that came our way. We should have added new things piece by piece. I think that would have made a big difference.

@ClaudnDaye

This is already more on their shoulders than most other kids will ever have to deal with so we just have to remain supportive, encouraging and try to foster in our kids the importance of being “on the ball” where D management is concerned so that they can be around much longer than the two of us.

I cannot agree more with you, except that you put it in much better words than I!

@ClaudnDaye

It’s so difficult to diagnose a problem because “growth hormone” causes our kids bodies to react in so many unexpected ways

Again, I find this to be 100% true I think it is hard for people to identify with some of the problems we have.

@ClaudnDaye

I would only say don’t allow this to make you go without sleep as much as you can control.

I think that this is one lesson I must learn to apply. You know how it is with parents, we want our children to get the best. But by shortchanging our own sleeping needs I think we do end up making suboptimal decisions, you are absolutely right.

[Michel]

@TiaG

your challenge seems quite challenging indeed

I think one mistake was to expect we could deal with it all at all times I should have progressively introduced one thing after another.

@TiaG

maybe injecting Tresiba for basal and then using the pump so that your son can have easy bolusing for meals or during, say, swim practice might be worth it at some point if you can’t get things under control with the pump.

You are right. This is something I need to keep in mind as an option.

@TiaG

the angled plastic cannulas (like in the OmniPod) tend to have more issues with absorption as well, compared to the metal needles, so it may be that this is adding to your variability.

I had not considered that issue Yes, this could totally be another cause of vairability.

[Michel]

@Thomas

what is the nighttime range you are using right now?

@Thomas, depending upon the days we use 70-120 or 80-120. If he starts the night on a big high we dial in 80-120 so we can catch the low before too late. In fact, in the case of a big high I may go as high as 100-120 to start the night. Then, once he has recovered from the hormone high, I will switch to a standard 70-120.

A couple of very hard nights I have broken down and gone for 70-130, because 120 did not seem a reachable goal given violent swings.

[Michel]

@docslotnick

just loosen up a bit.

I am starting to feel that I need to

@docslotnick

I’ve not had the best control over my whole 46 year tenure with diabetes, but it’s been good enough to not have had any complications.

I do think of that. But I also worry that maybe it is because you have some great D genes, when my son may not have them?

@docslotnick

But a slightly higher target will go a long way towards ensuring not only your sanity, but also your son’s.

I hear you!

[Michel]

@dm61

Set your goals not in terms of some super aggressive bg targets, but in terms of uninterrupted sleep.

I am getting to feel that you are right. With little sleep I am sure I am not making very good decisions. I am irritable and easily down when I am normally a perennial optimist. These are not helpful changes

@dm61

I have to say that cannula+tissue interactions bring in another variable that could be behind at least some of the inconsistencies you are observing.

You and @TiaG are both mentioning this. This could well be an issue for us:( I had very high expectations for the pump because of sports, and I HATE to move away from it because it makes things such as swimming so much easier. But, clearly, what we are doing today is not working well for us. I will definitely look into a switch to MDI, if only temporary, or a combination of the two.

[Eric]

@Michel

depending upon the days we use 70-120 or 80-120. If he starts the night on a big high we dial in 80-120 so we can catch the low before too late. In fact, in the case of a big high I may go as high as 100-120 to start the night. Then, once he has recovered from the hormone high, I will switch to a standard 70-120.

So at times you have anywhere from a 50 to 20 point BG range?

In all seriousness Michel, you won’t ever get much sleep like that. Seriously, loosen this up a bit, okay?

[Michel]

The 20 point range is only to catch a big high that is coming down, because if he comes down quickly, a CGM reading of 100 going down could be a real reading of 70. So the real range is 70 or 80 to 120.

[Michel]

@TravelingOn

I am wondering though, if you could include some indoor aerobic/anaerobic “circuit” that would mimic swimming somewhat?

This a GREAT idea. I am now reading your link, that is really interesting. I will be pursuing this for sure!

[Thomas]

When I give a nighttime bolus and I expect (hope??) the BG to be dropping, I set the cgm low alarm to be as high as possible which is 100 on my version of the follow app.

If the BG is in a good range (for whatever I consider good) with little to no IOB and mostly flatline, then I would set the cgm to a low alarm of 85.

I try to use the cgm alarm to wake me up before it drops low out of range so I can look at the situation and decide whether additional corrective action is required. Depending on the slope, I might adjust the alarm at that point and just go back to sleep or I might need to give some carbs on a steeper downward slope so as to avoid a real “low”.

[Eric]

Just as a general observation, I have done MDI for many years and know all about my D and everything. But it still took me a while to recognize differences with pump and MDI and get things tuned really well.

[Sam]

@Michel

So the real range is 70 or 80 to 120.

This is not a reasonable expectation for an adolescent… hell it’s not even recommended, let alone achievable. Crank the upper end to 140 for starters. You are trying to manage a diabetic teens blood sugars tighter than a non diabetics natural range. It’s not possible or even a good goal…

[Michel]

Well, we were able to trigger on these levels until we went on the pump. I am not saying it was easy, but we learned to deal with it. So it was not absurd for us.

You can understand that I am reluctant to give up on control that we had. @drbbennett has a similar issue with the 670.

But, really, I don’t know if it is the pump. I am floundering at this stage because too many things are going wrong at once. If the issue is that his puberty hormones require loosening triggering levels, we will have to come to that. I am hoping that the problem is somewhere else, with how we deal with D.

[Michel]

@Eric, what is your triggering range?

[Sam]

@Michel

But, really, I don’t know if it is the pump

It’d be really really easy to rule that out wouldn’t it? What’s the hesitation? Like I said I see this hesitation all the time and I really don’t understand it. There is a psychological attachment to pumps that I don’t understand and can’t relate to it seems

ETA— the absolute worst that could happen with an mdi trial is that you’d be up all night… hmm…

[Eric]

@Michel

what is your triggering range?

I only use it at night. During the daytime I catch it well before the CGM alerts. At night the alarm is set for 140.

[Eric]

I think before you give up on the pump, you might consider changing a few things.

• Having a solid basal that doesn’t get reduced except for exercise.

• Making sure your basal is high enough.

• Fixing highs with a bolus instead of a basal.

• Treating a low with carbs instead of a basal.

• Look at pod day and see if that is a factor.

If you are making 2 day basal adjustments, unless he is sick or something like that, your basal is not set correctly. If you are dropping it 30% for 2 days, he needs to eat more carbs.

Just go back to fundamental stuff.

[dm61]

@Michel

depending upon the days we use 70-120 or 80-120

@Michel looks like you’ve already received some good feedback on these numbers, so I’ll just add my voice to the chorus: these ranges are just way, way too tight for anyone with T1D, let alone a teenager - no wonder you and your family are not sleeping well. I have no medical expertise or references to back this up, but not sleeping is probably more harmful (for all of you) than spending some time at slightly elevated bg levels. Again, find a range that first of all let you all sleep well through at least 5-6 nights a week. Then, you may tweak things to tighten that range, but not at the expense of sleepless nights.

[dm61]

@Michel

This could well be an issue for us:( I had very high expectations for the pump because of sports, and I HATE to move away from it because it makes things such as swimming so much easier.

Just to add some anecdotal evidence from personal experience: I started pumping with a particular type of insertion sets that had a 6mm cannula perpendicular to the skin. Everything worked fine for a few years, but then I started noticing some strange inconsistencies and I recall my CDE at the time told me some slender people (such as myself) were having issues with those sets, and she encouraged me try a different type that had a longer cannula inserted at an angle. I have since had next to zero problems with insertion sets for many years now, so I am fairly certain that poor performance I observed must have been related to the particular set type (not exactly sure why or how). I am not familiar with pods: are they all the same, or are there different cannulas you may choose from?