@Jen, I can only imagine how frustrated you are. I am really hoping you end up making it work.
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I’m not as frustrated now as I was a while ago… At one point I was literally ready to hook my pump back up then and there, and would have were it not for this thread! But now I’m willing to give it until the weekend, at least. However, if I don’t have things at least in the right ballpark by Sunday night, I imagine I’ll just hook my pump back up. I was flatlining overnight with my pump, and there’s only so much fine-tuning that can be done with a flat basal dose. I also strongly suspect that in another week or two I’m going to skyrocket up and run extremely high and have to start figuring out doses all over again, in addition to the changes having a busy schedule will create. I think all that would be fine if at this point I had my dose mostly nailed down, but if it all happens while I’m still trying to figure out doses, I imagine it’ll get pretty frustrating.
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Offer still stands if you want a PDM loaner. I have several.
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Really glad to hear that you have a plan, and aren’t too frustrated. I wish I always had the discipline to not get frustrated.
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Thanks for the offers! The “free PDM” offer for Animas pumpers has been extended (at least in Canada) until June. I looked at the forms and nowhere on them does it say the Animas pump must be under warranty. So I’m going to see if I can get one from Insulet. 
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Interesting change today. Despite two corrections so far (five units Fiasp total), my blood sugar has just been steadily rising since I got up this morning (now at 12.3 mmol/L).
Maybe 25 units of Tresiba is too low for during the day, and yet I still dropped at night…
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Now I can do that too, I have an extra spare!
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I didn’t realize you guys switched to tresiba too!?!?
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Today I’ve run high all day (basically the past 10 hours straight). The lowest I got was 8.4 mmol/L, but for the most part I’ve been >11 mmol/L all day.
I’m planning to do 25 units again tonight, since I did drop significantly last night. But I’m definitely feeling today that my basal during the day is not enough, since even multiple corrections aren’t bringing me down into range (this is typically when I’d bump basal rates up on the pump). If I rise overnight then I’ll go to something like 28 units. If I still fall while I’m sleeping, not sure what my next move will be.
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Well, that sucks 
As much as I like MDI, I must say that the ability to adjust your basal quickly with a pump is really a wonderful thing.
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Yeah, that is one thing I’m definitely missing, the speed with which changes on the pump kick in. That and being able to quickly touch bolus.
Are you guys doing MDI right now?
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No, on the pump for the last 4 months. I really like the simplicity of MDI. Although, right now, with the variability we have seen since the beginning of the school year, I am afraid to go back
I like the idea of the simplicity, too. But I’m really getting the sense that some people’s bodies are more complicated than others. I’m still not sure what I’ll do come the weekend. I’m nervous that come Monday (when I have the commute to/from work plus work itself and then an evening class) that things will become even more chaotic and hard to sort out. I wonder, for example, how people on MDI handle exercise like an hour-long commute home from work. Usually the commute to work requires no special treatment, but the commute home I’d have to do a temp basal rate an hour before leaving or I’d end up low every single time. And the class I’m taking is an ASL class, and often I’d get spikes because I’m nervous signing in front of everyone (still not very confident with it), which were easily taken care of with a quick 0.5 or 1.0 unit touch bolus while sitting in class. I really dread trying to work out those types of fine-tuning details on MDI if I’m still trying to sort out which Tresiba dose is right for me.
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Jen… were you eating breakfast lunch and dinner? If so as we both know you can’t attribute running high all day to your basal… I understand it’s been frustrating but your basal trends are just starting to become clear… they’re going downward at night, when you’re not eating… that’s the distinction you have to make in order to make this work
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Yes, but with the same boluses that I’ve been using all along, plus additional corrections. In my experience, if I misbolus for food and end up high, typically one correction should bring it down into range. So it’s the fact that I’m correcting multiple times and still not ending up in range making me suspicious that it’s basal.
Have you ever had the experience of running high or low non-stop and needing to make a basal change? Even my endocrinologist suggests this course of action if all my readings are out of range one direction or the other.
Obviousaly I can’t say whether it’s basal yet, which is why I’m sticking with 25 units again. But if I run high all day again tomorrow, then I will be really suspicious.
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It’s a learning curve to me to realize how much pumpers think in terms of pump therapy… which is very in depth and most have become very good at it… but discussing mdi is like comparing two completely different understandings… that’s not to say you don’t understand mdi I know you did it for years… but you still frame everything now in pump context which i think we’d have more opportunities for excellence if we could reach beyond that
It’s not so much framing it in pump context, it’s framing it in “varying basal needs” context.
If I frame it in MDI context, then I still end up with varying basal needs, I just use food and boluses to make up for the gaps. For example, on Lantus I was unable to skip lunch without running low and often also needed an afternoon snack, as around noon and the afternoon were my lowest basal needs of the day. At dinner I’d often have to take a second bolus after dinner until I figured out that Lantus was wearing off before 24 hours was up. I also had to get up at 3:00 AM every morning to dose several units so that I would wake up relatively in range (I was still often high), as that was my highest basal need of the day. I had Lantus titrated for the middle ground, at a dose where I had to wake up to dose every night and couldn’t skip lunch and often had to eat an afternoon snack, but otherwise was okay at keeping me in range.
That was over ten years ago, and my basal profile has changed, but the fact that it’s not a perfectly flat profile hasn’t changed.
I personally do not think I’m going to come to one Tresiba dose that keeps me flat all day and all night. I think if I’m titrating the dose for my lowest basal needs of the 24 hour period (which is early morning), then there are going to be other times I need to use Fiasp to make up for the rest (during the day). That’s all I’m saying. If I continue to drop overnight and continue to lower the dose, personally I think I’m going to continue rising high during the day, even without food.
Do you not agree with the above? I know it hasn’t been your experience, but we are all different. What do you think will happen to my daytime readings once my overnight readings are stable?
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@Sam, how else do you diagnose this, though? Given a known daily profile, imho multiple corrections in sequence that don’t bring you in range pretty much rule out a food dosing issue, even for keto meals.
I completely disagree. “Given a known daily profile” is a total farce in my mind. If very many people had a “known daily profile” that could be managed by basal adjustments I have no doubt in my mind that men and women as smart as you and Jen would have no challenge whatsoever bringing A1Cs into the high 4s without hypos. However, that’s not the case.
How I “diagnose” this, as a layman, but a layman who’s very very good at bg management is we have a patient who’s used to turning up or down the basal when her bg is high or low and finding patterns in those events… which can work quite well with pumping, and therein lies it’s benefit—- however it will require some adaptation to get really good at mdi with the modern MDI technology… also my “diagnosis” is that there’s resistance to using more bolus insulin even when it’s obviously necessary and or maybe adjusting diet to match bolus profiles…
You asked;)
Jen you’re amazing and please don’t give this up until we reach the best benefit it can give you!
I find it so strange that, despite multiple people stating that they have varying basal needs throughout the day, you are so resistant to this idea simply because your basal needs are flat…
Also, this statement ignores the fact that, not only are basal needs variable on a daily basis, but they also vary over time (illness, stress, hormones, physiology) and there are a million factors that may impact control on a daily basis.
If it were just a matter of setting the right basal dose and mostly forgetting about it, getting a really low A1c would be easy. It’s the basal variability (throughout the day and over time) and all the other factors that makes it so extremely hard.
I disagree. The basal:bolus split is supposed to be around 50:50 for many people. On a low-carb diet it’s supposed to be more like 75:25. On a day like today, I’ve bolused far more than 25 units between meal boluses and corrections.
But we’ll see what happens when I’m able to skip breakfast and eat a late lunch. I’m hoping I can do that tomorrow morning, if I don’t wake up low.
As I said, I’m not giving up yet. But this weekend when I’m near the three-week mark we’ll see where I’m at and I’ll decide at that point whether to continue.