What made the difference?

By | 22 June, 2010

My HbA1c results show that my pump and CGM are working for me. But they’re not a cure so what is it about using those tools that’s made the difference?

Medtronic Paradigm pump & CGM

Doing the research

I read Pumping Insulin: Everything you need for success on a smart insulin pump by John Walsh.  It’s a weighty tome, but it helped me work out how to get the best out of my pump.

Beyond that, I think there are 6 main areas where I’ve seen major improvements:

1. Overnight levels.

Before – nights were a bit of a blood sugar rollercoaster ride of drops at 3am and rises at 5am. This meant I had to go to bed higher than I wanted to avoid hypos and I’d wake up higher than I’d have liked.

After – I can now go to bed at a 5 and wake up at a 5. I have the basal rate on my pump set to decrease at 1.30am, to ward off the 3am low and then increase at 3.30am to stop the 5am high. Looking at the CGM graphs of my overnight blood sugars helps me adjust the basal rates.

The CGM also showed that as soon as I get out of bed in a morning my blood sugar rises, even if I have no food. Now I take 0.5 units as soon as I get up to counter this.

2. Post meal peaks.

Before – I injected when the food was on the table and I could see what I was going to eat. Or sometimes I’d inject afterwards if I wasn’t sure how much I’d eat. If I was being good, I’d do an injection before a meal and then another after, but that wasn’t something I did often.

After – I conservatively guestimate how many carbs I’m going to eat and bolus for that about 30 mins before I eat, more if CGM shows I’m high. It’s no hassle, I just press a button. Then, when the food arrives I’ll put more insulin in if required. Dessert? Press the button again.

The CGM helped me see the impact of not injecting in advance of meals. I’d always known the theory, but nothing brings it home like an upwardly rocketing CGM graph. And nothing is more satisfying than seeing a gentle rise and fall after a meal, rather than a massive peak on a graph.

And then there’s the bolus wizard on the pump – I always thought I had no need for a glorified insulin calculator but I was wrong, when you get it set up right its much better at working out how much insulin I need than my finger in the air guestimates.

3. Dealing with certain foods

Before – pizza was a nightmare, if I injected for pizza as I ate it I’d be hypo in a couple of hours and then high for about 12 hours after that.

After – I use a dual wave bolus on my pump when I eat pizza. I set it to deliver some insulin as I eat, but then spread the rest of the insulin over the next 5 hours. The CGM lets me track whether I’ve got it right, and take more insulin early if I see I’m rising. Same goes for plenty of other foods too.

4. Less time spent flying high

Before – I’d only know if I was high when I did a blood test. If I was having a life and didn’t test for a whole afternoon, that would mean I’d be high for 5 hours and not know.

After – I have the CGM set to alarm if I go above 9.5. Plus,  if I look at the CGM and see that I’m rising fast I take more insulin to try and head it off early. That means when I mess up with carb counting or hormones kick in or whatever other reason means I end up high, I spot it early and take action quickly so I don’t rise as high or stay there for as long.

5. The little things

Before – a biscuit during a meeting or a couple of sweets stolen from a friend weren’t worth an injection.

After – I bolus for pretty much everything (assuming I’m not low of course). I’ll take 0.5 units for a small biscuit or a couple of sweets, it’s only the push of a button and it keeps my levels pretty flat.

6. Correcting highs

Before – If I was a 7 I couldn’t really do anything about it – I didn’t need a full unit of insulin so I was stuck with it.

After – Now, if I’m 7 I’ll take 0.3 of a unit to bring it down to around 5.5. A quick glance at the CGM lets me see where I am and whether I’m rising or falling. It puts the number in context – on it’s own a reading of 4 means I need to eat. With the CGM, a reading of 4 that’s been like that for several hours while I’m watching telly and have no plans to move needs no action at all.

So, the pump and CGM haven’t given me the magic bullet to diabetes control, but they’ve let me tweak my control is several key areas that all add up to better overall results. And better quality of life. It took a lot of research and effort to get to this point, but it works for me and importantly, it’s sustainable. I can manage my diabetes like this long term and have a life.

15 thoughts on “What made the difference?

  1. Mike

    Wow! It certainly looks like everything has clicked in to place, and I’m sure it has taken a long time and much effort, but you make it sound really easy!! 🙂

    Really need to spam my doc with emails as I the more I read and the more you here about the successful stories then more I feel I would benefit from having tools like the pump and cgms in place.

    Congrats Alison

  2. Mike

    Darn. I’ve been so sure over the last few years that a pump is not for me, but after reading this…

    Excellent ‘insider’s view’ of effective pump usage. Thanks.

  3. Mike

    @mike I can see the numbers dwindling from the MDI club already!! 🙂

  4. Alison Post author

    @mikeinspain Thanks. It took me about 3 months of hard work to get all that figured out, at times it felt like I was starting from scratch having to learn everything all over again. Since then it’s much easier, just a case of tweaking stuff as I go along.

    I think I need to sort out some kind of commission based deal for converting people to pumps, I’d have my mortgage paid off in no time!

  5. Caroline

    This is brilliant @Alison! Both your good control and the way you’ve laid the post out so we can see the main differences. I think I’m just coming to the end of my honeymoon period with my pump (just over 3 months now) and I’ve given myself time off to enjoy the freedom, but this inspires me to make it work better for me. Thank you! (don’t watch this space too closely – it’ll take me years to get round to figuring it all out I reckon.)

  6. Mike

    @alison Just wondering… do you rely on your CGM readings alone? I’ve read somewhere that they are not always hugely accurate (but what meter is, right?). Do you keep an old-school meter in a drawer for test-and-compare reasons, or just go by the CGM?

  7. Gillian

    Ooooh that all sounds really fascinating! I was thinking I was quite happy with my minimum of 4 injections a day but the pump is sounding increasingly attractive. Unfortunately I’m not going for my diabetic check-up at the clinic until November but I’m definately going to harrass and hassle the Dr until he gives up and is exasperated with me (,”) I’ve been thinking as well that in my line of work being on a pump instead of injections means that I won’t be taking time off the floor all the time or having to excuse myself while I go jag! Funny, I work with a nursing agency and yet when I mention to my employers that I have to nip to the staff room for 2 minutes to take my insulin they huff, puff and roll their eyes at me. How rude of me to take time off the floor to take my jag! I have to laugh at those same folks who nip off for at least 15 mins every hour to sook on their cancer sticks….*fume*
    Oh, and what’s a CGM? I’m intrigued!

  8. Gillian

    Oh another thing I wanted to ask – what happens when you’re in the shower/bath with the pump because I spend ages in it. Does it have to be disconnected?

    1. Gillian

      Thank you very much! Had a wee look on the net to see about CGM’s but there wasn’t all that much. I’ll have a wee nose at your link though. Thank you very much!

      1. Alison Post author

        Also, if you click on CGMS in the tags list on the right hand side of the screen (underneath the Facebook pics) that’ll show you everything on ShootUp that refers to CGM

  9. Steve Allen

    OOh im so envious been on the pump for 5 yrs and over the last 2 years have been suffering from severe hypos and i mean severe as in biting the inside of my mouth .The strange part is it only happens at night and since reading your site i see its not just me.Trouble is i asked for cgm and the doc straight away replied “theres no money available” so any advice is welcome on getting funding


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