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.