Are We Making Things More Complicated?

"Me Looking Confused"

I have to tell you,  sometimes I think we make things more complicated then they need to be.

What am I getting at?

I am not talking about relationships.  I am referring to technology, blood glucose testing, CGM's, and the hundred new meters and pumps that battle it out for a piece of the economic pie.

I have always tried every new meter, and reverted back to the simple design.

Mentally it is taxing, for me anyways.  Let me explain a little further.

I have talked about Flip-Flopping back and forth from Pump to MDI, and insulin to insulin. But in all this Self Experimentation, it all comes down to behaving my self in the diet department.

I can achieve decent control on just about any insulin regime, with the exception of the old fashion two shot a day regime. AS LONG AS; I measure smaller amounts of carbs accurately, don't cave to the temptations of cookies and milk, and cover my fasting states with enough basal insulin.

I see so many folks (myself included) that chase numbers, or make changes to quickly, before waiting for a trend to occur. Thus creating a serious yo-yo effect in the blood glucose readings, or some rather erratic readings in general.

I have driven myself bananas in the past doing the above, only to end up back where I started.

The best A1C I ever achieved, I say achieved cause that's exactly what it is, was 6.2.  It was a result of exercise and diet. Surprisingly before the use of fancy pumps, CGM's and super computer meters. Good old fashioned injections.

Now I am an advocate for doing what ever works, and these devices have increased my and many others quality of life in other ways, like; flexible bolusing, more accurate basal profiles, and less injections, but for me it has never really improved my control.

I find we live in a world where we look for an easy solution, I've been searching for one my whole life with diabetes, but with anything you want to be successful at, it comes down to our choices, actions and work.

Devices, as complicated, neat, and effective as they appear, can work well but;  if we don't measure our carbs, pay attention to trends, plan our exercise,  our diabetes control will inevitably waver.

Just my humble take on things.

Trev

Pump Adjustments - Part 2 (Carb Ratios)

"Carb to Insulin Ratios"

First a quick update on the basals.  So I've decided to stay Pump Bound, with Mr Wizard Senior.  All is well thus far.  I set my basals as listed in the last post.

 Day one, my AM reading sucked, so it was a bust, day 2 much better.

Lots of testing, and documenting. Every little detail, Carbohydrate, fat, protein, activity, glucose levels.....I knew it would be a lot of work, but today I 'm already seeing stable before meal numbers.

Tonight I will have an early dinner (easy on the fat and protein) and fast until tomorrow to test my night-time rates which means a 0300 AM check. 

Next on my list to tweak are the carb ratios.

So to refer back to Dr Conway and Colleagues,  The Professionals Guide to Insulin Pump Therapy  as quoted below:

Adjusting The Meal Time Bolus:

The goal is for the blood glucose to rise not more then 2.8mmol/L 2 hours after a meal.  The meal bolus is based on the insulin to carbohydrate ratio: one unit of insulin to a determined number of grams of carbohydrate.

Raise or lower the number of grams of carbohydrate covered by 1 unit of insulin.  Make small adjustments: 1 to 2 grams of carbohydrate for each adjustment.

For example, if the insulin to carbohydrate ratio is 1:15 and the blood glucose two hours after is only 1 mmol/L above the pre-meal blood glucose, adjust the insulin to carbohydrate to 1:16 or 1:17.

Okay, so I have programed the 1:10 ratio into my pump for all meals. We shall await the outcome. As I have pumped for many years I know my variables roughly, but I am pretending to be a newbie.

I know that breakfast requires more then lunch and bedtime snack much less then supper, if you follow me. But I will do the trial and error thing and hopefully refine the regime. 

Better test since it's 2 hours post lunch as I type this.  One second.........

Okay, now. I am surprised it is high (Well technically in target, but I personally shoot for single digits) Based on the recommendation I was 7.4 mmol before lunch  and 10.4 (3 mmol raise) so I guess I am being too hard on my self.

I still ask myself;   Did I count properly? (Carbs that is) I did eat 2 strawberries on steroids, well, I am not changing the rate yet and  I plan to leave it for a couple of days.

If I get the same reading tomorrow post lunch then I will heed the advice above and change the ratio accordingly.  Work, work, work, think, think, think, tis diabetes!

I think I may hit Cosco tonight and get some CGM sensors, but man they are 210 dollars. Ouch.

Once again I know a lot of my readers are well versed in pump management. Hopefully someone finds this review useful, I know I am.

Cheers!

Trev