Un-tethered Regimen and more...
Wow...It has been a while since I posted anything here. Sorry! I have been very busy with visitors from out-of-state and just recently, my sister moved here! It has been a busy time for my family but that's a good thing.
Lately I had been noticing my pump sites going bad at an increasingly fast rate. Lately I can't even get 24 hours out of them. I have tried both the teflon and steel sets ( various types of both ) with no improvement. Between that and trying Symlin (again!- after my little break)and the spikes with that, I have been really approaching burn-out. Oh, and did I mention my Dexcom CGMS has been acting up too? Sometimes it feels like insanity with all of these devices...So I talked my doctor into letting me take a little "pump holiday" to give my favorite sites a rest. My -non-pumping Diabetes regimen? Lantus- (which I was kind of looking forward to trying since that was out after I started on the pump so I never did get to try it) and of course a rapid acting insulin analog. I also remembered reading that Novolog tends to be a little better in the pumps as it is "cleaner" than Humalog, so I asked if I could try that in addition to the Lantus that way if I needed to go back to the pump I had another option.
16 hours into the pumping "vaca", I was soooo ready for my pump again!! I really missed being connected to bolus whenever without having to haul out a syringe or pen. I went online for some insight into my little break and found an article that Dr. Steve Edelman wrote describing an "Un-tethered Regimen" which you can read about here:
http://www.childrenwithdiabetes.com/clinic/untethered.htm
Basically, the pumper takes Lantus in addition to using the pump- just takes less of the basal insulin with the pump and covers that with Lantus, but still has the convenience and precision of the pump (bolusing options, increasing basals for dawn phenomenon over JUST the few hour period that is the culprit of the problem for most people). I did this for a few days and it worked AWESOME- Honestly the best BGs I have seen in a long time- they looked so "textbook" and that is so not me! I felt amazing too. More "even". Then I decided to try to introduce the Symlin again since things were going so well. That immediately pushed my baseline to 160s-170s! Yikes! (I try to keep it around 90-100 most of the time) However, I am thinking it was a bad site, because despite many futile bolusing attempts, by BG wouldn't budge. Eventually an insulin injection did bring me back down.
Anyway, I've decided to wait until I knew for sure if I am just having bad luck with sites and need to stick (pun intended!) with injections for a while before trying Symlin again-
I will say I don't think it is the material of the site but the actual continuous infusion of insulin that is irritating the tissues because I've had my i-port ( www.pattonmd.com) in for longer than the site now (both went in on Monday around noon)and still no problems. I could've just hit a lucky site too, hard to say. The i-port has a 6mm teflon cannula that looks very similar to the Minimed Quick-sets and is about the same size. It goes sub-Q (sub-cutaneous) jsut like an infusion set and has to be changed at least every 72 hours, but you can inject right into the little hub and no more than 1 stick every 3 days! The needle gauge is 27G as opposed to the 31G of the new insulin syringes, so much bigger, but less often. You can put them anywhere you would inject insulin. I heard about them on the website I host and thought they sounded like a great idea and decided it would be a good thing if I were to try them to have some practical advice for any patients who may be interested. So far I have no irritation like I did with the pump sites, so that is why I suspect the sites problems have more to do with continuous insulin infusion (albeit a tiny amount) than with reaction to the materials that the infusion sets are made of.
Well, I am running out of room but wanted to give an update on my quest for perfect control-lol- Keep checking back for updates- I suspect my pump break won't last long and I may even selectively pump for occasions where I know it will be very helpful, but for now I welcome the break with open arms!
Posted by Carianne (Cari) Roorda
Back to pumping...
Happy Birthday to ME! It is my 32nd birthday today. Also, I have been living with "the big D" for about 15 1/2 years now. So what am I doing for my "big day"? Well, of course I am going in to the office. (:
I didn't sleep the greatest. My CGMS kept alarming "Low BG" and then I would get up and have a snack only to have it happen again in a couple of hours. Looks like I need to tweak my basals even more. I had increased them because of being sick and the lovely resistance that comes along with that.
So yesterday I put my pump back on. For the first time in MONTHS it didn't hurt to put in! I think giving my sites that little break- albeit a short one- did make a difference. I am still doing the Lantus (aka the un-tethered regimen) as I love the freedom that comes with that. In fact I encourage anyone on a pump to try it! I love being able to disconnect for a shower and not worry about getting the pump right back on, or just connecting to bolus if I have a fitted outfit on that doesn't have a pump friendly hiding spot.
One of my friend's daughter is type 1 and on the pump. While I was at their house this past weekend, my friend was telling me how hard it has been for her to deal with the pump stuff with the busy summer, swimming, etc. Also she had taken a nap the week before and didn't realize her pump wasn't connected or was suspended, whatever it was, she didn't have any insulin delivery for a few hours and then woke up high and feeling lousy. This is why I love having the Lantus "safety net". I suppose the disadvantage is that you can't totally suspend the pump for exercise or illness where you can't eat and are low, but adjustments can be made for those circumstances. I may have more to offer in the way of practical advice once I am able to start exercising again (should be this week as I finally feel MUCH better!), but everyone is so individual. I suspect since I can set my basals at about 50% while I exercise, I will be able to do 50% of my basal dose as Lantus- right now I am closer to 90% and just had the pump to kick in for Dawn Phenomenon (DP)and a few times of the day when I need a slight increase in my basal rate.
If you are in the area and are considering a pump- CALL ME and I would love to talk to you about it! Also there are quarterly NW Iowa pump support groups hosted by Judy Hauswald ( Sioux Center's diabetes educator) where you can go and find out more about the pump and meet other pumpers. I will post the dates when I get them.
I have access to Minimed, Animas, and Cozmore pumps and will soon have even more. I am not certified YET to be a pump trainer but am working on it. I need some official pump starts before they will call me "Certified". But honestly I can't think of anything I wouldn't know how to deal with after using a pump myself for 7 1/2 years.
Well, enjoy your week...and the rest of the summer that has gone by WAY too fast!
Posted by Carianne (Cari) Roorda
August 2009
Hello friends...
I am still loving my pink Medtronic Pump with the Real-time CGMS. I can say that it has saved me from several bad lows already.
I had been using the original teflon canula sets but recently started having a real problem with my sites. It seemed that for about 12 hours they were perfect, but then started getting irritated (itchy, red) and also I noticed huge swings in my blood sugars. It was like I wasn't even bolusing for my food! I decided to try an old bent-angle-needle "Polyfin QR" set that I had on hand and instantly my blood sugars stabilized- I have since been using the steel needles with way better luck and much more predictable sugars. Yesterday, after pumping for almost 10 years now...I ended up with my first "infusion site infection". I think it may have been related to dirty lake water seeping under the tegaderm dressing that I had covering my site. It was soooo painful and swollen, red and hot yesterday. TMI here, but if there is ever drainage from a site- especially if it's not clear- CALL THE DOCTOR. I called my endo as soon as I pulled the old site and he immediately started me on a 5 day course of Cipro. After just 2 doses the infection is improving- thankfully!I have seen some pretty gnarly site infections and this really freaked me out! The funny thing is that my sugars were FINE (up until the Cipro-lol) so I couldn't believe there was an infection in there...
Now on the Cipro I was having some mildly elevated blood sugars- I am trying a "Temporary Basal" of 110% my normal rate (or 10% higher) and it seems to be covering the resistance nicely. It's weird with this class of antibiotics (called Quinolones) because one may cause hypoglycemia, while another one will cause severe hyperglycemia... luckily I know how to manage that when it does happen!
Let's see...what else is new? Well, I am changing my office hours to 4 mornings (actually M-Th, 9-1) a week this year during the school year. I will, of course adjust my schedule to meet the needs of my patients when necessary.
Stay tuned for upcoming events this fall and winter!
Posted by Carianne (Cari) Roorda
