[jeremiahtren]

I just started on the insulin pump(accu chek spirit)2 days ago and i keep getting blood sugars that are not able to register since they are so high.Even after I changed the infusion site to make sure there was nothing wrong with the set.Anyone else have these issues or have any advice.

By the way Iam going through 300 units of insulin a day and my basal is 3.3u/hr

 

[Richard157]

Did you need that much insulin when you were doing injections? Do you know why you need that much? I know people using steroid medication for other illnesses have to use much more insulin. There are reasons that explain increased use of insulin.

I started pumping in 2007 and I had numbers over 300 in the beginning. My endo gave me a terrible start when she programmed my pump. All the basal rates, carb ratios, etc were completely wrong for me. It took me several weeks to totally redo all the programming and stop having really bad highs. It took a total of three months before I had things running very smoothly.

One possibility you should consider. If you do not rotate sites and avoid using a body part repeatedly for a long time. you can develop scar tissue beneath the skin's surface. Absorption of the insulin is very slow and, sometimes, nonexistent, under those circumstances. That can cause very high blood sugar. I did not know about scar tissue when I started pumping. I started having high blood sugar and it continued until my problem was diagnosed. I use my lower abdomen for a few weeks, keeping the sites about 1.5 inches apart, and changing sets every 3-3.5 days. Then I switch to my upper legs while my abdomen heals. Any scar tissue that had started to form on my abdomen will disappear while I am using my legs. Rotation like this will prevent scar tissue. I cannot use my upper abdomen because I have permanent scar tissue there due to many years of not knowing I was supposed to rotate sites.

 

[onaughmae]

That is quite a bit of insulin. How much were you using before the pump? What kind of insulin are you using in the pump? When you got your pump...did they spend enough time teaching you how to use it?

When you bolus for a meal....check your blood sugar before you eat and then again 2 hours after you eat. Your blood sugar should already be back at least to nearly what was before you had your meal. If it is not...your insulin to carb ratio might not be right for you. What is your insulin to carb ratio now?

When are you supposed to see your dr again? If the machine wont register your blood sugar it is likely over 600. If it stays that way you need to be seen by someone ASAP.

 

[jeremiahtren]

Did you need that much insulin when you were doing injections? Do you know why you need that much? I know people using steroid medication for other illnesses have to use much more insulin. There are reasons that explain increased use of insulin.

I started pumping in 2007 and I had numbers over 300 in the beginning. My endo gave me a terrible start when she programmed my pump. All the basal rates, carb ratios, etc were completely wrong for me. It took me several weeks to totally redo all the programming and stop having really bad highs. It took a total of three months before I had things running very smoothly.

One possibility you should consider. If you do not rotate sites and avoid using a body part repeatedly for a long time. you can develop scar tissue beneath the skin's surface. Absorption of the insulin is very slow and, sometimes, nonexistent, under those circumstances. That can cause very high blood sugar. I did not know about scar tissue when I started pumping. I started having high blood sugar and it continued until my problem was diagnosed. I use my lower abdomen for a few weeks, keeping the sites about 1.5 inches apart, and changing sets every 3-3.5 days. Then I switch to my upper legs while my abdomen heals. Any scar tissue that had started to form on my abdomen will disappear while I am using my legs. Rotation like this will prevent scar tissue. I cannot use my upper abdomen because I have permanent scar tissue there due to many years of not knowing I was supposed to rotate sites.

Well I just rotated early because my insulin pump rep and dr wanted to make sure my numbers was accurate.All they could say is my body is insulin resistant.Before I started pumping I was using 400 units per day so the numbers arnt that unreasonable for me.

 

[jeremiahtren]

Hey before I was pumping i was on 400 units.now they changed my basal to 4/uh.I was using novolog but the dr think iam building a resistance now he put me on humulin r. my carb to unit ratio is 1 to 3 and insulin sensitivity is 1 per 10.I have my dr and pump rep and educator cell and they have me call them every 2 hours.And I do check my bs when I sit down to eat and 2 hours after.

 

[Richard157]

Jeremiah, I am type 1 with insulin resistance, just like you. I am taking a type 2 med to fight the resistance. You should ask your doctor for a med to do that for you, then you will not have to take so much insulin. I use only 35-40 units per day. If I did not take the med to deal with the resistance, I would be using much more insulin.

 

[jeremiahtren]

Wow that would be nice.I ll ask about it.Thanks!

 

[onaughmae]

If you are not currently taking metformin as well as your insulin I would inquire about it

 

[jeremiahtren]

Okay Il ask.I had a rough night last night.Dr raised my basal to 5.0u/hr

 

[onaughmae]

Out of curiosity, how many total grams of carbs are you allowing for your meals or snacks? Maybe if you can give us an idea of a typical menu that you eat we can help you find any hidden carbs you might be eating and not counting for.

 

[jeremiahtren]

Iam allowwed 60 carbs per meal at home and 75 eating out. Iam pretty accurate and always include everything.

 

[Shanny]

That is an awful lot of carbs, Tren . . . I think it would be good if you dialed it down a little, at least until you get stabilized on the pump, and can get some of your pending surgeries behind you.

The simple truth of diabetes is that carbs raise blood glucose levels, and even people who are pumping are usually watching their carb intake very carefully.

Give us an idea of what your typical meals are like.

 

[jeremiahtren]

I really couldnt since I eat out alot.Iam a lvn and work 14 hr shifts.My meals are never actually meals there more like snacks.Is that really too many carbs.Thats what the pump rep and diabetes educator told me to shoot for.

 

[Shanny]

Yes, it's too many carbs - especially now that you say they're more like snacks than meals. You would be wise to aim for under 100g of carbs per day for a little while and you'll be amazed at the changes in your BG. Even though you're on insulin, you can lower your carb intake and you won't need so much insulin.

It is common knowledge among diabetics with good control that the medical professionals, dietitians & diabetes educators - even and especially the ADA - give uncommonly bad advice about carbs.

If you want to gain control of your diabetes, Tren, you're going to have to buckle down and control your diet. You have been following the advice of the docs and nurses, and that hasn't worked out too well, has it?

If you must eat out, then avoid ordering fries and anything that comes on a bun or on bread. Soups and salads are pretty good choices. Focus on eating protein and fats - they provide good nutrition, energy and they do not raise your blood sugar.

 

[onaughmae]

Iam allowwed 60 carbs per meal at home and 75 eating out. Iam pretty accurate and always include everything.

WOW. That is a lot of carbs. There is part of your trouble right there. A good number to start with is around 45 for meals and no more than 15 or 20 for a snack. My meals normally range around 35grams of carb. I can go up to a about 60 for a meal...sometimes....but only if I have not had a lot of carbs for other meals during the day. I usually only go that high when I am eating out. If you cut back on your carb intake you are going to see a big difference. I also am a nurse...and I work 12 shifts at night...so I know how difficult it can be to do. But it can be done. I dont cook a lot at home either, but there are ways to eat out even and keep your carb intake lower.

I am actually quite surprised your doctor is telling you to eat that many carbs and is increasing an already huge dose of insulin without offering you realistic dietary guidelines. Please ask about metformin also...you are obviously very insulin resistant and I am not sure why you arent on it already.

I also work as a nurse here in San Antonio...would be a hoot if you worked for the same place as I do! LOL

 

[jeremiahtren]

Hi

WOW. That is a lot of carbs. There is part of your trouble right there. A good number to start with is around 45 for meals and no more than 15 or 20 for a snack. My meals normally range around 35grams of carb. I can go up to a about 60 for a meal...sometimes....but only if I have not had a lot of carbs for other meals during the day. I usually only go that high when I am eating out. If you cut back on your carb intake you are going to see a big difference. I also am a nurse...and I work 12 shifts at night...so I know how difficult it can be to do. But it can be done. I dont cook a lot at home either, but there are ways to eat out even and keep your carb intake lower.

I am actually quite surprised your doctor is telling you to eat that many carbs and is increasing an already huge dose of insulin without offering you realistic dietary guidelines. Please ask about metformin also...you are obviously very insulin resistant and I am not sure why you arent on it already.

I also work as a nurse here in San Antonio...would be a hoot if you worked for the same place as I do! LOL

How funny. I actually work for my dr.and my basal went up Again to 5.5 in am 6.0 from 10pm to 1am and 6.5 from 1am to 8am.

 

[jeremiahtren]

update....since i changed insulins my bs has been great.

 

[onaughmae]

Awesome..I am really glad the new insulin is working for you

 

[breezeonby]

update....since i changed insulins my bs has been great.

What type of insulin are you using in your pump? It is hard to keep track since you have been on so many.

 

[jeremiahtren]

Out of curiosity, how many total grams of carbs are you allowing for your meals or snacks? Maybe if you can give us an idea of a typical menu that you eat we can help you find any hidden carbs you might be eating and not counting for.

right now iam allowed 50 carbs per meal.My numbers have somewhat stabilized but my insulin requirements went up.iam on a basal of 9.6 u/hr and using over 500 units per day.