Feb 18, 2018
Keeping Calm and Carrying on: the Week that was with my Pump
One More Week ‘Till Auto Mode and Sanity, I Hope
As I have discussed, I received an “artificial pancreas,” aka the Minimed 670 G insulin pump. When I met last week with Ashley, Medtronics Representative/Trainer, I asked why I was to wait one more week before I went on full-auto mode. It turns out the meeting this week with Ashley was canceled due to a death in her family. She needed to deal with those more important issues, and it gives my pump more time to learn me and me more time to learn it. She said that the pump needed enough time with the sensor to learn my body’s needs and I needed time to learn about life with it. The learning time justified the wait. She also explained the sensor allowed the pump to stop the basal injections before my blood glucose (BG) was too low, or “suspend before low,” so I would experience less hypoglycemia.
The warning “remain calm” was given for when the pump suspended the basal dose before a low. She said not to overreact and eat a lot of extra sugar or drink too much juice to get the BG up. The pump uses algorithms and other complex math to predict what my BG will be using the sensor data. (Fun side note is that I read the reports from the pump that the web app makes, and I read the phrase “standard deviation” and flashed back to my undergrad Methods of Political Science class that I failed my last year at UT Tyler. That class was all I needed to attain an additional BS degree in Political Science. Oh, the bad memories that brought to mind…)
I really wish I remembered that warning Ashley gave me the Thursday morning after the sensor meeting when the exact scenario she warned of, “not overeating,” played out. I was due a site change since I only had 3 units of insulin my pump’s reservoir. I still cannot get the exact amount I want in the pump after getting the reservoir loaded. I decided to take the bolus, then change it. You are supposed to do that right before eating and not before doing a difficult task that might take an hour or so. I was doing my usual eating and exercise biking and my pump read that my BG was low and suspended the insulin. When it said it was around 60 or 70, I checked it with a finger-pricking test and got 52. So, as I was eating mints and drinking OJ while cooking my two turkey burgers, my BG swung from 52 at 3 a.m. to 252 at 6 a.m. after all the overreaction food and my usual food I eat. So, yeah, I overreacted, to say the least.
One really cool feature of the Medtronic Care-Link web app is the reports that I can get. Not only does it offer a really easy way to print records of my BG for any date range I choose, but also you can see percentile comparisons of weeks that show the algorithm that the pump uses to predict lows. It even has a running estimate of my A1 C from all the dates collected. It shows all the presets and parameters programed into the pump. It displays all the alerts and “events” that happened. It shows all rewinding the piston in the pump that pushes the insulin out of the reservoir, tubing changes, cannula, fillings, and the details of the boluses given. That is whether or not there was a carb total set and such. (The cannula is tiny tube that stays in your skin.)
The following Monday was much the same in overcompensating for the low alerts and basal suspension. I was warned twice when the sensor was in the 80s and resumed it because I knew food was in my body digesting. My BG was 260 by 6 a.m. and I had to do a corrective bolus of 2.7 with no food. I just hope the pump learns that I eat all carbs at once in the morning every day and the 104 carbs are coming. I can also know that and ignore the suspension alarm, keep calm, and continue with my eating and exercise biking. There are too many days to ignore warnings that say the BG will be way up 4–5 hours after eating. Tuesday went much better. I had no hypoglycemic episodes and my BG was between 120 and 160 all morning. Wednesday was another quick set site change and the first censor change that I did alone. The quick set was amazingly easy, but the sensor did not go as well.
Ashley suggested I try my leg as a site for a week since it was easier to move it around than the quick set that requires the pump to be close to work. So, I tried my left leg and it went okay, but the pump could not find and sync with the sensor. I pulled it off my leg and trashed that sensor set that attaches to my body and moved it to my stomach. Taping it down with the provided bandages is not easy. I am sure it will be as I do it in the future. I was immediately dealing with hypoglycemia after the pump finally synced with the censor. My BG was 83 and the censor was reading 81, so my basal insulin was suspended. I ate mints and turned an egg omelet into a sandwich. I did my bolus for one piece of the bread to keep my BG from rebounding too much. That was a mistake in hindsight. All 38 of the carbs would have done my BG well. I am happy that today by 8 or 9 it was stable in the mid 100s. Thursday went very smooth with the BG and everything going well. I was in the 100s all morning, and I peaked at 181 at 127 and settled at 152 later.
Friday, my BG again fell into hypoglycemia after I ate. I hit the 70s and took a while to finally get to the 100s after eating mints and drinking orange juice. Later, I realized that was a mistake when my BG was 254, and I had to do a bolus to knock it down. The highlight of the week was my meeting with a local advocate for disabled people for getting Social Security benefits. Ms. Rea is a local lawyer that makes her money by helping Social Security benefits for people that need them. So, she does not get paid unless I do. I gave her all my information and doctors’ names. I think I have a good case since I have 2 chronic illnesses and both have adverse affects on my mental health. I failed to go into the mental distress of those two diseases on my last appeal. Yes, physically I can sit in a chair and file papers, but will I stay sane while working part-time for an office? I hope that all goes as well as it can. Saturday, my BG was 139 in the morning and 167 later after I changed my infusion quick set. The BG got up in the 200s and later settled in the low 100s. I ate 3 mints with breakfast to try to avoid lows like Friday, and that appears to have worked out when my BGs were in the low mid-hundreds for the rest of the day.
Hopefully, the change to auto-mode helps mediate the episodes of hypoglycemia that are happening since I got my pump and sensor. At least the sensor shuts down the pump when my sugar is getting low. I’ve always thought that uncertainty about things in life is not always a bad thing. There is room for good things to happen. However, with two chronic illnesses of diabetes and M.S., and the daily ebbs and flows of my BG, I see the value in consistency and reliability.
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