Morning basal tests are never a problem. In reality most mornings are basal tests for me. And I know for sure that my basal is exactly right.

Note: Basal is the insulin I get 24 hours a day – the background insulin that is needed all the time, without food. If you do not have diabetes, specifically Type 1, your pancreas does this for you automagically. The most important reason is that your brain needs glucose to function. If your blood glucose is low this is one of the reasons you end up in a kind of brain-fog, unable to function.

Back to breakfast. Often, however, I don’t eat anything at all for many hours after I wake up. Yeah, that’s supposed to be bad for you. Breakfast is the most important meal of the day, they say.

If I end up having a reasonable breakfast within a few hours of waking, then I can forget about lunch. I’m just not hungry.

So why am I carrying around all this extra weight? No idea! Most of the time I do reasonably low-carb. All that falls over in the evening. Doesn’t matter what I do during the day – eat, not eat, snack, have big meals, the evening is the deal-breaker.

If I ever had to do lots of little meals a day (they say that’s better for metabolism), I know I couldn’t cope.

Unlike breakfast, in the evenings, I can eat when I’m not even remotely hungry. It’s a real struggle to tell myself I don’t need that snack and I’m not hungry. My brain tells me I am. Maybe it’s something to do with leptin not functioning at that time of night? I don’t know. Sometimes I’m successful at resistance and sometimes I’m not. (Yes, resistance is futile!) Even so, everything’s easier with an insulin pump. I can bolus in the middle of an extended bolus with anything I add to dinner, like desserts or snacks, or even more dinner. It’s so easy!

I think it’s the evening snacking that is playing havoc with my weight, but even if I don’t have them, I’m not losing a single ounce. It’s sooooo annoying! I think having a desk job doesn’t help either. And truly, I hate planned exercise, but I know I have to do it. I just keep putting it off. Lupus and arthritic pain doesn’t help. Any exercise I could actually do, probably wouldn’t make any difference. It never has before.

Exercise doesn’t really burn off calories… well I guess it does when you do enough of it. Figure out how much exercise you’d have to do to burn off a Big Mac! I don’t think anyone has THAT much time on their hands, let alone the effort-value. Exercise helps your cortisol levels, which in turn helps a whole bunch of things in your body. That should be the primary reason to do exercise, not the calorie-burning part of it but the cortisol part.

One time I always lose weight. When I have to move house! Something to do with skipping tons of meals, not snacking and moving bits of me a great deal (like 12 hours at a time) while packing boxes. If only I could do that every day! Moving house is coming up for me in the next few months. Something to look forward to in terms of weight loss!

These cases are not only cute, but protect the pump, which has to last at least 4 years! As a Type 1 with an Animas 2020 insulin pump, I know how important that is! They come with a matching belt and can also be worn with the clip that comes with the pump. I’m hoping that kids will love these and be proud to wear their pumps and show off the cases.

The cases are available at www.estore.zansuri.com. They are designed mostly for kids, but teens and adults can wear them too! Please don’t hesitate to contact me if you have any questions.

— Insulin Pump Cases

Insulin Pump Cases - Flyer

— Insulin Pump Case – Dalmation Puppy

Insulin Pump Case - Dalmation Puppy

Today (actually it’s 3:00am the next day) I was out at a venue, cooking for Rosh Hashanah (Jewish New Year).. and eating. What’s that Jewish credo? We fought, we won, we ate. But on Rosh Hashanah, we pass commiserating over 1 & 2 in our history, and go straight to eating.

Managing diabetes can be a minefield at the best of times.

Today, I had activity on top of yesterday’s activity (cooking and prepping), and (between serving & clearing) eating an evening meal of several courses that promised to be a carb-fest of the worst kind! I blogged yesterday about how much restraint I might show. All that went to hell in a hand-basket!

Despite all that, I seem to have managed ok-ish, but could have done a whole lot better.

I got to the warehouse around 3pm and we started work in earnest around 4pm. I couldn’t have anticipated that timing as I left home and thought to increase my basal. Glad I didn’t because we sat around for more than an hour shooting the breeze before we headed for the kitchen. I would have headed low before we started.

I had some highs during the afternoon and evening (under 9mmol/L (160mg/dl), though), but fought the urge to treat them fully. Every time I BGL-tested, I got freaked out by the higher numbers, but I knew if I treated more than I did (1 small correction at 5pm), I’d get into trouble later.

At 7:15pm I bolused for food at 1/3 of pump-suggested dose for the big fat carb-lie I told it (brave, eh?).

On a combo over 2 hours, I’d told the pump only about 1/3 the carbs I really had!!! Tell it 1/3 and bolus 1/3 – interesting formula? And then had square of banana cake and pretended I didn’t have diabetes at all!

I had apple dipped in honey, at least 4 half-slices of semi-sweet bread (Challah), sweet fish (Gefilte Fish), a stew that was loaded with rice and potatoes, salad with a dressing I made (that had tons of honey-mustard in it)… and some other salads. All that, along with tasting from 4pm, and boy did I taste a lot of dishes,.. adjusting seasoning and tasting again. Yummmm!

Seriously, I can’t tell you all the stuff I ate that was loaded with carbs! While I didn’t have huge portions, it all added up, and kept on adding up.

Only the coleslaw (S&W Mayo) and beetroot salad (lemon/oil) were without added sugar or honey. It was like one big hypo-food fest! I think I told the pump 30grams of carbs and I’m sure I had at least 100+grams and more!

On the other hand, I had been standing and walking around the kitchen so long, I was in pain, which usually raises my BGL (I have lupus arthritis in all the wong places for being on my feet). A few hastily-bought (today) supermarket painkillers at various times really helped. After that I could hardly feel my aching feet, legs and back.

Right now, I can barely move! All pain meds have definitely worn off!!

Last thing I ate was around 8:30pm – 6 hours ago.

Highest BGL was a 9.9 mmol/L (178mg/dl) at 8:41pm, just after we’d finished eating, and while that number is high, I kept fighting the urge to treat.

I’ve been on a 40% reduced basal for about 4.5 hours, and at midnight started to head down… 9 (162) then 8 (144) and I’m now 7 mmol/L (126mg/dl).

Talk about exhausted! I fell asleep (sitting on the sofa) around 9:30 when we got home and woke around midnight. My BGL could have gone higher during that time, but I’ll never know. I doubt it though. Without treatment before or during those 2.5 hours I slept, it would probably have stayed high for when I woke.

The last insulin I bolused was that combo at 7:15pm with 4.30 units. Before that was 0.7u around 5pm.

I’ve dropped 2mmol/L (32mg/dl) in just over 2 hours since midnight with 40% less basal started at 9:15pm and no bolus.

It’s only 3am now (yes, this night owl should be sleeping) and I assume I’ll come down further by 4am. Who knows where I’d be if I fully treated every time I tested? Probably in the hospital by now!

How could I have avoided those early highs and not had hypos later? Maybe I should have corrected more early on, or increased the basal for 4pm, but I also didn’t know how much I had to do and when I could rest.

Not so easy.

Difficult to know what to do when you don’t know what you’re going to be doing 1-2 hours later, when the insulin has its peak effect!

Early in the evening, every time I thought to do an increased basal, or a correction, I simply couldn’t estimate at what time my body would start doing its usual post-activity BGL drop, or indeed when that activity would end – and that was on top of yesterday’s activity and hypo some 6 hours after.

So, I just didn’t do much correction all day or evening, and the one time I did, it was at half the pump-suggested dose.

Most of the time, I totally ignored the pump-suggested corrections when I entered my BGLs.

You’d think I’d run a marathon the way I’m carrying on, when in reality what I did was a little like working in a slow-paced restauant kitchen for one 5 hour shift! Nothing like my usual chained-to-the-desk work though.

I know I’m steady at 7 mmol/L (126mg/dl) now, a little higher than usual for this time of night, but I suspect a small, long-acting carb might still be necessary. Will assess in an hour, if I can stay awake.

I don’t want to reduce the -40% basal any further at this point, but I’d set it to 9 hours and I have 4.5 hours to go. Will see how I am before sleep, and readjust then, at least to beyond when I’ll wake up, just to be safe. I’ll deal with whatever in the morning.

And I get to repeat all this for lunch tomorrow? Maybe not! No idea how I’ll drag myself out there again by 10am!

I definitely have a much better picture of what happens with increased activity over several hours, over two days… FOR ME – and I can’t emphasise this enough. Someone else’s blood glucose reaction to the same experience, might be vastly different. So many people go low during increased activity or exercise.

Having only been on an insulin pump since June 1st, relatively speaking, I’m still pretty much a novice. Maybe it gets easier as time goes by and experience grows.

The management of diabetes during (for me) unusual and rare prolonged activity is certainly a minefield. I learned lessons tonight and for me, that was as important as not getting enormous and immediately dangerous spikes during the process, or having equally worrying hypos afterwards. The middle-ground, erring on the side of caution, is surely better than possible extremes.

Entering your BGL during the day, and then entering BGL with the grams of carbs you’re about to eat, will allow the pump to accurately suggest how much insulin it should give. It’s done on an incredibly complicated algorithm and it also knows how much bolus insulin you still have active at the time. This is called Insulin on Board (IOB). It figures this amount into the insulin-suggestion calculation.

On some pumps, you can just accept the suggested amount. On the Animas 2020, you have to enter the amount yourself. I rather like this idea because the pump has no idea what I’m going to do next – exercise, sleep, eat more, suspend the pump after the bolus and many more possibilities. I can then give less or more according to my needs over the next 3 hours.

The pump can be set to remind you to test your BGL. I have mine set to remind me every two hours after entering my BGL, which I test several times a day. After any entry, the reminder comes on screen for you to confirm it or change the reminder time – 1 hour, 2 hours and so on. When I sleep, I set the reminder to zero hours, so it doesn’t do the reminder alarm and wake me.

Because of what the pump records and the reports it produces, I have not yet needed to record anything manually.

Once a week, I upload the data from the pump to my computer via an infra-red cable. I produce the reports as PDF documents that I email to my medical team. They can then see trends, averages, total insulin and more, and perhaps suggest  adjustments.

The sample report below is just one of a number of reports available. It’s the one most people with diabetes will recognise – it’s very similar to a handwritten log. Yes, it’s my log for last week, with reasonably OK numbers (only reason I’m sharing).

Looking at the report, I see if any adjustments need to be made to any of the pump settings. Of course I’d probably look at a week or more of data, not just a couple of days.

Last week, I made a huge effort to keep my carbs fairly low, lower than my usual under 120 grams per day. It certainly paid off for me.

You’ll see the following:

The time of day across the top. Each day has 3 lots of data: BGL, Grams of Carbohydrates Eaten, Insulin Bolus.

At the far right, you’ll see the average BGL for the day, the total carbs for the day and the total insulin bolus for the day.

At the bottom of the report, the last 3 rows are the averages for the time of day, and the averages for the week on the right.

Note that the BGL measurements are in mmol/L, the standard in Australia. To convert to the USA standard, multiply by 18, or see the chart at the end.

— Animas 2020 Logbook

Sample Animas 2020 Report

There’s another report hat shows all the BGL testing data. You might test more than once an hour, eg if you’re low, or after a site change. The log book only has BGL value in any given hour – the average of all tests done in that hour. You can’t see in the chart below how many times I might have tested for any one BGL shown.

I’d love it if my HbA1C would be done on just the four days showing! Now, wouldn’t that be nice! Almost everyone I know in the diabetes world, has highs and lows. The days shown aren’t typical for me. I’m still having a problem going high between 11pm and 1am. I’m slowly tweaking the pump to take care of this. It’s not easy because I tend to go low in the early hours of the morning. I don’t want that to happen while I’m sleeping, so any insulin I have between 11pm and 1am will still be active 2-3 hours later.

I wanted to share because it was something I wanted to know and see before I decided which insulin pump to get. As you may have already read, I totally love my pump and I’m extremely happy with the choice I made.

— Blood Glucose Conversion Chart

Blood Glucose Conversion Chart - HbA1C to mmol/L to mg/dl

This chart shows HbA1c and what your average BGL would be in both mmol/L and mg/dl. It’s such a handy chart, I use it all the time!

New Tricks for Tweaking Dosing Formulas for Your Insulin Pump
I’m giving it serious thought.

Taken from an email to H:

From an email to S:

— Inset II Infusion Set

I was sure I’d had a site failure.

A ‘site’ is where the cannula goes under the skin with whatever infusion sets are used with the insulin pump. In my case, with the Animas 2020, I use the Inset II (pictured) – today, a pink one.

So off I went to grab another infusion set. Inserted it a couple of inches over and hooked up with the old line. Meanwhile, my BGLs had been going up and up. Once hooked up, and because I wasn’t all that high, I bolused again. Success! Within 45 minutes my BGLs were starting to come down. Yessss!

I then pulled out the old infusion set and sure enough, a bent cannula. I thought I’d done everything right with the insertion of that infusions set, but something still went wrong.

It happens.

(Internal Ref: 2umga7pxrz )

It was clearly a while (no idea how long) before the pump alarmed me, and I was extremely surprised to see that my BGL went up so quickly.

I changed the site with a completely new inset, then took a new cartridge and filled it with insulin. On rewinding the pump, it all went a bit strange. I hadn’t rewound properly and I had to call support for some assistance. A few minutes later, no problem, but I ended up with a cartridge with only 100u of insulin instead of 200u. No problem, I thought, I’d change it again in a couple of days, which I did yesterday afternoon. Somehow I’d napped through the 20u-left alarm. Lucky I woke when I did, I guess.

These things happen on a pump. In retrospect, I’d used my lower belly where I’d been injecting insulin for the past few years. And I’d occasionally had trouble with with absorption because of hard, fatty deposits that some people are prone to with insulin injections. I’m pretty sure I stuck my site into one of those places that were half-healed, but not quite.

Pump occlusions do happen, but insulin pumps alarm as soon as they detect it, so you can take action as soon as possible.

Otherwise everything is going really well. I’ve never had such good, steady BGLs – and this was one of the major reasons for me to go on a pump. Absolutely no regrets!

With only one very explainable hypo early Saturday morning (lots of activity on Friday plus a party), I’ve been going great. Two site changes on my own so far – one last Friday and one yesterday. Both went well, although I was a little worried about the one yesterday, but it turned out ok.

There’s no doubt that my blood sugar levels are really great, especially compared to this time 6 months ago on MDI. I’m astounded at the freedom this pump gives me.

Yes you need to test lots, but on MDI you should be doing the same if you want good BGLs. For the rest, it’s so easy!

I uploaded a food database and it went fine. In Australia, the food database doesn’t come installed.

I’m downloading pump data every few days because my DE needs to see what still has to be tweaked. We’ve already upped my basal by .1 an hour, and for some times during the day, maybe it’s a tad too much. I’m just waiting for a call from me DE to see what can be tweaked from a full week of data.

Am so loving this pump!! I made exactly the right choice for me.

Some hints before anyone goes on the pump.

• Do lots of homework.
• Download the manual and familiarise yourself with the functions.
• Do the online pump-school on the Animas site.
• Read “Pumping Insulin” by John Walsh, and then once you’re hooked up, use it to understand more.
• Play with the virtual pump on the Animas site.
• Make a list of your favourite foods with carbs so you can upload them to your pump later.
• Read pumping blogs and posts on Tu Diabetes and other sites.
• And ask questions!

The more you learn beforehand, the easier pump-start day will be. No two people’s requirements will be the same, but reading about others’ experiences was invaluable for me!

I have the most awesome Animas trainer on the planet (sorry, I want to claim this one). Not only does she wear the Animas 2020 herself, but is a fountain of knowledge and helpful information, given in a language catered to whatever level you’re at. She’s very kind and encouraging, and has a wicked sense of humour – definitely things I appreciate in any trainer. I can’t praise her and my DE highly enough for making this transition easy and painless in so many ways.

I’m definitely hooked up and flying!