I don’t know about pumps, this is more a general comment on a few of your blog entries.

One is that A1c aint everything. As you joked about somewhere, lows will affect your A1c. I know you meant it ironically but think for a moment: this means that A1c certainly isn’t everything.

In fact, I have discovered something that has been causing all sorts of side effects on me for years (13 of type 1)that a fast speed of fluctuating blood sugars, even if in relatively “normal” ranges, will stress the mind and body and cause systemic fatigue. Your endo will probably not recognise or treat this fact with sufficient seriousness (I’ve gone through 6 over the years that simply have no idea).

This is something your A1c can not show you. Being stressed and not thinking clearly is the greatest enemy possible, to your health and long life. That’s food for thought that getting things more even (even if A1c doesn’t change) may actually be of more value to your health than many other things. Lowering your stress (and I feel it and recognise it) will let you make decisions better, and you will make better progress as you solve your metabolic puzzle.

Interestingly, you mention that your endo “suspects” you are on too much lantus because of night problems: they suspected that for me too. I thought that for many months, and felt guilty for not being able to discipline to test in the night and morning, so never getting a “handle” on what was going on.

Lately circumstance led to me focusing heavily on getting to a better place with my D. After 5 weeks of ultra intensive testing, food logging, sleep logging etc, I came to and actioned this change: _double_ my Lantus dose and half my rapid acting. This created more even blood sugars than I have had in years and the resulting easing of stress and fatigue was astounding.

What was happening in my case? Something else endos can often “forget” to pay due attention to is that insulin can have strange absorption rates at different times. My night problems were actually caused by my dinner dose of Novorapid, which decided to regularly defer itself till the wee hours. A test or two in the night was not actually going to reveal this: I had to commit to getting a real picture of how my BG was going.

I’m not saying this is happening in your case, but it’s something to think about and an example of how endos can just plain have it wrong (or seem overconfident) and put an idea in your head that can stop you getting to the truth. Be careful of that.

Going back to the fluctuating BG is bad, tiring and stressful: my decision for less short acting and less carbs, consistant low gi meals, good amount of Lantus, stacks of fibre… and my body can find it’s metabolic rythym and overnight things are not nearly as sensitive and reactive (including my moods). That’s my movement to solution, I wanted to let you know there is a better place to be in than you seem to be, and the endo probably won’t find it for you… you will find it. I do recommend periods of intensive testing, andtrying to take a childlike, learning appoach to the data that’s presented.

Getting the motivation to do it is another story: in my case it was a trauma which can hardly be recommended

Good luck with it!

I tried MDI for a year, and it was absolutely for the birds. Of course, being a teacher, it is impossible for me to keep any type of regular schedule.

At least do a saline trial and see how wearing one goes. It is not as bad as you think.

workouts and Lantus? Oh my. You so want a pump!

I like to push myself; this would be completely and utterly impossible without the pump — unless I went running or biking with a backpack full of glucose tabs. (Hmmm … perhaps one could dissolve them in a Camelbak hydration pack?)

No, if your idea of being physically active is more han a slow ambling walk around the block, you don’t want to have long-acting or intermediate insulin in your system.

The other thing is, since you can nicely fine-tune your basal rates, correction factors, and I/C ratios, the formerly elusive comes within a pumper’s grasp. My HbA1c is consistently under 5.0%; I have not had a severe hypo after I got my normal and work-out basals adjusted; and my BG variance is always under 30 and mostly under 25 mg/dL. Yes, you can finally get decent results without killing yourself with lows!

Oh, and the 7.0%? Uh, no. 6.0% is what we should aim for. Sorry!

Cheers,
Felix.

I have been a type 1 for 39 years and pumping for the last 3. I was on NPH and regular for 35 years and then switched to Lantus and Humalog for a year where it took me 6 months to figure out that one shot of Lantus did not last me 24 hours and I too was having severe lows during the night and then extreme highs after dinner. Finally I split my Lantus into two doses taking it every 12 hours and shooting humalog for my meals, it worked great, but…..5 shots a day just to eat and more for corrections and if I wanted a snack….well you know. Bottom line I switched to the pump and I am the biggest chicken on the face of the earth and so programmed to shots and also did not want it hanging on me 24/7. In my opinion, a pump is the best form of insulin delivery and I feel every Type 1 should at least try it. All it really is, is a big syringe with fishlike tubing delivering insulin just under your skin, very very simple concept. Believe me diabetes still sucks, but my life is so much easier and two weeks ago my A1C was 6.5, and could be even better if I just stuck to three meals, but that is not living.

Karen

My decision was pretty much made overnight. If you’re going to leap from the fence, you’ll do it when you’re ready. I have complete faith in you!