6 months on the 530G

Well, my A1c is 6.4%.  That's higher than it's been for the last couple years, but not by much (my previous three readings were 6.3, 6.0 and 6.2).
So in terms of the A1c, I guess switching to a pump has not made any major change.

Switching to the 530G did not make a difference to my hypoglycemia in the first couple of months, as far as I could tell. However, in the last few months, there has been an extremely dramatic reduction in the frequency and severity of my hypoglycemia, particularly at work and also asleep. It has NOT helped with mealtime hypoglycemia, a major issue for me (where I bolus and go low due to food not absorbing).

I thought I was having a lot more, and more severe, highs. However, my A1c does not reflect that, so perhaps it's not as bad as I thought.

I have not been able to do as much site rotation as I would like. Neither of the types of teflon set worked for me, and the longest tubing length is not available for the "steel cannula" (I put that in quotations because really it's just a needle). So although absorption is fine in my arms, I can't, with short tubing, wear it comfortably there. The legs hurt way too much. That leaves the butt and abdomen. I've been using sites on the abdomen further up than I had before, which necessitates shaving the area, and still doesn't leave me with all that much available tissue.

My pump reports that my average TDD over the past 12 weeks is 39.5 units. For the 9 week period prior to pumping, I averaged 32 units. I believe that this is a significant increase in my TDD.

I gained four pounds since starting on the pump, which probably doesn't have anything to do with it. I'm happy about it anyways.

Features and symbols on the pump that I do and don't use:
Homescreen symbol showing how full the reservoir is... not useful. One bar means anything from 0 to 45 units, and everything beyond that is plenty.
Clock- look at and use a lot.
Communication symbol with sensor... ignore. I'm always looking at the graph anyways.
Battery bar- useful but it gains as well as loses bars, so I don't really know what to make of it.
Bolus wizard- don't use. I haven't been carb counting regularly in years, and the evidence suggesting that it helps is weak. I did have it set up at first but I just don't see it being helpful.
Square bolus and dual bolus- for the most part I have just set an increased temp basal instead, but I have occasionally used this feature. Right now it's turned off.
Audio bolus- used it at first, stopped. I never wear the pump in a way that I can't look at the screen, and audio bolusing is SLOW.
Bolus using the "B" button- rarely remember to use it.
Manual Suspend- I use this mostly when I disconnect, but occasionally to cancel a bolus in progress that I've thought better of.
Sensor is usually on, although not always. I generally have only the predicted low, predicted high, low suspend, weak signal, and calibration due alarms on.
I currently have five basal rates in my standard basal. I don't use the basal patterns, although I initially gave them a try. I would use them more if I could have more than two alternates, they would automatically switch on on particular days of the week, and they did not result in a "special status" circle on the home window.
I usually use temp basals where I set the rate. I change it to percentage, and set a temp basal percent, when I want a temp basal to run during periods where the basal needs would change. I would LOVE to be able to set a temp basal profile rather than one temp basal(ie, next two hours 0.5 u, following two hours 0.4 u). I probably use temp basals on about 4 days of any given week.
I don't bother locking the keypad. I tried that at first, to stop butt-basaling, but it unlocks itself when it alarms and that's just too useless.
I occasionally set the alarm clock. I wish it allowed one time alarms instead of repeating the 1:15 alarm everyday.
I often look at daily totals. I like to know where I stand.
I have had the alarm at various settings.
I don't use the connecting meter. Not gonna have insurance pay five times as much for test strips. Plus don't like navigating that meter.
I don't currently use capture event, because I rarely upload data.
I find the active insulin settings only slightly useful. I would like to program my own way to calculate IOB. I like seeing last bolus, but would like the status screen to show all boluses within the previous four hours. Then I can more easily calculate for myself a more realistic IOB.
I think it's really silly that the status screen shows me when I started my reservoir, rather than when I changed infusion sets. Those are the ones I'm much more concerned about.
I like seeing units left, but often use it past 0, because it's got quite a bit past 0.
I like seeing ISIG, and next cal is nice but would be nicer if it were accurate.
The backlight is nice. I forgot that there was a way to turn it on when you're not on the homescreen, and finding that again was great.

Oops?

I read a  study that kept using the term insulin dependent diabetes mellitus to describe a group of people who seemed unlikely to be type 1 diabetics (they were on average 68 years old diagnosed at age 53, their average BMI was 30, and they were more than 1% of the study area's over-50 population). When I got to where it said they classified people as type 1 diabetics aka insulin dependent based on their answering yes to the question "Are you an insulin dependent diabetic" I was sure that the population was in fact mostly type 2s who were taking insulin.

So I fired off  an email to the study authors, telling them that their premise that insulin dependent diabetes has blah blah blah effect was not really valid.

Only then did I read the rest of the study. At the end of the limitations, the authors admit that their insulin dependent population seems unlikely to actually be absolutely insulin dependent because less than 10% of the "insulin dependent diabetics" were diagnosed under the age of 30.
They say that their group of "insulin dependent diabetics" is type 2s who are "relatively insulin dependent". Which, although I think it's a bunch of bull hookie, still means my email was not exactly news to them.
Oops.

It's been six months pumping. I've got an endo appointment for Monday, and I'm holding out for the A1c and discussion with the endo before I weigh in on the pump.

Decisions, decisions

I got a piece of mail yesterday that brought unwelcome news.

It was a flyer from Activa Brand Products. It said that due to new regulations regarding sterilization of vial adapters, both Activa and Medi-Jector have stopped selling supplies.

However,  Activa is trying to figure out if they might be able to continue, with raised prices, so they are asking for people to commit to supporting the company.

Now, I don't really think I'm gonna stick with pumping. The sensors have misled me and resulted in me getting extremely high blood sugar twice recently (pump read 87 and meter said 357; pump said 60 and meter said 436). I've had numerous lost sensors recently.
The number of sites that work for me is too limited for the infusion sets and the sites are not healing well. Absorption is slower than with shots. I have a lot more highs. And I just don't much like it.

Buuut... it actually has made  dealing with lows easier. LOTS easier! Both the low suspend and the ability to turn down basal help.

 So I was thinking I might wait and get an A1c (I'm way overdue- working full time makes it harder to find time for doctor visits) and see where it's at so I can think about whether or not the highs are as problematic as I think they are (I'm guessing my A1c is up by more than a point and less than a point and a half).

I've also been thinking it might be good to use the pump to allow me to experiment with NPH. 

And wondering if I'm stuck with the pump for a while longer because I don't think insurance will want to pay for a new Dexcom for me within a year of me starting on this pump (could be wrong on that score).

So, thinking about the jet: with the raised prices, it's probably only economic for me to get membership and buy from Activa if I order a lot of years of supplies. On the jet, I need very few supplies partly because my insulin needs on shots are only about 70% of my insulin needs on the pump (nope, my insulin needs have not dropped- still taking about 45 units per day pumping vs  32 I was averaging on shots). But I kind of feel like keeping the jet injector business going is a good thing.

Thoughts, anybody?

Tired

I started working as a CNA in August, and my coworkers are a lot of tough ladies (also two men I haven't got to know because they work nights and I usually work 7 am to 3 pm). Some routinely work 3 or more jobs, sometimes 24 or more hours in a row... and they're grandmothers! Me, on the other hand... I can't work a 12 hour shift without falling apart. I've been getting just a little bit of teasing about it, from women who say, "I'm 60 years old, I work 12 hours and then I love to go dance karaoke- you're a young man, you have no excuse".

Last night,  I went into work for my very first night shift, and somebody asked me if I was going to be working 16 hours- to work my usual day shift as well. And I said "NO!" and she said that she had worked the previous night shift, had worked private duty for 8 hours, and then worked her usual, the evening shift- she'd worked 24 hours straight. And she's a grandma.

And I... I offered diabetes up as an excuse. I said that because of diabetes, I haven't had a solid night's sleep in 8 years. Which is not quite true; but I have 3-4 nights per week with lows and/or highs bad enough that either I stay up late because of them, or they interfere with the quality of my sleep. And 8 years puts me a few months before my dx, but April 2006, I had started wetting the bed and couldn't sleep due to thirst, so I think it's pretty fair to say that my sleep was being interrupted by diabetes then.

I feel a little guilty and uncertain blaming diabetes for my lack of sleep. I was never the world's champion sleeper, even when I definitely didn't have diabetes. And I'm aware that there are many type 1 diabetics out there who are capable of working 24 hour shifts and who probably would not appreciate me saying that diabetes is why I can't do a 12 hour shift. In fact, a few of my coworkers are type 2 diabetics... but not, as I understand it, in any kind of symptomatic way.

I believe that I am impaired by diabetes.
I do not believe that blood sugars like mine would impair everybody.
I believe that I have the right to say that I am impaired by diabetes.
I do not believe that I have the right to say that diabetes is by its nature impairing.
I believe that it is not my fault that I am impaired by diabetes.

And these are hard things to reconcile.

Not Much Management Monday March 31st

Rose overnight from about 0130 hours, when my bg was about 120, until about 0400 hours, when sg was 210.

When I got up at 630, sg was 211 and bg was 246. 

Had 2.4 u correction at the time; went to synagogue, sg had dropped to 190 at the end of services near 0800 when I bolused 10 units. Ate 20 g of crackers and I think 48 g of oatmeal (uncertain regarding the oatmeal because my father cooked it with raisins).  SG was down to 130 at 0900, rose a little bit and dropped; at lunchtime was 90 and looking stable. Took only 0.5 units for a snack of two rice cakes.  SG shot up to 155 by 1400 hours, and then drifted up a little so when I left work SG and BG were both 175. Took 1.1 units and walked home (2 1/4 miles). SG stayed steady the whole walk home but took a nose dive as soon as I got home. Bolused 8.5 units and ate supper without carb counting; it was split pea soup and noodles and I ate four bowls. SG dropped to 95, then came up to 140, and is now drifting very slowly downward. 

Today's blood sugar has been rotten and I don't want to post it. I was over 300 a couple times. I had 140 grams of carbohydrate for breakfast, took 17 units, and apparently should have taken 21 units. Correcting the resulting high resulted in lows. I don't know how much I ate for the lows, but I rebounded badly.
BLAH BLAH BLAH.

Monday Management March 17

At 0000, SG read 75.
I was asleep. The pump had suspended itself an hour earlier due to its belief that I was low.

At 0100 SG read 143, and turned the basal on at a rate of 0.6 u/hr. I slept on.

At 0200 SG read 201. I slept.

At 0300 SG read 236. I slept.

At 0400 SG read 248. I woke up briefly, bolused 1.5 units, and went back to sleep.

At 0500 SG read 236. I slept.

At 0600 SG read 207. I woke up a little later, thought it was dropping, left it alone, went to the synagogue. At 630, basal dropped to 0.3 u/hr.

At 0700 SG read 206. At 7:17, I decided it wasn't dropping enough and bolused 1 unit.

At 0800 SG read 187. I calibrated and bg on the meter was 147. Bolused 10 units at 820. At breakfast at 845. Breakfast was cereal with soymilk (24 grams carb for the cereal, 2 for the soymilk), a hamentash (about 25 grams), three large jellybeans (9 grams), 1/4 cup trail mix (10 grams), and some lettuce and hummus (1 gram?). Total of about 70 grams carbohydrates.

At 0900 SG read 115. At 9:35, I decided to change the basal to 0.15 u/hr.

At 1000 SG read 90.

At 1100 SG read 61. I suspended the pump (briefly), and at 1120, I ate lunch, which was tangerines (19 carbs) and bissli (21grams). I unsuspended the pump (so it resumed basal at 0.3 u/hr), but did not bolus for the 40 grams of carbs.

At 1200 SG read 98.

At 1300 SG read 138

At 1400 SG read 154. At 1430, basal increased to 0.425 u/hr.

At 1500 SG read 168.

At 1600 SG read 162.

At 1700 SG read 152. At 1720, bg on the meter was 175. Bolused 10 units at 1735 (I wanted to wait for the calibration to take). I also changed sets so I may have missed a fortieth of a unit in there.

At 1800 SG read 155. I ate supper, which was barley (just over a cup, so 40 grams) and eggplant tomato and tempe, about 10 grams of that.  Desert was an apricot and some raisins (about 15 grams).

At 1900 SG read 88.

At 2000 SG read 105. Bolused 1.7 units at 2018, and ate a packet of bissli (21 grams). Basal increased to 0.6 u/hr.

At 2100 SG read 99. Bolused 1.6 units. Ate another packet of bissli (21 grams).

At 2200 SG read 125. At 2220, with SG reading 137, bg read 185. Bolused 0.5 units, went to bed.

At 2300 SG read 186.

At the very end of the day, SG read 169

Monday Management, March 10

I went to bed Sunday night at 11 PM with a blood sugar around 204 and I bolused 1 unit correction.

At midnight my SG was reading 161. Basal was at 0.7 u/hr.
At 100 hours my SG was reading 145.
At 200 hours my SG was reading 132
At 300 hours SG was 137
At 400 hours SG was 177. Basal increased to 0.8 u/hr.
At 500 hours SG was 229
At 600 hours SG was 258. I woke up at 6:10 and bolused 4 units of correction. Felt lousy. At 6:35, tested bg - it was 246.
At 700 hours SG was 247.
At 7:15 I bolused another 2 units.
At 800 hours, SG was 258. Checked bg- 259. Changed sets. Bolused 10.3 units. Realized later I forgot to prime set so probably 2 units of that was in the priming. Basal dropped to 0.2 u/hr
At 900 hours, SG was 222. Ate ~35 grams carb.
At 1000 hours, SG was 222 again.
At 1100 hours SG was 154 dropping rapidly and I was feeling a little woozy. Between 1100 and 1200, I had two lemon head friend gummies, at 10 grams of sugar each.
At 1200 hours SG was 111. At 1230, I had one packet of instant oatmeal (28 g carbs) and bolused 0.8 units.
At 1300 hours SG was 170.
At 1400 hours SG was 132. Realizing that bg was dropping and basal was about to increase, I set a temp basal in order to keep the basal at 0.2 u/hr.
At 1500 hours, SG was 93.
At 1600 hours, SG was 59, and I had another lemon head friends gummy - 10 grams sugar- and started walking home. At 1630, basal increased to 0.425 u/hr
At 1700 hours, SG was 79. At 1715, with SG 87, bg was 111.
At 1800 hours, SG was 93. Bolused 10 units for supper, and ate supper immediately. I had one bowl of brown rice, two bowls of split pea soup, and one bowl of zucchini.
At 1900 hours, SG was 180.
At 2000 hours, SG was 181. Basal increased to 0.6 u/hr.
At 2100 hours, SG was 153.
At 2200 hours, SG was 133. BG was 134. I bolused 0.1 u at 22:50
At 2300 hours SG was 150
And I finished the day with an SG of 123.

4 units at 6:11 and 2 units at 7:15 and 10.3 unis at 8:05

Just Call Me Pump Killer

Last week I called to re-order supplies, they told me insurance said I couldn't reorder til March 2, and that on March 2 it would be shipped overnight. It's March 6 and I hadn't heard anything or received anything so I called back. Turns out insurance hadn't approved the reservoirs for shipping until APRIL. Of course, now I'm out of sure Ts and am gonna have to use some of the quick sets. My new sure Ts and sensors will be here Monday or Tuesday.

Then I tried to bolus for lunch... motor error. They're replacing this pump.
Pump #1 was replaced due to repeated motor errors.
Pump #2 was replaced due to a software error (although I called because I had a no delivery error fairly soon afterwards).
Pump #3 is being replaced due to repeated motor errors.

I have been pumping now for 88 days. That means my average pump has lasted just 27 days. My first one is the one that made it over a month. This one has lasted three weeks.