Should I go with an insulin pump?

[froggypond]

Originally Posted by blondy2061h

When you say Humulin 500, 20 units, do you mean you are actually taking 100 units with each meal? I assume by Humulin 500 you mean the U-500 strength of Humulin. If you are actually using 20 units (ie, pulling back to the 4 unit mark) there is no reason to use the U-500 concentration.

hello I am not quite sure what you mean by pulling back to the 4 unit mark ? It is Humalin R U-500 concentrate but when I give the Humalin I go the the 20 unit mark I use Bd Ultra fine 2 1cc 5/16 31 gauge needles and pull insulin down to the 20 unit mark do you think thats to much because I know at night when I give that much I get low sugars besides taking the lantus twice a day and the Humalin r u 500 with each meal I also do a sliding scale which is 4 units for every 50 over 150 which most of the time i am taking 16 extra units on top of the twenty units with meals.I thought I had it understood somewhat but the more I research the dumber I feel I thnk sometimes the doctors don't listen to what I say whenever I tell them that something is going on they just seem to prescribed some new meds and I walk around like a zombie for weeks till I adjust I would like to walk in there and speak like I am very well knowldged on this so maybe they won't look to give me more meds everytime I get a new one I come home and research it but still end up taking it because I think maybe it will help but still the same.Any extra info would be greatly appreciated THANK YOU

[blondy2061h]

Ok, if you are drawing to the 20 unit mark on a U-100 syringe with U-500 insulin, you are taking 100 units of Humulin, as U-500 is 5x as strong.

That means you are using 200 units of Humulin a day, and only 50 of Lantus. This may indicate a problem with dosing in and of itself because Basal (lantus)/Bolus (Humulin) insulin is usually a 50/50 split. Yours is 20/80. Some of this may be skewed though as you are taking the Humulin only twice a day, but I would expect that to skew it in the opposite direction.

Long story short, you would probably do better on more Lantus and less Humulin.

[lesley500]

Froggypond,

I too have a very difficult to manage Type 1 diabetes and have been at it for 27 years. Although I encounter many unstable times, my control improved 1000 percent after switching to the insulin pump 7 years ago. The pump really gives you the freedom to make adjustments. What's really important is finding a decent endocrinologist who has the wisdom to deal with non-textbook patients such as yourself. The amount of insulin does sound extreme---maybe you have been poorly diagnosed. Next time you visit your doctor, you might ask him/her about a new medicine called Symlin---it's not insulin--it's a protein which enhances the action of the insulin you take and vastly reduces the amount of meal bolus---the results can be really dramatic--so much so that you must be sure to eat a high carb meal so you don't get into serious shockout low. My doctor had me take it once a day with the eve. meal---I use this program when I run into days of severe ongoing highs.

But, in answer to your original question, I really think the pump, especially the new minimed machine with the monitering system is the way to go.It seems to be the best "delivery system" we have at this time.

Hope you start feeling better,

lesley500

[Mark1e]

Originally Posted by froggypond

..... the doctors have me on .... 200 grams of carbs a day.....

The easiest way to reduce your insulin requirements is to reduce those carbs - I would suggest to about 50 grams a day. Your blood sugars will come right down.

As blondy mentioned, the basal/bolus mix seems wrong. You are taking 100 units of Lantus (2x50) and 348 units of Humulin R with meals (20x5x3+48), which is total of 448 units a day (including the sliding-scale corrections). And I agree that the proportions are way out. It should probably be more like a 50:50 split - 224 units of both Lantus and HumulinR a day. Doing this would mean that your blood sugar wouldn't go so high between meals.

I am very aware that my insulin resistance increases exponentially as my blood glucose goes up. And if it goes over, say, 250 large amounts of insulin are needed to bring it down again. It seems you are fighting this battle all the time. Increasing your basal insulin could give you a breakthrough. But you would need to do it gradually and in a controlled fashion.

The fact that you are dropping so much at night is probably mainly the result of the the 100 units of HumulinR you are taking before supper. Regular insulin acts over about 8 hours, so the pre-supper dose would still be busy in the early hours of the morning. I would suggest minimising carbs at the evening meal and reducing the HumlinR at the same time. You will also find that minimising carbs at breakfast will get your day off to a much better start. I find that my blood glucose is far more tolerant to carbs in the middle of the day, which is when I normally eat fruit.

What oral meds are you taking? an insulin sensitizer or Januvia, Byetta or Symlin might help reduce your insulin requirements too. I also agree that, while the pump is the most sensitive delivery mechanism, using one would be would be an uneccessary complication at this stage.

Sounds like a really difficult situation. Hope this helps,

Mark

[rraszews]

Originally Posted by Mark1e

The easiest way to reduce your insulin requirements is to reduce those carbs - I would suggest to about 50 grams a day. Your blood sugars will come right down.

I was under the impression that reducing your carbs that low could bring on ketoacidosis. Isn't that rather worse? Or do the particulars of this situation make that less of a danger?