Insulin on the up...

It's been a busy few days and my blog love has been neglected! The next ten days or so are likely to be the same as we count down to our impending holiday - more on that in the next day or so, I promise.

I wanted to do a quick update on how I am finding my blood sugars and insulin requirements as I approach my third trimester. As expected I am starting to notice that my blood sugars have been creeping up and therefore my doses have needed a lot more adjusting. I must admit I haven't been as quick on it as I probably should of been. Things had been ticking along okay recently, although my last hba1c had risen from 6.5% to 6.8% and a few weeks ago I was struggling to remember the last time I had a good feast on some jelly babies, which is great to be avoiding hypos but I also knew this meant things were rising.

It's only when I write everything down and assess a week that I can see where things might be creeping a little out. But life has been getting in the way slightly as it does and all of a sudden a few days have gone by and my monitoring diary is looking sparse.

I'm trying to regain that control and today I have adjusted my doses again in preparation for tomorrow's after lunch peak. My insulin to carbohydrate ratio is now set to 1 unit = 5g for lunch, it used to be 10g then 8g then 7g and more recently 6g. I have also increased my basal slightly for the afternoon from 0.500 to 0.550. I could be heading for disaster making these two changes at the same time but I am fed up of getting sugars of 12..11...10 mmol/l two hours after lunch and then it not coming down any further despite knowing that my carb counting at lunch was correct. Something isn't right!

My other ratios have also increased and I know this will happen more and more over the coming weeks. I was taking part in an online diabetes survey yesterday and one of the questions asked how many units I took a day, I was surprised to see I am now on about 44 per day, which has increased from around 32 per day. So it's clear to see my demand for insulin is increasing. It will be interesting to see what tomorrow afternoon holds.

My other motivation for getting things back on track will come on Friday when I have my 26 week growth scan and I can see how things are going size wise. The thumps are getting stronger and I sense it's getting more cramped in there not to mention my ever visible growing bump. I'm intrigued to know if he is normal size or whether we are now on the road to big baby syndrome! Will report back on that front too....

Little by little...

Third day in and I can't believe how much more sensitive I am to my insulin/how effective my insulin is now I am on the pump.

I have cracked the latter part of the day (I think!) Two evenings running I have had steady blood sugars from my evening meals to waking in the morning. I have been weighing my food and referring to my carbs book just to make sure I can get everything accurate. It's the rest of the day that's the problem! 

I am still going a little too low for comfort, like this morning when I got out of the shower I tested and I was 3.9, so it was jelly babies pre-breakfast, then some more pre-lunch...good job they are on buy one get one free in Tescos at the moment.

The first challenge for the next couple of days is going to be working out what I need to take at breakfast, today I did 0.5 units for 10g carbs, not enough I had to correct. But 1 unit for 10g carbs would have been too much as the amount I corrected by plus the bolus I took with my breakfast was less than the total amount I would of taken if I had done 1 unit to 10g carbs. Get it?!

It's going to be a case of tweaking each day and seeing what happens, a bit like a science experiment, just a very long one, but hopefully a very beneficial one!

(Picture credit: http://www.flickr.com/photos/jurvetson/2798315677)

Up and Pumping!

So as you can see I am all connected and into my first 24 hours of pumping! I had a bit of an information overload yesterday so decided to steer away from an update till this morning. Although now I fear I am about to give you an information overload...

The pump training took about 4.5 hours yesterday and by the end of that I was all set up and on the bus back home. One of my first jobs was to find a spare cupboard for all my pump paraphernalia, my flat was getting over taken by boxes of infusion sets...

My pump is an Animas 2020 (in silver), filled with Novorapid and I'm currently using the Inset II 60 mm infusion set. My trainer advised to stick to the basics for now, so one basal rate, one insulin sensitivity factor and one carb to insulin ratio. It's kind of like starting again and if you go in with all different rates and ratios and don't get it correct (I think it would be a miracle if you did!) it's harder to work out what factor you need to change. So here's my set-up:

Basal: 0.600U/HR (a 20-25% reduction on my basal rates with injections)

Insulin Sensitivity Factor (ISF): 1 unit lowers 3mmol/l

Insulin to Carbs Ratio (I:C): 1 unit = 10g carbs

Target: 7.5mmol/l

I doubted that these settings would be suitable for me for the entire day, but I was willing to try it and see what happened.

I rang my nurse, Amy, before she left the hospital for the day to update her on my blood glucose (7.6) she had previously told me that I would probably run a bit high for the first few days so I was surprised I was getting lower readings. She recommended that with my evening meal bolus I override what the pump suggested if I felt it was too much. Which I ended up doing, in fact I halved my insulin to carb ratio. Despite the lows my results are looking good, my blood glucose already feels more steady, although I don't know if this is completely the effects of the pump or just because I am concentrating so much on it at the moment!

(all results in mmol/l)

16:45 - 7.6

18.15 - 2.3

18.30 - 3.2 

19.55 - 5.4

20.35 - 7.3 

22.50 - 7.8

01:00 - 8.7

04:30 - 12.3 

08:15 - 7.1

09:25 - 10.2

11:20 - 10.8

Don't worry I won't be letting you know every single result every hour of the day...

I'm going to see what this afternoon brings now, see if we have a repeat episode of yesterday and if we do I have evidence to suggest introducing another setting. I stocked up on supplies last night just in case, cupboards full of juice and jelly babies! 

Feeling Hot, Hot, Hot

It's hot in London. Very hot, almost as hot as being on holiday.

So, if that's my conclusion why am I not reducing my insulin like I would do on holiday?

This morning on waking my blood glucose was 8.1mmol I took my normal breakfast dose and ate the same cereal and amount I always do. When I tested about 2 hours later I was only 7.6 (lower than usual at that time of the day for me), my morning snacks then consisted of 10 grapes, a small smoothie and a cereal bar - so near enough 50g of carbohydrates. Lunch time blood glucose, 8.2 mmol. 

Perfect, this sun has some bonuses. Plus it means I get to eat nice things like Fab lollies because I 'need' them!

Picture Credit: (http://www.flickr.com/photos/worldofoddy/339925295)