Hi Paul! Yes sorry been a bit less chatty on here lately! So here, let me make up for that now all at once
In non-pump news, the 21-week-long strike by teaching assistants, research assistants and contract faculty at my university is FINALLY over, although sadly through government intervention rather than through actual negotiation. It was the longest strike in the academic sector in Canadian history. I'm glad to be back to work and to see signs of life on campus again, but there's a mad rush to get all the paperwork done and to try and limp through the remaining material (for students) and work hours (for us) from a term that was interrupted 5 months ago. And of course it's like pulling teeth trying to get clear information about procedures and things because nobody really has a clue, this is an unprecedented situation!
Pump-wise things are going well! My time in target for the last month according to Libre is 61% (and 75% for the last 7 days - I'm getting the hang of things!) Still some minor frustrations and of course I'm constantly running into situations that I don't know exactly how to handle. E.g. "Wait, should I reduce basal by 25% or 30% for this? For 2 hours or 3?" Of course I've been in the diabetes rodeo long enough to know it's pretty much always down to "educated guesses" but I do feel like it's the sort of thing that, over years, I will build up a knowledge base of what generally works, as a starting point - a knowledge base I don't quite have yet.
All my real problem areas are food-related (story of my life!). I need to work out how to account for high-fat, high-protein meals that also have some carbs. I know for protein without carbs, it converts at around 30%. But there are a few meals, like hamburger tortillas (ground beef and all the hamburger fixings but wrapped in a tortilla instead of a bun) where I have counted the carbs precisely, including condiments and veggies, and still my BG goes soaring, so I expect that I will have to work out a percentage for those situations as well. I mentioned it to my CDE and she said she's seen the same research as me on that point and wants to look into it more anyway for her own knowledge, and will let me know what she finds!
Lately I have made some changes to diet and exercise, which as it always has in the past, has affected my overall insulin needs. When I eat more carbs regularly, I need more insulin overall - including basal insulin for when I'm not eating, and I need more insulin for the same amount of carbs than I do when I'm eating more reasonably on a regular basis. And being more regularly active also contributes, though interestingly not as drastically as diet, I find (I've maintained the same activity levels for about a month, but only recently added diet changes, and that was when my BGs went wonky!). So after consistently having hypos after meals I've just gone ahead and changed my I:C ratios from 1:6 to 1:7, and from 1:5 to 1:6, all on my own
And I lowered my basal rates by 0.05 in a couple of places that I could see were trouble spots even without mealtime insulin. So far it's looking like it worked really well! Of course the goal posts WILL move eventually but I'm enjoying those nice flat lines on the Libre graph while they last!
It's interesting to see that my sense of my overall "patterns" on MDI still pretty well correlates now that I'm on a pump. I have a dip in insulin needs in the late afternoon (3-5 p.m.) and a dip in the early morning (3-5 a.m.), and significant DP that kicks in around 6 a.m. and continues over the morning. When I eat more carbs my IR goes up all around, I need more basal AND more insulin per carb. I say interesting because I know that hasn't been the case for others on here (thinking specifically of Sedge) and I was sort of prepared for the fact that I might find out something unexpected about my body, but turns out I pretty much had my finger on it all along! Nice to feel validated, haha!
I still think my correction factor will need to come down a bit, I'd expect at least 1u/2.5, but I'm trying not to make too many changes at once and only when there is an obvious pattern. Trying not to overanalyze too, but it's tempting when you have so much data and so many options you can fiddle with. I'm also still working at dealing with exercise, but it's kind of all wrapped up in needing to adjust basal rates and correction factor. My high-intensity workouts (which generally need additional insulin to cover) tend to happen early in the day when IR is already high and/or I already need a bit of a correction due to morning basal not being quite spot-on. And my lower-intensity walks (that often need a reduction in insulin) tend to be running errands right after OH gets off work, i.e. right in the "afternoon dip" period that I'm still working on too. What's interesting is with the pump being such a precise instrument, those effects are suddenly much more significant, i.e. I used to be able to just walk to the grocery store and that activity would kind of "come out in the wash" of the general margin for error of MDI - I usually wouldn't need to compensate for a walk unless it was very long (like hours) or particularly strenuous. Now if I walk even just 30-40 minutes, I have to think about how to compensate for it!
So, all a learning curve, but I'm down to the details now that we spend our whole lives working out anyway. Definitely feeling more confident to make changes on my own (it helps that, like I said, my understanding of my body's needs has mostly been validated by the pump so I feel I can trust my own analysis of any patterns that I see!).
Site-wise, I've discovered I quite like the thighs, nice and out of the way for any kind of bendy movements for yoga or cardio workouts, and not too uncomfortable to sleep on. I never used legs for MDI 'cause injecting there was too painful, but I definitely have a good fat layer there and since the pod is only one needle per 3 days it's a lot less uncomfortable in the long run. Absorption seems to be just fine! I can get 5-6 good sites out of each leg per rotation so that's a good month altogether before I need to move on to another site. I've completely ruled out the upper abdomen as being just too painful (same as it was on MDI - nearly ALWAYS bruised there!) but lower abdomen is pretty comfy, only problem is that I've got some decent fat rolls that kind of limit placement options, plus waistband limitations. These sites are kind of in the way for forward bends and squats and things (but super comfy otherwise). I can get 4-5 sites across lower abdomen, so that's another 12-15 days per rotation. I want to try lower back/upper butt again - I only ever did one pod there and it was the first one that I noticed leaking after large boluses, so I got scared that maybe that wasn't the best site (especially as I wear a backpack a lot). But now that I know what's what about the leaks, maybe it's still a viable site to try. Reckon I can get about 4 sites in there too, so another 12 days per full rotation. And I want to try arms, but I feel like I need to time that correctly with regard to Libre sensor changes. I suspect I'll like arms a lot too since they're also out of the way for most exercises. Maybe enough to be willing to risk moving my Libre sensor to an unapproved site to leave my arms free for pods! My suspicion is that I will end up mainly cycling between thighs and arms, which would still give me a good 45-50 days before coming back around to using the same body part again. Is that enough of a rotation, do you think?
Clinic-wise, I just had an appointment this past week, and we basically just went over details and brainstormed how to tweak things, same as I do at home but with 3 heads instead of one! I have another appointment with them end of this month, and I'm due to make up my missed appointment with the endo a bit after that. I think at that point we're going to start looking at transferring me over to their sister clinic that's more for longer-term care. If I have the option, I wouldn't mind staying with the current clinic, but I don't think that's possible and anyway having seen the kind of situations that some of their other patients are in, I also don't want to take up their time and resources unduly so that they can help those who need it more than I do!
And finance-wise, I've finally gotten my first cheque from ADP, now I just have to work out how to properly forward all the payment info and the receipts to insurance to get them to cover the remainder. Oh and it's almost time to order my next batch of pods (they said to allow about 2 weeks of margin). Hard to believe I've already gone through 20+!
Also, I FINALLY got some Unisolve in from Amazon and BOY is that ever a game-changer!! Thanks for suggesting it
Omnipod rep also gave me a bottle of Mastisol to help tack down the cannula end of pods to hopefully help secure the cannula more and prevent leaking from it getting jostled too much. Though so far I have mostly used it to stick down peeling Libre sensors and stickers