The insulin pump does NOT allow you to eat as if you don't have diabetes


(Dylan404) #1

I don't know if you guys were told so, but I was led to believe once I was on the pump I could eat how I wanted as long as I gave myself the correct bolus. This couldn't be further from the truth if you want good control. Every time I have over about 100 grams of carbs in a meal, my sugar almost automatically rises to about 330. It doesn't matter if I bolus properly, or even double the insulin to carb ratio, I'm going to be high. The only way to control my sugars is too really limit the carb intake or spread it out through out the day. No buffets.


(qtpie14212) #2

wow. i actually did not know that.  i was also led to believe that once i got the pump i could eat whatever i wanted.  thanks for the helpful tip/advice.


(system) #3

i don't have any problem eating when i want. i have 3 different bolus rates depending on the time of day. also some meals (specifically chinese food/pizza/pasta) have to be combo bolused. I would talk to your CDE/nutritionist and find out if they can adjust your settings and teach you what is necessary at all times of the day.


(Dylan404) #4

Oh it's not about basal/bolus rates, its a matter of insulin absorption into the blood. For example, I went for sushi today and had about 150 grams of carbs. Normally I use a 1unit:10 grams of carb bolus ratio, which works fine normally. I did 25 units of insulin and wound up with a blood sugar of 337. I guess "binge" would be a better term than eating what I want, but I certainly still can't do that. 


(AmandaStewart) #5

I had the same problem that you have.  But i had to lower my 1:10 ratio with certain foods.  I also had to raise my basil and i'm now at a 1:5 ratio so 1 unit for every 5 carbs, but thats during the evening times, during the day its i unit for 8 carbs.  You need to talk to a endo or try switching, it will work out, i totally thought it was the foods i was eating but it took me over a year to figure out that its the carb ratio.   It takes a while to get it to work out.  How long have you been on the pump?


(sstrumello) #6

It's a myth that a pump or for that matter, any insulin analogue will enable you to eat as you'd like as long as you give the "correct" bolus because the truth is that insulin-to-carb ratios are at best, estimates anyway.  One thing you might try, however, is giving your bolus about 10-15 minutes before you expect to eat ... which may assist in this, something else to consider is adding Symlin (pramlitide acetate, which is synthetic amylin, a hormone normally secreted by the pancreatic beta cells which are completely destroyed with type 1 diabetes).  To understand why a pump won't resolve this matter, you may wish to read a Diabetes Health article on this subject (see http://www.diabeteshealth.com/read/2007/11/28/5565.html) which discusses how large doses of insulin, regardless of how they're delivered, any subcutaneously dosed insulin creates a pool of insulin in the subcutaneous tissue that approximates a ball or sphere. After the insulin is injected, it starts to be absorbed by the tissue it actually contacts. As you will see from the formulas and examples below, the larger the shot, the more time it takes to be absorbed by your body.  See this graphic for more details:

 

Sphere
Volume = 4/3 πr3
Surface = 4πr2

 

units of insulin* surface area
in mm squared
1 0.24
2 0.38
4 0.60
8 0.95
16 1.52
32 2.41
64 3.82
*1 unit of insulin is .01 ml

Looking at the chart, you can see that as the shot gets larger, there is less and less surface area as compared to the volume of the shot. This forces the insulin to wait longer to be absorbed, because the insulin molecules in the middle of the injected ball won't come into contact with the tissue until the insulin molecules surrounding them get absorbed first.

Symlin helps by delaying the surge of glucose from digested foods from entering your bloodstream until the insulin has been absorbed, thus assisting in leveling the peaks of blood glucose levels.

Also, dosing 15 minutes before does enable the insulin to start to enter the blood before the carbs are absorbed, which enables it to avoid the huge spikes which are so common after eating.

 


(Dylan404) #7

Hmm Thanks scott that is very interesting and I think what you've talked about applies to my issues the most. Symlin seems very interesting, but wouldn't it increase the risk of suffering a hypoglycemic episode leading to unconsciousness, as it would delay the rise in blood [glucose] after ingesting carbs to correct the hypoglycemia? Thanks. 


(whatruhere4) #8

i have never really eaten like a "perfect" diabetic. but i have always had good control. so with the pump i eat what i normaly ate and i dont really have too many problems. the nice thing about my pump is that i can do a combo bolus, i'm not sure if every pumper has this feature on their pump, but what that does is spreads out the amount of insulin i have according to what i eat. like sushi. i just hit the combo button and put in the total bolus amount and set it to give me that amount within a certain amount of time, for me it splits up the total amount and gives me half of the amount right then and there then the other half within that time frame. it's nice and my BG is usually pretty good afterward.


(DavidHein) #9

it doesent matter if you have a pump or not u still have diabetes and need to watch what you eat and when thats why i threw my pump away its just easier to do shots, that and i kept rippin the god damn tube when i went hunting


(Gina) #10

dylan,

Have you tried taking a dual wave bolus? dont forget you are eating rice which is much higher in carbohydrates and it takes longer to digest etc.. if you do a 70/30 percent split for like 2-3 hours that may help too. And if you know you are going out for sushi / chinese food and other higher carb foods you can try to bolus 15 minutes before you eat so this way there is insulin on its way before you actually start eating. if you use all the tools inside your pump the correct way you can eat what you want. I have been doing this for a while with chinese, sushi and pizza and it works like a charm for me. if you see a nutrionist of cde maybe they can help you with something like that split but for your own personal needs.


(Gina) #11

David,

You actually threw your pump away?


(slkboston) #12

Keep in mind-regardless of whether you pump or use syringes, anytime you eat carbs your BG will raise for a time until the insulin will work through.  For example, say you eat 100 carbs & you bolus.  Your BG WOULD be higher initially, the good thing though is your pump would NOT necessarily allow you to bolus if you checked 3 minutes later & your BG was up.  If you took manual shots you might not factor in all the variables & end up low later on. The pump factors this in.  It is really a great machine because it does a LOT more math & considers a LOT more factors than we might.

The other thing I like to explain to non-D's when they ask about eating stuff I "can't" have is that a diabetic could have a WHOLE cake & bolus for it & keep their blood at 100 after the insulin works through, but just because the freedom is there to eat & stabilize blood sugar, doesn't mean I can do it because I would be as BIG AS A HOUSE!

There is more freedom, but you still have to be careful about REGULAR nutrition.

Hope this helps some.

 


(ScrappyDy) #13

Well, my Medtronic Pump Rep told me that the pump is not supposed to allow you to eat just whatever you want, but more like give you the flexibility when to eat.  As a diabetic, you should always try to practice good eating habits (eating smaller meals throughout the day rather than 3 big meals and not skipping any meals), healthy eating, and portion control.  If you are on shots, you have to follow a stricter routine schedule, eating your meals at the same time every day.  With the pump, you can have more flexibility with this routine.  This is mainly what it is supposed to do, not BE your artificial pancreas.


(whatruhere4) #14

i agree completely, i don't really ever eat more than anybody. seriously i feel like i have the smallest stomach in the world. one PB & J and a glass of milk will fill me right up. if i get ice cream i usually only have like one regular scoop. but if im at home that's at least one and a half.


(Roo) #15

Hi Dylan.  I was on an insulin pump for over 9 years and I found that my A1C's were better but since I always had good A1C's that was not much of an advantage.  In terms of eating normally the only thing that you might consider if you have not tried this is to use the Square Wave Bolus when you eat high carbs.  Anytime I ate pasta, lots of bread or anything with high starch or fat I used the square wave to add insulin to fat ratio (for me it was one unit of Humalog for every 10 grams of fat--that was over and above the regular bolus I took at mealtime) and the timeframe for the square wave should be about 2-4 hours depending on how you react to it.  Try it if you have not yet and see if that helps.


(livygrrl1416) #16

I was also my doctor said i can eat WHATEVER i want as long as i bolus and to check in an hour or so!


(Dylan404) #17

I've changed my habits a bit, and I think there are two keys for myself: 

1. Smaller meals. The appropriate insulin:carb ratio seems to apply if I keep it under 60 carbs each meal
2. Reduced stress. Stress definitely interferes with blood sugar  


(darkene) #18

hi guys-  i justed joined this group last night so still learning to use it- but wanted to say i have a 6 year old boy who is on the pump (mini med) he has diabetes since he was 3 yrs old and been on the pump for 2 yrs  and it has been such a diference in alittle guys life-  BELIEVE me we still are figuring things out he goes through growth spirts, very active likes to eat junk that 6 yr old do-might be in a bad spot and one day he is higher than usual- but it still is so much better- we dual wave square wave reduce the insulin when he is in gym class-  but i am still learning his a1c have been ok-  but as a mom sending him to school i feel better with the pump-    i will say too i do agree at first i thought too oh he can eat what he wants-  it is hard with a little one-  


(system) #19

I haven’t had that problem. I can eat huge amounts (250g - 300g) of carbs in one meal and I almost always have good levels afterwards. The only time I do get high levels is when I tend to graze, eating something and bolusing every 20 minutes or so, that usually sends me high. And I have had plenty of buffets before. I'm not sure what pump your on, but with the Minimed you can set a dual wave bolus, for really low GI foods or when your eating over a long period, works for me.


(ScottT) #20

It is so misleading when marketing would suggest the pump replaces the beta cells.  Although Scott did a super job on describing how mathematically a large dose takes longer to diffuse in a single site, I learned this by trial and error.  I found that taking several small doses in different locations got quicker results.  I still will not bolus over 10 units - and very rarely use dual or square wave unless the site is new.  When I down 250 carbs eating sushi, I'll do a 10u bolus and a 15u shot.  I really don't like to bolus too soon before a meal - my reaction/absorption  time/rate varies from day to day and site to site.

The MAIN reason I use a pump is flexibility and control.  For so long, I was control by the NPH peak or that peak ... now I control.  Better.

Symlin (sp), I tried for a while - I didn't find it helpful in most cases and I was frustrated that I was on the pump and looking at 3 shots a day again.  Somehow, I worked out the problems that I went to get help for, and got a script. of Symlin ... it's odd how things have a way of getting resolved especially about eating behaviors!

I can't say that I don't get those HIGHS, but I get them down quickly.