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[IP] Getting an infusion set to last three days-Yes!



>From the great conversation and the tips you shared, I made a list of things
to try and have been working through it. I have used Humalog since Sept
1996.B  I remember trying Apidra once and checking and checking again to see
if I had forgotten to bolus - the startup time was so slow.B  So I stayed with
Humalog.
Here are the things I have worked through - I'll tell you in advance there is
a "miracle happens" moment.
1. I changed to Comforts.B  After some experience, including operator error
and remembering how painful insertion can be, I went back to my Accu-chek
Ultraflex 8mm set on the day I was off to an all-day meeting and had no time
to deal with a faulty insertion.B  I found the Ultraflex worked as well as the
Comforts.

2. I also pumped only basal trying to minimize what the set had to handle.B 
The best I could do with the Comforts was getting a third day by pumping 160%
or more to keep it going.B  The Ultraflex did that, too, so I returned to
Ultraflex.
3.B  I tried new territory, upper arms, with no difference.B  I still have
raised bumps where the sets went in and it's been a month.
4.B  I finally turned to a mix of Humalog and Regular 5:1 on March 1st.B  Had
some learning curve on getting a 5:1 cartridge but was not too far offB  When
I had an empty bottle for better mixing, it was easier.B  Continued 5:1
through March 20.

I thought there was some improvement but I did never got three days without
increasing the basal.B  I was pretty confident on getting 2 days, though. And
was using 130% basal to get the third day.B  I did make 4 days once with 160%
basal so I got some confidence I could meet the Medicare three days/set
mandate one way or the other.
5.B  Then on March 19th I had an all-day meeting; it was day 2 on the infusion
set so I thought I would be fine.B  Driving home that evening my Dexcom went
up a little to 106 but in traffic here there is no pulling over and I was ok
with that number.B  When I got home Dexcom read 116. But when I checked my BG
it was 175.
I believe when I do not have enough basal on board, my liver gives me a push
just as in the 3am Dawn Phenomenon.B  And when that happens Dexcom does not
pick up on this rising BG like it does for a BG rise coming from eating
something. You don't have to agree here.B  This is my YMMV experience.B  I
only mention this because it added frustration that led to my subsequent
decision.B 

Apparently this set stopped working at 48 hours, even using 5:1.
6.B  Now the miracle occurs.B  I changed the set that evening when I got
home.B  The next morning when I was making up a new cartridge, I decided to
try a cartridge of only Regular. I did not have meetings for a few days and I
would be home and able to watch this.B  Here's what happened.
I left my basals as they were rather than try to think back to how R should be
programmed earlier than Humalog since it comes on slower.B  To my amazement my
basals worked very well.B  I felt like I had a little more basal in fact.
(That's very subjective but I am sensitive to having a every three minute
basal delivery.) Something felt different and good.
I got three days out of that set, and never raised the basal percentage.B B 
On the next set I ran for 4 days and again did not have to raise the basal
percentage. Running at 100% only.B  What a surprise!

I used Humalog by injection for meal boluses so I would not have to rethink
that part.

Overnight I run a little lower than I'd like (60-80) but the pattern is pretty
level.B  No drops.B  (My overnight basals can be a crap shoot so this is
different.)

7. The other miracle is how well Dexcom works since I switched to R.B  I had
changed to the G5 when I lost my G4 transmitter in Feb 2016.B  I found the G5
very slow to sync up.B  Was usually 20 points off, could be either up or down,
too.B  I talked with Dexcom and they said it had to be in the sensor.B  I told
them my G5 didn't work any better than the Dex 7.B  Did not sync up well until
the 6th day.B  Usually the G4 worked well from day 1.B  But I had converted
the receiver to G5 so I was stuck.
I am on day 11 of the Dexcom sensor today - began a new one the day before I
started using R - and it continues to track well.B  Often spot on. This is a
change.

8.B  My conclusion is I do have an allergy to Humalog.B  There is no overt
reaction like a red bump or itching so I'll call it a mild allergy.B  But I
was not getting all the basal delivered.B  Which may be bringing my liver into
play.B  Which in turn affects my Dexcom readings.

 With only R basals I am more stable, sets last three days, Dexcom works
great.B  I am truly amazed.

To take this a little further, I have been bolusing R with the pump, too, for
the last two days.B  Again I am surprised that my usual bolus is working quite
well.B  Not sure if there is a little more tail on it, but it is mild if so.
I don't see my endo until late May so I am building up data until then.B  She
will likely give me a prescription for Novolog, but she may not believe me.B 
Once again, I am glad to have IP to learn from.B  A very big learning for me
this time. Couldn't have done it without you!B  Thank you all.

MaryleDexcom - Spirit
.
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