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Re: [IPk] Re: sites

Regarding the fragments from Nanette's post (below)...
Just recently, inserting new sets has become much more painful, sites have
been lasting much shorter times, getting itchy after 2-3 days whereas they
used to last 6-7 days without significant discomfort, and when I remove the
sets there are often nasty red bumps - look like irritation not infection.
He thinks that part of the problem is due to basically unpredictable stuff,
but also that I am too hesitant to make changes - it's true - firstly I am
always in denial that my insulin requirements might be going up - for no
intelligent reason that I can fathom out, I hate the thought of my
requirements increasing, and secondly, I never can decide if low or high blood
glucose readings are the result of something very temporary, like having a
minor virus or a day of unusual exercise or stress, or if the change is
something which is here to stay for long enough to justify a change in basal
Re sets:
I have always been told that I should remove a set after 72 hours.  I usually
get about 100 hrs., but past that I get the itchy red bump.  I use Silhouttes,
which I prefer to Tenders.  The Silhouttes adhere to me better and I can see
where the cannula goes in.  I also had my one mega-infection when using a
Tender set.  Bad memories!

Re adjusting basals:
Keeping a logbook of your bgs and bolus amounts may help you may see the more
clearly patterns indicating your insulin needs.  The "rule of thumb" I was
taught: if something (a low, a high) happens three days in a row at the same
time, it's a trend and it's time to do something about it.

I have overcome some psychological hurdles about to upping my basal rates and
my scale for CHO.  (Incidentally, it's quite possible that changing your scale
for correction boluses and taking 1 unit per a couple fewer grams of CHO than
you do now--i.e., adjusting your 1 u per X mm/mol over Y mm/mol scale and your
1 u per X g CHO will be very effective. You may not really need to screw with
your basals much--back to the paragraph I started....).  I realized that my
psychological block had a lot to do with "you know, insulin makes you gain
weight," which someone who meant well had said once.  I don't even remember
who said it or when, but it rang in my mind and I worried about upping my
insulin requirements.

Well, now that I take an average of 45-50 units per day rather than the
"limit" of 35 u/day that I'd tried to impose upon myself a few years ago (when
my hormones were less active, when I ate a restricted diet, when I had a more
regular schedule--when my life was hardly anything like it is now), I am in
better shape!  Taking enough insulin and exercising regularly not only keep my
bgs better, but I have a little "wiggle room" in my diet.  I know that if I
didn't pay attention to my insulin needs (1 u per 12-13 g CHO) and I didn't
exercise, a dessert would be bad news, but now I can savor it in moderation.

Another psychological block: guilt!  When I was a relatively new pumper, I
feared being "discovered" tampering with my insulin dosage.  I began taking
insulin injections at age 12, when the refrain "never self-adjust your NPH!"
resounded in all the diabetes literature I read.  What's a basal rate but a
better substitute for intermediate-acting insulin?  When I started pump
therapy at 14, I was also told that I should aim to have 1/2 of my insulin
come from boluses each day and the other 1/2 from my basal rate.  That formula
just doesn't seem to work for me.  It took me about 3 years to realize that if
I have a 43-unit day, about 27 units will be basal, the rest will be bolus,
and that is fine.

[soapbox mode--directed at no one in particular--ON] Intensive therapy
requires willingness to assume responsibility.  If my HbA1c is not great (as
it was last fall), I am the one with some changes to make.  If my HbA1c goes
down some within a couple of months, I get to celebrate the improvement.
Intensive therapy requires the rhetorical question "if we blame others for our
failures, do we credit them with our successes?"  Of course one can't do it
alone, but there's a BIG difference between assuming the doctor knows best at
all costs and knowing when to seek guidance so one can have better control.
[soapbox mode OFF]


Melissa Ford
IDDM 7 years; pumper 5 years

M.A. student, Theology
The University of the South
Sewanee, Tenn.
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