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Re: [IPk] intense contact after commencing treatment and weight g ain

On Monday 17 December 2001 08:56, you wrote:
> Hi Mary
> I saw your comment regarding Tony's e-mail and the ammount of
> contact follwing the onset of pump treatment.  I had a week
> of training with saline.  Every day I was phoned and told to
> do something (change the clock, vary basal rates, try a
> square wave bolus etc).  After the first week I went on to
> insulin.  The first day I was phoned 3 or 4 times and for the
> next four days I was phoned twice a day.  I found this very
> reassuring but I had very few problems.  I was fortunate in
> that my BGM's settled down very quickly.

Hi Bev
I think it's quite an individual thing really. If you're used to messing 
about with your insulin a lot, there's probably not much that your pump 
specialist can help with that you can't figure out for yourself.  It's not 
rocket science after all - all the same basic principles apply with a pump. 
Of course, it's good to have the backup of an expert, but not everyone is 
fortunate enough to have expert advice on hand 24 hours a day, or someone who 
can respond to emails and faxes. I certainly didn't have the benefit of any 
support like that (though I had a mobile number to use in an emergency).
Apart from the initial training in how to fill the pump and insert the 
cannula, I figured everything else out - like basal rates, boluses, high BG 
boluses, what to do for exercise, etc. myself and with the help of the list. 
Most of it is trial and error in any case, since everyone is different. But 
fo course, this method doesn't suit everyone. It works for me, because I tend 
to have a very hands-on approach to my own control, and because my experience 
of the medical profession has been that when it comes to fine tuning control, 
they're about as much help as a wet dishcloth (not through any fault of their 
own, but because different things work for different people).

As a couple of people have already mentioned, it takes time to get rid of the 
long acting insulin in your body, and to let things settle down, so for the 
first week things are bound to be a bit haywire, and it may take several 
weeks before you can establish any patterns.  My advice is to take it slowly 
and be patient - don't expect perfect control immediately. I'm also one of 
those people for whom doing basal profiles while fasting doesn't work, 
because my BGs don't behave the same way when I fast! It works better for me 
to eat something that has a known action - e.g. glucose tabs, or fruit, or a 
measured amount of cereal or something. Nighttime basal testing is also hard, 
because if I wake myself up to test in the night, I then can't go back to 
sleep and my BGs then change because of that.
> As for the question about weight gain - Do most pumpers gain
> weight?  I thought it was the reverse as less insulin should
> mean a small weight loss?  Perhaps it depends on your reason
> for swapping to a pump.  As mine was severe night-time
> hypoglycaemia (an effect of dawn phenomena.  My choice was
> either too low at 2 am or too high at 7 am.  I chose the
> former) then stabilising my BGM's meant no more chocolate
> eating in the night and a 9lb weight loss since I started on
> my pump.  The weight loss seems to have stopped now
> unfortunately.  I guess nothing good lasts forever!

Some people lose weight, some gain it, some stay the same. For some people, 
they gain weight because they're not tied to a rigid eating schedule any 
more. If you want to have a chocolate biscuit, or two or three, there's 
nothing to stop you, whereas on MDI you might think twice about it if it 
means having an extra injection to cover it. Some people find that foods they 
couldn't eat without great difficulty before are now much easier to deal with 
on a pump. 
Personally my weight stayed pretty much the same for the first couple of 
years, although I've recently lost almost a stone. I concentrated on getting 
really good control without worrying too much about the weight first of all. 
Now that's sorted out, I'm concentrating on the weight loss.
Hope that helps
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