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[IPk] Re: Pump Holiday, and an idea

Apologies for replying late - I have been busy and plagued with a
feverish cold (now feel like a human being again thankfully) and got
behind with emails.

I agree totally with everyone else who said that if blood glucose
control is not going well, the last thing you need may be a pump
holiday, though for sure you really do need is not only a lot of
sympathy, but also some sort practical ways to deal with the
difficulties you are experiencing.

Your email reminded me that control has not been very good for me over
the last weeks, and that I really should do something about it. So I
did what I am lucky enough to be able to do, and what I understand to
be sadly quite out of reach within any reasonable time framework for
most people in the UK. I picked up the phone to my friendly
endocrinologist and told him I needed help - we arranged that I would
go and see him with all my bg records and graphs in a couple of days.
Every time this happens, he looks at the records and graphs and almost
always has insight into where I should experiment with changing basal
rates or boluses. This always helps me back on the right track, and he
is happy for me to phone him or come in briefly for follow-up help if
the initial changes do not work out as planned.

This is possible partly because he is essentially a colleague since I
also work in the same hospital and we have collaborated on some
projects, but also because relations between doctors and patients here
tend to be less formal, and though not many people can, like me, just
walk up one flight of stairs and drop in for for some quick advice from
their doctor, it is not unusual for patients to have (and to make use
of) phone access to doctors. And all this despite a very bad financial
situation in the health service here, and cutbacks etc.

I thought how much it helps me to have someone who understands look at
my BG data. Almost always, he points out things that I could have seen
myself had I thought carefully, or had I looked in a more impartial way
- so very often it is not some special professional expertise or the
fact that he is a remarkably intelligent person, but simply that he is
experienced, and looks at the data from a sane distance, and without
the prior assumptions and lonely despair that I sometimes develop.

I know that occasionally people on this list present BG records, and
ask for help problem solving how to change basal or bolus rates for the
better, and I wonder whether it is possible, without treading on
professional territory, or generally on dangerous ground - after all
our lives depend on basal rates and boluses being correct - to take
advantage of all our combined expertise gathered slowly and painfully
over the years, and to expand this function of the list.

On a slightly different tack, Melissa wrote suggesting the need for
more checking of basal rates by fasting. I have come to despair
somewhat of this method of testing. My basal requirements are almost
never the same when fasting. A prime example is when I eat a late
breakfast (for example if fasting for an early morning blood test), my
blood glucose always, without fail, rises during that fasting time,
unless I agressively up the basal rate by at least 30% - it continues
to rise at least until 11 or 12 o'clock (after that if I continue
fasting, basal requirements decrease until I have to decrease the basal
rate by 30%). If I do eat breakfast as usual at 7.15, and bolus
appropriately, I have to watch carefully that I do not go hypo around
10 or 11 - i.e. after the effect of a 7 am pre-breakfast bolus should
have worn off - so it seems like a difference in basal requirement in
the fasting vs the non-fasting state. This is not a problem for me - I
can make the necessary adjustments, but it has made me very sceptical
indeed about the 'traditional' recommendation for fixing basal rates
according to fasting requirements. Has anyone else found this sort of


> Subject: [IPk] Pump Holiday
>  Can anyone give me any advice on what to do about coming off the
> pump for a
> while. Over the past few months things aren't as good on the pump as
> they used
> to be, and it's becoming a little of a burden. Blood isn't as good as
> it used to
> be, neuropathy getting worse etc. I thought maybe a short break from
> it would
> soon get me appreciating it's value once more.

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