Studying and Tuning

Usually, about once a month, I study my Dexcom trends and make minor adjustments here and there in my insulin needs (with permission from my endocrinologist, of course). This ritual then becomes a weekly thing during pregnancy, and this time is no different. And, later in the pregnancy, I tend to do this every couple of days or so due to all of the increased resistance and stuff.

Since I switched back to my Medtronic pump after issues with the t:slim last week, I wanted to get a good few days of data before making any changes since typically you do have to make some adjustments between insulin pumps. Not all of them deliver in the same manner (though relatively the same, but juuuuuuust enough to possibly need minor changes in insulin dosing). Here’s what I mean:

6 days on tslim 2
6 days on the t:slim I had been using during the first part of my pregnancy…
6 days on the *replacement* tslim... NO changes in rates as they're the same brand of pump so it shouldn't have made a difference...
6 days on the *replacement* tslim… NO changes in rates as they’re the same brand of pump so it shouldn’t have made a difference…
...and the last 6 days since being on MedT with practically the same rates.
…and the last 6 days since being on MedT with practically the same rates.

If you compare the first and the last picture, you can see that there’s not entirely too much difference, and the average BG between the two was only a few mg/dL off from each other. The replacement, however, was whacko.

Either way, I’m doing a lot better on the MedT and will probably stay on it. And since I have made that decision, it’s time to get down to fine tuning things. I’m dropping every night around midnight, and it’s taking longer to treat them, thus I over treat and go high. BUT, the thing is, I’ve not corrected those highs. I’ve been trending back down on my own. So that tells me I have some work to do between supper, bedtime, and overnight basals and other factors.

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I usually look at my trends on the computer and try to identify things. If I think I see something or have a hunch, I’ll print out the Daily Trends report so that I can see the days individually and not as an average, and I’ll write my basal rates below it. This time (for example), I noticed that I dropped an average of 57mg/dL from my highest average to my evened out number when I wake up, which, ironically, is close to my insulin sensitivity factor (55mg/dL currently). So, I took the 1u and divided it by the number of hours it had been dropping  before leveling out, which was 7hours, and it came to 0.14, which I interpret that to be a needed basal rate change of 0.15u per hour less than what I have it set at now.  It all may not be exactly right, as most of what I think I’ve figured out is simply a hunch that I try out and see if it works. If not, I have record of my information pre-changes and I go switch everything back to what I had before.

This the stuff that goes through my head while I’m examining my data. This is why having as much of my data in one place is as crucial as air to me, especially while pregnant. It’s such a pain in the butt to have to look at multiple reports and have to spend more time organizing it than actually analyzing it. So, I’ve also resolved to leave my beloved Verio IQ and use the Contour Next Link meter that works with the pump, so that all of my data from the pump and meter at least are in the same place. That, and since using the CNL meter, my Dexcom data more closely matches it whereas it hardly ever matched my Verio. I’ve done a lot of research over the past couple of days, and it seems that maybe the CNL meter is a bit more accurate than the Verio, and with the Dexcom using the more accurate 505 software, maybe the two are just meant to be… Or I could just be completely off my rocker. 😉

So, I’m off to my endo tomorrow for my monthly checkup and to share my observations and changes with him.

(What I do and write here are in no way medical advice that you should ever take as such. I have worked very closely with my endocrinologist over the years and he has helped me learn how to do these things. If you want to learn how to manage and fine tune, please speak with your health care professional, as I am not one.)

 

Noted

How do you keep up with your pump settings for doctor appointments? Do you print out the sheet from your pump program or do you go through the pump during the appointment to pull this stuff up?

Do you ever use a “note” to keep note of what your prior basal rates were before basal testing? Or do you use just a separate basal profile for testing?

I’ve just begun to use the “Notes” app in my phone to keep track of my basal rates for appointments and basal testing changes. Do you have another apps that work better than the notes app? I’m an app geek, so any suggestions are welcome. 🙂