Endo's labyrinth, Protocol is catch 22 for obtaining prescription Options

[Tool]

I'm setting-up for a tune-up on insulin doses and carbs. In the beginning (30years ago) I had to count and measure everything: carbohydrates, proteins and fats, with a balance of 50/30/20%. Now the directions are: find out what your ratio:insulin to carbohydrate is. Find out how many units of insulin does it take to lower high BG to target range, when high, etc. After a visit to a dietician, we figured out the ratio I've been doing is 1 unit insulin to 6 grams of Carbohydrate; 5 units insulin lowers BG 100 mg/dl. Sent in the read-outs from my one-touch meter and the Endo tells me, 'Too many lows, go to 1::12 ratio.' Basel was OK. No prescription for pump until there a fewer low readings, too risky!
So I couldn't do it. I had never been told to take half the amount of fast-acting, cold turkey, that one should only reduce insulin by two or three units at a time. I was doing 10 units for 60 grams of carb (as a rule of thumb) per mealtime and with fairly predictable within range readings afterwards. So, where were the lows coming from? Back to the dietician, she told me to eat more protein and fiber to sustain any residual insulin from before the meal. I'm nearly confident that it'll work.
I wasn't that happy to be told to reduce the amount of insulin for meals and that I couldn't get the pump before doing corrections, knowing that there is going to be a learning curve once I get it anyway.

[Linda B]

It does sound like your situation is a bit of a catch-22. There is definitely a learning curve with a pump, but, as you said you are going through a learning curve with your new protocol.
Most people find they have FEWER LOWS on a pump because the basal insulin dose can be adjusted according to the time of day. You may be having lows because your basal insulin releases the same amount of background insulin every hour.

My pump settings involve a change in the amount of basal insulin 5 times during the day! You can't do that on injections.

Hopefully your doctor will not wait for your BGs to be perfect, if s/he does you won't ever be ready for a pump (IMG:style_emoticons/default/Crying.gif)

Linda B.

[bkh]

Cutting your meal bolus in half does seem extreme to me. I favor many small adjustments with lots of testing. But it depends on how severe and how frequent your lows are. If you find yourself in the 40s and 50s a couple times per day, then yes I would make big changes quickly for safety reasons.

Work with your endo. But if it isn't working out, I'd suggest that you look for an insulin pump support group in your area. (You could ask around at a local hospital if you have no better way to look for a group. Or in the USA you could even contact the Medtronic pump help line via 1-818-576-5555 to see if they know of any pumpers' support group in your area -- I don't know whether they have any such list, but maybe they have a suggestion or an initial lead, perhaps via a pump trainer in your area.) Anyway, if you can find a pump support group, you can ask the members which physicians they find helpful.