Apidra, again.

A few weeks ago I decided to give Apidra a try for Princess.  We have had huge success with Lovebug using it and I thought maybe it would be easier to have them on the same insulin  I know that sounds like a bit of an oxymoron because they are on different pumps so I am not confused.  I am not a big fan of accidentally filling the wrong pump with the wrong insulin.  Just don't need that headache.  I have to make enough changes to basal and bolus amounts as it is!  I really don't need to make MORE work for myself.

The first week, I was seriously ready to pull my hair out.  Princess kept going low an hour after she would eat and she hadn't done that with Novolog.  I raised I:C ratios, and kept raising them. To no avail, that was not working.  So I lowered them back down and started using the Square Bolus and evening her bolus out over an 1.5 hours.  That didn't seem to work at first.  It just prolonged the low.  But I kept with it for a few days and it started to work!  A little victory, at last.

Then  we started seeing higher numbers over all.  I raised her basal rates and we are still raising them. Maybe I should say tweaking them.  I think they are as high as they need to be, (i could be wrong though) I just really need to figure out how to balance the day out with what she needs.

Take for example, over night (for us that is 8pm to 8am right now) She typically goes to bed in range and then spikes up about 200 points with in and hour after she falls asleep.  (dusk phenomenon)  We still can't get that spike to go away.  I did, for a while, but then she was waking up too low in the morning.  So needless to say we are still working on that one.  Plus we have this weird pattern that has been happening after breakfast.

I have been giving her a normal bolus and she will spike and come back down in range within 1.5 hours and then a half hour later is going straight back up again!! (double arrows up on Mini)  And has been high at lunch.   (around 200)  I raised basal for the morning but it doesn't seem to be helping. Might need another basal tweak there too.  All those tweaks just never end!

Now three, (almost 4) weeks in I am happy with Apidra for Princess and very hopeful we will be sticking with it!

Our Revel

Nablopomo ~ Day 26

When I sat down to blog for today, I had a post in mind that I was going to write then I realized that today is the 26th. The 26th was Princess pump start day. The 26th will be one of those dates that forever sticks with me, right along with the 1st, and the 10th. Want to know something crazy?  Lovebug was diagnosed on April 1st and her Pump start was on September 10th.  Then Princess was diagnosed on April 10th and had her pump start on May 26th. If I hadn't begged for a different date, Princess pump start would have been on June 1st. (that was the date that was originally scheduled.)  Kinda crazy, huh?  :)

Pump start day was two months ago now. Yikes, has it only been two months??  Goodness, it seems a lot longer then that. Pretty sure the days since Princess was diagnosed have dragged on...good thing it's summer and it's making summer feel longer!

I am getting used to Princess's pump and loving it.  I'm not an expert on it yet, I know there are more tricks to learn, but I am getting the hang of it. The pump continues to amaze me.  It's not because I don't like Lovebug's pump, it's that I am finding there are many features on the Revel that I just like better then on Lovebug's Ping. (that is also the joy of having the girls on two different pumps.  I am getting to know both of them inside and out.

I love the Bolus button, it makes it SO much quicker to bolus and easier for friends and family to operate it since there aren't as many buttons to push.  I think the resevoir set up is a easier too.  I love that there are fewer steps to fill the resevoir, even though it took me a few try's to get used to it and in the process, squirted myself with insulin. (the smell of insulin is really not that pleasant) I like that the resevior has cap similar to a bottle of insulin. It makes it easier to draw insulin into the resevoir and to take it out with a syringe if needed.     I also love that the pump saves the amount of insulin you use to fill the cannula. It's just one small step that makes the whole site change process go quicker.

Of course there is the Square Wave Bolus feature that I talked about here. (that I just LOVE) I also find that changing the battery out is a bit easier too.  You don't have to do a complete rewind and prime with the Revel like you do with the Revel. Although when the battery goes on the Revel, it goes quick.  With the Ping I know I usually have 6-8 hours before I have to change the battery.

We really do love our Revel.  Of course there isn't the remote bolusing like there is with the Ping (which I really love) But I also I feel like I just traded the remote for the integrated CGM.  Which for Princess is perfect.  She is so small I couldn't see her carrying around her pump and CGM reciever.  Way to much for my little pumping Princess.

There are a few things I don't like about the CGM but I will save a comparison of the DexCom and Guardian for another post.  Don't want to do a information overload on you! :) Needless to say, we are very happy with our little Revel.

Combo Bolus Squared

Nablopomo ~ Day 19

When I first decided to go with two different pumps for the girls, I thought I might be taking on too much. Maybe I had lost my mind?  Well, I am pretty sure I lost it a couple years ago when Lovebug was diagnosed but I was thinking pretty clearly when I choose to go a different route for Princess then I had for Lovebug.

So, when it came time to choose a pump for Princess, I was immediately drawn to the Medtronic Revel with the integrated CGM.  I knew the CGM would befit her and if I could avoid her having to carry two devices around her waist like her sister, then I was going to go for it.  Of course I had some reservations about Medtronic's Guardian. The size and the insertion are a lot different then the DexCom and I was a little uncomforable at first.  I decided to call our endo and see if there was a trial like with the DexCom.  Thankfully there was and after a few days, I was hooked.  I knew we were going the right route with Princess and her pump.

Needless to say, there are A LOT of things that I LOVE about the Medtronic Revel.  One of my favorite is what they call the Square Wave Bolus.  At first I was a little "scared" to use it, but I was like that with the Combo Bolus on the Lovebug's Ping.  Are you wondering what the heck a Square Wave Bolus is? Well here you go:

Square Wave Bolus: delivers a bolus evenly over a period of time (30 minutes up to 8 hours). This bolus can be used for insulin delivery when you have eaten a long meal with extended snacking (commonly called grazing!) It can also be useful for delayed food digestion or (my favorite) meals high in fat (hello Pizza!) A Square Wave bolus can be useful if a normal bolus drops your blood sugar too rapidly.  

Can I hear a WOO HOO! I LOVE this bolus!  It works GREAT with ice cream, pasta and pizza. (for Princess anyway)  All the foods with fat or slow adsorbing carbs.  It has worked SO well for Princess that I found myself wishing that Lovebug's pump had that feature.

Cue the "aha moment"!  One day I was thinking about the Combo Bolus and how it works on the Ping. Remembering that you can give a certain percentage of insulin upfront and a certain percentage of the bolus of a period of time. Then it hit me...I bet I could do a Square Wave bolus using the Combo Bolus on the Ping.  How, you ask?  Well let me explain.

Remember that a Square Wave gives you your entire bolus over a set amount of time. It drags it out, so to speak.  Well, I figured with the Combo Bolus if I gave 0% up front and 100% over a certain period of time, wouldn't that be the same as a Square Wave Bolus on the Medtronic?  A couple weeks ago I got brave and tried it when we had pizza for dinner.  And you know what? IT WORKED!!!  Lovebug didn't have a delayed spike from the pizza!!  She stayed nice and steady!  I was super excited!! (yes, I have used it numerous times since then and It's still working!)

Another common problem we have with Lovebug is that she will be low before a meal, we will wait to bolus her until after she is done eating (yes, we typically bolus before meals, for both of the girls) and then a couple hours later we check her (or Dexie is beeping at us) and her blood sugar is HIGH.  Then we do the big, "oops" I forgot, yet again!  Ugh, I hate it when I forget and she suffers for it!!

So another conclusion I came to was, why not use a Squared Combo Bolus (as I call it) for Lovebug when she is low before a meal? (I am talking  between 60 and 80 here) I can still bolus her (because she isn't getting any insulin up front) and then by the time her blood sugar is back up and her food is starting to kick in, the insulin is starting to trickle into her system. Hence no low blood sugar and no rebound spikes from the low either. And guess what?  I tried it and IT WORKED!!  It works wonderfully!

Needless to say, I am VERY happy!  These two little "discoveries" were a God send to me. It has made managing Lovebug's crazy numbers a little easier.  Anything to make this disease a little easier to handle makes for one (a little) happier mama!!