Diabetesnet.com
12-14-2009, 08:25 PM
Visit our Ask John Q&A Blog (http://www.diabetesnet.com/ask_john/) for more entries and leave your comments (http://www.diabetesnet.com/ask_john/?p=58#respond).
Hi John,
I have your book, Pumping Insulin. It was very useful when I started pumping. I’ve run into a snag lately with pumping. I was on the Cozmo for many years and doing well. A1C was between 6.5-7.5. Then Cozmo announced they were going out of the insulin pump business. Minimed offered a deal on their pump to Cozmo users. I switched to the Paradigm and have had nothing but problems. Keeping my settings the same from pump to pump gave drastic differences. My A1C is now 8.5 consistently and I can’t get it down. I’ve increased my basal, my carb ratios and nothing has helped.
I use Novolog in my pump.
Any help will be beneficial.
Thanks so much,
B
Hi B,
If you are using Quick-Sets, that can cause this problem when not anchored well.. Try the Silhouette set, or contact Animas and try their reservoir replacement (they send two samples free) and use the set that worked before, or try one of the many luer lock infusion sets that are available (Animas and Accu-Chek both send free set samples).
Other differences:
The Paradigm bolus calculator recommends excess bolus amounts in some situations (your A1c suggests this is not the problem),
Don’t use a target range in this pump, use a single target (the Paradigm always aims for the high target when high and low target when low),
The cartridge design can introduce air into the infusion set (a less common problem, but check your infusion line for air, then use the cartridge replacement above if you see this).
However, none of these would cause consistent highs.
Novolog is good and should not be causing your problem, but start a new bottle just to be sure if you have not already done so.
Let me know if you are not using Quick-Sets. If you are, let me know if changing these helps.
Best regards,
John
Hi John,
Thanks for the quick reply. I am using Silhouettes with my Minimed and used those with the Cozmo as well. My range is 100-100, so it is a single target.
-B
Thanks. Can you provide any other clues – wt change, activity change, stress, possible mild infection, steroids, over the counter wt loss supplements, other new supplements or meds, broke a leg and can’t exercise……?
Also, are you sure the original settings are exactly the same and is your pump clock set to the correct current time (am and pm, especially)?
J
Settings are exact. Yes, there has been an increase in weight mostly due to starting antidepressants.
B,
OK. Antidepressants are known to increase glucose levels at the same doses that are needed to treat depression. They help raise seratonin and norepinephrine which provide the antidepressant action, but they can also raise epinephrine and cortisol which elevate the glucose . Cortisol is a contributor, perhaps a major one, to Type 2 diabetes. The reason I asked about weight loss supplements is that they often contain epinephrine masked under a wide variety of names (Ma Huang, etc), and this can be a major source for high readings.
If you like mild chemistry, there is an old book called “The Way Up From Down” by a female physician who battled with and overcame depression. The book outlines the chemical pathways for depression and what you can do about them. More than I can cover here, but avoiding red meats and cheese which add amino acids that compete with the production of norepinephrine and seratonin, and adding amino acid precursors to aid their production helps. High glucose levels, unfortunately, causes more depression, so control of glucose levels is very important.
Depression definitely needs to be treated. Work with your doctor or psychiatrist to see if a different antidepressant or a lower dose might be possible. You may want to read about supplements in this article. Some are likely to work much better than others, and be sure to discuss these with your doctor before trying them to avoid unwanted interactions.
Let us know what you find,
John
Actually, I’ve read quite the opposite that sertraline decreases blood sugar levels. As far as chemistry, it’s odd you said that since I am a chemist!
Your chemistry background will definitely help. Generally, sertraline is a better choice, but individuals differ. See this article for a case where it raised the glucose.
Depending on how much weight the sertraline adds, this can counteract the benefits it has on the potassium (K) channel benefits and the high glucose levels can negatively impact the K channel. If epinephrine and cortisol are increased, this may overcome the K channel benefit from the sertraline.
Best,
John
Hi John,
I reviewed your Pumping Insulin book yesterday and I made a few changes to my settings. The main one being my insulin sensitivity. That was the one that stuck out the most. Throughout the next month, I am going to do the little ‘tests’ to fine tune my other settings again. I’m hoping the main reasons my sugar has been high is that I’m just not getting enough insulin. I was refusing to give myself more. Based on the weight gain, stress, and antidepressant, I believe I just need more insulin. As far as an antidepressant, my therapist suggested switching to bupropion.
B,
These changes sound good. Keep focused on your depression level as this is your main goal at this time if symptoms are significant. The glucose can always be controlled.
For setting your carb factor, talk to your physician about using our new formula:
Carb Factor = (2.6 x wt)/TDD
Be aware that your correction factor or “insulin sensitivity” (A poor term since it is not really your insulin sensitivity!) is not a main problem. The Correction Factor is “make-up insulin” – it makes up for basal rates that are too low, a carb factor that is too high, or for undercounting carb or other lack of carb bolus insulin. The correction factor is important for control, but much less so than your basal rates and your carb factor.
Best,
John
Visit our Ask John Q&A Blog (http://www.diabetesnet.com/ask_john/) for more entries and leave your comments (http://www.diabetesnet.com/ask_john/?p=58#respond).
Hi John,
I have your book, Pumping Insulin. It was very useful when I started pumping. I’ve run into a snag lately with pumping. I was on the Cozmo for many years and doing well. A1C was between 6.5-7.5. Then Cozmo announced they were going out of the insulin pump business. Minimed offered a deal on their pump to Cozmo users. I switched to the Paradigm and have had nothing but problems. Keeping my settings the same from pump to pump gave drastic differences. My A1C is now 8.5 consistently and I can’t get it down. I’ve increased my basal, my carb ratios and nothing has helped.
I use Novolog in my pump.
Any help will be beneficial.
Thanks so much,
B
Hi B,
If you are using Quick-Sets, that can cause this problem when not anchored well.. Try the Silhouette set, or contact Animas and try their reservoir replacement (they send two samples free) and use the set that worked before, or try one of the many luer lock infusion sets that are available (Animas and Accu-Chek both send free set samples).
Other differences:
The Paradigm bolus calculator recommends excess bolus amounts in some situations (your A1c suggests this is not the problem),
Don’t use a target range in this pump, use a single target (the Paradigm always aims for the high target when high and low target when low),
The cartridge design can introduce air into the infusion set (a less common problem, but check your infusion line for air, then use the cartridge replacement above if you see this).
However, none of these would cause consistent highs.
Novolog is good and should not be causing your problem, but start a new bottle just to be sure if you have not already done so.
Let me know if you are not using Quick-Sets. If you are, let me know if changing these helps.
Best regards,
John
Hi John,
Thanks for the quick reply. I am using Silhouettes with my Minimed and used those with the Cozmo as well. My range is 100-100, so it is a single target.
-B
Thanks. Can you provide any other clues – wt change, activity change, stress, possible mild infection, steroids, over the counter wt loss supplements, other new supplements or meds, broke a leg and can’t exercise……?
Also, are you sure the original settings are exactly the same and is your pump clock set to the correct current time (am and pm, especially)?
J
Settings are exact. Yes, there has been an increase in weight mostly due to starting antidepressants.
B,
OK. Antidepressants are known to increase glucose levels at the same doses that are needed to treat depression. They help raise seratonin and norepinephrine which provide the antidepressant action, but they can also raise epinephrine and cortisol which elevate the glucose . Cortisol is a contributor, perhaps a major one, to Type 2 diabetes. The reason I asked about weight loss supplements is that they often contain epinephrine masked under a wide variety of names (Ma Huang, etc), and this can be a major source for high readings.
If you like mild chemistry, there is an old book called “The Way Up From Down” by a female physician who battled with and overcame depression. The book outlines the chemical pathways for depression and what you can do about them. More than I can cover here, but avoiding red meats and cheese which add amino acids that compete with the production of norepinephrine and seratonin, and adding amino acid precursors to aid their production helps. High glucose levels, unfortunately, causes more depression, so control of glucose levels is very important.
Depression definitely needs to be treated. Work with your doctor or psychiatrist to see if a different antidepressant or a lower dose might be possible. You may want to read about supplements in this article. Some are likely to work much better than others, and be sure to discuss these with your doctor before trying them to avoid unwanted interactions.
Let us know what you find,
John
Actually, I’ve read quite the opposite that sertraline decreases blood sugar levels. As far as chemistry, it’s odd you said that since I am a chemist!
Your chemistry background will definitely help. Generally, sertraline is a better choice, but individuals differ. See this article for a case where it raised the glucose.
Depending on how much weight the sertraline adds, this can counteract the benefits it has on the potassium (K) channel benefits and the high glucose levels can negatively impact the K channel. If epinephrine and cortisol are increased, this may overcome the K channel benefit from the sertraline.
Best,
John
Hi John,
I reviewed your Pumping Insulin book yesterday and I made a few changes to my settings. The main one being my insulin sensitivity. That was the one that stuck out the most. Throughout the next month, I am going to do the little ‘tests’ to fine tune my other settings again. I’m hoping the main reasons my sugar has been high is that I’m just not getting enough insulin. I was refusing to give myself more. Based on the weight gain, stress, and antidepressant, I believe I just need more insulin. As far as an antidepressant, my therapist suggested switching to bupropion.
B,
These changes sound good. Keep focused on your depression level as this is your main goal at this time if symptoms are significant. The glucose can always be controlled.
For setting your carb factor, talk to your physician about using our new formula:
Carb Factor = (2.6 x wt)/TDD
Be aware that your correction factor or “insulin sensitivity” (A poor term since it is not really your insulin sensitivity!) is not a main problem. The Correction Factor is “make-up insulin” – it makes up for basal rates that are too low, a carb factor that is too high, or for undercounting carb or other lack of carb bolus insulin. The correction factor is important for control, but much less so than your basal rates and your carb factor.
Best,
John
Visit our Ask John Q&A Blog (http://www.diabetesnet.com/ask_john/) for more entries and leave your comments (http://www.diabetesnet.com/ask_john/?p=58#respond).