Q & A time!
Q) A question about your Symlin pump–do you use some basal Symlin as well as boluses at meals, or is that pump’s basal rate set to zero?
A) On my Symlin pump I run a tiny basal rate of 0.10u/hour. This was based on advice from Gary Schiener (who pumps Symlin too). Apparently Symlin is a little more prone to blockages or occlusions because it sticks to the infusion set material more than insulin does. Running a small basal rate keeps the fluid moving enough to help minimize that. I’ve not had a blockage/occlusion alert yet.
Q) Scott, am I reading correctly that pumping Symlin means one constant rate of 0.1u with no boluses for meals?
A) Before my meals I take a bolus of Symlin, above and beyond the basal (which is such a small rate that it really doesn’t do anything other than help prevent blockages/occlusions). I take 10 units, which is the equivalent of the 60mcg dose on the pens, and try to get that Symlin bolus in 15-20 minutes before eating. I also start an extended bolus of insulin through my insulin pump for the carbs in the meal when I actually start eating. Again, mimicking what has worked for Gary, I run an extended (or square
wave) bolus for 90 minutes. This seems to work pretty well, but (like everything else with diabetes) there is room for improvement. There are also different situations where I need to time the bolus differently, and I’ll either stretch it out more or wait a while to start it.
Q) This is fascinating. Do you run out of sets? How do you deal with insurance?
A) I talked about this a little in the last Pumping Symlin post (part 3).
Q) Can you fill us in on the 2nd pump thing? Which model? Where do you put the 2 infusion sites?
A) I rotate both my insulin site and Symlin site (usually) at the same time. I try to stick to a 3 day schedule, but may stretch it to 4 days to conserve supplies. This is a hard balance because I don’t want to fight scar tissue in the future (from wearing each set too long). I put the Symlin infusion sets in the same types of places that I put my insulin infusion sets. A few configurations I’ve used so far is the insulin set on my upper rear end and the Symlin set on the love handle/side/lower back area. Or maybe the insulin set on one side of my belly button and the Symlin set on the opposite side. It really can go wherever you can put an insulin infusion set. Today? I’ve got my Symlin set in my lower back and my insulin set in my arm.
Q) Have you lost any weight as of yet?
A) I think about 4 pounds. My weight fluctuates a lot, especially when I play basketball. The first day of the week that I play basketball I usually lose a little over 5 pounds of water weight. I play an additional 2-3 times more through the rest of the week, and struggle to drink enough to stay hydrated. So, if I weigh myself on Monday (before any basketball) I might be 5-10 pounds heavier than if I weigh myself on Friday (after a week of heavy exercise and sweating). I have not gotten into a routine where I weigh myself at a consistent time under consistent conditions, so it is hard for me to tell. Does that make sense? With that being said, I am trending down, so it is heading in the right direction. Because I’m trending down I am not overly focused on the numbers. I’m just going to keep doing what I’m doing and let it rock for a while.
Q) Do you think the pump will live much longer? How old is it?
A) That is a very good question. The answer is: I don’t know. I think the pump will keep on ticking, but as we all know, stuff happens. The pump is a little over four years old. My two other old pumps still work (one is over 10 years old!), but I don’t have a steady line on supplies for them. I guess I’ll cross that bridge when I get to it.
What other questions do you have? Did I answer everything so far? Let me know in the comments, and if there are enough I’ll throw up another post (otherwise I’ll answer them in the comments).