Pumping, TAG and Gastroparesis

Yesterday, I wrote about the Flatliners Club and shared some pictures.  When I was taking pictures last week to share for that article, I thought I would also share what a good gastroparesis day is for me.  It is far from perfect, but if I can avoid the extremes, that is a good day.

One of the first big improvements for me with gastroparesis was learning to split my mealtime shots into multiple shots.  That helped some of the crashing after eating and the highs later once your food finally started to digest.  Doing that, I was able to start seeing A1cs in the 5s.

The next big improvement was getting a CGMS – thank you Mary!  Although one reason for getting it was because I am hypounaware, I also wanted it for help with the gastroparesis.  I am able to set alarms to warn me when my blood sugar starts going up.  I especially like the Dexcom because you can set your high alarm to alert you at 120.  With gastroparesis, the sooner you can correct once your blood sugar starts going up, the better.  A lot of people with normal stomachs will pre-bolus for their meals.  Waiting until your blood sugar is high to take insulin with gastroparesis is like someone eating a food that they know will cause their blood sugar to climb rapidly, but not take their insulin until after they eat.  The Dexcom has been a great help in helping me catch my blood sugar before it gets too high.

In June, I started pumping with the Animas Ping.  Before getting it, I really did not think that it would make that much of a difference in how I bolused for my meals. I wanted it to help with dawn phenomenon.  I liked the idea of being able to have more basal rates that I could have using Levemir.  I liked the idea of being able to scroll thru the pump and find out exactly when I took insulin without worrying because I did not write it down. 

Even after starting the pump, I continued to bolus for meals the way I was on MDI.  I would space out my boluses based on when my blood sugar was starting to go up.  I was afraid to try the extended bolus feature (combo on the Ping).  Then I started using TAG and I have seen an improvement in my blood sugar.   If I had tried to use the combo bolus based on what I was using with MDI, it never would have worked.  Calculating the protein and fat for the extended bolus has made a big difference.  You can read more about TAG here:  https://kellywpa.wordpress.com/2010/11/10/total-available-glucose-tag-2/

I shared this picture from last Friday with yesterday’s flatliner post and called it my Rocky Mountain:


It probably looks worse than what it is, but that was actually not too bad of a day.  I did two screen shots from my Dexcom for the 24-hour period that picture represented.  I wanted to show the Hourly Trend Chart for that 24 hour period.  You can’t get everything on one screen so I did two different screen shots.  With the Dex software, it is the numbers that are different on the second screen, not the chart at the top.  If you click on the pictures, they will get bigger and the numbers will be easier to see.


My average for the day was 104.  I was having a very good sensor day and every time that I checked with my meter, I was only a couple points different between the Dexcom and my meter so the 104 is a pretty good reflection of my average for the day.  Although 104 sounds high to some people, if that was my average every day, that converts to a 5.3 A1c. 

What I am most happy with is my standard deviation was 24.  Yes, I know people do much better than that, but for having gastroparesis, that is a good number.  If you look at the hourly time periods, 16 of those 24 hours were below 10. 

My high for the day was 161 and my low was 39.  Actually, my meter logged me in at 44 so I did not technically hit the 30s. 

Although I still have more lows than what I want, they have improved and having the Dexcom gives me more confidence in fighting the highs.  It is very challenging when you don’t know when your food will digest, but with work and technology, it is possible to have more good readings than bad.  I have come a long from where I was before!
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