PD dialysis and type 1 diabetes using insulin pump

My husband is about to start home PD and has type 1 diabetes ( uses Medtronic 670G pump with glucose sensor). We would be interested in hearing from others with Type 1 to hear how they had to adjust pump settings. The low kidney function already creates challenges with nighttime lows - now we wonder if the dextrose solutions will cause highs.

That’s a great question, Shelmers, and I hope you get some answers here. We have a LOT more discussion these days in our closed Facebook group for Home Dialysis Central, which you can find here: https://www.facebook.com/groups/HomeDialysisCentral/

My husband is type 2 we use a longer acting insulin in the evening it’s on a sliding scale so we can adjust the amount. If he’s low before the cycler on shot if normal he gets a dose

Thanks for replying, Hochie. The Medtronic pump only uses humalog, so we have to make adjustments via pump settings. My husband is type 1, not type 2.

Thanks for the suggestion! I’ll check out the Facebook group.

Hi, I’m type 1 and been pumping about 15 years. Been on PD since start of this year and now on APD. The best help with fiabetic control was having a Libra sensor… my consultant got me on this about 6 months before pd started. This enables you to get reading whenever you scan but also shows a graph of what happens between the readings. This allows you to adjust your basal insulin to the extent that through the night I’m practically straight lining through the night. Initially I found the sugar solutions sent me high but thanks to Libra Ive now adapted. Still find the 3% a devil so prefer to drink less to prevent overloading. Good luck!

Welcome, David, and thank you for your terrific suggestion! Using a continuous glucose monitor (CGM) like a Libre is a great way to learn your blood sugar patterns and what influences them–including PD solution.

Hi I am type 1 as well, just started low volume PD and have found that with 1.5% solution my CGM readings hover in the 190-200’s pretty consistently. I am tightly controlled and this freaks me out. I am slowly adjusting to the changes in insulin dosage in this journey. I am on a cycler and dialyze over night, much better than manual exchanges in my opinion. My changes As per my endo’s suggestion are in small increments. For example I adjust my basal rate in tenths of units, for example let’s say my rate at 6 PM is 0.7 units an hour. I will adjust to 0.75 or 0.8 and see what happens over the course of a day or so. Hopefully your husband’s doc is skilled at pump therapy and you have also been given recommendation to have adjusted your insulin sensitivity, carb ratio and also the duration of action that your husband’s insulin is working. Insulin activity as are most drugs when you have kidney failure either slow to work or work for a longer period of time in your husband’s body than it used to. It all changes with kidney failure. I am happy to converse with you all to commiserate. Hopefully he will abide by diet low salt, high protein low phosphorous and potassium and agree in re how much volume he should have when instructed so as to not have to take the 2.5% and 4.25% solutions and more medications that often. Remember Insulin aggregates fat and realize dialysis fluid is like drinking a coke or eating another 5oo calories each day. Maintaining a healthy weight and BMI for your health and your ability to obtain future transplant are key. Wishing you all the best…,