Multiple Daily Injections, a Second Time Round


I definitely felt hesitant about going back to Multiple Daily Injections when I was contemplating a pump break.

I didn’t really have too many fond memories of managing diabetes prior to insulin pumping. Lantus was very uneven and inconsistent the last time I used it. I felt I could never get the dose quite right. I remember lots of carb guesstimates, and the wildly fluctuating levels that followed.

But at the same time I knew that I was armed with a lot more knowledge, and motivation compared to when I last did injections. I was actually curious as to whether I could apply these newfound skills into Multiple Daily Injections a second time round.

I gave 9 units of Lantus at around 9pm on the first night of my pump break, which was the sum of the 24 hour basal profile on my pump. I was pretty pleased to see that it did keep me fairly stable when I woke up the next morning.


I was definitely contemplating splitting my Lantus dose, but I wasn’t sure how best to go about it. The general consensus in forums seemed to be that Lantus lasted around 18 hours at best. After running high during the first two afternoons, I decided to experiment with a smaller second dose at 1pm to cover the final third of my day. 3 units seemed to be enough to cover, without sending me low overnight.

After months of diligent carb counting, I knew I definitely wouldn’t be able to survive without a bolus calculator. Although there were plenty of flashy diabetes apps to choose from in the App Store, many of them lacked a bolus calculator. I eventually found RapidCalc for $12.99. Although it didn’t have the flashiest interface, it fitted my needs nicely. I was able to set up my insulin to carb ratios, correction factors, insulin usage profile, and reminders for my Lantus doses.


This break definitely reinforced that to me that you tend to use less insulin on the pump. On the pump, I was using a carb ratio of 1:10g and a correction factor of 1:2.6mmol. On injections, I needed a ratio of 1:6g and a correction factor of 1:1.6mmol. Being off by even half a unit of insulin had a big impact on my blood sugar levels after meals.

What I loved most about injections was the simplicity of it all. There was instant relief from the lows, and far less thinking about where my blood sugar was heading. Small activities around the house had minimal effect on my blood sugar levels. I witnessed steady trend arrows on my Libre during afternoon walks, rather than downward ones. Using Lantus for my basal, rather than rapid acting insulin on the pump, made a BIG difference here. The only time I had to think about lows was when I had mealtime insulin on board.

Gotta say, it was also just awesome to sprawl out on the couch or in bed and not feel that chunk there in my pocket. And I loved having a little less weight in my pockets every time I left the house.

Overall, my blood sugar levels were just as good on injections as they were when I was pumping.

But shots were definitely a LOT of work. Although I carried my pen around with me in my pocket everywhere, I don’t shoot up in front of others. So I really had to make a point of finding a quiet corner to do so when I wanted to eat or correct a high blood sugar level. Speaking of, morning blood sugars were a LOT harder to manage. I didnt have the flexibility of increasing my basal insulin to cover the morning rise after I woke up. I often found myself giving at least 3 corrections after breakfast to bring me back into range. If I had stuck with injections for longer, I would definitely basal test with a few extra units of rapid acting insulin to cover the morning rise.

My pump break definitely reminded of something that Ginger at Diabetes Daily wrote recently. She says that neither pens or pumps were perfect, and that we were choosing between the flaws that bothered us the least. I couldn’t agree more.

For me personally, an insulin pump is a LOT more work than injections. Keeping on top of site changes, dying batteries and insulin cartridges, and having to be on my game in setting basal rates around my activity. It’s more careful thinking about what you’re doing. Not to mention the extra chunk in my pockets pulling my shorts down!

But a pump also offers me more convenience when I’m on the go, more precision in my basal rates and greater flexibility with insulin dosing to cover different kinds of meals.

For the time being, those benefits outweigh the flaws when managing my diabetes.

Staycation

I am often asked when my next holiday will be, or if I have any travel plans in the pipeline. As much as I do love going on a holiday, they are equally exhausting by the time I return home. AND they cost money.

I’m not the kind of person who goes on a holiday to sit on the beach. I can easily do that at home. I want to go somewhere that I can explore and sightsee and be a tourist. But that is exhausting in itself. So ideally I’d love an extra week up my sleeve when I return home just to sleep in and catch up with life. But with a full time job, no lotto wins and only four weeks of annual leave, it rarely happens.

Throw diabetes into the mix of work and life, and after a while it feels like you’re just pulling it along, struggling to keep up. It’s monotonous. It’s always there. It never ceases to throw curveballs my way. 

Towards the end of last year, I definitely drew back a fair bit from my blog and from social media. I was feeling a lot of frustration towards my pump, which I’ll write more about soon. I felt like I was venting my diabetes frustrations all the time, without anything of value to say. 

I had a lot of other things going on at home and at work, leaving me with little enthusiasm for much else. It had been ages since I’d binge watched a good TV drama, or even gone to the beach. But I was exhausted.

So, after working through most of December, I decided to take a much needed Staycation. You know, being able to sleep in, make breakfast at 10am, go to the beach, binge on a good TV drama at midday, go to the shops without being in a hurry, stay up late into the night and recharge the batteries. 

First day back at work.

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In the excellent company of Mr Roger Federer tonight at the #HopmanCup.

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Today was fun.

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It began with all of this seemingly endless time stretched out in front of me, and before I knew it I was wondering how it could be over so soon. I guess that’s a good thing…

Staycations are awesome. They’re cheap. They’re a good way to charge up the batteries quickly. And they kind of let me catch up to diabetes a little, so that I’m not lagging behind for too long.