I felt a lot more comfortable adjusting to the insulin pump at home, despite the enormous patience and mental strength it required. I didn’t have the added stress or pressure of being at work, or anywhere, at a given time. By the end of week one, my overnight basal rates were holding me steady through the night, and my diabetes educator was confident in my ability to justify the decisions I’d made around my basal rates. I saw out the week with a greater level of confidence in the device that was attached to me.
Going back to work, however, threw a curveball into the mix. It was a great relief to be able to pull out the pump and show everyone that it wasn’t a surgery, or a great big computer strapped to my back. But suddenly, my pump workload had doubled. I had two very different days, with very different activity and insulin requirements to consider.
My job is quite a physical one. I am on my feet for much of the day. Some days I am simply standing around the table where my team breaks down deliveries. Other days I am climbing ladders, lifting things intensively, or furiously unblocking the cardboard chute. The intensity of my activity often varies throughout my work day.
My biggest setback in those first few days was hyper programming my pump settings, without being patient enough to see them through the day before making changes.
I had initially set my basal rate to drop back a notch at 7.30am, half an hour into my work day. In response to a 17.0 on my FreeStyle Libre on Thursday morning, I gave a 2.5 unit correction that my pump suggested.
The ease of access to glucose data through my FreeStyle Libre tested my patience that morning. I was compulsively scanning. Scanning, scanning, scanning, way too frequently. Upward trend arrows, hitting glucose levels of 18, 20 and 22 within minutes. I was impatient, and set a temporary basal insulin rate of +10%.
Within half an hour, my levels were starting to fall. Feeling satisfied, I cancelled the temporary basal rate.
Half an hour later, I was still falling. I kicked my basal rate down again.
Half an hour later, and I found myself hypo. I set a temporary basal rate of -50%, and treated it.
My biggest mistake in those first few days at work was trying to micro manage data after meals, before the insulin had finished doing its work. My diabetes educator had told me that the first thing we needed to do was to minimise the lows. Yet I couldn’t get that stupid high off my mind.
I know damn well that insulin takes time to kick in, but I ignored my better judgement. I probably upped my basal rates unnecessarily, which was essentially extra rapid acting insulin in my system in the hours that followed.
I paid for my compulsion throughout those first few days with some very exhausting lows.
This week, I am trying not to hyper program my pump. I am setting basal rates the night before, and sticking with them through the day before making changes.
I am trying to remember that what goes up, must eventually come down again.