Pump Break II

My current pump break is surprisingly different to the one that I took a year ago.

At the time, I was feeling full of anxiety over all of the lows I was having from physical activity. I was still relatively new to insulin pumping, and felt a little overwhelmed at my failure to get everything right. I wasn’t missing my pump one bit, and if it weren’t for the Christmas smorgasbord around the corner I’m not sure that I would have ended up reconnecting.

This time round I’m feeling purely fatigued from the device that I’m using. I’m fatigued from being connected all of the time, and from staring at basal rates and insulin on board all of the time. I find myself getting a little slack with my management, and not getting the most out of my pump. I’m already missing the convenience after just a week, so I’m not confident how long this break will last.

I was deliberating over whether to start my pump break in the morning or evening. I’d read elsewhere that 1) morning would make it easier to monitor my blood sugar in those initial hours, and 2) the effects of Lantus tapering off at the 18-24 hour mark are felt the least. However, I’ve only ever known giving Lantus in the evening. I was also hesitant to have insulin tapering off in the early hours of the morning while I was experiencing dawn phenomenon. So, I stuck with dinner time.

I started with 10 units, the sum of my total daily basal given by my pump. That night, I had about two helpings of Skittles to ward my way out of lows. Residual rapid acting basal insulin from my pump was also very noticeable in those first few hours before bed, and I’d probably create some lag time between disconnecting my pump and giving Lantus if I were to do this again.

The following morning I woke up with terrible insulin resistance, which carried on through much of the day. In the morning it was obviously dawn phenomenon to blame, while in the afternoon my Lantus was likely tapering off.

On night two, I dialled my Lantus dose back to 9 units and added an injection of 3 units the following morning. The evening lows continued, and boy did those Lantus lows feel different. Heavier? Deeper? More intense? It’s hard to describe.

From there my evening Lantus dose went from 7 units to 5 units to 6 units, while my morning dose has remained at 3. That gives me a total daily dose of 9, which is pretty close to the 9.7 units I was giving via my pump. It seems to be keeping me fairly steady while I sleep, so I’m really pleased with that.

My biggest challenge is the moment I get out of bed in the morning. I’ve doubled my insulin to carb ratios at breakfast to combat the insulin resistance. Just don’t make my mistake of putting off brekky for 2 hours and still using double the insulin dose! For the remainder of the day, my regular carb ratio of 1:8 and correction factor of 1:2.6 seem to do their job as per normal.

I’ve been doing all of this blind, aka without the help of a FreeStyle Libre sensor, which means that I’m really feeling the brunt of the pricks on my fingers. BGs have probably suffered in the first week – Lantus was causing some lows in the beginning, while high blood sugars aren’t as easy to manage without a pump. However, I’m looking forward to seeing how this week treats me now that the dust has settled.

At the moment, I’m absolutely loving the freedom from attachment and not staring at my pump every hour. Bolus insulin also just seems to be “working” better. During those last few weeks on the pump, I definitely felt like I was correcting high blood sugars after meals all the time. Having the same kind of insuin for bolus and basal on the pump felt “blurry” at times, if that makes any sense at all.

When I made my decision to start pumping two years ago, I told myself that injections were too clunky and simply didn’t work for me. But after 18 months on an insulin pump, I know that this is not true. So long as I’m prepared to make the commitment to learn and take responsibility for my decisions, I can make any method of insulin delivery work for me.

How long do I think I will stay off the pump? I am missing it already. But I’d like to think I’ll give it until the end of the month, at least.