Pump Break: The Good, The Bad and The Ugly

As I enter the fourth week of my pump break, I’m slowly beginning to remember some of the reasons why I abandoned Multiple Daily Injections in the first place. But if there’s one thing that’s keeping me from reconnecting right now, it’s the thought of attachment and doing those daily maintenance tasks once again.

This pump break has definitely made me more disciplined with my insulin dosing. Having to physically inject forces me to be more meticulous with my insulin decisions, rather than just lazily dosing another unit to counteract a rising BG. I am using less insulin on Multiple Daily Injections today compared with recent pump history and my initial six year tenure on Multiple Daily Injections.

RapidCalc, the app I am using as my bolus calculator, is telling me that my average bolus insulin is sitting at 19 units per day. I feel that those 19 units reflect most of my days, rather than being an average of variable numbers. Scrolling through my more recent pump history, boluses have become very variable, with most days ranging between 20 and 30 units.

Thinking back to those first six years on Multiple Daily Injections, I also remember lots of wild guesstimates, corrections and big mealtime insulin doses of 5-10 units at a time. Nothing seemed to be able to get the job done. With a much smoother Lantus regimen and a newfound dedication to carb counting today, I can give those small insulin doses of 1-3 units and actually get the job done.

Then there was Lantus. My number one reason for ditching the shots was Lantus. I could never seem to get the dose right at night, while during the day blood sugars felt unmanageable.

Today, my 66/33% split seems to be giving me the best coverage I could ask for from a basal insulin. Six units keeps me fairly steady overnight, with no significant effects of dawn phenomenon while I sleep. A further three units in the morning helps to combat morning insulin resistance, and makes the remainder of my day much more manageable as my nighttime insulin tapers off.

It’s not perfect. Just this weekend I’ve re-learned that skipping a meal will send me low. I also went low one night last week, after skipping my afternoon coffee and then eating a fairly low carb dinner. So yes, Lantus does like it’s routine. But what I am achieving today is more than I ever expected I could get from Lantus, so I’ll take it as a win.

Some aspects of my diabetes management are exactly the same as when I was pumping. Like the delayed bedtime spikes from afternoon snacking that need a correction at midnight. And the weekend blood sugars that tend to cruise a little higher than their weekday counterparts. As much as I’d like to blame my pen or my pump here, I only have myself to blame!

I really miss having my pump on me to conveniently bolus or correct a high blood sugar when I’m out and about. Just last week, I was interrupted mid-injection at work. Which is frustrating, because I really need to focus while I’m injecting to make sure that it all goes in. Which brings me to my next point.

The drops. Those bloody drops of insulin that manifest on the end of my pen needle when I pull out too quickly after an injection. I’m left wondering whether all of the insulin went in, or whether I need to give another shot. There is a technique, by the way. Gently lift the skin beneath your injection site (don’t pinch), inject your insulin, hold the pen in for 15 seconds post injection, release the skin and then pull the needle out.

I’m also finding it harder to rotate injection sites, as they are less visible than pump sites and I do several of them each day. I find myself continually going back to the usual suspect areas, which i know I shouldn’t be doing.

The most enjoyable thing about my pump break is being able to go for a walk in the afternoons and not worry about rapid acting insulin sending me low. Getting changed without having to accommodate a pump in the process. Laying in bed and not having to feel that chunk in my pocket. In fact, I think that this is the least I’ve thought about diabetes in several weeks.

I still remember some wise words from fellow d-blogger Ginger Viera. She says that both methods of insulin delivery have flaws, and that it’s up to us to choose the flaws that bother us the least.

With the Festive Season well and truly upon us and my first Lantus pen nearing empty, I’m wondering just how much longer this pump break will last me. I guess time will tell…