Diabetes Burnout

Burnout Is In The Air

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Don’t even get me started on those Spring has Sprung statuses…

I’ve been very much burned out these past couple of days. Surprisingly, nothing insulin pump related, either.

The truth is, I’ve had diabetes on the brain these past couple of weeks. I am striving to bring my A1C down by the end of the year. I’ve been stalking my glucose levels around the clock, demanding perfection. Carb counting. Weighing portions. Pre bolusing mealtime insulin. I’ve even heard the words remember to pre bolus escape from under my breath occasionally when I’ve been in the shower. I’m not kidding, either.

Last week, this constant diligence finally caught up with me.

I had two identical mornings, where I woke up slightly out of range on each. On Tuesday morning, my breakfast bolus failed to do it’s job of bringing me back into range. When I woke up slightly out of range again on Wednesday morning, I added another 10g worth of insulin to my identical breakfast, only to end up with an even higher blood sugar level than the day prior.

It got to me. It really got to me. Despite my best efforts, despite the constant monitoring and adjustments, I had still failed myself. Two identical days should be easier to manage, and yet they still produced completely different results. Diabetes is so damn unpredictable.

So I dropped the diligence. I didn’t feel like carb counting. I didn’t feel like weighing portions. I couldn’t be bothered pre bolusing insulin. I ate Croissants and chunky Kit Kats for lunch, because that’s what I felt like. Upward trend arrows on my Libre were compensated for with wild insulin boluses and temporary basal rates. Having access to unlimited glucose monitoring through my FreeStyle Libre sensor definitely made me feel I could get away with this downright shameful behaviour.

What scared me the most, however, was that this behaviour often mirrored my attitude towards diabetes prior to getting the pump. Lazy eating. Guesstimates. Rollercoaster swings in glucose levels. I lacked that sustained motivation. I didn’t really feel very much in control of my diabetes at all.

If this old reality has become “burnout” behaviour today, then I feel I’ve made a great deal of progress in the past couple of months.

A Basket Case?

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I’m sitting here, typing this, with a blood sugar level of 18.8. My FreeStyle Libre graph for the past 8 hours looks absolutely dreadful. I had to override the maximum insulin delivery limits on my pump so that I could give higher insulin boluses, and run higher basal rates to bring my blood sugar levels down.

I feel like crap. I feel ridden with guilt. I feel sick and tired of all the discipline that diabetes involves. I feel like I really don’t give a shit about diabetes today.

Rewind back to yesterday morning, when I woke up to a 9.1. Nothing too terrible, but far enough out of range to make my breakfast bolus less sensitive. Which, despite an added bolus for 10 grams worth of insulin with breakfast, still led to a reading of 15.0 afterwards. Which led to an I-don’t-give-a-shit slice of black forrest cake with lunch. Which led to an I-couldn’t-give-a-flying-f*** about being diligent attitude for the remainder of the day.

Diabetes demands so much discipline. Checking my blood sugar. Counting my carbs. Weighing my portions. Delivering my insulin. Pre bolusing that insulin 30 minutes prior for a optimal post-prandial result. Setting the alarm to check my blood sugar at 2am to ensure that I won’t wake up high the next morning. Foregoing so much temptation, for the sake of better blood sugar levels.

Diabetes already demands so much of me, and yet it never seems to be enough. It never seems to be enough, and that’s where the cracks begin to show. 

Yesterday afternoon, I was curled up in front of the couch with a coffee and an almost-finished (not by me) packet of melting moments biscuits. I had eaten one, and was sitting there staring at the last one in the packet for what must have been 10 or 15 minutes. Should I eat it? Or I should put the packet away?

I eventually ate the second one, and of course watched my blood sugar rise in the aftermath. As I gave corrections that couldn’t quite catch up to my rising blood sugar, I began to murmur to myself “you’ve got problem, mate.” “You need help.”

The funny thing being that if I didn’t have diabetes, this would hardly have been a problem. I would have eaten the second biscuit and enjoyed the hell out of it, instead of feeling guilty. I might have bragged to the next person I saw about eating those two whole biscuits, instead of feeling ashamed. I might have complained about feeling ready for bed after satisfying my stomach, instead of cursing my rising blood sugar levels.

If I didn’t have diabetes, this would hardly have been a problem.

If I didn’t have diabetes, I wouldn’t be talking to myself like I were a basket case because I ate two damn biscuits.

Pump Doubts

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After a few infusion site failures of late, I’m starting to become really self conscious. After every new site change, I become really paranoid of whether it’s a failure or success.

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I poke my infusion site, trying blindly to detect a kinked piece of teflon that should be sitting underneath my skin. I prod around the infusion site on my stomach, trying to feel bruising and pain. I stand still while my pump is delivering an insulin bolus, waiting on edge to detect any stinging. I lift up my jumper compulsively, watching the colour of the skin underneath my site like a hawk.

I think about whether the skin tissue underneath my infusion site is strong enough to handle 3 days worth of insulin boluses. I frequently glance at my Total Daily Dose history on my pump, questioning whether it’s too high. I feel guilty for the carbohydrates I am consuming, for the sake of the subsequent insulin boluses that will have to go underneath my skin.

I check my levels like crazy after a site change, impatiently looking for signs that the insulin is heading successfully underneath my skin. I keep an eye on glucose movements like a hawk. In a moment of paranoia on Saturday, I even ripped out a perfectly good infusion site because the correction was taking too long to work it’s magic.

I draw dots on my stomach in permanent marker, in a desperate bid to keep on top of site rotations. I stare persistently at the real estate on my stomach, deliberating over just the right spot to place my new infusion site. I worry about how soon I will be able to re-use an area of real estate again.

In moments of site failures, I question whether this is really worth it. I think about results around my diabetes, and I’m almost certain that I won’t see any improvement yet. I’d be lying if I said I haven’t had fleeting thoughts that maybe this is not working for me. I worry that I won’t be able to make this work for me. I stand in my room for minutes on edge, pacing, deliberating over a site change or a shot of Lantus.

But when I think about going back to Lantus, I think about the level of control I will lose around my basal insulin rate. I think about how unfocussed I was on injections, blindly guessing and correcting all the time. I think about all of the time and investment I’ve put into this insulin pump, and I know that I’m not ready to pull away from it just yet.

A Rough Patch

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I’ve been going through a bit of a rough patch with my diabetes lately.

I’ve been using an insulin pump for six weeks now. I am loving it, and I do genuinely feel a greater sense of control compared to what I did on Multiple Daily Injections. I feel that I am putting far more effort into my diabetes than I did towards the end of my reign on injections, which is a good thing. I feel motivated to put that effort in, because that effort does produce both results and less stress.

Yet at the same time, the insulin pump has been one of the greatest challenges I have faced in the course of managing my diabetes. There are an endless number of variables I can program for with the pump. Fine tuning the pump settings has taken a great deal of time and incredible patience. With a job that entails physical activity, this workload is essentially doubled. As I’ve somewhat come round full circle in fine tuning my pump settings, I am finding that my basal insulin requirements need to be lowered further. I’m needing to go round the clock again with basal testing (urgh).

The occlusion I wrote about yesterday was the last straw. It set off a rollercoaster of emotions. Sadness, failure, anger and frustration. I’ve been snappy. I’ve been quiet. I felt very tempted to rip out the pump and take a break last weekend. The words fucking diabetes have often been on my breath. I’ve even wished my diabetes away, something I can honestly say rarely happens. Opting out of renovation work last weekend was a tough, but necessary call so that I could have some time alone.

My diabetes educator recently reminded me that sometimes we need to take a step back from diabetes. Not literally, of course. I guess more like trying to put it to the back of my mind, and bringing some of the non diabetes stuff to the forefront.

For me, a big part of dealing with this burnout has been taking a step away from social media. I’ve really just needed a break from reading and engaging myself in the the constant conversations about diabetes online. I’ve pulled out a book, and started reading again. I even finished it. (If you know me, you will know how much of an achievement this is). I made dinner on Thursday night. I’ve focussed my attention finding some different stuff to snack on. I’ve also been ducking out into the Winter sun when it makes an appearance, too.


At the moment I’m just trying to look at my diabetes day by day, and trying not to set unrealistic expectations in fine tuning my insulin pump. I’ve put a plan in place to move past that occlusion. I’m giving the centre of my stomach an indefinite break from insulin pump sites. I visited my doctor last week, and am subsequently applying bruise cream to the centre of my stomach to hopefully heal some of that scar tissue. I’m placing my pump sites on the outer edges of my stomach, and drawing dots in permanent marker to track my rotations. I’m also checking my pump sites when I get dressed each day for signs of bruising and bleeding.

This week, the bruises are finally starting to fade. And with it, I feel like some of that burnout cloud is beginning to clear, too.

The Occlusion That Triggered a Burnout

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Two weeks ago, I made my first venture over to the right side of my stomach. I had worked my way across the left side of my stomach during my first month on the insulin pump. Infusion sites only need to be changed every three days compared to injections, and I was pretty damn pleased at the thought that the right side of my stomach had gotten a break for a whole month. So I was pretty surprised to discover bruising underneath that very infusion site two days later in the shower.

I knew that I had to rip it out straight away. As I ripped it out, it began to bleed. As I watched the bleeding and nasty purple bruising on my stomach, I really couldn’t believe it. I hadn’t touched that side of my stomach for a whole month, and I really had no explanation for it. I was pissed off, and wondered to myself where I had gone wrong.

As I went about replacing the infusion site, I wasted two insertion devices in the process. The first site came a little unstuck from my stomach as I pulled the insertion device away from my body. Not wanting to risk a failed site, I pulled it away from my body completely and started over. The second one was also a failure. The details are a little hazy, but I remember seeing a bent needle as I pulled the insertion device away from the site. By the time the third one was in, I had wasted close to an hour of my afternoon dealing with it. In addition to being angry, I was now very much emotional as well.

Yet, it was only about to get worse.

I decided it was as good a night as ever to turn down one of my favourite dinners (stuffed eggplants) in favour of testing my evening basal rates. Ironically, I was also moderating an OzDOC chat that night on diabetes and emotional health.

My levels were in range prior to kicking off the chat. I was confident my basal rate was close enough, although I did suspect that my levels might drop a little that night. So it was to my great surprise to find that towards the end of the hour, my BGLs had hit 10mmol with an upward trend arrow. I don’t know what possessed me to check my stomach, but I did. And I discovered my very first occlusion in my insulin pump line.


This one didn’t bleed a little. It bled and bled and bled. Words cannot describe how devastated I felt that night as I lay there on the couch, applying tissues on my stomach and waiting for the bleeding to subside. The two nasty purple bruises that were left on my stomach in the days that followed were a lasting reminder of my diabetes and of how long I’d had it. I had never felt so failed by my body in my life.

I stood for at least five minutes in front of my wardrobe, deliberating whether or not to replace the site. After the day which I’d had, I really didn’t feel like dealing with another site change. After the events that had transpired, I wouldn’t even be able to go to sleep with confidence that the site would stay put. I was seriously considering injecting Lantus and taking a break from the pump for a day or so.

I eventually gathered the courage to replace the site, opting for the outer edges of my stomach. I’ve since decided that the centre circle of my stomach needs an indefinite break before it’s ready to handle three day long infusion sites. I’ve visited my doctor, and I’m applying bruise cream to my stomach in the hopes that it will heal some of that stomach tissue.

I now make sure to look at my infusion sites every day. In the shower, when I’m getting dressed and before bed. I always make sure that the skin underneath the site looks clean and free from dark marks and bruising, because I want to minimise the chances of this ever happening again.

It was the occlusion that triggered a really rough period of diabetes burnout over this past week and a bit.