Insulin Pumps

Dawn Phenomenon, Breakfast, Physical Activity and Diabetes

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A couple of months ago, I wrote about the relentless hypos I was having at work. There have been days where my blood sugars have been bouncing up and down like a yoyo. The smallest insulin correction would be enough to send me plummeting within half an hour. My Libre would then show me rebounding after a hypo (and I now know that the Libre tends to pronounce movements in my BGLs). I would have the urge to correct it again, only to end up low once again. This seemingly vicious cycle made it impossible to obtain a steady line while I was at work and left me feeling exhausted at the end of the day.

The one thing I genuinely do miss about injections is that insulin sensitivity during physical activity was hardly an issue. I don’t remember having to pay half as much attention to my diabetes at work while I was on injections. I’ve felt very conscious of the number of times I’ve had to tend to diabetes in a day. Unlike a Lantus injection, my pump delivers basal insulin in tiny amounts throughout the day as I’m working. In addition to physical activity, dawn phenomenon and breakfast boluses are also thrown into my morning diabetes equation.

After a lot of trial, error, and notes in my diary, I finally feel as though I’ve got my mornings down pat in recent weeks.

The obvious one has been making sure that my basal rate is right. I cannot stress how difficult morning blood sugar levels are to manage if I do not wake up in range. No amount of correction seems to be able to fix them, and I end up really grumpy at 8am as I see my levels soaring after breakfast.

A couple of weeks ago, I noticed that my levels were climbing at around 3am each morning, warranting a change in overnight basal rates. Until that was fixed, I wasn’t able to properly focus on the mornings. Another thing I’ve learned is that my waking basal rate (when my liver begins dumping extra glucose) needs to run for at least a full hour before I wake up. Even a gap of 15 minutes is enough to screw up my morning basal test. Going on intuition seems to have done the trick in fine tuning the remainder of my morning basal rates.


Breakfast really has been a case of trial and error. I’ve learned that I do not need to subtract any carbohydrates from my breakfast insulin dose. Subtracting 5g from my breakfast dose is the difference between a post prandial result of 9mmol or a post prandial result of 15mmol. My pump will also add a correction dose to my breakfast bolus if my blood sugar level is over 7mmol. 


I’ve learned that I need to ignore it unless my blood sugar level is above 8mmol, and that I need to subtract insulin accordingly if my blood sugar is lower than 6mmol.

Morning coffee at work normally happens anywhere between 8.30 and 9am. My medium cappuccino with no sugar probably has around 15g of carbs, 10g of which I do not need to bolus for. It’s been so hard to wrap my head around these tiny insulin doses, but they are indeed enough! Pre bolusing is also not necessary, as I slowly sip my hot coffee when it first arrives.

Morning tea comes anywhere between 10 and 11am, and is usually a banana which is weighed before I leave home. Again, bolusing for 10g less carbs seems to do the trick, as do the rules for correcting.

Not foregoing what I love in the mornings has been really important to me. It would have been easy to simply forego breakfast or the morning coffee, but I know that would have made me unhappy (and hungry!). I work diabetes around my life and my activity, and not the other way around.

It’s been a lot of hard work, but I do genuinely feel that I have my mornings down pat. Instead of going up and down multiple times in a day, it might happen 2 or 3 times in a week. Levels are also looking great, thanks to continued pre bolusing and my moderate carb approach. I plan on taking a break from my Libre after today, and I’m quite confident that I will be able to manage just fine on finger sticks for a while.

I’ve been nominated for a Wego Health Activist Award. If you enjoy reading my blog, I’d really appreciate your endorsement which you can do by clicking here. 

Trialling an Angled Infusion Set

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On a grey Saturday afternoon back in July, I was out painting. The rain was pouring down outside. I remember checking my blood sugar level after a perfectly carb counted and pre bolused lunch to find an unexplained high. After I gave an insulin correction with no effect, I lifted up my shirt to find my 6 hour old infusion site bleeding. In addition to those feelings of failure and guilt, my supplies were all the way back at home. I was doubly devastated. Diabetes had ruined my afternoon. I hesitated for a moment, unable to find the words to explain to my brother that I had to take off.

As I drove home in the pouring rain that afternoon, I was on the verge of tears. Once again, I felt failed by my diabetes.

Infusion sites were one of the most overwhelming issues I faced during my first three months of insulin pumping. I spent ages obsessing over where on my stomach my site would be least likely to fail. After every site change, I was left in suspense for hours on end, almost waiting for a site failure. Wondering if the cannula had “clicked” in smoothly underneath my skin, or whether it had kinked. Checking the skin underneath my infusion sites like a hawk, looking for any signs of bruising or occlusions. Worrying about the rapid loss of usable real estate on my stomach, and how much longer I would be able to continue using my beloved insulin pump. I actually felt guilty for the amount of insulin I was using, because more insulin meant quicker onset of site failures.

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I was using a 90 degree infusion set with an insertion device at the time. Others had suggested I try a different type of infusion set. I knew that there were different kinds of infusion sets on the market. Ones that went in on an angle, rather than straight in. I don’t really know why it took me so long to look into it. I guess I just thought this was normal. I thought that the site failures were simply a side effect of six years worth of insulin injections. I thought that my body simply couldn’t handle 3 days worth of insulin infusions into the same spot. Besides, it was daunting to try something new.

When I woke up one morning to a bleeding infusion site that I was yet to actually begin using, I knew I had nothing to lose. I grabbed the box of Animas Comfort infusion sets that had been sitting in my wardrobe for a week, and I haven’t looked back since.


This cannula goes into my stomach on an angle, rather than straight in. For starters, I don’t feel it “digging in” when I’m laying on the couch or in bed. On the angle, it doesn’t hit blood vessels and nerves which likely caused the bleeding and site failures so easily. Not having a lot of fat on me probably didn’t help, either…

Yeah, I have to stick a big long needle into my stomach with every site change, but it virtually eliminates the possibility of the cannula kinking on the way in. It’s so much less wasteful, too. If for some reason my infusion set feels uncomfortable after insertion, I can stick the needle back into the infusion set and re apply. Previously, infusion sets were pretty much useless once they came unstuck from the insertion device.

Since I began using the comfort infusion sets a month ago, I’ve had one failed site. The first one. The rest of them have been a breeze. And did I mention that I can actually get them to last the whole three days? Even four? Possibly five…

I keep thinking back to a comment Laddie left me several weeks ago. She mentioned that she couldn’t find a 90 degree infusion set that worked for her. Looking back on my experience, I’m very much inclined to agree. 

I feel so much more comfortable with site changes today. I can change a site and actually get on with my afternoon, rather than stress about it for hours. My stomach is actually starting to look like a stomach and not like some blood stained wasteland. I finally have an explanation for all of the site-related issues I went through, which I can take great comfort in. All those feelings of guilt and failure are gone.

Today I can finally close that book of doubts and confidently call myself an insulin pumper.

Massive thanks to all of you who suggested trialling a different kind of infusion set. I do read and appreciate all of your comments of encouragement. I apologise for being so hesitant to give it a go. I owe you all coffees some day…

Sidenote: I’ve been nominated for a Wego Health Activist Award. If you enjoy reading my blog, I’d really appreciate your endorsement which you can do by clicking here. 

Highs After Exercise

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It’s amazing how something as simple as a conversation has given me some much needed clarity in recent weeks.

For several weeks, I’ve been giving corrections to stubbornly high glucose levels in the afternoons after I’d finished work. Highs that have made afternoon tea difficult to manage. Highs that have made my dinner time insulin dose less effective and pre-bolusing a complete waste of my time. Highs that have often carried through to bedtime and even resulting in a disappointing waking number.

I didn’t think that there could possibly be anything wrong with my afternoon basal rate, because I knew that it was fine on non working days. I thought maybe I was disconnected in the shower for too long. I thought maybe I was eating too much at lunch. I thought maybe it was time to give up the toasted sandwiches slathered with butter, and cheese oozing out of the edges. Maybe buy those addictive donuts from Woolies less often?

When I recently sat down with my new diabetes educator and my Diasend logbook, she instantly pointed out a recurring pattern of red readings in the afternoons. I knew that afternoons had been a problem area. I can see the afternoon ascent in my Ambulatory Glucose Profile.

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Yet in all these weeks, I had never really stopped and thought twice about it.

It took my educator’s small suggestion of increasing my basal rate in the afternoons for me to finally make sense of all of this. Could these afternoon highs possibly be an after-effect of my physical activity at work all day? Could my body be responding with extra glucose as I put my feet up in the afternoons and breathe a sigh of relief that the day is over? A quick google search confirmed that this indeed, could be a possibility.

The most incredible thing is the positive flow on effect that this small change has produced in the past two weeks. Since increasing my afternoon basal rate from 2-5pm on work days, I find that my BGLs stay in range through the afternoon. My dinner time insulin dose is far more effective, and I no longer receive frustrating highs after an accurately carb counted dinner. Overnights have also been looking much healthier, which will ultimately account for a large chunk of the hba1c result I am chasing.

As my educator reminded me, I can easily be doing this at home as well. I have the tech that is capable of uploading my data to the computer. I have Diasend, the software that compiles all of my data into one easy to read report.


Judging by my Diasend report that is now looking a little less red, I really need to be making the time to do this more often.

Does An Insulin Pump Make Me Lazy?

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In a recent blog post, I expressed that my insulin pump has offered a greater level of convenience in giving my insulin doses. I lamented that I was often slack with carbohydrate counting, weighing my portions and delivering insulin in a timely manner when I was on injections. This led to a few comments from social media trolls that accused me of getting an insulin pump because I was lazy.

Of course, I could absolutely count carbohydrates, weigh portion sizes and pre-bolus insulin on injections. But there were a number of other factors that lead to my ultimate decision, which I wrote about here. I felt failed so often despite my best efforts, that I simply lacked the motivation to do those things that I should have.

So in hindsight, maybe ‘lazy’ was the wrong word to use. I only used it in the context of trying to be honest. However, an insulin pump is definitely not a lazy decision.

Attending an insulin pump information evening was not lazy. Doing my research was not lazy. Making an appointment to discuss pumping with my diabetes educator was not lazy. Going home and giving myself three months to think about the pros and cons of pumping was not lazy, despite how tempted I was to say yes. Being active and seeking out options that may improve my health is not lazy. Wanting to better manage my diabetes is absolutely not lazy.

The very first thing that Gwen drummed into my head is that an insulin pump is not any easier than injections. In hindsight, I would argue that it is much more work compared to injections. There’s a good reason why clinics like to make sure that their patients are deadly serious about it and prepared to make a commitment. Wearing an insulin pump is a big responsibility. Just read every post I’ve written here in the past three months.

I am very conscious that I’ve been writing a lot about insulin pumping here of late, but that’s simply because my insulin pump is a big part of my diabetes at the moment. I certainly don’t have an agenda to ‘push’ insulin pumps onto anyone. I don’t believe that one is any better than the other. I simply believe that different methods of insulin delivery may suit some better than others. There’s a big difference between giving advice, and sharing my experience in the hope that it might inspire you.

Insulin pumps and diabetes tech are often the hot topics among bloggers and diabetes websites, and it sometimes does leave injections looking under-represented. But then again, don’t we all feel we are in the minority in some context or another? I feel in the minority because I can’t play sport to save my life. I feel like I’m in the minority because I don’t work in an office. At work this morning, I’ll be in the minority because I’m the only person who watched Australian Survivor last night. And in the DOC, I feel in the minority because I don’t use a CGM. 

Truth be told, I couldn’t care less about being in the minority! I’m happy to go for a walk instead of a run. I’m happy that I’m employed, earning money and have goals that I’m working towards. I love Survivor. And I’m happy to prick my finger 15 times a day, because that’s what works for me.

It comes back to the point I made last week in this post about inclusiveness. If there’s a topic that speaks to you, then please do add your voice to the conversation. And if I’m reading it, I promise I’ll treat it with absolute respect.

Finally, an insulin pump does offer me the convenience of dosing insulin under the table, or when I’m on the go. Dealing with diabetes every day for the rest of my life is already hard enough, and I refuse to feel guilty for it.

First hba1c Result Post-Pump

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The very last thing that I was expecting to hear was that my hba1c had gone up after three months on an insulin pump.

I mean, I wasn’t expecting dramatic improvement straight away. I knew full well that my pump is not a magic wand. I knew that my glucose levels were fluctuating far too much pre-pump. When we looked at my Ambulatory Glucose Profile with Gwen back in May, she said just as much to me.

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But I definitely believe that this variance is much tighter today. I feel I don’t peak above 15mmol half as often as I used to. Lows aren’t too bad either, but they are definitely a work in progress. I’ve been putting so much work into my diabetes. More than I used to on injections.

So I guess I went in there, mentally prepared to hear that my a1c result was the same. But definitely not half a point higher than my last one.

For a while now, I’ve stared at half decent a1c results. The doctors have been quick to dismiss me, but I’ve never truly felt satisfied with my results. Deep down, I knew that my levels were fluctuating far too much. I knew that I was peaking way too high after meals, and having far too many lows. I knew that my a1c result was not an accurate representation of what was going on with my levels. But I never had the courage to ask for help. I pushed these thoughts to the back of my mind, telling myself I would fix that problem before my next check up in six months time.

But I never quite got around to it.

So, I guess there was a damn good reason for the rise in my hba1c result last week. For the first time in a long time, I have a clear picture of where my glucose levels actually sit. It definitely means that I have made some progress. But at the same time, my goal post feels a lot further away. I am realising just how much hard work lies ahead of me in order to get that a1c to where I want it to be.

As I made a long drive home in peak hour traffic and pouring rain, it was hard not to feel disappointed. It was really hard not having Gwen, who recently retired, there with me that day. She had been with me all the way through my journey, and I’m sure that she would have understood exactly where I was at. I’m sure she would have known exactly what to say.

I dream of the celebratory dinner I’ll have when I get my a1c to where I want it to be. I dream of the satisfaction I’ll feel. The grin on my face. The sense of achievement. The victory. Feeling somewhat in control of this unpredictable disease. And the cake.

I am motivated. I know that I have made some solid progress in these last three months. I know that I am going make it to that dinner table one day.