Insulin Pumps

First Site Change

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I had it under good authority that first site changes are a mess, and boy did I learn my lesson last Thursday morning when I did mine.

I left the old site on my stomach in place, until I was sure that the new one was a success. I opened the insertion device, unwound the cannula, unwound the paper from the adhesive, and pulled back on the inner white plastic. I squeezed on the edges of my insertion device until it “clicked” into place onto my stomach, directly above the old one.

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I pressed down to ensure the adhesive had stuck, and then pulled the insertion device up. This is what was left on my stomach.

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I could feel uncomfortable pinching underneath. My first site certainly didn’t feel like this. I looked at my site, and I knew straight away that I’d gone too far left, and too far up on my stomach. There was hardly enough body fat underneath the site to cushion it. I had to rip it out, and start all over again.

After connecting the other end of the tubing to the insulin cartridge inside my pump, I went to prime it. Insulin wasn’t coming out. I primed again. I still couldn’t see any insulin coming out.

By this point, I had been disconnected from my insulin for at least half an hour. My desk, my bed and my dresser were strewn with diabetes junk. Fucking diabetes. Fucking diabetes, I cursed out load as I searched around frantically for my workbooks. Not to mention I had the live Survivor finale on timeshift that morning, which I’d planned to be watching by this point. After finding the page that talked me through refilling and replacing an insulin cartridge, I primed again. There wasn’t a single drop of insulin coming out of the cannula.

With all avenues exhausted, I decided to give the AMSL diabetes helpline a call and see if they could help.

Guess what? You know how when you start a new insulin pen, you have to prime 10 or so units until the insulin comes out? That’s all I had to do with the pump. Hold down the prime button until insulin came out. I felt so stupid.

On the bright side, my second site change on Saturday was a piece of cake. I think I’ve got this…

FreeStyle Libre: First Observations!

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With the life of my FreeStyle Libre sensor coming to an end in a few days, I thought I’d better write some observations while they are fresh in my mind.

I first put my Libre sensor on during Diabetes Exchange in Sydney (disclosures are at the bottom of this post). We were advised that the best place to wear the sensor was on the underside of the upper arm. In similar fashion to an insulin pump infusion site, the sensor came packaged in what looked like an insertion device. It simply “clicked” into place on the arm.

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I’m the kind of person who easily gets annoyed by things. I fiddle with my watch, my medic alert bracelet presses too hard on my skin, and I am always picking at scabs. So I was pleasantly surprised that I have hardly noticed the Libre sensor. So far, the sensor has held nicely on my arm. I had one bath where the sensor was submerged in water for some of the time. I’ve had showers and changed my clothes every day, where the sensor is inevitably subject to some bumps and friction. The sensor is starting to look a little grubby around the edges, though, as it heads towards the end of its life.

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Being Winter, my sensor often sits under warm clothes and I notice it less. It is likely exposed to lesser impact and outdoor activity compared to the warmer months of the year. I’m also not sure how comfortable I’d feel wearing this $95 sensor to the beach under some rough waves.

Some of the other bloggers raised the issue of the Libre not having alarms to alert them of high and low blood glucose readings, which is a very valid point. I am not particularly concerned by this. Just as with finger pricks, I check often enough to be able to catch any impending highs or lows. I’m all for something simple, and that minimises the diabetes junk that I have to carry around with me. The Libre fits the bill nicely. As with anything, more features will mean an even higher price tag.

A great deal of my Libre use has been checking my glucose levels after meals. This has given me an insight into where my levels are heading after I eat, and in evaluating the need to readjust settings and ratios on my new insulin pump. We were told that data may be less accurate than a finger prick when glucose levels are rapidly changing, so please bear this in mind around my observations. 

My Libre reader has typically run around 1-2 mmol higher than the reading on my meter. I have also noticed a more significant difference where my Libre presents a reading greater than 15mmol. I have found greater accuracy where my levels are in single digits, and where there is no active meal bolus in my system.

That being said, the Libre has been super convenient to have while I’m transitioning to the insulin pump. It’s been a huge relief on my fingers at a time where I would likely be using test strips like water. Every morning, I plug it into the computer and upload the data to Diasend. It gives me access to detailed graphs that have tracked the movement of my levels through the night, which is extremely helpful in making decisions around my overnight basal insulin rate.

I walked around without my meter and test strips while I was in Sydney quite comfortably, too. The reader was quite easy to carry around, and fitted nicely into a t-shirt or jeans pocket. It was a really convenient tool to evaluate my blood sugar levels after some big Sydney meals, and a reliable indicator of glucose trends. I would definitely consider buying a sensor next time I plan on travelling.

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After a week and a half with my sensor, I am also feeling extremely challenged not to micromanage data. It’s extremely challenging to look at those annoying trend arrows after meals and not respond to them. It’s for the same reason that I’m not particularly interested in using a Continuous Glucose Monitor (not to mention the price!). I will definitely miss the convenience and the detail of my Libre data when my sensor shuts down on Thursday, but I am also very much looking forward to a break.

You can find out more about the upcoming Australian launch of the FreeStyle Libre at freestylelibre.com.au.

Disclosure: Abbott paid for my travel and accommodation expenses to and from Sydney. I received a FreeStyle Libre reader and 2 sensors free of charge. There was no expectation that I would blog about the Libre. All opinions expressed here remain my own.

First Week On The Insulin Pump

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The last two weeks have been an absolute blur. This month has been diabetes overload. The new devices that are attached to me are a big reminder of that, although not necessarily in a bad way. My desk is an absolute mess of cable cords, information booklets, carb counting books and test strip containers. Every time I clean it up, I end up needing to pull the stuff out again.

I’ve been asked so many times about how I was feeling in the lead up to insulin pump day. Yet the reality didn’t actually set in until I was at diabetes clinic last Monday morning. Some of the other questions around it, however, have been rather amusing.

So when do you go in for your surgery?

Is it like a computer that’s strapped to your back?

It’ll be quite heavy. Will you still be right to work here?

Does the insulin go in through an IV line?

And my favourite, courtesy of one of my Aunts:

They’re going to have to cut you open! They’re going to have to cut you open!

It’s so bloody hard to explain what it actually is, so I’m really looking forward to being able to pull out my pump and show everyone.

Sidenote: My favourite diabetes hack from Friday’s Diabetes Blog Week prompt goes to Laddie at Test Guess and Go – objects photograph better on colours.

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The biggest misconception here, is that people thought I was taking time off for a physical recovery after the insulin pump. The truth is, it’s been more of a mental one. I’ve slept over almost every alarm that I’ve set for myself during the night to test, simply because my brain is fried from diabetes. Even harder, is the fact that most people won’t see the huge learning curve of these initial weeks.

Every night this week, I’ve been putting my overnight basal insulin rate to the test. Seeing if it will hold my BGLs steady, drop me further, or make me spike. Every morning, I’ve plugged my devices into the computer and analysed the results. Having access to such detailed data through my FreeStyle Libre (I received a reader and two sensors free of charge – further disclosures are here) has been helpful in tracking the movement of my BGLs overnight, and making changes to my basal insulin rate. It’s also a challenge not to respond to those annoying trend arrows and micromanage data. 

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Having both my diabetes educator, and my family to talk it through with each day has been a huge support. I’ve sorely missed my educator’s guiding hand over the weekend, and I hope that I haven’t veered too far away from the road in my decision making. Being home to navigate my way through it this past week has also been a massive relief. But I’m also a little overwhelmed at the new factors that will be thrown into the mix when I head back to work tomorrow.

This past week has taken enormous patience. I’ve hardly even made a dent in my homework. Once my overnight basal rate holds me steady, I’ll move onto testing my morning basal insulin rate, where I’ll have to deal with morning cortisol glucose dumps. Then the afternoon, and then the evening. Then fine tune Insulin to Carbohydrate ratios, and correction ratios.

It’s hard to remind myself that this will take time to get right.

Amongst all of this, it was hard to believe that it was also my birthday yesterday. 

It was such a relief to have that guidance from the pump in bolussing insulin for my birthday dinner, rather than my lazy guesstimates. It was so nice to simply pull out the pump from my pocket, and push a few buttons to bolus for the cake. 

The pump is one of the greatest birthday gifts I could have wished for this year. It’s a brand new chapter for my diabetes, and I’m confident the change will be a positive one.

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Thursday Night, Diabetes Style

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When I last visited my diabetes educator in February, I brought my meter along in order to show her my numbers. I was stepping outside of my comfort zone. I was essentially exposing myself, and all of my highs and my lows. I wouldn’t be able to choose what I would share with her. I wouldn’t be able to summarise. It was a big step for me, but one that I felt ready to do.

Unfortunately, the focus seemed to be more on what I hadn’t done – logging my insulin doses into the meter. I apologised, and promised that I would send through two weeks worth of meter reports before my pump day, so that she would be able to work out insulin ratios and settings.

It was a simple task, yet one that has been weighing heavily on my mind for weeks.

Every time I have attempted to make a start, something gets in the way. In March, I got sick and was rage bolussing stubborn highs like crazy. A week later, Easter rolled around and I was eating more than I should have. I took some holidays, and the numbers didn’t reflect my regular routine. But most of the time, I’ve just been telling myself that the numbers aren’t perfect enough to send through.

I can probably guess what a healthcare professional might think. Lazy, slack, non-compliant (insert your favourite word here). But when diabetes already takes up so much of my time and energy, a simple task like stopping to log my insulin doses is a big deal. It’s hard to carry the same meter around with me, rather than rely on the others that are stashed in convenient places. It’s hard to stop and punch in the insulin dose, when all I really want to do is sit down and eat.

But I knew that I was going to honour my promise. I knew that I wasn’t going to lie.

Come Thursday night, I generated 14 days worth of Insulinx meter data on my computer and printed it out. I took a seat at my desk for what would be somewhat of a long night.

I went backwards, day by day, reflecting on the past two weeks of my diabetes life. Recalling exactly where I was, and what I was doing on that particular day. Thinking about what I’d had for dinner that night. Remembering the circumstances surrounding that stupid low, that stubborn high, or that victorious overnight result. It took me a few hours. It was a little confronting, staring at those numbers on paper and being reminded of where I had gone wrong.

I attached a note to my meter reports, apologising to my diabetes educator for not directly logging the insulin doses into the meter. I explained that I had thoroughly gone through my last two weeks, and provided what I believe to be a very comprehensive overview. I wrote notes about my typical day. A work day, where I was on my feet, moving around and lifting things. Night times, where I was often chasing post bedtime highs from things like Pasta, Fat and Protein foods. Insulin to carb ratios, correction ratios and Lantus doses.

I carefully folded my paperwork, placed it into an envelope and stuck an express stamp onto it.

As I placed my letter into the Post Box on Friday afternoon, that big weight that had been sitting on my shoulders for weeks was finally gone.

More Reasons For The Insulin Pump

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It feels like forever ago that I made the big decision to switch to an insulin pump, and now the big day is only two weeks away.

Over these past couple of months, one of my reasons for making the big switch is becoming much clearer.

I cannot wait to be able to fine tune my insulin to better suit the time of day.

I usually head to bed at around 10pm most nights, which is usually before all of my rapid acting insulin from dinner has worn off. I often find myself needing a good correction dose later on, and I’m not awake to be able to do this. If I’ve eaten something really Low GI like Pasta, it often needs some delayed insulin to cover it. If I’ve eaten something higher in fat or protein, ditto. So most nights, I end up setting 1am or 2am alarms which allow me to test and correct. It’s a lot of work.

Lantus tends to work best when I eat a similar amount of carbohydrates each day. Some nights, 10 units isn’t enough to keep me stable through the night. Some nights, 10 units will send me plummeting to lows. Other nights, my blood sugar will hold nicely until 4am, and then begin to plummet. Ideally, I imagine that my pump would be able to deliver a heavier background insulin rate between say, 10pm and 1am, and then a lighter rate for the rest of the evening.

Part of me is ridden with guilt. I feel like I have failed injections, and that I should have been able to get them right. I question whether I am getting the pump to be more lazy with my diabetes. I feel guilty for demanding an expensive piece of diabetes technology, when other people in the world can’t afford insulin alone. I feel guilty for not having the willpower to follow a regimented diet. I feel like I have a bad diet, simply because I can’t get my blood sugar levels quite right around the food that I eat.

However, none of this could be further from the truth.

I am working hard – extremely hard – with a very demanding condition. A condition that never lets me rest, and is changing all the time. I am striving, constantly, to do better. I know exactly why I am getting an insulin pump, and what I want from it. I haven’t made this decision lightly. I don’t eat exactly the same thing day in and day out. I enjoy variety in my diet, and I don’t apologise for it.

I’m going to try and stop feeling so guilty.

It’s my diabetes, and my choice in the way that I manage it.

Let the final countdown to pump day begin…