Insulin Pumps

Do Your Insulin Needs Increase During Winter?

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I could feel my blood boiling.

With every single swipe of my FreeStyle Libre reader against the sensor on my arm, I felt increasingly frustrated.

Despite being pretty confident in what I’d eaten and covered with insulin for dinner, my levels dipped slightly before slowly but steadily ascending once again. A pattern that had become somewhat typical over the past couple of weeks following meals.

Despite correction after correction, my blood sugar levels were yet to budge.

My mind wandered back to the pump break I had taken in late April and May. I thought about how easy blood sugar levels had been to manage with pens and needles. How free my mind had been from frustration.

That pump complacency I felt on the night I disconnected my pump in late April had returned. I didn’t want to be feeling it, but it was there, plaguing my thoughts against my own will.

Then, I just had this sort of ‘epiphany.’

I set a temporary basal rate increase of 10% on my insulin pump, hoping that it would help my correction doses to start working better.

When my insulin still seemed ‘sluggish’ a few hours before bed, I increased it to 20%. After a few more days had passed, I went into my pump settings and permanently adjusted the basal rates upwards by 20%.

I’ve heard it discussed before in the diabetes community. I’ll be the first to admit that I never brought into the whole concept of insulin needs increasing during the Winter. And decreasing during the Summer, for that matter.

I don’t know what causes it. There’s been no significant change in my activity levels. I’m very active during my work day as usual, and don’t go anywhere near the gym or a pair of running shoes when I’m at home. My routine is the same. Admittedly, I probably spend less time outdoors or in the sunlight at the moment. Maybe there’s an increased inclination to drink coffee, eat cannoli and watch Australian Survivor.

More than anything, I think it may be an environmental or physiological factor.

I’m just grateful that my insulin is working again and that I can spend more of my day in range, fighting less of an uphill battle in doing so.

After eight years, I’m still learning new things about my diabetes. I truly believe that the more time and experience I have under my belt, the better equipped I am to live with it.

YpsoPump: Eight Weeks Old!

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I was full of enthusiasm when I learned that I would have the opportunity to road test a new diabetes toy in the YpsoPump.

The YpsoPump does have a fair few differences to traditional insulin pumps, but for the majority of my eight week adventure these differences were far outweighed by its sleek and lightweight nature.

With a stockpile of supplies belonging to my late Animas Vibe sitting in the wardrobe, I made the decision to pull my old pump out of retirement two weeks ago. It actually has reminded me of some of the features that I have been missing.

One of my biggest issues with the YpsoPump has been occlusion alarms. Unfortunately, at least 1 or 2 infusion sets in each box that I have used so far have triggered occlusion alarms. There have been no visible signs of site failures such as kinking or bleeding. High blood sugars clearly indicated that insulin was not getting through, however the alarms only seemed to trigger during a decent bolus of at least 3 units.

I’ve been connecting to a new infusion site at mealtimes where I’ll give a decent bolus, hoping that any occlusions will be triggered. I have reported the issue to Ypsomed with little answer, although I was pleased that my level of diabetes knowledge was acknowledged over the phone. I do wonder if this is simply an issue of me being too thin and lacking enough tissue to cushion the cannula beneath my skin.

I do also miss having the option of having infusion sets that sit on an angle beneath my skin. I can really feel the Ypsomed sites ‘digging in’ when I’m lounging on the couch or sleeping. The marks and bumps left on my skin after removing an infusion set also seem bigger, presumably from the sets ‘digging in.’

Being fairly thin, I don’t think the Orbit inserter is the best practice for me to apply a new infusion site. Inserter devices didn’t agree with me on my late Animas Vibe. While my experience was better than the Animas insets, I definitely intend on manually inserting my sets when I next use the pump.

The one thing I would change about this pump is its lack of a built in bolus calculator. While performing bolus calculations on my iPhone is largely okay, I have found myself slacking off here and there. I’d also like to see more customisation in Ypsomed’s bolus calculating app, such as being able to adjust insulin to carb ratios for things like physical activity.

It was also far too inconvenient having to wait for the app to sync with the pump for insulin data to perform a bolus calculation. Bluetooth was also a significant drain on the pump’s battery. I have since switched the bolus calculator to Multiple Daily Injections mode, instead relying on my ability to log all of my bolus calculations to obtain accurate insulin data. With Bluetooth switched off, I’ve also managed to get a more decent 21-24 days from an Energiser AAA battery.

The thing I like most about the YpsoPump is its sleekness, size and lightweight nature. I have definitely missed that in these past two weeks, especially when I’m travelling and have other things to carry around in my pocket as well. I feel confident that I can live with those differences in return for its weight – particularly in the Summer, when pump complacency is a real issue for me.

The YpsoPump has definitely been a learning curve over these past eight weeks, but as with all other aspects of managing diabetes, I’ve learned how to best make it work for me.

Disclosures: Ypsomed Australia provided me with a YpsoPump, infusion sets, reservoirs and an inserter to trial at a launch event in Sydney. There was no expectation that I would blog, or even trial the pump itself. All opinions expressed here are, as always, my own. 

Basal Rate Intuition.

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This morning, I woke up to a relatively flat line and a number in range.

I shuffled into the kitchen, knowing full well what I should do. I stared longingly at the coffee machine, knowing full well what I should do.

Instead, I took a seat at the table and opened up my iPhone. After I had whiled away some time, I headed back into my room and gave that dreaded swipe of the FreeStyle Libre.

I was almost expecting to see an upward trend arrow, indicating that I would need to go back to the basal rate testing drawing board and start again tomorrow. I wasn’t even too sure if I would be that disappointed, because then I would be able to validate my need for coffee.

Instead, I was pleasantly surprised to see a result that had barely moved since waking up, accompanied by a steady trend arrow.

I don’t really know what my morning basal rate is. Not since my morning routine changed a year ago. I just make small tweaks here and there, going by how my blood sugars react after my breakfast. I’ve been putting off doing a proper basal test for ages, because it’s so damn hard to wake up without coffee or breakfast. Not to mention that a basal test will only work when you wake up to levels that are steady and in range (less than 6mmol).

Since starting on the YpsoPump, I’ve been forced to make some tweaks to my morning basal rates to account for its limitation of only being able to set basal rates on the hour rather than half hour. I’ve noticed my blood sugars trending upward after breakfast recently. I’m also not as active as I once was at work, which could warrant an increase in insulin as well.

As I got ready for work, drove in and began my day, I was pleasantly surprised by the result of every single scan of the Libre.

I wasn’t expecting that diabetes would let me off this easy after just one day. Or that my basal rate intuition was this good.

With a mental ‘tick’ against my morning basal rates, my only homework for tomorrow is to drink coffee and revisit the insulin to carb ratio I’m employing to cover it.

One Messy Night.

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I was ready to go to bed.

As I watched my blood sugar slowly climb into the 10s, I gave a unit of insulin to correct. Thinking about the after effects of stacking my dinnertime insulin on top of a late afternoon coffee and one of Nonna’s biscotti, I set a temporary basal rate of 150% for 2 hours to help that insulin better do its job.

I set the alarm on my iPhone for 1am and switched off the lamp on my bedside. With a nagging feeling of doubt as I turned on my side, I fumbled for my pump in the dark and gave another unit.

DURN! DURN! DURN! DURN! 

I hastily fumbled for my phone to silence the shrieking alarm, before switching on my bedside lamp again. As I swiped my Libre reader, I was half expecting see blood sugars heading into low territory.

Instead, I was actually a pleasant 13.8.

I was in disbelief. However, I thought it could be plausible after having pasta for dinner. I reached for my insulin pump, and gave a rage bolus of 3 units.

ZZZZ! ZZZZ! ZZZZ! ZZZZ!

My rage clearly wasn’t enough to fuel the delivery of this bolus, which was stopped in its tracks by a very irritating occlusion alarm that was hissing and vibrating at me for attention.

I ripped the cap off my infusion site, which revealed a perfectly clear looking site. A poke and prod around the area showed no signs of any discomfort. I primed several units of insulin out of my pump line, watching it spill over the cannula and pool around the cap to satisfy my paranoia. I held my pump line up in the air and ran it through my fingers, watching it like a hawk for signs of air bubbles.

With my paranoia satisfied, I reattached the cap to my infusion site and delivered the remainder of the bolus that my pump had cut off. I set another temporary basal rate of 150% for the next two hours, setting my alarm for 3am.

When I stirred at 2.17am, feeling rather uncomfortable, my Libre reader revealed a reading of 17.7 and rising. I hastily grabbed my pump and went to deliver another rage bolus of 5 units.

ZZZZ! ZZZZ! ZZZZ! ZZZZ!

That hissing, vibrating occlusion alarm sounded once again, stopping my rage bolus in it’s tracks.

By this point, I was furious as I flung my bed covers away from me and was forced out of bed.

Finally, I ripped the infusion site away from my stomach. There was no kink in the cannula. There were no signs of blood, bruising or bleeding on my stomach where I’d placed the site. Everything looked fine, and I was convinced I had just wasted a perfectly good site.

After inserting a fresh infusion site, setting a temporary basal rate and delivering my third rage bolus of the night, I was finally able to close my eyes.

I wasn’t surprised to learn that I’d slept over my 6.25am alarm. I gulped down my coffee, showered, and hastily threw two pieces of frozen Pane Di Casa into my bag to toast at work.

I soldiered on, reminded of just how much responsibility rests on my shoulders every day.

YpsoPump: The First Few Weeks (Part One)

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I’ve been staring at my chunky old Animas Vibe with its holes in the coating and an interface from the ‘90s, thinking about how I will possibly be able to while away another two years before its warranty is up. I’ve been dreaming up scenarios in my mind where new pump options would arrive on our shores and be rolled out to existing Animas customers sooner rather than later.

But I never, ever, really imagined that I would have one of these exciting new options in my hands so soon.

(This is the part where I tell you that Ypsomed Australia provided me with a YpsoPump and consumables to take home and trial. Followed by the part where I tell you that was no expectation that I would write, or even trial the pump itself. Followed by the part where I remind you that there’s a bias in place and that you should take my enthusiasm with a grain of salt).

I’ve been YpsoPumping for almost four weeks, and I am absolutely loving how sleek and light it is. When I started pumping insulin two years ago, I wanted it purely for the benefit on my blood sugars. I never thought that this sleekness was something that I could ever ask for, or want, in a pump.

It weighs eighty three grams, inclusive of a AAA alkaline battery and filled insulin cartridge. To put that into perspective, It’s about half the size of my wallet and a third of the size of my iPhone. Did I mention that it’s slimmer, too? I hardly notice it in my pocket when I’m lounging on the couch or in bed at night.

It’s also way quieter than my late Animas Vibe. I no longer hear the swish of insulin boluses being delivered. Or that little ‘tick’ every three minutes as the pump infuses basal insulin into my body.

The interface is made of up of predominantly symbols and numbers, rather than words, which definitely took some getting used to.

It also has a touch screen, which can only be switched on by pressing the button on the side of the pump. The main menu also has a three tap access code before you can go in and administer insulin.

Basal rates can be set in increments of 0.01 units per hour, which gives greater customisation than the 0.25 units on my late Animas. The biggest challenge for me is that they can only be set on the hour, rather than the half hour. So when I wake up at 6.30am, I can only set my elevated waking basal rate to run from either 5am or 6am, rather than my ideal time of 5.30am. I’ve been experimenting with some basal tweaks this week, and hopefully I’ll be able to work around this.

I’m also liking the vibrating reminders when my temporary basal rate is finished running. I tend to sleep over middle of the night alarms, but the pump has even woken me up during the night to let me know a temporary basal rate has finished running. It’s a really handy feature to have, reminding me to check my blood sugar and evaluate whether I need to run it for longer.

The biggest difference to my late Animas is that the YpsoPump does not contain a bolus calculator. That is contained in the companion mylife smartphone app. Or any other bolus calculating app, for that matter. So you would need to open your app, work out your bolus, and enter that number into your pump. The app then syncs with the pump via Bluetooth to obtain insulin data. At the launch event, we were told that the pump could eventually be controlled from the app.

I have no problem using a phone app to calculate insulin boluses. I’ve done it before when I’ve taken pump breaks. But I found it frustrating having to wait a good 15 seconds for the app to sync with my pump so that I could do a bolus calculation. I’m so used to being able to quickly glance at my insulin on board during the day before various activities. Not to mention that having my Bluetooth constantly switched on is a drain on both my pump and iPhone battery. As a result, I must say that I’ve been slacking off on bolus calculations.

I expressed to the rep last week that it would be helpful if the bolus calculator worked independently of having to sync with the pump. After suggesting that I could switch my insulin therapy settings to Multiple Daily Injections, I’ve been able to do just that. So long as I’m logging all of my bolus calculations and insulin doses in the app, I’ll be able to see my insulin on board without having to sync the pump via Bluetooth.

The pump can deliver insulin boluses in increments of 0.1 units, which is slightly less than the 0.05 my late Animas allowed. The bolus calculator automatically subtracts insulin on board from a bolus calculation, which might not always be necessary. It also lacks the flexibility to make adjustments to insulin to carb ratios or insulin sensitivity factors for things like physical activity. However, it is working a lot better for me in MDI mode.

I know just how hard a good bolus calculator is to find, and for me a diabetes app without one simply has no value. Ypsomed do appear to see the bigger picture of people who don’t use pumps and CGMs, and I’m confident that the company is working hard to make Multiple Daily Injections and glucose monitoring ‘smarter’ as well.

If you are looking for a bolus calculator, you can search for the ‘mylife app’ in your Google Play or App Store.

Come back tomorrow for part two of my review of the YpsoPump!

Updated: Find part 2 here!