Insulin Pumps

My New Look Diabetes

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This is what my diabetes currently looks like.

One evening injection of Lantus, which is currently giving me freedom from attachment and freedom from thinking about rapid acting basal insulin. After a few mild night time lows, eight units seems to be the magic number.

One infusion site still stuck to my stomach, which I am able to connect my insulin pump to at mealtimes to deliver boluses.

One late Animas Vibe insulin pump, which I now carry around in my diabetes travel case rather than on me. My insulin pump offers me the convenience of an ezCarb calculator at mealtimes, and no needles to deal with while I’m on the go. 

This was a very spontaneous decision that I made in the space of an hour over the weekend. I honestly had not had a single, fleeting thought cross my mind in the days leading up to it.

Despite being only a few days into this pump vacation, I feel as though I have finally escaped the feeling of a dog chasing its tail while managing my blood sugars throughout most of April. Lately, there have been a few too many highs and a few too many lows.

Just as I wouldn’t enjoy eating a ham sandwich for lunch every day, I feel like I need to shake things up every once in a while in order to me feeling fresh and motivated to manage blood sugars. Whether that be a new sticker for my meter, a Rockadex patch for my FreeStyle Libre, or in this case a new insulin regimen.

Every time I do this, I learn something new.

Rather than rushing into splitting Lantus injections after some high blood sugar levels, this time I’ve decided to wait a few days for my basal insulin to settle in.

Yep, Lantus does take some time to settle in, in my experience.

After reconnecting to my pump following my last break in December, I discovered that residual Lantus hung around in my system beyond its 24 hours, causing some lows in the first 24 hours.

So this time, I wanted to wait a good 2-3 days for my Lantus to settle in before coming to any conclusions. So far, one injection per day is treating my blood sugar levels kindly. Besides, I was feeling that split injections were just too many variables to play with at the end of my last break.

I’m sticking with my evening injection, which keeps me stable through the night. I only experience a slight effect of dawn phenomenon after I first wake up, which I can manage with an extra unit or two of rapid acting insulin.

Safe to say, I’m feeling a bit more enthusiastic towards diabetes this week.

Stay tuned.

Insurance, Insurance.

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I’m currently shopping around for health insurance. I don’t feel as though I can do this post any justice given that I have not come to any conclusions yet. So I’m offering you one long, conclusion-less post instead.

So, I said that I was shopping around for health insurance.

Why? Because HBF, my current insurer, have recently announced that insulin pumps will no longer be covered on lower tier hospital policies. A visit to my branch recently revealed that it will now cost me an extra $500 a year to retain that coverage for my pump.

My excess for a stay in hospital will also jump from $100 to $500, which is insane considering that I could just as easily admit myself to hospital as a public patient and pay nothing!

I’m a young, healthy adult. I don’t claim a lot. I can’t remember the last time I went to hospital. There’s a good chance that I won’t even need any of the additional extras included on that mid hospital policy. It sucks that there’s not an add on where I could just pay solely for insulin pump coverage. I’m simply being penalised for having diabetes, a health condition that I didn’t ask for.

I am really sad about the possibility of leaving HBF, given that they are West Australian owned, not for profit, and have plenty of branches around the place where I can visit and speak to an actual person – rather than someone in a call centre on the East Coast. Maybe I am being too hard. Is an extra $500 a year such a bad deal for the $10,000 device that I’m getting in return?

I will need a new insulin pump when my upgrade is due in two years time. With Animas going out of business, the day will come where consumables to service my late Vibe will no longer be available. I suspect that new pump options may be rolled out to eligible Animas customers sooner rather than later. Not to mention that if the Vibe packs up after my four year warranty period has lapsed, I won’t get a replacement. So, pump coverage is really not optional.

Another option is to remain on my current level of cover, which would see me lose my insulin pump coverage, and revisit the issue in 12 months. If I waited until then to upgrade, I would likely need to serve out a 12 month waiting period that would be completed just in time for my pump upgrade in May 2020.

But as I said, I highly doubt that Animas will have the capacity to service in warranty pumps for up to another four years. I suspect that new pump options may be rolled out to eligible Animas pumpers sooner rather than later. With last week’s announcement of Tandem’s tslim touch screen insulin pump finally hitting our shores later this year, that is one boat that I do not want to miss.

Then there’s the option of searching for a new health insurer. Yes, other health insurers do cover insulin pumps on lower tier hospital policies. You do need to ring them up and ask though, given that pumps aren’t commonly listed on health insurance websites. Of course, there’s always the possibility that they may make changes to insulin pump coverage in the future, leaving me with the same dilemma to deal with.

I have been following the many health insurance conversations going on in Facebook groups, and speaking to some friends with diabetes. But the reality is that everyone has different needs, so I can’t really compare what someone else pays for health insurance with my own policy.

So, now I am left trying to compare apples with apples. Comparing what I have covered on my current hospital policy, with offers from other health insurers. Thinking about what I need, and what I don’t need from my health insurance.

Safe to say, my brain is fried.

Ironically, I also happened to pull my pump off over the weekend.

So maybe I won’t be needing a new one after all…

Insulin Gone Bad.

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I couldn’t help but notice the reading of 14.1. Is that high? My friend asked me from across the table as I was demonstrating my FreeStyle Libre.

Yeah, I obviously haven’t given enough insulin for the banana bread, I replied, pulling my pump out of my pocket and bolusing for another 30 grams of carbs ever so casually.

I had already bolused a very generous 60 grams of carbs for the slice of banana bread and iced coffee I had ordered at the local cafe, but I wasn’t overly surprised to see the upward trend arrow on my Libre.

My blood sugar was still skyrocketing by the time I arrived home an hour later, with my Libre clocking in at a lovely 17.4. I bolused for another 10g of carbs, bringing the total for my mid morning coffee catch up to an overly generous 100g of carbs. I was certain that all of this insulin was bound to kick in any minute now.

After another hour had passed and my Libre clocked in at 25, I had figured that banana bread was the devil. After a prick of the finger came in at 20.4, I ignored all insulin I had on board and gave a full 4 unit correction. I also set a temporary basal rate of 100% to help get things moving in the right direction.

After a bucketful of insulin, my blood sugars slowly but surely began moving in the right direction over the course of the afternoon.

When dinner time rolled around and I was back in range, I bolused for the 50 grams of carbs on my plate. I drank a glass of water. I stepped outside and turned the sprinklers on. I washed some strawberries that I planned on having post dinner. I drank yet another glass of water. I stepped outside again, and switched the reticulation off. After distracting myself for a good 20 minutes or so for the bolus to kick in, I finally tucked into my dinner with the hope of avoiding another blood sugar rollercoaster.

Fast forward to me in front of the television 2 hours later, and my blood sugar clocked in at 16.1 with an upward trend arrow on my Libre.

I scrolled back through my pump history, noting that my last prime was four and a half days ago. As I swapped out the infusion site, my brain began to cotton on to other moments of particularly difficult-to-manage post meal blood sugars in recent days.

The lone milky coffee that sent my blood sugar upwards of 10. The hot cross bun that I’d carefully pre bolused for, but landed me close to 20. Rising blood sugars, despite a long walk fuelled by 10g of chocolate beforehand. Even a pasta meal had been extremely difficult to manage.

As I connected all of these recent occurrences together, I eventually recalled another occurrence of skyrocketing levels when my insulin had spoiled 2 years ago.

My insulin had spoiled! There was my answer! 

So, maybe Banana bread wasn’t the devil after all.

Four Foods I Cannot Bolus For To Save My Life

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I remember starting off on vague insulin doses of 5 to 10 units at every meal instructed to me by the hospital. Then I saw a diabetes educator, and learned to carb count. Adding up every gram of carb on worksheets supplied by my dietician only led to frustration over why logic was not translating into steady blood sugars. (Of course, little did I know about the gazillion other factors that could affect my blood sugar back then…)

For a few years in the middle, I just swaggered by and thankfully lived to tell the tale.

Fast forward to today where I’m using an insulin pump, carb count nearly everything I eat at home and have a pretty good idea of what most foods that I eat will do to my blood sugars. I know exactly why my blood sugar is high as I’m typing this right now (hello, potato bake with no pre-bolus). Overall, I feel pretty comfortable with being able to eat, give insulin and manage my blood sugar levels today.

That being said, there are still a few select foods that I cannot bolus insulin for if my life depended on it.

Pasta.

If there’s one food that confuses the life out of me, it’s Pasta. You can’t go by what’s on the packet, because most packets only refer to the uncooked weight. Seriously – who in the world eats dry pasta? If you were to make that mistake, I‘d be surprised if you weren’t chugging down litres of coke or making a dash to the emergency room.

Logic tells me that Pasta has around 28% carbs in it. The carb counts in our plates of pasta at home would be huge, because who on earth can only eat 1 cup of pasta? But if I were to give a massive insulin dose for all that carby goodness, I’d be eating glucose tabs for dessert.

All the extended boluses in the world can’t keep me from the Pasta lows, which can only mean that Pasta must be a really really really slowly digested food. These days I tend to settle for bolusing for 50 to 60% of the carbs at the time of the meal, accepting that the remaining 40% of the carbs that have absolutely no effect on my blood sugar whatsoever must be magic.

Soup

If there’s one meal that I despise purely for diabetes reasons, it’s soup. Who on earth can count the carbs in all those lentils, veggies and pastina that have been sitting there in the pot stewing all afternoon?

Then there’s the hassle of attempting to drain all of the liquidy goodness from the soup ladle for the purposes of weighing my plate, and then scooping up only liquid from the pot to add to my dry plate.

Add to this the same principles as pasta – all of those lentils and pastina are really slowly digested and would send me low quite easily. With carb free veggies and meat in the mix, I’ve sort of settled on bolusing for about half the number of carbs I would with Pasta.

Bananas.

Fun fact: I cannot eat a Banana without going low. Which is shit, because I actually happen to like them a lot. I very much look forward to my mid morning coffee and banana, while other times I slice it up to mix in with my Overnight Oats.

Logic tells me that a Banana with skin intact has around 13% carbs in it. But if I were to weigh my banana and bolus that much, I would be low within the hour. I’ve sort of settled on bolusing for around 50 to 60% of the carbs in my bananas, and some days this does the trick while other days it does not.

Steak and chips. Or Pizza. Or any kind of restaurant meal, really…

I have a love hate relationship with pub meals. I love how delicious and mouth watering and salty a steak and chips are, but I absolutely hate the night sweats and resilient high blood sugars that follow in the aftermath.

After learning that restaurant meals tend to be higher in fat to make them more delicious, I tend to set a temporary basal rate increase of 50% on my pump for 8 hours to combat the insulin resistance. I don’t prebolus for anything, given that fat slows down the digestion. I might also bolus for 40 to 50% of the protein in my steak after the meal is over, using a extended bolus over 2 to 3 hours.

Get the insulin in too early, and you go low. Get it in too late, and my blood sugars go up, up, up. It’s definitely a case of hitting the sweet spot.

***

Ahh, food and insulin…if only it were as easy as counting the carbs, giving an insulin dose and catching a unicorn 2 hours later.

Diabetes at 3.14am

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I stirred in my sleep, registering the blaring red 3.14 on the clock radio beside my bed. Pulling my left arm out from under the covers, I fumbled around for the switch at the base of my bedside lamp. When my desk was finally illuminated in cosy warm white light, I heaved the remainder of my body up from the bed, reaching for my meter and test strips.

This certainly wasn’t the number that I was expecting to see, considering the full 2 unit correction that I had given prior to bedtime for a 10.7. (And in case you’re wondering, I’m only using the OneTouch Verio to deplete my final box of strips…)

I immediately ripped my pump away from it’s resting place inside my inner left pocket, and gave another full correction of 3.3 units for that very uncomfortable number. My frustration was only further fuelling my actions, as I set a 50% basal rate increase for the next two hours on my pump to ensure that this correction insulin did its job.

As I flicked off the lamp and rested my body back onto my bed, I couldn’t get back to sleep. I could feel the heat emulating from my pillow, and flipped it over to the cool side. My whole body felt stuffy, presumably a consequence of the higher blood sugar.

As I lay there, tossing and turning, my mind was quickly consumed with guilt.

I wasn’t happy that it had taken me this long into the night to finally stir in my sleep and check my damn blood sugar. I felt terrible for the fact that I had been sitting there, at that very uncomfortable level, for the better part of five hours. I felt frustration, because a mere two weeks ago I was super insulin sensitive and today I feel like I’m not getting enough.

Second guessing my prior decision in the darkness, I reached for my pump and lowered that 50% temporary basal rate to 30% before clipping it back inside my pants pocket.

Trying to purge those thoughts from my mind, I began thinking about all of the positive things that I am doing in managing my diabetes, reminding myself that numbers like those are isolated occurences nowadays.

If this had happened in the middle of the day, I’d have corrected the high without giving it a second thought. But laying there in the middle of the night with nothing else on my mind to worry about, was a completely different story.

By the time I woke up on a grey Sunday morning, last night’s occurrences felt like nothing more than a dream.