“Do You Ever Get Sick of It?”

“My daughter’s friend has diabetes, and she had to have needles all the time. What a pain that would be! Do you have to do that?”

“Not anymore now that I have the pump,” I replied as I pulled it out of my pocket and began gesturing wildly. “So, the pump does two things. It gives insulin continuously in small increments to keep me steady in the background. Then I enter insulin doses myself to cover the foods that I eat. So yeah, the pump is really convenient when I’m out and about or at work,” I concluded in response to her remark.

“Do you have to do that thing where you prick your finger all the time as well? My daughter’s friend said she had to do it 10 times a day! You would think there would be some kind of technology that could do that for you by now!”

“Yeah. I’m wearing this at the moment” I said, picking up the FreeStyle Libre reader that was sitting on top of my iPhone. “So, I wear this sensor on my arm,” turning sideways and showing it to them. “And then I just swipe the reader over it and it tells me my blood sugar. So that’s a pretty good reading,” I said, holding it up and showing them my unicorn and graph.

“I’ll have to tell her about it.”

“Yeah, it’s really good for figuring out trends and things. But it’s expensive so I don’t wear it all the time. And the numbers do my head in sometimes.”

“Can you have a lot of this stuff?” She asked me, gesturing at the hot cross buns and chocolates on the table.

“Yeah, of course I can. I need insulin for most food that I eat, so that my body is able to convert it into energy. I would look at this,” I said, picking up a marvellous creations wrapper from the plate of Cadbury Favoutites on the table, “and say its about 8 grams of carbs. I know that I need 1 unit of insulin to cover every 8 grams of carbohydrate, so I would give a unit with my pump.”

Do you ever get…sick of it? I know that you would probably be used to it by now…

“I wouldn’t say I get sick of it. Most of it is second nature to me. If anything, it just feels really, really monotonous. Getting up and doing the same thing over and over again every day. Looking at the same items and devices all the time. I get bored of it.”

Vacation’s End.

When my Lantus pen finally neared empty after my evening dose on Wednesday, I knew that I was just about ready to reconnect to my insulin pump.

Its been almost a month since I started this pump break, and it’s been just what I’ve needed to clear my head and feel a little more ‘free’ from my diabetes.

But I’m also beginning to feel a little over the effort required to physically inject my insulin, moreso at this time of the year.

When I was in the comfort of my own home with all the time in the world to spare, injecting wasn’t really a big deal. But when I was on the go and short of time, i was really starting to miss the convenience that wearing an insulin pump allowed me.

I really had to make a big point of injecting before I could go and have my morning tea or lunch. Which meant finding a place where I wouldn’t be disturbed, pulling out my iPhone, opening up the RapidCalc app, calculating my insulin dose and then concentrating on actually injecting it.

Concentrating?

Yep, concentrating.

If I didn’t put all of my focus towards the task of actual injecting, I ended up with those annoying little drops that manifested on the end of my insulin pen. I was left wondering how much insulin actually went in, shooting out half a unit to compare while deliberating over whether or not I should top up.

In case you’re wondering, there is a technique to avoid this. Gently lift the skin beneath your injection site (don’t pinch), inject your insulin, hold the pen in for 15 seconds after the injection, release the skin and then pull the needle out. I’m not sure I’ve quite mastered it yet, but I have successfully revealed a few clean needles by using this technique.

Then there was the effort required to swap out blunt needles. Because they sure did hurt when I forgot to change them.

Injecting is a lot of effort to put in during my break when I really want to be savouring my coffee and Walkers Shortbread. Or when I’m in the car, trying to give a quick correction inbetween traffic light changes. Also in the middle of the night, when I actually have to switch on my lamp and physically get up out of bed to make sure I properly administer my correction dose.

I fully get that these are all first world problems, and I’m super grateful that I have the luxury and choice to choose the style of management that suits my needs.

On Wednesday evening before bed, I inserted a fresh pump site on my left side and loaded a fresh insulin cartridge. When I woke up on Thursday morning, I skipped my morning dose of Lantus and clipped my pump line into the clean infusion site on my hip. I rode out the day as the rest of my Lantus tapered off. By 3.30pm I thought I could safely switch my basal rate back on, and I was pumping insulin once again.

Pump Break: The Good, The Bad and The Ugly

As I enter the fourth week of my pump break, I’m slowly beginning to remember some of the reasons why I abandoned Multiple Daily Injections in the first place. But if there’s one thing that’s keeping me from reconnecting right now, it’s the thought of attachment and doing those daily maintenance tasks once again.

This pump break has definitely made me more disciplined with my insulin dosing. Having to physically inject forces me to be more meticulous with my insulin decisions, rather than just lazily dosing another unit to counteract a rising BG. I am using less insulin on Multiple Daily Injections today compared with recent pump history and my initial six year tenure on Multiple Daily Injections.

RapidCalc, the app I am using as my bolus calculator, is telling me that my average bolus insulin is sitting at 19 units per day. I feel that those 19 units reflect most of my days, rather than being an average of variable numbers. Scrolling through my more recent pump history, boluses have become very variable, with most days ranging between 20 and 30 units.

Thinking back to those first six years on Multiple Daily Injections, I also remember lots of wild guesstimates, corrections and big mealtime insulin doses of 5-10 units at a time. Nothing seemed to be able to get the job done. With a much smoother Lantus regimen and a newfound dedication to carb counting today, I can give those small insulin doses of 1-3 units and actually get the job done.

Then there was Lantus. My number one reason for ditching the shots was Lantus. I could never seem to get the dose right at night, while during the day blood sugars felt unmanageable.

Today, my 66/33% split seems to be giving me the best coverage I could ask for from a basal insulin. Six units keeps me fairly steady overnight, with no significant effects of dawn phenomenon while I sleep. A further three units in the morning helps to combat morning insulin resistance, and makes the remainder of my day much more manageable as my nighttime insulin tapers off.

It’s not perfect. Just this weekend I’ve re-learned that skipping a meal will send me low. I also went low one night last week, after skipping my afternoon coffee and then eating a fairly low carb dinner. So yes, Lantus does like it’s routine. But what I am achieving today is more than I ever expected I could get from Lantus, so I’ll take it as a win.

Some aspects of my diabetes management are exactly the same as when I was pumping. Like the delayed bedtime spikes from afternoon snacking that need a correction at midnight. And the weekend blood sugars that tend to cruise a little higher than their weekday counterparts. As much as I’d like to blame my pen or my pump here, I only have myself to blame!

I really miss having my pump on me to conveniently bolus or correct a high blood sugar when I’m out and about. Just last week, I was interrupted mid-injection at work. Which is frustrating, because I really need to focus while I’m injecting to make sure that it all goes in. Which brings me to my next point.

The drops. Those bloody drops of insulin that manifest on the end of my pen needle when I pull out too quickly after an injection. I’m left wondering whether all of the insulin went in, or whether I need to give another shot. There is a technique, by the way. Gently lift the skin beneath your injection site (don’t pinch), inject your insulin, hold the pen in for 15 seconds post injection, release the skin and then pull the needle out.

I’m also finding it harder to rotate injection sites, as they are less visible than pump sites and I do several of them each day. I find myself continually going back to the usual suspect areas, which i know I shouldn’t be doing.

The most enjoyable thing about my pump break is being able to go for a walk in the afternoons and not worry about rapid acting insulin sending me low. Getting changed without having to accommodate a pump in the process. Laying in bed and not having to feel that chunk in my pocket. In fact, I think that this is the least I’ve thought about diabetes in several weeks.

I still remember some wise words from fellow d-blogger Ginger Viera. She says that both methods of insulin delivery have flaws, and that it’s up to us to choose the flaws that bother us the least.

With the Festive Season well and truly upon us and my first Lantus pen nearing empty, I’m wondering just how much longer this pump break will last me. I guess time will tell…

Pump Break II

My current pump break is surprisingly different to the one that I took a year ago.

At the time, I was feeling full of anxiety over all of the lows I was having from physical activity. I was still relatively new to insulin pumping, and felt a little overwhelmed at my failure to get everything right. I wasn’t missing my pump one bit, and if it weren’t for the Christmas smorgasbord around the corner I’m not sure that I would have ended up reconnecting.

This time round I’m feeling purely fatigued from the device that I’m using. I’m fatigued from being connected all of the time, and from staring at basal rates and insulin on board all of the time. I find myself getting a little slack with my management, and not getting the most out of my pump. I’m already missing the convenience after just a week, so I’m not confident how long this break will last.

I was deliberating over whether to start my pump break in the morning or evening. I’d read elsewhere that 1) morning would make it easier to monitor my blood sugar in those initial hours, and 2) the effects of Lantus tapering off at the 18-24 hour mark are felt the least. However, I’ve only ever known giving Lantus in the evening. I was also hesitant to have insulin tapering off in the early hours of the morning while I was experiencing dawn phenomenon. So, I stuck with dinner time.

I started with 10 units, the sum of my total daily basal given by my pump. That night, I had about two helpings of Skittles to ward my way out of lows. Residual rapid acting basal insulin from my pump was also very noticeable in those first few hours before bed, and I’d probably create some lag time between disconnecting my pump and giving Lantus if I were to do this again.

The following morning I woke up with terrible insulin resistance, which carried on through much of the day. In the morning it was obviously dawn phenomenon to blame, while in the afternoon my Lantus was likely tapering off.

On night two, I dialled my Lantus dose back to 9 units and added an injection of 3 units the following morning. The evening lows continued, and boy did those Lantus lows feel different. Heavier? Deeper? More intense? It’s hard to describe.

From there my evening Lantus dose went from 7 units to 5 units to 6 units, while my morning dose has remained at 3. That gives me a total daily dose of 9, which is pretty close to the 9.7 units I was giving via my pump. It seems to be keeping me fairly steady while I sleep, so I’m really pleased with that.

My biggest challenge is the moment I get out of bed in the morning. I’ve doubled my insulin to carb ratios at breakfast to combat the insulin resistance. Just don’t make my mistake of putting off brekky for 2 hours and still using double the insulin dose! For the remainder of the day, my regular carb ratio of 1:8 and correction factor of 1:2.6 seem to do their job as per normal.

I’ve been doing all of this blind, aka without the help of a FreeStyle Libre sensor, which means that I’m really feeling the brunt of the pricks on my fingers. BGs have probably suffered in the first week – Lantus was causing some lows in the beginning, while high blood sugars aren’t as easy to manage without a pump. However, I’m looking forward to seeing how this week treats me now that the dust has settled.

At the moment, I’m absolutely loving the freedom from attachment and not staring at my pump every hour. Bolus insulin also just seems to be “working” better. During those last few weeks on the pump, I definitely felt like I was correcting high blood sugars after meals all the time. Having the same kind of insuin for bolus and basal on the pump felt “blurry” at times, if that makes any sense at all.

When I made my decision to start pumping two years ago, I told myself that injections were too clunky and simply didn’t work for me. But after 18 months on an insulin pump, I know that this is not true. So long as I’m prepared to make the commitment to learn and take responsibility for my decisions, I can make any method of insulin delivery work for me.

How long do I think I will stay off the pump? I am missing it already. But I’d like to think I’ll give it until the end of the month, at least.