Multiple Daily Injections

Three Month Pump-aversary!

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The very first thing Gwen emphasised to me last year was that using an insulin pump would not be any easier than Multiple Daily Injections. Boy, oh boy, was she right.


These past three months have been by far the most challenging I have faced since being diagnosed with type 1 diabetes six years ago. I have gone through site failures, occlusions, ketones, frustrations and burnouts that have lasted for several days on end. It has required enormous patience, a commitment to learn, and it has seen me agonise over many a decision. I have been through it all. I have poured my heart onto these pages over the last three months.

There have been a lot of low points that I have talked about quite candidly over the past three months. There have been a few times where I’ve reached breaking point. Times where I have found myself pacing up and down my room, deliberating over whether to rip my pump out and take a break for a couple of days.

But every time I have contemplated removing my pump, I knew that I really didn’t want to say goodbye to that added level of precision. I have never truly felt ready to say that this wasn’t for me.

Stability during the night is miles better compared to injections. I felt that when I was using Lantus, I could never get the dose quite right. I felt that I needed to eat a similar number of carbohydrates each day in order to achieve that smooth coverage I needed during the night. I felt that if I ate more than normal, my basal wouldn’t be enough to keep me stable through the night. Then if I were to skip a meal the next night, my basal would likely send me plummeting at 4am.

For the first time in my life, I have confidence that my basal rate keeps me stable. When I give a correction at 1am, it actually works and sends me back into range by the time I wake in the morning. When I go low during the night, it’s only through my own fault.

I could never seem to get my breakfast insulin dose just quite right. In the months leading up to the pump, I noticed that I would end up frustratingly high after eating virtually the same thing for breakfast each morning. Now my pump delivers extra basal insulin to cover the extra glucose that my liver dumps when I wake up each morning, and my breakfast insulin dose actually does it’s job!

Highs are also so much easier to manage with the pump. I remember stubborn highs that were so resilient they needed multiple insulin corrections that didn’t make any sense. Now with the pump, I know that highs are a little less sensitive to insulin. When my levels soar into the 20s, I can set a temporary basal rate of +200% to get things moving a little more quickly. When i think about it, I don’t think my levels peak above 15mmol half as often as they used to. And when they do, they don’t stay there for too long at all.

On pump day, Gwen reminded me that I was the kind of person who wanted that extra level of precision. I knew that I wanted to be able to customise my insulin delivery to match the hour of the day or a specific activity. I feel that my insulin pump has given me that.

The pump has given me an added focus and drive with my diabetes. I am working my butt off with carbohydrate counting, pre-bolusing and watching my portion sizes (which I could easily do without the pump, too). I guess what I’m trying to say is that my diabetes goals seemed unattainable on injections. With the pump, they do. Hence, the drive to keep up the hard work rather than being lazy.

I’ll hopefully have an a1c result at the end of today. I have a good feeling that it will likely be around the same mark as it was in May, and I’m pretty content with that. Over the years my a1c results have been ridden with too many peaks and troughs, so I’m pretty pleased that those peaks are a little less peak-ey today.

As I reach the three month mark on an insulin pump today, I feel like I can finally focus on some of my other diabetes goals, which feel far more in reach than they ever did on injections.

Thanks for all of your support and encouragement over the last three months. I really couldn’t have done it without you all cheering me on.

Pump Doubts

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After a few infusion site failures of late, I’m starting to become really self conscious. After every new site change, I become really paranoid of whether it’s a failure or success.

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I poke my infusion site, trying blindly to detect a kinked piece of teflon that should be sitting underneath my skin. I prod around the infusion site on my stomach, trying to feel bruising and pain. I stand still while my pump is delivering an insulin bolus, waiting on edge to detect any stinging. I lift up my jumper compulsively, watching the colour of the skin underneath my site like a hawk.

I think about whether the skin tissue underneath my infusion site is strong enough to handle 3 days worth of insulin boluses. I frequently glance at my Total Daily Dose history on my pump, questioning whether it’s too high. I feel guilty for the carbohydrates I am consuming, for the sake of the subsequent insulin boluses that will have to go underneath my skin.

I check my levels like crazy after a site change, impatiently looking for signs that the insulin is heading successfully underneath my skin. I keep an eye on glucose movements like a hawk. In a moment of paranoia on Saturday, I even ripped out a perfectly good infusion site because the correction was taking too long to work it’s magic.

I draw dots on my stomach in permanent marker, in a desperate bid to keep on top of site rotations. I stare persistently at the real estate on my stomach, deliberating over just the right spot to place my new infusion site. I worry about how soon I will be able to re-use an area of real estate again.

In moments of site failures, I question whether this is really worth it. I think about results around my diabetes, and I’m almost certain that I won’t see any improvement yet. I’d be lying if I said I haven’t had fleeting thoughts that maybe this is not working for me. I worry that I won’t be able to make this work for me. I stand in my room for minutes on edge, pacing, deliberating over a site change or a shot of Lantus.

But when I think about going back to Lantus, I think about the level of control I will lose around my basal insulin rate. I think about how unfocussed I was on injections, blindly guessing and correcting all the time. I think about all of the time and investment I’ve put into this insulin pump, and I know that I’m not ready to pull away from it just yet.

Goodbye, Gwen

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A diagnosis with type 1 diabetes back in May 2010 changed my life.

I remember how awkward I felt around my new condition at the time. Carefully finding a spot on my stomach and willing up the courage to insert the needle and administer an insulin injection. Standing in the kitchen eating a white bread sandwich at bedtime, feeling uncomfortable as soon as someone walked in and saw me. The way I tried to carefully follow the very vague instructions I had been given upon my discharge from hospital – 20 units of Lantus at dinnertime, 5-10 units of Novorapid at meal times, and a white bread sandwich at bedtime to stop me from going low.

I remember how “different” I felt at the time. The reality that this condition would be around for the rest of my life was still sinking in. Nervously walking into diabetes clinic for the first time, and seeing other patients there reminded me that I was now a “diabetic” – something I felt very labelled by at the time.

It was there that I first met my diabetes educator, Gwen, a straight talking woman with plenty of diabetes knowledge and experience. My Mum was there with me at my appointments, and Gwen made her feel very much included as well. I’ll never forget her famous diagram of the mouth, the liver and the pancreas, as she demonstrated the role of a functioning pancreas when food entered the body. A diagram that she still uses to this very day.


In the months that followed, Gwen went on with helping me to fine tune my insulin doses, so that I wouldn’t need that white bread sandwich at bedtime. When she saw how complex and spontaneous my meals were, she taught me how to carb count. She always made herself available to me outside of appointments by phone and e-mail, despite how busy she was. When my first endocrinologist told me that I had very poor control, Gwen was the first to see the look of disappointment in my face. She was prepared to go and have a word with him, and she made sure that I didn’t see him again in future.

Gwen often reminded me that the first year was biggest hurdle to get through, in terms of education and clinic appointments. Her job was to make her role as my diabetes educator redundant. After the first year or so, I went on managing my diabetes without regular education sessions.

As I began to consider insulin pumping last year, I felt that it was time to touch base with Gwen again. Nerves after such a long space of time were immediately relieved, as Gwen proceeded as though our last appointment was only yesterday. She approached the matter with the seriousness it deserved. She never sought to influence or sway my decision either way, and respected the decision that I eventually made.

It’s hard to imagine starting out on an insulin pump with anyone other than Gwen. Nerves were eased going into it with someone I was so familiar and comfortable with. It was fantastic to be able to chat with Gwen over the phone every day during that first week. I was very comfortable uploading all of my data to Diasend for her to see.

Last week, I had my final education session with Gwen before she retires at the end of the month. Even though there has been considerable distance between our sessions over the years, I still find it hard to say goodbye to someone who’s been there since the very beginning.

Gwen has been a huge part of my diabetes journey. She is the professional who has the time for me. Who sits down with me, and has my undivided attention for a whole hour. Who knows me, and the very hands on approach I take towards managing my diabetes. My GP, although excellent, doesn’t often have the time for me and is quick to dismiss my concerns. I don’t always see the same endocrinologist on clinic days. Too often, they are quick to sign off on my six monthly checkup and move on to a higher priority patient.

There have been a lot of changes over the past six years.

Back in the beginning, I managed my diabetes with a meter, insulin pens and a paper logbook. Today marks four weeks since I first started using an insulin pump. I also have access to a logbook meter, Diasend software to analyse my data electronically, and a FreeStyle Libre.

Back in the beginning, I was a nervous newly diagnosed teenager who used to shy away from his diabetes. Today I am a confident, passionate and knowledgable person who is empowered to make his own diabetes decisions.

In some ways, I feel as though I am reaching the end of a chapter in my diabetes journey. And it feels nice to have been able to close that chapter with Gwen.

Goodbye, Gwen. Wishing you a very happy and fulfilling retirement that you deserve.

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…