Multiple Daily Injections

May The Force of Low Blood Sugars Be With You

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Because I was on holidays, because the fridge was empty and because I’d been wanting one for several weeks, I had a Subway footlong Italian BMT sub for lunch last Wednesday. I dialled up 18 units of insulin, and I was rather pleased with the way the results were tracking in the hours that followed. I was 14.1 at 2.18pm, 8.7 at 3.09pm, 5.7 at 4.04pm and 7.6 at 5.15pm.

At the time of that last test result, I was getting ready to go and see Star Wars. Still feeling full from that Subway, I figured that I would skip dinner (sorry, Mum!). I gave my Lantus dose an hour and a half earlier than normal, and headed out the door. I parked the car at 5.59pm, and a quick test showed I was 5.1. I knew straight away that I was on a downward trend. Definitely a combination of overlapping Lantus doses and skipping dinner that night. Which I should have anticipated, given this just happened a few weeks ago.

We walked in, bought our tickets, and went to sit down in the theatre. I knew that I was hypo, and that I would need some sugar to last me through the movie. For a lack of personal space in the theatre (brother on my left, stranger on the right), I decided to go and test outside. I leaned over to my brother and asked him for my ticket.

A quick test outside the theatre confirmed that I was a borderline hypo 4.0. I headed over to the candy bar, where thankfully, the line was empty.

“Do you have any juice in the fridge?” I asked the attendant, squinting at the drinks fridge behind the counter. I returned to the theatre with a very overpriced bottle of orange juice, noting the 34g of carbs on the label.

I sat back in my seat, reluctant for a few moments to open that bottle of juice in front of the two people I was with who I hadn’t brought anything for. I decided I could excuse myself later, and skulled two thirds of the bottle.

Thankfully the guy on my right had moved down 2 seats, giving me some personal space to test again 15 minutes later. By this point, it was dark. I was relying on the bright scenes on screen in order to see what I was doing. My meter backlight told me I was 2.9, and I quickly skulled the rest of my juice.

Another 15 minutes later I was 7.4, and at last I could finally focus on the movie.

While the force of low blood sugar levels were with me that night, I was pretty proud of how I handled the situation. One year ago, I would have sat that hypo out in the theatre until I truly felt those low symptoms coming on. 

Today, I have the confidence to attend to a hypo in public right away.

Three Hypos in One Night

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It was a cool, breezy Summer evening. That perfect kind of early Summer weather that never seems to last long enough.

We’d had a barbecue lunch that day. Steak, sausages, eggs, onion, salad and cherries. The kind of lunch that left me feeling like it was Christmas Day – stuffed, sleepy and happy.

I wasn’t particularly hungry by dinner time. I wanted to make sure that my blood sugar levels had stabilised before bedtime after that barbecue, and I didn’t want to spoil my appetite for breakfast the next morning. I had some leftover salad and cherries, and gave myself a small correction dose.

14 units of Lantus is what had been keeping me stable those past few nights. 14 units. I figured with that big barbecue lunch, 14 units would do the trick once again.

I sat down outside with my laptop after dinner, catching up on some of my dBlog reading. I started browsing for Christmas gift ideas a little later on, but somehow ended up comparing prices of items on my own Christmas want list.

My blood sugar levels were looking good during the course of that night, clocking in at 7.1 and 6.2. I had the best of intentions to settle in for an early night before the start of another working week. Little did I know, however, that my diabetes had other intentions.

I was 3.8 at 9.18pm. I figured that the majority of my rapid acting insulin had worn off. I thought 3 marshmallows would do the trick, but I gave 4 just to be safe. 20g of carbs, because I was about to go to sleep. I laid in bed, surfing on my phone for a while longer, until it was nearing 10pm. I was a perfect 7.6, but I was convinced that I’d given myself too much for that hypo. I set the alarm for midnight, ready to catch a rebound high in it’s tracks.

That was hypo number one.

I woke up a while later, and my pyjama pants were sticking to the sweat on my thighs. I knew that I didn’t need to test, but I needed to know how low I was. 3.2. I reached for the bag of Marshmallows beside my bed, carefully counting them out in my hand so my hypo induced brain wouldn’t forget how many I’d eaten. One, two, three, four, five. I shoved the 25g of carbs into my mouth and rested my head back on the pillow, feeling instant relief.

I finally noticed that it was 11.53pm, and switched off the midnight alarm on my phone. By this point, I figured that I’d given myself more Lantus than I needed. By this point, I knew that there wouldn’t be any rebound highs to catch that night. By this point, I realised that these hypos were a consequence of skipping dinner. I switched out the light, and went to sleep.

That was hypo number two.

By 4.30am, I was startled awake by my favourite sound in the world. I felt shaky once again. I wasn’t sure if it was another hypo, or if I didn’t have enough blankets on the bed. My meter confirmed that it was the former, clocking in at a very hypo 3.4.

I shuffled into the kitchen, my mouth tasting of dry sugar, and prepared myself the most refreshing thing I could think of. A bowl of Weet Bix, a sliced banana and lots of cold milk.

As I sat there relishing the cold, refreshing milk on my dry throat, I thought about what a great start to a Monday morning it had been.

That was hypo number three.

Revisiting Gwen

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I know that the decision to switch to an insulin pump is not something that I should take lightly. I’ve been deliberating the matter for a while. I wrote about it earlier this week here. I also recently went to see my diabetes educator, Gwen, for some advice.

Gwen is a truly amazing person. You can read about just how amazing she is right here. Gwen’s stated goal was to arm me with the knowledge and skills to manage my diabetes, so that her position as my educator would eventually become redundant. And it sure did. The last time I had a session with Gwen was back in 2010, towards the end of my first year living with diabetes.

I knew that Gwen was always available to me outside of appointments if need be. I had her phone number, e-mail address, and I can even remember her squeezing me in once during her lunch break when I was anxious about too many hypos. I can remember giving Gwen a box of chocolates on the first Christmas after my diagnosis, because she had just been so wonderful during that first year of diabetes. I’ve seen her a few times in passing at the clinic when I go to see my endocrinologist. However, since transitioning from the ‘young adult’ to ‘adult’ diabetes clinic, I’ve seen her less frequently.

I was extremely nervous to go back and see Gwen a few weeks ago, after such a long time. In the car on the way there, I was reciting over and over in my head what I would say to her. Would she take what I needed to say seriously? Would she be supportive of insulin pump therapy? Would I talk to her about my blog, and my involvement in the Diabetes Online Community this year? Would she even remember me?

But walking into her office that day, my nerves were instantly settled. As she began reviewing our last session five years ago, she was so thorough. As she talked through the results of my last endo appointment and hba1c result, she was so familiar and so well prepared for me. As her patient, it felt as though that last session five years ago could have taken place just yesterday.

So, Gwen’s verdict on pumping, in a nutshell?

A pump is a big commitment.

Pumping is not any “easier” than Multiple Daily Injections.

However, a pump can give me more “flexibility.” A pump delivers insulin constantly in order to regulate glucose levels, as opposed to injections which are given at set times of the day. The rate at which a pump delivers insulin can be adjusted throughout the day to factor in activities such as work, physical activity and sleep. The units of insulin delivery on pumps are so precise that you can bolus for something as small as the milk in your coffee!

There are also a few requirements for pumping in Australia.

First up, I must have an appropriate level of Private Health Insurance for a period of at least 12 months, in order for the cost of a pump to be covered. Big tick there.

Second up, I need to show that I qualify for a pump. Translation: I have type 1 diabetes and I’m a good student who will show up to my education sessions. Big tick there.

Third up, a pre education session with Gwen (big tick there), where paperwork is completed and passed onto my endo for sign off (not quite there, yet).

Finally, pump fitting day followed by 3-4 daily sessions with Gwen in order to fine tune the pump. Sadly, there’s a 3 month waiting list at my diabetes clinic for this.

I’m really glad that I did go and get another perspective from Gwen that day. Gwen was plain thorough. She discussed the matter with the seriousness that it deserved, without trying to sway my decision either way.

So, as the session came to an end, I sensibly decided that I would go home and think about it, and come back in the New Year for another check in. Class dismissed!

To Pump, Or Not To Pump?

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A few weeks ago, I went to an insulin pump information evening. And I must say that I was quite keen on the idea after that night despite the politics of it all, which you can read about here. The promise of better control, long term health, insulin dose calculator, ease of insulin delivery and the statement that “very few people give these back to me and say that they don’t like it.”

But I’m not naive. I know that a pump is a big decision. I know that a pump is a big commitment. I don’t want to get a pump just for the sake of getting one, and then end up in no better of a situation with my diabetes management. I don’t want to get a pump with the mindset of being able to slack off and get lazy with diabetes. And it might not necessarily solve all of my problems. I’ve been talking about it at home, talking with friends in the Diabetes Online Community, and deliberating over the matter in my head for weeks.

My biggest struggle is achieving stable numbers consistently. There will be weeks where I seem to do it at ease. And then there are weeks where the numbers suffer, due to changes in my level of activity and the level of food that I eat. I seem to be adjusting my insulin doses every second day to get the balance right in the background. Lantus Adjustment Struggles are real. And they drive me crazy. There are times where my Lantus dose is more than enough, and other times where it’s just not enough. My hba1c level has been hovering around the borderline of “acceptable” for quite some time, but I’d really like to get it down further for the sake of my long term health.

In some ways, I feel that a pump could potentially offer that to me. I’ve heard nothing but good things about pumps from friends in the #DOC. But I also expect that the pump will be a big learning curve. It will be a lot of work. And I’m expecting a lot of frustrations in the beginning, at least. I’m concerned that a pump might make things more complicated. Potentially having control over more variables, such as basal insulin could do my head in. And, will a pump actually make my job as the operator of a broken pancreas easier? Or is it essentially a different way of doing the same thing?

At the moment, I do feel quite “free” with my Multiple Daily Injections. I take my insulin injections whenever I eat, and in the meantime my Lantus dose keeps me (relatively) stable for a whole 24 hours. I like the fact that if something were to happen and I couldn’t access my insulin, my blood glucose levels would be fine for a whole day.

I am a bit scared of being reliant on technology to keep me going. Relying on one, continuous source of insulin to keep me stable is scary. If that one source of insulin was suddenly cut off, or if my pump suddenly stopped working during the night, I could go into a state of diabetic ketoacidosis within hours. And I absolutely hate carrying junk in my pockets. An insulin pump would only add to that problem, as lame an excuse as it sounds!

A pump would certainly be more convenient, though. These 13 Truths About Insulin Injections would be no more. I would be able to administer my insulin at the touch of a button, rather than often waiting until the dinner table conversation has ended. The carb calculating function on the pumps look awesome. And, I wouldn’t necessarily be stuck with the pump. I could get it, learn how to use it, and then I would always have it as an option.

So, to bring this jumble of thoughts from my head to a close, I haven’t made up my mind about an insulin pump yet. I’m still thinking, I’m still researching, and I’m still talking about it.

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Not Your Ordinary Bag of Shopping

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It was lunchtime on Friday afternoon. Friday is traditionally my I-can’t-be-bothered day, where I buy all of my food and drink for the day. My morning coffee, my morning tea and my lunch. And I really savour those 10 extra minutes that I have on a Friday morning which I normally spend making a ham and cheese toastie, peeling eggs that I boiled the night before, pulling a can of tuna and a packet of crackers out of the cupboard, or wrapping up two slices of Burgen fruit toast and a chunk of butter. I love my Fridays.

As much as I love to just collapse into a chair at lunch time (I’m on my feet most of the day at work), I try to run my errands so that I can head straight home when I’m finished. Usually that involves topping up my supplies at work – muesli bars, coffee capsules, tea bags, my block of dark chocolate, and everything else I eat at home that I forget to add to the weekly shopping list.

My diabetes educator gave me some sample 4mm needles to try with my insulin pens at my last appointment (I’ve been using 6mm for a long time), and they are amazing. I have more freedom to inject in areas where I have less fat on my stomach. The needles don’t irritate my skin so much, and they don’t sting so much in those “skinny” areas. I had intended on burning through my hoard of 6mm syringes first, but I am absolutely sick and tired of them to be honest. Which brought me to a rare workday diabetes errand on Friday at lunchtime. A trip to the Chemist for some 4mm syringes.

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I walked back into the staff room at work with two plastic bags in my hand – the first which contained my “healthy” lunch, and the second which contained my needles, and some hypo-fixing marshmallows. I slapped both bags onto the table, and went off to grab a cup and some water from the cooler.

I walked back to the table with my cup of water, and placed the bag with the needles underneath my chair. When I sat back down, one of my colleagues sitting at the table started to ask me something. She said a few words, none of which I heard, before she stopped. She kindly retreated, smiled, and said “never mind.”

I knew what she was going to ask. I’m certain she had seen the syringes through my plastic bag. Whether she had any clue why, is anyone’s guess. Would she have any idea what they were for? Unlikely.

Maybe she knew what they were for. Perhaps she knew someone with type 1. I would have happily had the diabetes chat with her, like I naturally have with many of my other colleagues when it comes up. However, I didn’t want to make her feel uncomfortable. And, I knew that she was only being courteous to me.

But as I sat there, and began to eat my cheeseburger and chips, I don’t think that she would have had any clue in the world that I had diabetes. Perhaps that’s a conversation for another day.