Multiple Daily Injections

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.

Lantus Adjustment Struggles

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It was the night of Easter Monday four years ago. The very first Easter after my diagnosis. My chocolate haul was proudly spread across my desk, a remarkable feat considering how old I was getting. The fridge at home was full of leftover food and deserts from our family gatherings over the weekend. I’d been pigging out over the past few days and eating more than normal. We were getting new floor coverings in my bedroom tomorrow, and I was sleeping in the spare bed in our games room.

My blood sugar level was somewhere around the 14 or 15 mark before bed. I gave myself three units of correction, knowing that one unit of insulin would bring my BGLs down by 3mmol/L. I tossed and turned, and before I knew it another hour had passed. I tested again, and my BGL hadn’t budged below that 15 mark. I was frustrated, and made an impatience-driven decision to give another 3 units of insulin. I finally drifted off to sleep, and woke up again at around 2am. I tested again. My BGLs had barely budged, and I gave another 3 units of insulin. The same thing happened at 4am. And again at 7am.

I was so angry that my blood sugar levels had been that high for the whole night. I was so frustrated that despite my best efforts, I couldn’t get my blood sugar levels to budge.

Ever since that night, I’ve known that my Lantus dose needs to be adjusted to match the overall amount of food that I eat in a day. Lantus is my long acting, or basal insulin dose that I take once a day to keep my BGLs regulated. On days where I eat more than normal, I know that I need more Lantus in order to keep my BGLs stable through the night. If I’m eating out at a restaurant, pigging out on party food or going crazy at Christmas time, I generally dial up my Lantus dose.

Doctors and other people I talk to have struggled to understand this concept over the years. Most have tried to talk me into giving rapid acting correction and waiting the full four hours for my BGLs to drop. It doesn’t work. That Easter Monday night four years ago was evidence that it doesn’t work. And up until now, I’ve been lost for the words to explain this concept to them.

Multiple Daily Injections are hard. It takes so much fine tuning to get right. There are so many variables that change every day such as food intake and physical activity, which impact on my BGLs and insulin requirements. I was really pleased to hear that my #DOC friend Ally at Very Light No Sugar understood the Lantus adjustment struggle. She offered me a really good analogy to help explain this concept. Lantus, or long acting insulin is like a mitten. And we fine tune this mitten with rapid acting insulin to make it fit like a glove.

At the end of the day, I’m not telling you what to do. I’m just telling you what works for me. Because it’s not anyone else’s diabetes but mine. But I really could use some advice on dealing with Lantus dose adjustments if you’ve ever experienced anything similar. Just putting it out there.

The Day My Insulin Ran Out

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I have two rapid acting insulin pens that I use. The first one sits on my desk at home, beside my blood glucose meter and my phone. I use it with my breakfast, my dinner, my snacks that I shouldn’t be having and for any corrections inbetween. The second one normally accompanies me on my travels. If I’m going to work, it usually sits in my satchel amongst my other clutter. If I’m going out, it’s normally stashed in my jeans or jacket pocket. I use the travel pen less than the home pen, but it probably cops the bigger-than-normal insulin doses from eating out and going overboard at parties.

Every time my home pen runs out, I’ll replace it with my travel pen. And I’ll replace my travel pen with a brand new pen. I swap them so that my insulin pen will always run out at home, where I have a spare stash of insulin sitting in the fridge, rather than on my travels. I know it sounds like a confusing system, but it works for me.

Ever since I returned home from my holidays in July, I’ve only been using the one pen for both home and travel. I’ve had to remember to grab my insulin pen in the morning to take to work, rather than it just already being in my bag. I’ve had to go searching for my insulin pen in my bag or in my jeans when I get home, rather than it already just being on my desk. In all of these weeks, did it ever occur to me that I was making life harder for myself? In all of these weeks, did it ever occur to me that I could just re-employ that second pen? Nope. Or maybe I just couldn’t be bothered doing it.

Last Tuesday night, I noticed that my insulin pen was nearly empty. Too lazy to replace the cartridge then and there, I told myself I’d deal with it tomorrow morning. And I didn’t give it another thought. That was, until after I’d eaten my lunch the following day at work. I was in the locker room, ready to dial up the pen, when I noticed once again that the cartridge was almost empty. My stomach sank. I hoped that there would be enough there to cover my lunch. Even more stupidly, I primed the pen without even thinking about what I was doing. I dialled up my dose of 5 units, stuck it in and pushed. It was cut short. I had managed only 1.5 units of the 5 that I needed.

Thankfully, I’d only had a Burgen bread sandwich and a Muesli bar for lunch. I only had an hour left until knock off time at 3pm. And I live very close to work. Under any other curcumstances, I would have headed home immediately (okay, I probably should have headed home immediately). But under those circumstances, I thought I would be okay to last out the rest of the day. I hadn’t eaten anything ridiculous. And I was just over an hour away from getting my insulin.

My mind was preoccupied for much of my last hour at work. I left at 3pm on the dot, bolted through the door at home and headed straight to the fridge to grab a spare insulin cartridge. It was the first time in five years that anything like this had ever happened. And quite honestly, I was disappointed in myself.

It didn’t take me long to get that second insulin pen out of retirement and back into the workforce at Frank’s diabetes. And I know that I’ll never let it happen again.

Thirteen Truths About Insulin Injectors

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I am not one of the cool kids with an insulin pump or a Continuous Glucose Monitor (CGM). If you start talking to me about basal rates, temp rates, boluses and infusion sites, I’ll probably nod my head without understanding a word of what you’ve just said. And if you tweet me your CGM graphs, you’ll likely put me to sleep because I absolutely hate maths class.

I’ve been on Multiple Daily Injections since I was diagnosed five years ago. What I do understand are words like FlexPen, Penfill and Lantus. If you start talking to me about injection sites, doses, corrections and priming, you’ve probably got my attention. And if you can relate to my thirteen truths about insulin injectors, then you’ve probably got a lot in common with me.

1. Finding a comfortable place in my jeans to stick my insulin pen without squashing it when I go to sit down.

2. Having my insulin pen fall out of my shorts pocket whenever I’m driving, and then having fumble around for it under the driver’s seat.

3. Injecting before dinner, only to realise there’s no carbs on the dinner plate.

4. Trying to pay attention to the conversation at the dinner table when all I’m really thinking about is the carbs that were on my dinner plate.

5. Trying to find a subtle moment at the dinner table to escape to the bathroom without anyone noticing.

6. Dialling up really quietly in the Men’s bathroom so the person in the next cubicle doesn’t think I’m a total weirdo. Or taking drugs.

7. Drawing dots on my stomach to keep track of my injection sites.

8. Frantically putting the cap back on my needle and the lid over my insulin pen the minute I hear someone coming towards the locker room at work.

9. Trying to figure out how much to increase my Lantus dose by after eating more food than usual today.

10. Going hypo in the middle of the night because I ate less than normal today and my Lantus dose was too much.

11. Succumbing to the urge to overcorrect a ridiculously high blood sugar reading, only to end up hypo 2 hours later.

12. Finding a corner to subtly inject because there isn’t a bathroom nearby. Or because I just can’t be bothered going into one.

13. Doing the four touch tap when I leave the house. Wallet. Keys. Phone. And Insulin Pen.

Who says that technology is the only thing that does your head in? Insulin injecting does my head in all the time!