BGLs

Lesson Learned: Don’t Overfill Your t:slim Cartridges

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Yesterday morning after breakfast, after I could no longer ignore the vibrations coming from the needy insulin pump in my pocket, I swapped out the cartridge on my t:slim.

I slowly drew insulin from my penfill cartridge into the syringe, filling it all the way up to its 3ml capacity. After tapping and priming the air bubbles from my syringe, I stuck the needle into my black t:slim cartridge and began to slowly inject the insulin in.

As I tried to continue pushing that last bit of insulin from my syringe into the cartridge, I was met with a little resistance. The cartridge must have been nearing full.

I knew I should have stopped then and there. Except that I didn’t.

After pushing a little more in, I pulled the syringe out and slid the cartridge into place on my pump. I was feeling a little hesitant, but figured I’d be able to pick up on anything weird soon enough.

I had lunch a little later on, and found myself at 10.6 when I checked my blood sugar afterwards. Which felt plausible, given that I had also eaten ice cream with my lunch. I can never seem to bolus for ice cream quite right.

After some correction insulin, a walk and nothing more than a coffee that afternoon, I was still lingering around the 10 mark.

After loads of corrections that evening, I don’t know why I didn’t just replace my insulin cartridge before I went to bed.

I guess a part of me was seeing the 200+ units of insulin in the pump, and didn’t want to be wasteful by throwing it away if there was actually nothing wrong.

After a full correction at bedtime that had little effect by the time I woke up at 5.30am this morning, I hauled myself out of bed and made a dash to the fridge. I swapped out my cartridge for a fresh one, this time only filling to around the 2ml mark on my syringe.

Yes, Frank was told to put less insulin into his cartridges when he got set up on his t:slim a few weeks ago. But Frank also didn’t like to be wasteful and wanted to get his money’s worth from the cartridges that he paid for with his hard earned money. Frank also doesn’t like not being able to reuse these cartridges like could with his Animas pump.

Anyhow, lesson learned.

Don’t overfill your t:slim cartridges. It just feels like your insulin isn’t working.

Forever Learning

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“I never get it wrong. I just learn for next time.”

If there’s one quote that truly resonates with me in the way I manage my diabetes, Grumpy Pumper summed it up for me perfectly in a tweet that surfaced this weekend from the Sports and Exercise Weekend he was attending in the UK.

The biggest piece of diabetes wisdom that I often impart is that time and experience is my biggest asset in living with diabetes. Because each and every one of those valuable hours spent managing my diabetes have taught me something. Like only bolusing for 60% of the carb count on my banana. Or living to regret every hypo that I’ve treated with something nicer than skittles or glucose tabs. Or remembering to bring a spare of everything with me.

I am a bit of a perfectionist in the way I manage my diabetes. I meticulously monitor my basal rates, count my carbohydrates, time my insulin to the kind of food I’m eating and give deep thought to the physical activity I undertake each day. It’s no simple equation, by any means.

My biggest downfall is that I don’t handle it very well when things don’t go to plan. I can often be found swearing out loud in front of my meter, verbally expressing my frustrations.

Yesterday was one of those days, as I found myself low twice after my breakfast and wondering how today had been any different to my other mornings of late.

As I sat in my desk chair at work, recalling the actions I’d taken that morning, two particular things came to mind. The first being correcting a blood sugar of 7.1 upon waking up, ignoring the insulin I already had on board from an earlier correction (and perhaps if I’d washed my sweaty bed hands prior to checking, the number may have been different). The second being the ginormous orange I added to this morning’s brekky. As I searched through my Calorie King app, I learned that oranges had 5.5% carb content, rather than the 8% I had in my head.

Living with diabetes is a constant learning process. I still surprise myself at how much I continue to learn after a good two and a half years of more diligently managing blood sugars. I wonder if I will ever live to see the day where I’ve learned everything that there is to learn.

What I do know, however, is that I don’t feel so guilty for my blunders when I can identify reasons for them.

Do Your Insulin Needs Increase During Winter?

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I could feel my blood boiling.

With every single swipe of my FreeStyle Libre reader against the sensor on my arm, I felt increasingly frustrated.

Despite being pretty confident in what I’d eaten and covered with insulin for dinner, my levels dipped slightly before slowly but steadily ascending once again. A pattern that had become somewhat typical over the past couple of weeks following meals.

Despite correction after correction, my blood sugar levels were yet to budge.

My mind wandered back to the pump break I had taken in late April and May. I thought about how easy blood sugar levels had been to manage with pens and needles. How free my mind had been from frustration.

That pump complacency I felt on the night I disconnected my pump in late April had returned. I didn’t want to be feeling it, but it was there, plaguing my thoughts against my own will.

Then, I just had this sort of ‘epiphany.’

I set a temporary basal rate increase of 10% on my insulin pump, hoping that it would help my correction doses to start working better.

When my insulin still seemed ‘sluggish’ a few hours before bed, I increased it to 20%. After a few more days had passed, I went into my pump settings and permanently adjusted the basal rates upwards by 20%.

I’ve heard it discussed before in the diabetes community. I’ll be the first to admit that I never brought into the whole concept of insulin needs increasing during the Winter. And decreasing during the Summer, for that matter.

I don’t know what causes it. There’s been no significant change in my activity levels. I’m very active during my work day as usual, and don’t go anywhere near the gym or a pair of running shoes when I’m at home. My routine is the same. Admittedly, I probably spend less time outdoors or in the sunlight at the moment. Maybe there’s an increased inclination to drink coffee, eat cannoli and watch Australian Survivor.

More than anything, I think it may be an environmental or physiological factor.

I’m just grateful that my insulin is working again and that I can spend more of my day in range, fighting less of an uphill battle in doing so.

After eight years, I’m still learning new things about my diabetes. I truly believe that the more time and experience I have under my belt, the better equipped I am to live with it.

Replicating the Good Days

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At the moment, I’m trying to replicate days like these.

Rather than these.

I have whole weeks where my carb counting is spot on, insulin just ‘works’ and blood sugars are simply effortless to manage. There are less highs, and less lows. The stream of good blood sugars seem to have somewhat of a flow on effect, so long as I can keep the train on course.

Then there are the weeks where blood sugars simply do not want to co-operate with the maths. Blood sugars feel like a lot of effort to manage, because naturally the insulin doesn’t work as well when levels are out of range. The urge to rage bolus is real, ultimately leading to more lows, and more rebound highs. It feels much more difficult to get the train back onto the course, rather than simply keeping it on the course.

In the midst of trying to pinpoint things, this was yesterday’s discovery.

11.1 was the greeting that I received from my FreeStyle Libre sensor after breakfast yesterday. It’s not what I was expecting, given that I had woken up to a blood sugar of 6.2 and carb counted my eggs on toast and milky coffee.

I gave an additional unit of insulin, and decided against reducing my basal rate for a day on my feet at work until that stubborn high started to come down.

Normally, a one unit correction while ripping open pallets of bulky furniture would send me plummeting. Yesterday, I was lucky to nudge the top edge of my target range.

As I recalled the day prior, my blood sugar had also remained stubbornly in the 8s despite repeated corrections. After increasing my basal rate in the evening and avoiding every urge in my body to rage bolus, I slowly but surely landed back into range by bedtime. Only to find that the ascent had begun once again when I checked at 1am.

By this point, I knew what had happened. In fact, I was feeling like an idiot that I had not picked up on this sooner.

Perhaps not as terrible as the banana bread highs that spoiled insulin had given me last time, but spoiled enough to make my blood sugars noticeably more stubborn to manage than usual.

Tools and technologies are only as smart as the people using them.

By sharing some more bits of the daily grind here, I’m hoping to make myself a bit more accountable to replicate more of those good days.

One Messy Night.

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I was ready to go to bed.

As I watched my blood sugar slowly climb into the 10s, I gave a unit of insulin to correct. Thinking about the after effects of stacking my dinnertime insulin on top of a late afternoon coffee and one of Nonna’s biscotti, I set a temporary basal rate of 150% for 2 hours to help that insulin better do its job.

I set the alarm on my iPhone for 1am and switched off the lamp on my bedside. With a nagging feeling of doubt as I turned on my side, I fumbled for my pump in the dark and gave another unit.

DURN! DURN! DURN! DURN! 

I hastily fumbled for my phone to silence the shrieking alarm, before switching on my bedside lamp again. As I swiped my Libre reader, I was half expecting see blood sugars heading into low territory.

Instead, I was actually a pleasant 13.8.

I was in disbelief. However, I thought it could be plausible after having pasta for dinner. I reached for my insulin pump, and gave a rage bolus of 3 units.

ZZZZ! ZZZZ! ZZZZ! ZZZZ!

My rage clearly wasn’t enough to fuel the delivery of this bolus, which was stopped in its tracks by a very irritating occlusion alarm that was hissing and vibrating at me for attention.

I ripped the cap off my infusion site, which revealed a perfectly clear looking site. A poke and prod around the area showed no signs of any discomfort. I primed several units of insulin out of my pump line, watching it spill over the cannula and pool around the cap to satisfy my paranoia. I held my pump line up in the air and ran it through my fingers, watching it like a hawk for signs of air bubbles.

With my paranoia satisfied, I reattached the cap to my infusion site and delivered the remainder of the bolus that my pump had cut off. I set another temporary basal rate of 150% for the next two hours, setting my alarm for 3am.

When I stirred at 2.17am, feeling rather uncomfortable, my Libre reader revealed a reading of 17.7 and rising. I hastily grabbed my pump and went to deliver another rage bolus of 5 units.

ZZZZ! ZZZZ! ZZZZ! ZZZZ!

That hissing, vibrating occlusion alarm sounded once again, stopping my rage bolus in it’s tracks.

By this point, I was furious as I flung my bed covers away from me and was forced out of bed.

Finally, I ripped the infusion site away from my stomach. There was no kink in the cannula. There were no signs of blood, bruising or bleeding on my stomach where I’d placed the site. Everything looked fine, and I was convinced I had just wasted a perfectly good site.

After inserting a fresh infusion site, setting a temporary basal rate and delivering my third rage bolus of the night, I was finally able to close my eyes.

I wasn’t surprised to learn that I’d slept over my 6.25am alarm. I gulped down my coffee, showered, and hastily threw two pieces of frozen Pane Di Casa into my bag to toast at work.

I soldiered on, reminded of just how much responsibility rests on my shoulders every day.