Insulin Pump

Insulin Gone Bad.

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I couldn’t help but notice the reading of 14.1. Is that high? My friend asked me from across the table as I was demonstrating my FreeStyle Libre.

Yeah, I obviously haven’t given enough insulin for the banana bread, I replied, pulling my pump out of my pocket and bolusing for another 30 grams of carbs ever so casually.

I had already bolused a very generous 60 grams of carbs for the slice of banana bread and iced coffee I had ordered at the local cafe, but I wasn’t overly surprised to see the upward trend arrow on my Libre.

My blood sugar was still skyrocketing by the time I arrived home an hour later, with my Libre clocking in at a lovely 17.4. I bolused for another 10g of carbs, bringing the total for my mid morning coffee catch up to an overly generous 100g of carbs. I was certain that all of this insulin was bound to kick in any minute now.

After another hour had passed and my Libre clocked in at 25, I had figured that banana bread was the devil. After a prick of the finger came in at 20.4, I ignored all insulin I had on board and gave a full 4 unit correction. I also set a temporary basal rate of 100% to help get things moving in the right direction.

After a bucketful of insulin, my blood sugars slowly but surely began moving in the right direction over the course of the afternoon.

When dinner time rolled around and I was back in range, I bolused for the 50 grams of carbs on my plate. I drank a glass of water. I stepped outside and turned the sprinklers on. I washed some strawberries that I planned on having post dinner. I drank yet another glass of water. I stepped outside again, and switched the reticulation off. After distracting myself for a good 20 minutes or so for the bolus to kick in, I finally tucked into my dinner with the hope of avoiding another blood sugar rollercoaster.

Fast forward to me in front of the television 2 hours later, and my blood sugar clocked in at 16.1 with an upward trend arrow on my Libre.

I scrolled back through my pump history, noting that my last prime was four and a half days ago. As I swapped out the infusion site, my brain began to cotton on to other moments of particularly difficult-to-manage post meal blood sugars in recent days.

The lone milky coffee that sent my blood sugar upwards of 10. The hot cross bun that I’d carefully pre bolused for, but landed me close to 20. Rising blood sugars, despite a long walk fuelled by 10g of chocolate beforehand. Even a pasta meal had been extremely difficult to manage.

As I connected all of these recent occurrences together, I eventually recalled another occurrence of skyrocketing levels when my insulin had spoiled 2 years ago.

My insulin had spoiled! There was my answer! 

So, maybe Banana bread wasn’t the devil after all.

Four Foods I Cannot Bolus For To Save My Life

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I remember starting off on vague insulin doses of 5 to 10 units at every meal instructed to me by the hospital. Then I saw a diabetes educator, and learned to carb count. Adding up every gram of carb on worksheets supplied by my dietician only led to frustration over why logic was not translating into steady blood sugars. (Of course, little did I know about the gazillion other factors that could affect my blood sugar back then…)

For a few years in the middle, I just swaggered by and thankfully lived to tell the tale.

Fast forward to today where I’m using an insulin pump, carb count nearly everything I eat at home and have a pretty good idea of what most foods that I eat will do to my blood sugars. I know exactly why my blood sugar is high as I’m typing this right now (hello, potato bake with no pre-bolus). Overall, I feel pretty comfortable with being able to eat, give insulin and manage my blood sugar levels today.

That being said, there are still a few select foods that I cannot bolus insulin for if my life depended on it.

Pasta.

If there’s one food that confuses the life out of me, it’s Pasta. You can’t go by what’s on the packet, because most packets only refer to the uncooked weight. Seriously – who in the world eats dry pasta? If you were to make that mistake, I‘d be surprised if you weren’t chugging down litres of coke or making a dash to the emergency room.

Logic tells me that Pasta has around 28% carbs in it. The carb counts in our plates of pasta at home would be huge, because who on earth can only eat 1 cup of pasta? But if I were to give a massive insulin dose for all that carby goodness, I’d be eating glucose tabs for dessert.

All the extended boluses in the world can’t keep me from the Pasta lows, which can only mean that Pasta must be a really really really slowly digested food. These days I tend to settle for bolusing for 50 to 60% of the carbs at the time of the meal, accepting that the remaining 40% of the carbs that have absolutely no effect on my blood sugar whatsoever must be magic.

Soup

If there’s one meal that I despise purely for diabetes reasons, it’s soup. Who on earth can count the carbs in all those lentils, veggies and pastina that have been sitting there in the pot stewing all afternoon?

Then there’s the hassle of attempting to drain all of the liquidy goodness from the soup ladle for the purposes of weighing my plate, and then scooping up only liquid from the pot to add to my dry plate.

Add to this the same principles as pasta – all of those lentils and pastina are really slowly digested and would send me low quite easily. With carb free veggies and meat in the mix, I’ve sort of settled on bolusing for about half the number of carbs I would with Pasta.

Bananas.

Fun fact: I cannot eat a Banana without going low. Which is shit, because I actually happen to like them a lot. I very much look forward to my mid morning coffee and banana, while other times I slice it up to mix in with my Overnight Oats.

Logic tells me that a Banana with skin intact has around 13% carbs in it. But if I were to weigh my banana and bolus that much, I would be low within the hour. I’ve sort of settled on bolusing for around 50 to 60% of the carbs in my bananas, and some days this does the trick while other days it does not.

Steak and chips. Or Pizza. Or any kind of restaurant meal, really…

I have a love hate relationship with pub meals. I love how delicious and mouth watering and salty a steak and chips are, but I absolutely hate the night sweats and resilient high blood sugars that follow in the aftermath.

After learning that restaurant meals tend to be higher in fat to make them more delicious, I tend to set a temporary basal rate increase of 50% on my pump for 8 hours to combat the insulin resistance. I don’t prebolus for anything, given that fat slows down the digestion. I might also bolus for 40 to 50% of the protein in my steak after the meal is over, using a extended bolus over 2 to 3 hours.

Get the insulin in too early, and you go low. Get it in too late, and my blood sugars go up, up, up. It’s definitely a case of hitting the sweet spot.

***

Ahh, food and insulin…if only it were as easy as counting the carbs, giving an insulin dose and catching a unicorn 2 hours later.

Diabetes at 3.14am

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I stirred in my sleep, registering the blaring red 3.14 on the clock radio beside my bed. Pulling my left arm out from under the covers, I fumbled around for the switch at the base of my bedside lamp. When my desk was finally illuminated in cosy warm white light, I heaved the remainder of my body up from the bed, reaching for my meter and test strips.

This certainly wasn’t the number that I was expecting to see, considering the full 2 unit correction that I had given prior to bedtime for a 10.7. (And in case you’re wondering, I’m only using the OneTouch Verio to deplete my final box of strips…)

I immediately ripped my pump away from it’s resting place inside my inner left pocket, and gave another full correction of 3.3 units for that very uncomfortable number. My frustration was only further fuelling my actions, as I set a 50% basal rate increase for the next two hours on my pump to ensure that this correction insulin did its job.

As I flicked off the lamp and rested my body back onto my bed, I couldn’t get back to sleep. I could feel the heat emulating from my pillow, and flipped it over to the cool side. My whole body felt stuffy, presumably a consequence of the higher blood sugar.

As I lay there, tossing and turning, my mind was quickly consumed with guilt.

I wasn’t happy that it had taken me this long into the night to finally stir in my sleep and check my damn blood sugar. I felt terrible for the fact that I had been sitting there, at that very uncomfortable level, for the better part of five hours. I felt frustration, because a mere two weeks ago I was super insulin sensitive and today I feel like I’m not getting enough.

Second guessing my prior decision in the darkness, I reached for my pump and lowered that 50% temporary basal rate to 30% before clipping it back inside my pants pocket.

Trying to purge those thoughts from my mind, I began thinking about all of the positive things that I am doing in managing my diabetes, reminding myself that numbers like those are isolated occurences nowadays.

If this had happened in the middle of the day, I’d have corrected the high without giving it a second thought. But laying there in the middle of the night with nothing else on my mind to worry about, was a completely different story.

By the time I woke up on a grey Sunday morning, last night’s occurrences felt like nothing more than a dream.

Cellnovo Mobile Insulin Pump Launches In Australia!

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The Cellnovo Mobile Insulin Pump officially launched in Australia last week at the ADS-ADEA conference (ADS-ADEA disclosures are at the bottom of this post). The pump is being distributed by Medical Specialties Australia, and subsidised consumables will be available through the NDSS from October 1. MSA’s Diabetes Division Manager, Aaron Cook, was kind enough to come and meet with myself and a few other consumers last week outside of the trade hall to give us the scoop.

The Cellnovo system consists of a small insulin pump that sits on the skin via a Velcro patch, in close proximity to the infusion set. Tubing is virtually non-existent. The pump is rechargeable, rather than battery operated, with each charge typically lasting 3-5 days. There is a second identical pump included in the box, so that the user can charge one up while using the other.

 

If you know me in person, you’ll know that I’ve dreamt of a touch screen insulin pump that I could control from my Smartphone (yes, I’m well aware of Looping and We Are Not Waiting). Frankly, the interface on my Animas Vibe looks like something out of the 1990s.

So for me, the real selling point of the Cellnovo system is the touch screen mobile handset that connects to the pump via Bluetooth. The screen is bright and colourful. There are menus for insulin delivery settings, bolus calculations, activity tracking and food databases. The handset also has a built in blood glucose meter, which uses Accu Chek Performa strips.

Aaron was telling us something about wax and pistons inside the cartridge (or possibly the pump) that allows for more superior and precise delivery of insulin infusions. Insulin cartridges can only hold 150 units of insulin, which may be a consideration for those on larger doses. I would rarely fit the maximum amount of insulin into my cartridge once air bubbles have been primed out, so this may be closer to 100-120 units of insulin. Your Diabetes May Vary…

There were a few choices of infusion sets, with 5.5mm being the smallest. Aaron informed me that all infusion sets are 90 degrees, which is an issue for me personally as I prefer my 45 degree angled ones. However, I was encouraged to hear that there are options for manual insertion rather than insets. 

Another consideration was the minimum basal profile being 0.05, rather than 0.025. To put this into perspective, my pump gives me the option of delivering 0.300, 0.325, 0.350 or 0.375 units of basal insulin per hour. The Cellnovo would reduce this to 0.300 or 0.350 units of insulin per hour. For some this might not be an issue, but during overnight fasting 0.025 does make a massive difference between a steady or a steadily dropping blood glucose level.

I’m also a little concerned about sleeping or lounging comfortably with the pump stuck to my stomach, so placement of the infusion site would be a big consideration. That being said, consumers overseas are happily wearing the Omnipod tubeless pump in similar fashion. Diabetes Educator Fiona was also questioning how well the pump would stick to the Velcro patch, however I thought that it indeed looked very tough.

Aaron describes Cellnovo as a medium sized startup company. They have been in the UK for around 2 years. Aaron is currently the only sales representative for Australia, and is basically travelling where the demand takes him. I am a little concerned around how well they will be able to handle customer service issues, although I am told this will soon change. Updated: I am told there will be a full customer service team in the office to deal with any issues. They are the same team who looked after the Cozmo pump.

It is really, really exciting that we have a new insulin pump option on the market. I can’t wait to hear from people who do decide to take up this pump, and whether it would be a worthy option for me to consider in two years time. While it won’t be for everyone, I believe that this might be just the thing that some have been waiting for.

Special thanks to Aaron for being so patient with a group of crazily excited people with diabetes and answering all of our questions. No, Aaron does not have diabetes himself…

From the left: Me, Aaron, my friend Tammy, fellow blogger Ashley and Victorian Diabetes Educator Fiona.

Excitement that only someone with diabetes would understand!

Travelling With an Insulin Pump

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My latest column is now up over at Diabetes Daily, and I’m tackling the topics of travel and insulin pumping.

When I first started on insulin pump therapy last year, I was given an overload of information in the space of a day and a half. At the time, I was still trying to get my head around the strange new device that was attached to me. I took all of the information packets away with me and tucked them into my diabetes file at home. However it wasn’t until I embarked on my first flight with an insulin pump earlier this year, that I began to consider some of that information in more depth.

You can read the rest of my column over at Diabetes Daily, so grab a coffee and settle in.