Insulin Pump

Working Towards a Lower hba1c

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I am only two weeks away from finding out what my latest hba1c result will be. And I am dying to know.

In August, I learned that my hba1c had gone up after three months on a pump. I was extremely disappointed at the time, but did take solace in the fact that my BGLs are far less variable than they once were. 

I’ve been working hard at taming my blood sugar levels over the past two or so months. I do genuinely feel like I am making progress and taking steps in the right direction. But there are definitely still some tough spots that are taking time to work through. 

Routine has been key to taming my blood sugar levels. Through the week I generally wake up, go to work, have my meals, come home and go to bed at the same time each day. Having that sort of consistency makes it easier to experiment, compare and make adjustments to insulin doses.

Nights have probably been the most consistent. I still wake myself to check once through the night. Sometimes small correction doses are needed, but I am waking up in range almost every morning.

Mornings are probably the smoothest portion of my day, blood sugar wise. It is still extremely tough to obtain consistent results, because I begin work at 7am with varying levels of physical activity from day to day. While breakfast on Monday left my levels smooth sailing, the exact same breakfast (and an identical waking BGL) yesterday sent me a little higher than I’d like. As much as I try not to beat myself up, this is ever so frustrating!

Afternoons have been somewhat tricky to smooth out. I sit down to lunch for an hour at 1pm after a morning of physical activity, which means I need a higher basal rate in action for this hour alone. I go back out to work at 2pm for another hour of physical activity, before finishing at 3pm where I once again need a higher basal rate of insulin. It’s definitely been a loooong game of trial and error, with many curse words thrown towards the sight of upward trend arrows on my FreeStyle Libre. Urgh.

Speaking of FreeStyle Libre, it is a lifesaver. Having easy and unlimited access to glucose monitoring means I have greater insight into what’s happening with my levels. Adjustments are easier to make, and I can better respond to highs and lows. Like this low, that rebounded high, and ended miraculously in a steady line.

 It’s becoming hard to live without it (first world problem, I know…).

Evenings are probably affected a little by my afternoon levels, and I’m confident that they will be easier to manage once my afternoon basal rate is right. My evening meal is also a cooked one, meaning that my carb counts are more estimated and varied than others. 

I am also being super diligent with my eating. I am putting more effort into preparing my meals and snacks through the day. This has definitely resulted in more variety and enthusiasm towards the food in my lunch box (hello ham and eggs on toasted Sourdough), and less of a desire for junk food and unnecessary carbohydrates. I definitely want to expand on this in another post to come. 


I’m also noticing that my total daily dose of insulin is now both lower and more consistent, which can only be a good sign!

Which brings me to now. I am nervous. I have absolutely no idea whether I have done enough to make a dent in my hba1c. I’m trying not to be too unrealistic about my expectations, but I’d be lying if I said I didn’t have high hopes. If my average glucose readings are anything to go by, I’m expecting that I’ll be sitting around half a point lower to where I was in August.

I’m determined to make these last two weeks count. And not because I’m scrambling, like I did back in my diabetes juvie days. I’m watching my FreeStyle Libre reader like a hawk, and making those last minute improvements that will hopefully make all the difference.

I am absolutely dying to find out where my hba1c is sitting right now. Crossing my fingers and toes for November 9…

Dawn Phenomenon, Breakfast, Physical Activity and Diabetes

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A couple of months ago, I wrote about the relentless hypos I was having at work. There have been days where my blood sugars have been bouncing up and down like a yoyo. The smallest insulin correction would be enough to send me plummeting within half an hour. My Libre would then show me rebounding after a hypo (and I now know that the Libre tends to pronounce movements in my BGLs). I would have the urge to correct it again, only to end up low once again. This seemingly vicious cycle made it impossible to obtain a steady line while I was at work and left me feeling exhausted at the end of the day.

The one thing I genuinely do miss about injections is that insulin sensitivity during physical activity was hardly an issue. I don’t remember having to pay half as much attention to my diabetes at work while I was on injections. I’ve felt very conscious of the number of times I’ve had to tend to diabetes in a day. Unlike a Lantus injection, my pump delivers basal insulin in tiny amounts throughout the day as I’m working. In addition to physical activity, dawn phenomenon and breakfast boluses are also thrown into my morning diabetes equation.

After a lot of trial, error, and notes in my diary, I finally feel as though I’ve got my mornings down pat in recent weeks.

The obvious one has been making sure that my basal rate is right. I cannot stress how difficult morning blood sugar levels are to manage if I do not wake up in range. No amount of correction seems to be able to fix them, and I end up really grumpy at 8am as I see my levels soaring after breakfast.

A couple of weeks ago, I noticed that my levels were climbing at around 3am each morning, warranting a change in overnight basal rates. Until that was fixed, I wasn’t able to properly focus on the mornings. Another thing I’ve learned is that my waking basal rate (when my liver begins dumping extra glucose) needs to run for at least a full hour before I wake up. Even a gap of 15 minutes is enough to screw up my morning basal test. Going on intuition seems to have done the trick in fine tuning the remainder of my morning basal rates.


Breakfast really has been a case of trial and error. I’ve learned that I do not need to subtract any carbohydrates from my breakfast insulin dose. Subtracting 5g from my breakfast dose is the difference between a post prandial result of 9mmol or a post prandial result of 15mmol. My pump will also add a correction dose to my breakfast bolus if my blood sugar level is over 7mmol. 


I’ve learned that I need to ignore it unless my blood sugar level is above 8mmol, and that I need to subtract insulin accordingly if my blood sugar is lower than 6mmol.

Morning coffee at work normally happens anywhere between 8.30 and 9am. My medium cappuccino with no sugar probably has around 15g of carbs, 10g of which I do not need to bolus for. It’s been so hard to wrap my head around these tiny insulin doses, but they are indeed enough! Pre bolusing is also not necessary, as I slowly sip my hot coffee when it first arrives.

Morning tea comes anywhere between 10 and 11am, and is usually a banana which is weighed before I leave home. Again, bolusing for 10g less carbs seems to do the trick, as do the rules for correcting.

Not foregoing what I love in the mornings has been really important to me. It would have been easy to simply forego breakfast or the morning coffee, but I know that would have made me unhappy (and hungry!). I work diabetes around my life and my activity, and not the other way around.

It’s been a lot of hard work, but I do genuinely feel that I have my mornings down pat. Instead of going up and down multiple times in a day, it might happen 2 or 3 times in a week. Levels are also looking great, thanks to continued pre bolusing and my moderate carb approach. I plan on taking a break from my Libre after today, and I’m quite confident that I will be able to manage just fine on finger sticks for a while.

I’ve been nominated for a Wego Health Activist Award. If you enjoy reading my blog, I’d really appreciate your endorsement which you can do by clicking here. 

Playing the Diabetes Card

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A few weeks ago, I was consulted about some potential changes to my position at work. I felt that what had been asked of me was huge, and very unexpected. It was a big step out of my comfort zone. It left me feeling stressed and with blood sugar levels that were through the roof in the hours after I first found out.

I knew that this change was not going to be great for my diabetes, either. It was going to mess majorly with the routine that I had become ever so familiar with over the past four years. I knew that it would make me unhappy and ruin my attitude towards my job.

I pulled out my pump and explained to my boss that I had diabetes. That the little pager-like device attached to my hip delivered all of my insulin, and that I had only just finished fine tuning the insulin delivery settings after three months. I went on to say that I thrived on a routine, and that I didn’t really feel too comfortable messing with it to such a huge extent so early on into my pump therapy.

I felt terrible. I felt so small, and so defined by my diabetes that day. I absolutely hated myself for having to fall back on diabetes as an excuse. I absolutely hated that first impression I had given to my relatively new boss, of both diabetes and otherwise. I couldn’t even begin to imagine what he would have thought, as he asked me if there was anything he could do to help make this change happen.

I was prepared to go back and make a compromise that I felt more comfortable with after much thought, but ended up being offered an even better option.

I felt absolutely terrible for using my diabetes as an excuse in that situation. Very rarely do I use my diabetes as an excuse for anything. Morning coffee. Christmas lunch. Taking on extra responsibilities at work. Helping others. Doing handy work myself to save hiring someone.

But two weeks into this compromise, I realise that it was well worth speaking up. I knew that I would have been unhappy with the original change, and that it would not be good for my diabetes and general wellbeing at all. I know that I am miles happier than what I would have been. And as one of my work Mums reminded me yesterday, this would not have happened had I not spoken up.

The reality is that I do have diabetes, and it can afford me some special privileges if I see fit. Taking into account the special privileges that I’ve been given in trying to operate a broken pancreas for the rest of my life, I think we can just about call it even.

Does An Insulin Pump Make Me Lazy?

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In a recent blog post, I expressed that my insulin pump has offered a greater level of convenience in giving my insulin doses. I lamented that I was often slack with carbohydrate counting, weighing my portions and delivering insulin in a timely manner when I was on injections. This led to a few comments from social media trolls that accused me of getting an insulin pump because I was lazy.

Of course, I could absolutely count carbohydrates, weigh portion sizes and pre-bolus insulin on injections. But there were a number of other factors that lead to my ultimate decision, which I wrote about here. I felt failed so often despite my best efforts, that I simply lacked the motivation to do those things that I should have.

So in hindsight, maybe ‘lazy’ was the wrong word to use. I only used it in the context of trying to be honest. However, an insulin pump is definitely not a lazy decision.

Attending an insulin pump information evening was not lazy. Doing my research was not lazy. Making an appointment to discuss pumping with my diabetes educator was not lazy. Going home and giving myself three months to think about the pros and cons of pumping was not lazy, despite how tempted I was to say yes. Being active and seeking out options that may improve my health is not lazy. Wanting to better manage my diabetes is absolutely not lazy.

The very first thing that Gwen drummed into my head is that an insulin pump is not any easier than injections. In hindsight, I would argue that it is much more work compared to injections. There’s a good reason why clinics like to make sure that their patients are deadly serious about it and prepared to make a commitment. Wearing an insulin pump is a big responsibility. Just read every post I’ve written here in the past three months.

I am very conscious that I’ve been writing a lot about insulin pumping here of late, but that’s simply because my insulin pump is a big part of my diabetes at the moment. I certainly don’t have an agenda to ‘push’ insulin pumps onto anyone. I don’t believe that one is any better than the other. I simply believe that different methods of insulin delivery may suit some better than others. There’s a big difference between giving advice, and sharing my experience in the hope that it might inspire you.

Insulin pumps and diabetes tech are often the hot topics among bloggers and diabetes websites, and it sometimes does leave injections looking under-represented. But then again, don’t we all feel we are in the minority in some context or another? I feel in the minority because I can’t play sport to save my life. I feel like I’m in the minority because I don’t work in an office. At work this morning, I’ll be in the minority because I’m the only person who watched Australian Survivor last night. And in the DOC, I feel in the minority because I don’t use a CGM. 

Truth be told, I couldn’t care less about being in the minority! I’m happy to go for a walk instead of a run. I’m happy that I’m employed, earning money and have goals that I’m working towards. I love Survivor. And I’m happy to prick my finger 15 times a day, because that’s what works for me.

It comes back to the point I made last week in this post about inclusiveness. If there’s a topic that speaks to you, then please do add your voice to the conversation. And if I’m reading it, I promise I’ll treat it with absolute respect.

Finally, an insulin pump does offer me the convenience of dosing insulin under the table, or when I’m on the go. Dealing with diabetes every day for the rest of my life is already hard enough, and I refuse to feel guilty for it.

First hba1c Result Post-Pump

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The very last thing that I was expecting to hear was that my hba1c had gone up after three months on an insulin pump.

I mean, I wasn’t expecting dramatic improvement straight away. I knew full well that my pump is not a magic wand. I knew that my glucose levels were fluctuating far too much pre-pump. When we looked at my Ambulatory Glucose Profile with Gwen back in May, she said just as much to me.

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But I definitely believe that this variance is much tighter today. I feel I don’t peak above 15mmol half as often as I used to. Lows aren’t too bad either, but they are definitely a work in progress. I’ve been putting so much work into my diabetes. More than I used to on injections.

So I guess I went in there, mentally prepared to hear that my a1c result was the same. But definitely not half a point higher than my last one.

For a while now, I’ve stared at half decent a1c results. The doctors have been quick to dismiss me, but I’ve never truly felt satisfied with my results. Deep down, I knew that my levels were fluctuating far too much. I knew that I was peaking way too high after meals, and having far too many lows. I knew that my a1c result was not an accurate representation of what was going on with my levels. But I never had the courage to ask for help. I pushed these thoughts to the back of my mind, telling myself I would fix that problem before my next check up in six months time.

But I never quite got around to it.

So, I guess there was a damn good reason for the rise in my hba1c result last week. For the first time in a long time, I have a clear picture of where my glucose levels actually sit. It definitely means that I have made some progress. But at the same time, my goal post feels a lot further away. I am realising just how much hard work lies ahead of me in order to get that a1c to where I want it to be.

As I made a long drive home in peak hour traffic and pouring rain, it was hard not to feel disappointed. It was really hard not having Gwen, who recently retired, there with me that day. She had been with me all the way through my journey, and I’m sure that she would have understood exactly where I was at. I’m sure she would have known exactly what to say.

I dream of the celebratory dinner I’ll have when I get my a1c to where I want it to be. I dream of the satisfaction I’ll feel. The grin on my face. The sense of achievement. The victory. Feeling somewhat in control of this unpredictable disease. And the cake.

I am motivated. I know that I have made some solid progress in these last three months. I know that I am going make it to that dinner table one day.