Insulin Pump

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.

Three Month Pump-aversary!

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The very first thing Gwen emphasised to me last year was that using an insulin pump would not be any easier than Multiple Daily Injections. Boy, oh boy, was she right.


These past three months have been by far the most challenging I have faced since being diagnosed with type 1 diabetes six years ago. I have gone through site failures, occlusions, ketones, frustrations and burnouts that have lasted for several days on end. It has required enormous patience, a commitment to learn, and it has seen me agonise over many a decision. I have been through it all. I have poured my heart onto these pages over the last three months.

There have been a lot of low points that I have talked about quite candidly over the past three months. There have been a few times where I’ve reached breaking point. Times where I have found myself pacing up and down my room, deliberating over whether to rip my pump out and take a break for a couple of days.

But every time I have contemplated removing my pump, I knew that I really didn’t want to say goodbye to that added level of precision. I have never truly felt ready to say that this wasn’t for me.

Stability during the night is miles better compared to injections. I felt that when I was using Lantus, I could never get the dose quite right. I felt that I needed to eat a similar number of carbohydrates each day in order to achieve that smooth coverage I needed during the night. I felt that if I ate more than normal, my basal wouldn’t be enough to keep me stable through the night. Then if I were to skip a meal the next night, my basal would likely send me plummeting at 4am.

For the first time in my life, I have confidence that my basal rate keeps me stable. When I give a correction at 1am, it actually works and sends me back into range by the time I wake in the morning. When I go low during the night, it’s only through my own fault.

I could never seem to get my breakfast insulin dose just quite right. In the months leading up to the pump, I noticed that I would end up frustratingly high after eating virtually the same thing for breakfast each morning. Now my pump delivers extra basal insulin to cover the extra glucose that my liver dumps when I wake up each morning, and my breakfast insulin dose actually does it’s job!

Highs are also so much easier to manage with the pump. I remember stubborn highs that were so resilient they needed multiple insulin corrections that didn’t make any sense. Now with the pump, I know that highs are a little less sensitive to insulin. When my levels soar into the 20s, I can set a temporary basal rate of +200% to get things moving a little more quickly. When i think about it, I don’t think my levels peak above 15mmol half as often as they used to. And when they do, they don’t stay there for too long at all.

On pump day, Gwen reminded me that I was the kind of person who wanted that extra level of precision. I knew that I wanted to be able to customise my insulin delivery to match the hour of the day or a specific activity. I feel that my insulin pump has given me that.

The pump has given me an added focus and drive with my diabetes. I am working my butt off with carbohydrate counting, pre-bolusing and watching my portion sizes (which I could easily do without the pump, too). I guess what I’m trying to say is that my diabetes goals seemed unattainable on injections. With the pump, they do. Hence, the drive to keep up the hard work rather than being lazy.

I’ll hopefully have an a1c result at the end of today. I have a good feeling that it will likely be around the same mark as it was in May, and I’m pretty content with that. Over the years my a1c results have been ridden with too many peaks and troughs, so I’m pretty pleased that those peaks are a little less peak-ey today.

As I reach the three month mark on an insulin pump today, I feel like I can finally focus on some of my other diabetes goals, which feel far more in reach than they ever did on injections.

Thanks for all of your support and encouragement over the last three months. I really couldn’t have done it without you all cheering me on.

Navigating Diabetes Through a High Carb Breakfast

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I have always found diabetes extra challenging to manage around big meals. I’m the kind of person who likes to try a bit of everything at a party. I try not to let diabetes get in the way of enjoying myself on special occasions like birthdays or Christmases, because they only come around once a year. Often the consequence of this has been high blood sugar levels that are tricky to bring down in the hours that follow.

One of the biggest advantages of having an insulin pump is the extra flexibility that it gives me to work around high blood sugar levels. With tricks like temporary basal insulin rates, the pump has definitely saved me hours of frustration in trying to bring my blood sugar levels down in the aftermath.

Yesterday my pump got it’s first taste of a high carb meal, as I took the wheels out for a spin over breakfast. I had been craving pancakes all week, so my order was going to be a no brainer.

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In anticipation of the extra carb load, I set a temporary basal rate of +100% to ensure that my mealtime insulin did its job effectively. I did this before I left home, so that the basal rate would kick in by the time I sat down to breakfast.

The cafe looked pretty busy, and I wondered how long I would be waiting for my pancakes. I guessed that I would probably need insulin to cover somewhere in the vicinity of 60-80g of carbohydrates, but I didn’t know for sure how big the serving would be. I decided to play it safe, and pre bolused half my insulin when I placed my order, and the other half when my meal arrived.

When I left the cafe, my blood sugar was 13 mmol. When I checked again at home half an hour later, I was 13 mmol once again. I noticed my blood sugar begin to creep up again at around the 3 hour mark, as I would expect for a higher loaded meal. I entered my blood sugar reading into the pump, overrode the insulin on board subtraction, and gave a correction dose. I kept the temp basal running, anticipating that I would need it to cover the delayed fat/protein spikes.

By around 2pm, my blood sugar was almost back in range at 8.3.

The majority of my numbers throughout the morning were around the 12-13 mmol mark, save for one brief peak at 15.7 mmol. To put that into perspective, a loaded meal like that has the potential to send me well above 20 mmol. 

Safe to say I was pretty damn pleased with my handy work.

Take that, food police.

Pump Doubts

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After a few infusion site failures of late, I’m starting to become really self conscious. After every new site change, I become really paranoid of whether it’s a failure or success.

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I poke my infusion site, trying blindly to detect a kinked piece of teflon that should be sitting underneath my skin. I prod around the infusion site on my stomach, trying to feel bruising and pain. I stand still while my pump is delivering an insulin bolus, waiting on edge to detect any stinging. I lift up my jumper compulsively, watching the colour of the skin underneath my site like a hawk.

I think about whether the skin tissue underneath my infusion site is strong enough to handle 3 days worth of insulin boluses. I frequently glance at my Total Daily Dose history on my pump, questioning whether it’s too high. I feel guilty for the carbohydrates I am consuming, for the sake of the subsequent insulin boluses that will have to go underneath my skin.

I check my levels like crazy after a site change, impatiently looking for signs that the insulin is heading successfully underneath my skin. I keep an eye on glucose movements like a hawk. In a moment of paranoia on Saturday, I even ripped out a perfectly good infusion site because the correction was taking too long to work it’s magic.

I draw dots on my stomach in permanent marker, in a desperate bid to keep on top of site rotations. I stare persistently at the real estate on my stomach, deliberating over just the right spot to place my new infusion site. I worry about how soon I will be able to re-use an area of real estate again.

In moments of site failures, I question whether this is really worth it. I think about results around my diabetes, and I’m almost certain that I won’t see any improvement yet. I’d be lying if I said I haven’t had fleeting thoughts that maybe this is not working for me. I worry that I won’t be able to make this work for me. I stand in my room for minutes on edge, pacing, deliberating over a site change or a shot of Lantus.

But when I think about going back to Lantus, I think about the level of control I will lose around my basal insulin rate. I think about how unfocussed I was on injections, blindly guessing and correcting all the time. I think about all of the time and investment I’ve put into this insulin pump, and I know that I’m not ready to pull away from it just yet.

A Tumultuous Night

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I’ve never had ketones in the six years I’ve lived with diabetes. Until yesterday, that is.

I performed a routine site change when I arrived home from work – probably around 2.30pm. There was no bruising or bleeding around the old site, which was another confident step away from the occlusion nightmare of three weeks ago. My blood sugar levels were in range, and I was good to go in no time.

By 5pm, I noticed my levels beginning to rise closer to the 10 mark. Dismissing it as a delayed effect of the buttered ham and cheese toastie I’d had for lunch, I gave a correction bolus.

When I sat down to dinner at around 6.30pm, I was 13. I bolussed for what I thought was a pretty accurate carb count of my dinner, with a generous correction. I did my best to eat slowly and pick at the lower carb things on my plate first, so that the bolus would have time to kick in.

After a little OzDOC banter, my levels were edging close to 20 by 8pm. I was obsessively looking at the site I’d changed a few hours ago, but I couldn’t find any reason to rip it out. It looked clean, and the boluses weren’t stinging as they went in.

I added some more carbs to my dinner bolus – this carb count was now extremely generous – and set a temp basal of 100%. I let it run for an hour, while watching my levels continue to soar into the low 20s. With no end in sight to the upward trend arrows on my Libre and feeling the high in my chest, I began to worry.

At 9pm I grabbed the insulin pen from my contingency pack, and injected six units into my stomach. It was my first insulin injection in 7 weeks. I went to check the site once again, and saw small amounts of insulin leaking out of the edges – finally noticeable thanks to the crazy correction boluses and basals of the past hour.

I ripped out the site to discover this.

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The small piece of teflon that sits under my skin was kinked, which meant I’d had little to no insulin in my system since the site change six hours ago.

My BGL was 25, which was honestly the highest I’ve ever seen it.

I checked for ketones, which were present in the mid range of 1.3. At this point, I was very aware of the possibility of having to go to hospital if I became nauseous.

Once I had changed my site, I hastily grabbed my diabetes file from the bookshelf, sending two others flying to the floor in the process. I furiously turned page after page, looking for the cheat sheet my diabetes educator had given to me a few weeks ago. The cheat sheet that I knew had quick instructions for treating ketones in the bottom left corner.

I set a temp basal of 200% to get that basal insulin kicking in my system ASAP (not educator recommended, FYI). As per the handy cheat sheet, I bolussed for correction plus 10% of my total daily insulin dose. I then headed straight for the kitchen, completely filled up my 600ml water bottle, and skulled it down to flush out the ketones. I filled it up again, ready to skull down in another half hour or so.

Slowly, but surely, my BGLs began to decline. When my meter finally rang in with a reading below 20, I breathed a massive sigh of relief.

By 11pm, I was 14, Ketones were down to a negligible 0.3, and I finally felt confident in turning off my temp basal rate.

It was a tumultuous night. By far, the worst scenario that diabetes has ever thrown at me. I crawled into bed at 11.30pm, exhausted.

Only to be woken again by a 4.30am low.

Here’s hoping that tonight diabetes lets me watch Wimbledon in peace.