Lantus

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.

Three Hypos in One Night

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It was a cool, breezy Summer evening. That perfect kind of early Summer weather that never seems to last long enough.

We’d had a barbecue lunch that day. Steak, sausages, eggs, onion, salad and cherries. The kind of lunch that left me feeling like it was Christmas Day – stuffed, sleepy and happy.

I wasn’t particularly hungry by dinner time. I wanted to make sure that my blood sugar levels had stabilised before bedtime after that barbecue, and I didn’t want to spoil my appetite for breakfast the next morning. I had some leftover salad and cherries, and gave myself a small correction dose.

14 units of Lantus is what had been keeping me stable those past few nights. 14 units. I figured with that big barbecue lunch, 14 units would do the trick once again.

I sat down outside with my laptop after dinner, catching up on some of my dBlog reading. I started browsing for Christmas gift ideas a little later on, but somehow ended up comparing prices of items on my own Christmas want list.

My blood sugar levels were looking good during the course of that night, clocking in at 7.1 and 6.2. I had the best of intentions to settle in for an early night before the start of another working week. Little did I know, however, that my diabetes had other intentions.

I was 3.8 at 9.18pm. I figured that the majority of my rapid acting insulin had worn off. I thought 3 marshmallows would do the trick, but I gave 4 just to be safe. 20g of carbs, because I was about to go to sleep. I laid in bed, surfing on my phone for a while longer, until it was nearing 10pm. I was a perfect 7.6, but I was convinced that I’d given myself too much for that hypo. I set the alarm for midnight, ready to catch a rebound high in it’s tracks.

That was hypo number one.

I woke up a while later, and my pyjama pants were sticking to the sweat on my thighs. I knew that I didn’t need to test, but I needed to know how low I was. 3.2. I reached for the bag of Marshmallows beside my bed, carefully counting them out in my hand so my hypo induced brain wouldn’t forget how many I’d eaten. One, two, three, four, five. I shoved the 25g of carbs into my mouth and rested my head back on the pillow, feeling instant relief.

I finally noticed that it was 11.53pm, and switched off the midnight alarm on my phone. By this point, I figured that I’d given myself more Lantus than I needed. By this point, I knew that there wouldn’t be any rebound highs to catch that night. By this point, I realised that these hypos were a consequence of skipping dinner. I switched out the light, and went to sleep.

That was hypo number two.

By 4.30am, I was startled awake by my favourite sound in the world. I felt shaky once again. I wasn’t sure if it was another hypo, or if I didn’t have enough blankets on the bed. My meter confirmed that it was the former, clocking in at a very hypo 3.4.

I shuffled into the kitchen, my mouth tasting of dry sugar, and prepared myself the most refreshing thing I could think of. A bowl of Weet Bix, a sliced banana and lots of cold milk.

As I sat there relishing the cold, refreshing milk on my dry throat, I thought about what a great start to a Monday morning it had been.

That was hypo number three.

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.