MDIs

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.

The Day My Insulin Ran Out

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I have two rapid acting insulin pens that I use. The first one sits on my desk at home, beside my blood glucose meter and my phone. I use it with my breakfast, my dinner, my snacks that I shouldn’t be having and for any corrections inbetween. The second one normally accompanies me on my travels. If I’m going to work, it usually sits in my satchel amongst my other clutter. If I’m going out, it’s normally stashed in my jeans or jacket pocket. I use the travel pen less than the home pen, but it probably cops the bigger-than-normal insulin doses from eating out and going overboard at parties.

Every time my home pen runs out, I’ll replace it with my travel pen. And I’ll replace my travel pen with a brand new pen. I swap them so that my insulin pen will always run out at home, where I have a spare stash of insulin sitting in the fridge, rather than on my travels. I know it sounds like a confusing system, but it works for me.

Ever since I returned home from my holidays in July, I’ve only been using the one pen for both home and travel. I’ve had to remember to grab my insulin pen in the morning to take to work, rather than it just already being in my bag. I’ve had to go searching for my insulin pen in my bag or in my jeans when I get home, rather than it already just being on my desk. In all of these weeks, did it ever occur to me that I was making life harder for myself? In all of these weeks, did it ever occur to me that I could just re-employ that second pen? Nope. Or maybe I just couldn’t be bothered doing it.

Last Tuesday night, I noticed that my insulin pen was nearly empty. Too lazy to replace the cartridge then and there, I told myself I’d deal with it tomorrow morning. And I didn’t give it another thought. That was, until after I’d eaten my lunch the following day at work. I was in the locker room, ready to dial up the pen, when I noticed once again that the cartridge was almost empty. My stomach sank. I hoped that there would be enough there to cover my lunch. Even more stupidly, I primed the pen without even thinking about what I was doing. I dialled up my dose of 5 units, stuck it in and pushed. It was cut short. I had managed only 1.5 units of the 5 that I needed.

Thankfully, I’d only had a Burgen bread sandwich and a Muesli bar for lunch. I only had an hour left until knock off time at 3pm. And I live very close to work. Under any other curcumstances, I would have headed home immediately (okay, I probably should have headed home immediately). But under those circumstances, I thought I would be okay to last out the rest of the day. I hadn’t eaten anything ridiculous. And I was just over an hour away from getting my insulin.

My mind was preoccupied for much of my last hour at work. I left at 3pm on the dot, bolted through the door at home and headed straight to the fridge to grab a spare insulin cartridge. It was the first time in five years that anything like this had ever happened. And quite honestly, I was disappointed in myself.

It didn’t take me long to get that second insulin pen out of retirement and back into the workforce at Frank’s diabetes. And I know that I’ll never let it happen again.