Multiple Daily Injections

The First Three Years on an Insulin Pump.

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Today marks three years since I first began using an insulin pump.

I can still remember just how excited I was for that initial clinic appointment. I had the feeling of somewhat ‘joining the fold’ with so many other pump users in the DOC. I also knew that I had so much riding on this, feeling as though it were my last chance to get on top of diabetes.

I initially wanted to go on a pump because I wanted better numbers. I felt like I owed it to myself to at least try it. I was also tempted by the promise of more even basal coverage. I never felt as though I could get my Lantus dose quite right.

In hindsight, I wasn’t really putting a lot of thought or effort into my (spontaneous) food and insulin dosing decisions at the time. I didn’t have a very good understanding of how insulin works. When I started on my pump, in some ways I was also learning some of what I should have learned a lot sooner.

There were a lot more variables in play when I started using a pump. Basal rates need to be configured, carbohydrate ratios need to be set, infusion sets replaced and insulin cartridges refilled. In many ways, moving to a pump was like learning diabetes all over again. I definitely lost my patience and got overwhelmed more than once.

The results didn’t come overnight. It probably took me three months to become completely comfortable pumping insulin, and at least six months to see my first sign of improvement. Three years later I never seem to stop learning new things when it comes to diabetes.

It is much, much easier to go low on a pump. Insulin needs to be adjusted or carbs consumed for something as simple as a walk around the block. I distinctly remember having to completely change the way I thought around insulin dosing during physical activity, or else I’ve found myself going low, low, low.

Pump breaks are okay. I’ve taken three lengthy breaks from memory over the past three years. Those breaks stemmed from a mixture of pump fatigue, and also from frustration when diabetes wasn’t playing along as nicely as I’d have hoped. Diabetes is extremely monotonous, and those changes to the way I managed were extremely refreshing.

The same level of management can be obtained using Multiple Daily Injections. It wasn’t until I began pumping that I truly began learning about blood sugars and insulin, and moving away from the spontaneously-eat-and-guess-the-insulin-dose. After transferring those skillsets to MDI during my pump breaks, I now know that the same level of management is possible.

My insulin pump has to work for me. My pump works for me when I know that I don’t have to constantly babysit it, or live in anticipation of something going wrong all the time. It works when I’m using manual infusion sets that don’t require insertion devices. It works when I’m using angled sets, that don’t kink so easily on my lean body. It also works because I can largely see what’s going on through the tubing and around the infusion site on my skin. If it didn’t work for me, I wouldn’t still be using it today.

I can still remember my diabetes educator stopping me in my tracks three and a half years ago and telling me that an insulin pump would not make managing diabetes any easier.

Today, a pump offers me more convenience as I go about my day. I like being able to give my insulin at the push of a button, without having to stop and lift up my shirt and pull out a needle and put it away again. I like having basal rates and profiles that can be customised around my life: such as when I want to eat, when I want to get to bed, when I have to go to work and when I want to go for a walk. I like that added level of precision.

While a pump has definitely helped me to ‘realise’ my potential, my diabetes educator was right. A pump hasn’t made diabetes any easier. It’s not a substitute for all the hard work I’ve put in to get the results. Today, I quite honestly see an insulin pump as my preference in insulin delivery.

A preference that’s definitely improved the quality of my life.

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.

To Pump, Or Not To Pump?

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A few weeks ago, I went to an insulin pump information evening. And I must say that I was quite keen on the idea after that night despite the politics of it all, which you can read about here. The promise of better control, long term health, insulin dose calculator, ease of insulin delivery and the statement that “very few people give these back to me and say that they don’t like it.”

But I’m not naive. I know that a pump is a big decision. I know that a pump is a big commitment. I don’t want to get a pump just for the sake of getting one, and then end up in no better of a situation with my diabetes management. I don’t want to get a pump with the mindset of being able to slack off and get lazy with diabetes. And it might not necessarily solve all of my problems. I’ve been talking about it at home, talking with friends in the Diabetes Online Community, and deliberating over the matter in my head for weeks.

My biggest struggle is achieving stable numbers consistently. There will be weeks where I seem to do it at ease. And then there are weeks where the numbers suffer, due to changes in my level of activity and the level of food that I eat. I seem to be adjusting my insulin doses every second day to get the balance right in the background. Lantus Adjustment Struggles are real. And they drive me crazy. There are times where my Lantus dose is more than enough, and other times where it’s just not enough. My hba1c level has been hovering around the borderline of “acceptable” for quite some time, but I’d really like to get it down further for the sake of my long term health.

In some ways, I feel that a pump could potentially offer that to me. I’ve heard nothing but good things about pumps from friends in the #DOC. But I also expect that the pump will be a big learning curve. It will be a lot of work. And I’m expecting a lot of frustrations in the beginning, at least. I’m concerned that a pump might make things more complicated. Potentially having control over more variables, such as basal insulin could do my head in. And, will a pump actually make my job as the operator of a broken pancreas easier? Or is it essentially a different way of doing the same thing?

At the moment, I do feel quite “free” with my Multiple Daily Injections. I take my insulin injections whenever I eat, and in the meantime my Lantus dose keeps me (relatively) stable for a whole 24 hours. I like the fact that if something were to happen and I couldn’t access my insulin, my blood glucose levels would be fine for a whole day.

I am a bit scared of being reliant on technology to keep me going. Relying on one, continuous source of insulin to keep me stable is scary. If that one source of insulin was suddenly cut off, or if my pump suddenly stopped working during the night, I could go into a state of diabetic ketoacidosis within hours. And I absolutely hate carrying junk in my pockets. An insulin pump would only add to that problem, as lame an excuse as it sounds!

A pump would certainly be more convenient, though. These 13 Truths About Insulin Injections would be no more. I would be able to administer my insulin at the touch of a button, rather than often waiting until the dinner table conversation has ended. The carb calculating function on the pumps look awesome. And, I wouldn’t necessarily be stuck with the pump. I could get it, learn how to use it, and then I would always have it as an option.

So, to bring this jumble of thoughts from my head to a close, I haven’t made up my mind about an insulin pump yet. I’m still thinking, I’m still researching, and I’m still talking about it.

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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.