2
Jul

First "pump vacation"

Last weekend I took my first "pump vacation."

It was short - very short. I had plans to go waterskiing/wakeboarding/knee skiing with Boyfriend, and since this coincided with a site change day, I figured I'd leave the pump at home for a few hours, rather than expose it to the (however slim) possibility that I'd lose it off of the side of a boat.

I think my problem was that we slept in. I had a late breakfast on Saturday, so my breakfast bolus was still in effect when I disconnected from my pump. When the time came, I figured out approximately how long I was going to be off of my pump (I figured about 4 hours), calculated my basal insulin over that time, and gave it as a bolus - then said goodbye to my pump, double-checked that my purse was loaded with juice boxes, test strips, and the Frio pack that held my Humalog pen needle, and I was off boating!

....enter low BG. I'm not sure if it was the heat (around 40 degrees with the humidity!), the stacking of my breakfast bolus + "missed basal" bolus, or the exercise from waterskiing (or trying to), but I spent the first 2 hours sucking back juice boxes just to stay above 4. The lowest I got was 3.6, but a lot of that was because I had around 8 juice boxes over that 2-hour period.

Yup -- that's 200 grams of carbs.

Looking back, I think I'm lucky it didn't end up worse than it did. I felt mostly fine throughout the day -- a little shaky at times, but overall more excited about water sports than concerned about BGs. It wasn't until later in the day that I realized just how much juice I had gone through. 

At least it helps me to realize that next time I want to take a pump vacation, there's a lot more to consider than just my "missed basal" insulin. Stuff like IOB (insulin on board, or Active Insulin), outdoor temperature, and exercise had a HUGE impact this weekend. I wish I could have anticipated that.

When bad things happen, my tendency (like that of many people with diabetes, I know) is to give myself crap for letting it happen. I'm trying to be better about focusing on how I really did try - I tried to figure out how much background insulin I needed, and I didn't think it would be so hot once I was in the water, so I hoped that the effects of the water would negate those of the heat. I really did try.

So much of the daily diabetes-things seem unpredictable and (semi)uncontrollable sometimes. I'm trying to take credit for the "good" numbers, but also trying to give myself credit for trying even when it doesn't end up going so well.

Saturday did not go well. I am lucky that it wasn't worse.

I am happy that I didn't ruin a fun day with diabetes-related "sick people stuff" that would have held up our water sports.

I am very, very happy that I had enough juice boxes around to keep my sugars from completely tanking.

On top of all of that, I can also say that I've learned something. It could have been worse, but it wasn't, and I can remember this next time I plan to take a short break from my pump.

I am feeling encouraged by the fact that I'm considering this as a learning opportunity. I certainly don't want to downplay what could have been a very serious, very dangerous situation, but I also don't want to dwell on it.

On a lighter note, I hope you had a fantastic Canada day! Cheers, folks! ­čÖé

13
Jun

Possible sitefail?

My ass hurts.

Hurts an awful lot, actually. It hurts when I stand, when I sit, when I walk. It hurts when I sleep.

I have a new infusion set on my butt, in case you're wondering.
Top left-hand side.

I started the new set last night, after dinner and before bed. Not a great idea, I know -- I can hear my CDE's voice in my head telling me to always insert a new site before a meal so that I can confirm that the site is fine. I forgot that I needed to change it last night, then I procrastinated, then before I knew it it was 11pm and time to go to bed.

I went to bed at 8.5, which is higher than I want to be, but ok since I *did* have a snack brefore bed and still had insulin on board. I figured I'd come down over the next two hours, and wake up fine.

Wake up...12.4. Argh. Bolus a correction plus insulin for breakfast, and after breakfast, still high. By this point I have a headache setting in, so I react (over-react? no...just react. I think.) with a higher temp basal and a super-sized correction bolus. As I write this, I'm on my way down (by mid-afternoon), so I'm wondering whether the high is from the new set -- maybe it isn't absorbing properly? It's probably more likely that the Insulin-On-Board from my before-bed snack caused a drop in my bg overnight, and my liver kicked in with some glucose (thank you,  liver) which brought me a little too high by the time I woke up. I'm not sure why that high has been so persistent, but the slight downward trend is looking promising.

I haven't had a site fail yet - & I certainly don't want today to be the first day that happens!

29
May

Week 1 on the pump

So...whoa. I guess I knew that it wouldn't be easy, but my first week on a pump was exhausting.  Hell, my first *day* on the pump was pretty scary.

I arrived for my pump start at 9am, and the first thing we did was to actually start me on the pump. I was so nervous/excited,  my hands were shaking a little :P. My nurse/CDE, Brenda, told me that for the first few set changes she wanted me to put the set somewhere on my abdomen -- somewhere I could see it, and also not someplace where my insulin absorption would change drastically if I exercised (like it might do in my thigh or butt). I noticed almost immediately after inserting the set that it was uncomfortable, and sure enough, it remained uncomfortable over the 3 days that I wore it (but more on my dislike for absomen sites later).

I got to eat breakfast next. Brenda and the nutrition student who was sitting in on a pump start (for credit hours, I think) left me for a bit while I chowed down, then came back about 20 minutes later to jump right back in to the pump training.

We next went theough "the checklist," which was essentially a (very repetitive) list of training items, most of which were things I already felt comfortable doing. We covered things like giving boluses, setting up carb ratios and insulin sensitivity, adjusting basal rates, etc. As far as using the pump goes I actually felt fairly confident, but I did want to spend more time learning how to make changes to basal rates & how to recognize when I need to make changes.

As we went through all of the training items, I did my 2-hour post-breakfast check (a little high), and my training went until around the 3.5-hour mark. After that they sent me home with instructions to check 2 and 4 hours after meals & twice overnight all week, and with a promise that Brenda would be calling me twice per day to discuss my numbers.

I had 2 bad lows on my first day on the pump; one after lunch and another after dinner.  Both were scary, for me, as they were 2.2 and 2.4 and came with no symptoms.I honestly think that I was just so excited/tired/hungry/stressed that everything was out of whack. I hope that's what it was, since I never get lows like that with no symptoms...

Things started to calm down over the rest of the week, although I spent a lot of the week running a little on the high side. I was up overnight, multiple times, so I spent a lot of my waking hours taking short naps in between eating & doing post-meal checks. Overall,  a pump start is definitely not an experience I'd care to repeat, but having gone through it I can say that I'm happy I put the work into fine-tuning my basal rates and carb ratios.

2 weeks in and I'm still feeling pretty good about being on a pump, so I'd say that's a good sign. There was always a small part of me that worried about the being-attached-to-a-device thing. I wondered whether having a visible sign of my diabetes clipped to my hip would start to weigh down on me and cause last year's burnout and depression to rear their ugly heads. If a pump was truly helping with my diabetes management, I know I could always turn to the wonderful doctors and medical professionals who helped me through it last time around, but quite honestly the while period was horrible and I wouldn't care to repeat it. The actual physical device has only been a minor annoyance when it comes to wearing dresses, but luckily that's it so far!

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