A little bit late, but here's today's photo. I found this when changing my infusion site. I guess this explains why it hurt to bolus...
I've had a few thoughts and things that keep coming back. In no particular order:
- We moved about a month ago. In the midst of unpacking and tidying, I've had a few lows that have fuelled house-cleaning rampages. These flurries of vacuuming, bleaching, etc are incredibly productive, if not particularly healthy.
- Hoosband was away camping with friends about 3 weeks ago. I fired up the Minimed Connect and added my mom to the list of people to be alerted by text if I went low, since Hoobs wouldn't have any cell service. Night 2 of this camping trip, I had a bad overnight low and I woke up to my dad offering me a glass of juice. I really, truly thought I was in good shape and had a handle on my overnight blood sugars. Guess it just goes to show that things are never certain when it comes to diabetes.
- My mom came grocery shopping with me on my first shopping trip after the move. When I mentioned that I needed dish soap, she pulled me aside and solemnly explained how I should go for the soap with a flip-top instead of a pull-top, as the pull-top bottles tend to get all gummed up with soap. I ended up stifling a laugh as I told her that it is a new house, yes, but this is far from my first time buying dish soap. I know what I'm doing. Sort of.
- I still haven't finished unpacking my pump supplies. I'll get to it... when the current box of infusion sets runs out.
Diabetes has been taking a backseat to the rest of Life lately. That should really change, soon.
I know I have no right to complain.
My site was on day 4, and as an upper-butt-cheek-infusion-set, it has seen quite a bit of wear over the last 4 days.
My 6-day-lifespan sensor was restarted and was on day 8.
I postponed changing my site and sensor last night. "It's wasteful to change a site when I still have a half-day of insulin left." "The infusion set doesn't even hurt that much. I'll just sleep on my other side again tonight." "That sensor worked so well for its first round! It will be fine for a few more days."
The lies we tell ourselves to justify not having to change a site. Not having to feel that jab, twice, as two devices are inserted for 3- and 6- day spans (or 5 and 10, if you tend to stretch out your supplies like I do). All of this led to me sitting at work this morning with a splitting headache and a thirst like you wouldn't believe (I'm at almost 2L of water so far. Been at work for just over 2 hours). Cal reminder alarm prompted me to check my BG and to be quite honest, I probably wouldn't have bothered if not for that alarm. My cgm had me at 8.4 and dropping, so I wasn't worried.
Still, though. I should calibrate.
Fingerstick, 18.6 (335 mg/dL).
Working on a set change with this kind of headache is challenging. I rip open an alcohol swab, then stop. Squint. Rub my aching temples. What was I doing? Oh, right. Syringe, wipe top of insulin bottle. Use now-disconnected pump to calculate the correction dose. Deliver correction.
Another alcohol swab. What was this one for? Wipe top of insulin bottle, feeling vaguely like I've already done this. Think back, pushing through the throbbing haze of red that clouds my head and makes coherent thought a distant memory. Aha! Yes, I did do this.
Do it again. Change infusion set. Charge transmitter. Replace sensor. Look at the mess of medical waste and wonder why I didn't do this yesterday.
I thought I have been doing quite well.
Sure, I've had a few more lows than usual. Sure, stress can do that. And sure, I keep having to remind myself after treating these lows that maybe it's time to slash away at my basal rates so these lows happen less often, but then I forget right up until the next 2.7 is staring me in the face.
Then this happened, and I found myself sitting in my office 2 days ago with an empty pump and a 6-day-old infusion set. That may be the norm for some, but I usually try to keep to a 3- or 4-day site rotation, so 6 is a bit much. Limiting sets to 3 or 4 days usually easy for me, since I've never made it past day 4 with any insulin left in my reservoir.
I think at this point it's safe to say that despite my best (okay, my medium-est) efforts, wedding planning has bested me. Diabetes care has fallen by the wayside. I'm still here, still bolusing for food and chowing back on glucose tablets when I'm low, but being proactive about my self-care is taking a backseat to all of the wedding stuff.
So, step 1 has been Recognizing The Need For Change. I guess step 2 is actually doing it. On that note, I will upload my cgm data to Carelink when I get home tonight. I will. Tonight.
I mean, not right away tonight. We have a meeting with the wedding DJ after work. But after that. Definitely.
I sometimes find myself negotiating with myself to downplay the gravity of my diabetes care. "Oh, I've been waking up high all week? ...Yeah, but yesterday I tidied the main floor AND vacuumed. PLUS, I emptied the garbage for the whole house this week so that Boyfriend didn't have to, because on garbage night he was out at his mom's place fixing that crack in the drywall beside the kitchen counter, so he would have been too tired to do the garbage, soo......yeah. I should get a pass on the diabetes thing. I'm obviously too busy to retest overnight basals."
"I wore an infusion set for 5.5 days last week? Yeah, BUT the DCM at work (A manager who is, I think, 5 or 6 managerial levels up above my boss) came to our office with a rush request on a Friday afternoon, so I stayed suuuuuper late on a Friday. I was crazy-efficient though! I produced everything that they needed for their meeting on Sunday!"
Or, my favourite, "I wore an infusion set for 5 days again? Well, that's 5-days-ago-Melody's fault. She shouldn't have filled the reservoir with enough insulin to last 5 days. She should've only filled it with 3 days' worth."
Sometimes I wish I knew some other actual, real-life diabetics, so I could figure out whether this is a thing we all do. I feel as though if others do it too, that makes it less bad. I'm sure there's a word for that.
Sometimes these moments of diabetes fatigue hit me out of nowhere.
Last night my pump site was itchy and sore. I'm not due to change it until tonight, so I figured I'd ride it out and just put up with the sore site for a day.
This morning I woke up late, rushed in to work without testing in the morning, and only checked when I got in to the office. I'd been going on my cgm values, which were a little high but nothing too critical.
My BG once I got to work? 18.7.
The most likely culprit is a site that's not absorbing properly any more. I know that to fix it the next thing I should do would be an injection (not a correction delivered through my pump!) and a set change.
I open the "diabetes drawer" at work, pull out my spare reservoir and Mio set... and I pause.
I just don't want to.
I'm actually finding myself contemplating getting the vial of long-acting Levemir that I keep in the fridge at work and switching back to shots for a day or two.
I know that a sore site makes me much more likely to want to take a break from pumping. A sore site is a reminder that I've got a plastic cannula below the skin, making a tiny part of my body itchy and uncomfortable.
For now I've delivered my correction and am waiting on the whole set-change-or-not issue. There is no need to decide right now.
It is uncomfortable, painful, and unfortunate, but it is not currently life-threatening. I can afford to take a minute to try to remind myself why I started pumping in the first place.
I've been having some issues with overnight lows lately.
I've been setting a 70% basal overnight for the last few weeks. Most of me knows that a 70% basal will make me wake up ok; fortunately for me I have a pretty solid network of friends who help me to fee not-so-terrible when I've had some delicious delicious wine.
My overnight basal rates have been too high for a while, and the weird thing is that it seems to take having friends over for dinner and drinks to figure out that I need to do something more permanent than a 70% overnight basal.
Bah! I don't want to have to re-jig my overnight insulin rates! Sometimes changes, whether stress levels or natural life stuff, BLOW.
I decided to try out the Silhouette instead of my usual Mio set this morning. Trying a brand-new infusion set in the morning as I'm rushing to head off to work? Baaad idea.
I watched Medtronic's youtube video about how to insert the set twice, then tried it myself. On my first attempt, I think I broke the little button on the insertion device that you push to expose the "teeth" that grab the infusion set. I pushed the button, and the whole pivoting piece sort of twisted. The pins on either side that hold it in had popped out, so it couldn't fit nicely over the infusion set.
I played with it for a few minutes and eventually managed to jam it back in to what I thought was the correct place.
I fit the set into the inserter, re-watched this part of the video again just to be sure, and chanted "insert, remove inserter, front tape, remove needle, back tape" (not a very catchy phrase, I admit) in my head as I went through the steps.
It went...okay. I squished some of the tape, so it doesn't look perfect, but overall I thought it went okay. It was not as painful as I thought it would be.
Until I sat down.
The site is in my stomach, fairly high up. I went there for visibility, and also because I was really hoping that an angled infusion set would make stomach sites more comfortable. It seemed a little sore, but mostly okay, until I sat - then OW OW OW OW OW. I'm hoping this irritation calms down a bit, because if not then I'm not sure I can make this set last three days :(.
I went whitewater rafting this weekend. I spoke to my d-team in advance so I could have a solid plan for switching to injections for a day, since my last pump vacation was a bit of a disaster. This time around wasn't perfect, but it was pretty damn good!
I disconnected from my pump and left it in a cooler in the car (along with my transmitter) after giving a bolus for half of my morning basal insulin. We decided to go with half because
a) rafting is a ton of exercise (possible lows),
b) I would be in the sun all day (again, another trigger for lows), and
c) On my last "pump vacation, " I went super low for a loooong time (so my full dose of basal insulin would probably cause -- you guessed it -- lows!)
I went low somewhere during the safety training. 2 bottles of juice and a banana for me, & then we were off to the boats! The rafting team had my emergency bag in their dry bag; Boyfriend and another close friend both had glucose gel packs in the pockets of their shorts, and I felt as prepared for the day as I could possibly be.
By lunch I was 15.7. Hardly surprising, since I gobbled down around 90g of carbs to treat the low before we left... At lunch I added together the insulin I'd need for the correction, the meal bolus, and the "missed basal" bolus, then gave 2/3 of the whole thing, and by the time we finished for the day I was back at 5.6. I think I'd call this a successful(ish) pump-free day. I've obviously got a bit of work to do to fix what happened in the morning, but I stayed safe all day and ended up with a good #, so I'm happy with it!
Of course, whitewater rafting beat the crap out of both my sensor and infusion set site. The infusion set (big bloody mess) still worked but was extremely sore afterwards, so it has been changed to a new location. The sensor was also pretty badly squished and abused throughout the day (and gave me a sensor error when I first reconnected it) but seems to be working fairly well again. The excess tape that I had to use to hold it down is making the whole thing feel like a big sticky glob of constantly damp and itchy grossn.ess on my side, but at least it's only 36 hours until I'm due for a new sensor.
CGM start day was... interesting. I got up early to do a set change before breakfast, and since it was an important day, naturally my pump kept giving me "NO DELIVERY" alarms. Every time. I don't know what caused it, but something about the set was blocking the tubing. Infusion sets are expensive, so I really wanted to try to make this one work. I tried reattaching the plunger to the reservoir and manually pushing insulin through the set -- no luck there. I swapped out the new reservoir for the old one, as it still had a few units in it -- & this time, manually pushing insulin through the set worked. I reattach the new reservoir, prime the tubing, and this time it all works just fine.
But wait! It gets better!
I got to the hospital and met with my nurse, the Medtronic nurse, and John (someone else who sees the same endo as I do), and we sat down in a conference room to start the training. My nurse showed us, using a "training" sensor and a pillow shaped like an abdomen, how to do the full sensor start.
We got the chance to use our own "training" sensors to do a practice run first, and I'm glad we did. My sensor jammed up in my serter and failed to insert. It turns out the tape got caught and was preventing it from inserting the sensor :(!
They gave me a new practice sensor, and the second time went off without a hitch, so John and I prepared to insert our first *real* sensors. I chose to put mine on my back, still above the belt line but very far from my abdomen. I know it would have been easier to do it where I could easily see what I was doing, but I also know that having something in my stomach for 6 days would drive me crazy.
I picked a spot, inserted my sensor, waited 5 seconds, and removed the serter. Voila! It was in!
Before even removing the needle, I twisted to pull the top of my skirt down a bit so I could see the sensor clearly.. aaaaand in the process, I rip out my infusion set.
& to make things even better?
HUGE BLOODY MESS.
So that was fun - being the person who's bleeding from her butt (the top of my butt....but still) while everyone waits for her to catch up. Awesome.
I took a second to remove the sensor needle and apply the overtape at this point. I also used some Skin Prep around the sensor at that time, as I need it to keep things stuck (showers tend to dislodge infusion sets when I don't use Skin Prep 🙁 ), and the Medtronic nurse told me that if I used the Skin Prep prior to inserting the sensor, the sensor would get gummed up by the Skin Prep and might not work properly. I had no idea!
She said it's not a problem to use it as long as the Skin Prep (or any other product that makes skin sticker) is applied around the sensor after it's already in the skin. It felt extremely awkward to try to wipe under the sensor-tape with a Skin Prep swab, but despite that it still seemed to work ok.
My nurse brought me a spare infusion set, so I just swapped it out for a new one. My reservoir was still working and thankfully didn't give me any more "no delivery" alarms...
Medtronic sensors need about 5 minutes for the sensor to "wet" after they're inserted into the skin, so I spent that time setting up my new infusion set. After that, It was time to attach the transmitter and tape the whole thing down.
Overall, I guess the whole thing went pretty well. A few relatively minor setbacks (a test sensor that jammed, a yanked-out infusion set...) did occur, but honestly if I'm ever going to have a sensor-insertion-experience that's filled with drama and unexpected events, it's prbably best that it happened at a hospital :P.
I've since inserted one new sensor, which went fairly smoothly. I can't say I'm comfortable with the process yet, but hopefully that part will come with time.