Monday, December 5, 2016

Taking A Break From My Insulin Pump.

I really don't know how to start this, because I have these very strongly juxtaposed feelings of "I am so over my insulin pump and all of its needs and now I'm having a blog name existential crisis" and "I am so lucky to even have an insulin pump and why am I complaining about this". So let's just start right off the bat with me saying that I recognize how #firstworldproblems it is to be tired of such an amazing, and for some inaccessible, medical device. I get it. Privilege, checked.

2005 was the last time I was on MDI (multiple daily injections), which means I continuously wore some version of an insulin pump for 11 years before taking my first pump break. There were a few things that contributed to my decision to shelve my t:slim after almost 3 years of use, and those reasons gradually began piling one on top of the other so that I eventually found myself smothered under an irritating, itchy dogpile of "UGH" that I could not help but shimmy myself out from under.

I'll also preface all of the explain-y business by saying that I made this move on my own. (Thoughts and opinions are all my own, blah blah blah, see disclosure policy.) I did attend Novo Nordisk's "Future of Diabetes" summit thing in April, and they did talk about Tresiba a bit then. At the time, I had zero interest in MDI so I think I just sort of put the conversation in my back pocket like "oh, that's nice"... but I'm glad to have had that little bit of a reference point to inform my recent choice.

I imagine all of this ::gestures grandly:: brings up a few questions, probably.

Are you still wearing your CGM, or have all robot parts banished from the land?

I am definitely still wearing my Dexcom G5. I think the safety net my CGM data provides me is why I feel so comfortable going back to MDI for a while. 

So what happened? Did something break, or...

I think just got reeeeeeeal tired of... everything? about pumping. 

The tri-weekly cartridge and infusion site changes that always seemed to need to happen at the most inopportune times, which had me like

...the too-frequent-for-me infusion site malfunctions, all of that wasted insulin (seriously... how is it that I would draw up 300 units in the syringe, fill the reservoir with those 300 units, prime 22 units through the tubing to get all of the air bubbles out... but I'd then have barely more than 240 units to start with? That's shamefully wasteful, and was never a problem with my previous insulin pumps), all of those goddamn air bubbles, the way I'd always manage to have it uncomfortably stuck under me when trying to sleep, the need to always have it in my bra if no pockets were available, how expensive insulin pump therapy is...

Like, one annoying thing would happen, and I'd say "oh, fine, it's just this one thing and I can handle that", but then something else would happen, and I'd be all, "well, nothing is perfect, I just need to deal with this", and then more things, and "okay this is pretty irritating, but what other choice do I have", until one day it just sort of dawned on me that I do have another choice. I don't have to just live with this part of my life with diabetes; I could opt out of wearing a pancreas made of metal and science on my hip. I could say that this isn't good enough for me anymore. I could eliminate a lot of this headache, even if it opens the door for other ones. I could go off the grid, as it were. It felt... liberating.

This can be my tiny act of diabetes rebellion. (My pen needles are my liberty spikes?)

What are you using now?

Three things! A few people I know and trust have been using Novo Nordisk's Tresiba and really like it. I knew Lantus didn't work all that well for me back in the day, so truthfully I don't think I would have been so "jump in with both feet" about all this if I didn't have a better long-acting insulin option. 

Additionally, I noticed that our new insurance plan has Tresiba on their formulary list, so the cost is manageable for me.

So I guess you could say I was... (sing it with me now) Tresiba REEEAADAAAAY! (Don't worry, I'm cringing at myself too.)

Secondly, I switched from Humalog to Novolog. ("Novolog REEEADAAAAY!" doesn't have quite the same ring.) This was 100% because of the aforementioned insurance plan switch - I would have had to put up a fight to stay on Humalog. I had never tried Novolog, so I thought I'd give it a go and see if the fight was worth it. So far, hasn't hasn't caused any adverse effects. 

And third, I'm using an app to keep track of everything. Part of the appeal of an insulin pump originally was that it would do a lot of the logging for me, and also remember all of the math-y things specific to that time of day, which I'm bad at doing when left to my own devices of not wearing...devices. 

I know I know; I'm sorry. Still cringing at myself.

Enter, RapidCalc ::imagines singing angels and floods of sunlight:: which came as a recommendation from an insulin pen-using friend since I had never, until last week, heard of it before. It manages a lot of the paperwork that my insulin pump was responsible for:
  • Knows what my I:C ratios, correction factors, and target BGs are for different times of day,
  • Suggests a bolus after entering a BG and carb intake (can set different ratios for different times of day),
  • Keeps an exportable to .cvs history of BGs, basal delivery, and bolus calculations, so I can email it to a healthcare provider
  • Keeps track of IOB (insulin on board) based on the settings I dictate
It also has a lock screen push notification to remind me to take my basal insulin, which is gold. Full list of features here. Seriously, I am loving this app. It's easily the most expensive app I've ever purchased, but it has been money well spent.

How's it working out so far?

I took my first Tresiba dose last week, and so far... it's been working surprisingly well. I've always needed an amount of insulin overnight that can be best described as "a truckload", so I was worried about running higher on Tresiba while sleeping, but so far... not the case. 

(Ignore the first hour of the above graph... that was a me-forgetting-to-bolus-for-a-midnight-snack thing, not a long-acting insulin thing.) I am pleasantly surprised. Even my post-breakfast spikes have been pummeled into submission. Whaaaaa?

How long will this pump break last? 

I honestly have no idea. I just know that I'm really enjoying being untethered... at least until something better comes along.