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.

Tuesday, November 1, 2016

Diabetes Awareness Month: My T1D Footprint.

November is Diabetes Awareness Month (or some variation of that moniker), and JDRF created an easy-to-use tool that helps you calculate some of your personal T1D stats. How much of a footprint has T1D made in my last 30 years of life? Here's a small sample:

You can calculate your own at

Thursday, April 7, 2016

Bear's Arrival.

Say hello to Vlasnik kiddo #2, who shall on the internet be referred to as "Bear":

A photo posted by Kim (@textingmypancreas) on

I'm a mom of two. That's... wow.

A photo posted by Kim (@textingmypancreas) on

As it turns out, I didn't get the seven more days of pregnancy that I was hoping for. I got two.

The last biophysical profile ("BPP" if you like acronyms) I received suggested that my amniotic fluid level had gone slightly north of the normal range. I found out this is not cool because that means that when your pregnancy is already technically full-term and you are dealing with crazy insulin resistance and trying to keep your blood pressure down, your delivering OB leaves you a voicemail after consulting with your high-risk one which essentially says "hey, just wondering what you thought about having a baby today" and then you frantically find childcare for your toddler, grab your bags, and go have a c-section that very night even though you weren't mentally prepared for it just yet.

Or, you know, that was my experience.

With Rabbit, we tried inducing labor. When that didn't work, we went the route of emergency c-section. I think the hours of labor prior to surgery were a large part of why that surgery was so hard for me to recover from, so I wasn't really looking to relive that scenario this time around. I knew that the result would likely be the same - this baby was measuring larger than my first had been, plus I was one more week pregnant when I delivered. I'm not a big risk-taker on matters like these, so I was totally fine with scheduling a c-section (and so were my doctors).

A photo posted by Kim (@textingmypancreas) on

The whole process was way less stressful than the first time - I guess because it wasn't an "emergency"? It helps to know how the whole thing goes down already.

As for diabetes, I opted to keep my insulin pump connected to me, rather than have an IV for insulin. I did the insulin IV option with Rabbit since we didn't know how long labor would last and I didn't want to be worrying about pump settings while having contractions - but with a scheduled surgery, I knew I'd be back "on" in a few hours and didn't want to hassle with an extra IV line. I wish I could say that I stayed totally in range throughout the whole procedure, but that's a big ol' bucket of nope. We had to administer a couple of partial doses of IV glucose as we prepped me for surgery - the last delivered a few minutes before my son was.

There have been lots of good things:
  • I didn't throw up after surgery this time! ::high fives self::
  • Bear didn't have the low blood sugar issues in the first 24 hours of life that his sister did. His BG was low right after delivery, but resolved itself within a few hours.
  • I was somehow able to stand up within 24 hours of surgery and was walking around within 48 hours, which, what, how.
  • I didn't need to take pain meds for as long after this surgery, as I did with the first. And most importantly, to me:
  • This recovery has been SO MUCH BETTER than my first. It has not taken nearly as long to be able to move around without pain, and I actually feel about 80% of the way to the "normal" I felt prior to this pregnancy, now that I'm two months out. Again, what.
I hope you'll forgive me that I'll continue to write less here. I'm not disappearing, but I am absolutely reallocating my time. Diabetes continues to challenge me, but it isn't my focus in my life right now.

You can probably guess what is.

(FYI, my diabetes turns 30 years old this month. I can't think of a better way to celebrate it than to, instead, spend that time with my kids.)  :)

Tuesday, February 9, 2016

38 Weeks.

Hi. I'm probably having a baby in 7 days.

Before the chaos of life with a newborn hits again, I wanted to note a few things that have been different about Pregnancy #2 vs. Pregnancy #1 for me:
  • First pregnancy: relentless lows. Second pregnancy: "wtf is even happening right now" highs and insulin resistance. All the time, even in the beginning. Current insulin pump infusion speed can best be described as "fire hose", but at least things have evened out significantly. My current insulin needs are very similar to what I experienced with Rabbit at the end of the third trimester; the ratios and rates are RIDICULOUS (like, you guys, my insulin-to-carb ratio during part of the day is 1:1 and that is not a typo), but they work, so do what you gotta do right?
  • First pregnancy: mild pre-eclampsia showed up during week 36, putting me on modified bedrest for the last week and a half of my pregnancy. Second pregnancy: no sign of it. I've had a few errant BP readings, but when they recheck me I've been "back in range", so maybe they should just let me sit and breathe for a second, instead of strapping the BP cuff on as soon as I sit down? I've never understood the logic of that strategy. "I know you just told me that you get short of breath with any kind of activity and I just had you walk down a couple of hallways after several minutes of hospital navigating, but let's go ahead and check your blood pressure right now and be surprised when it reads higher than normal".
  • First pregnancy: blogged a lot. Second pregnancy: mostly just Instagrammed because it's a much quicker/lazier solution for wanting to document things. :)
  • First pregnancy: my doctor offices were all over the literal map, with some appointments requiring a couple of hours of drive time to attend. Second pregnancy: every doctor is in the SAME HOSPITAL BUILDING HALLELUJAH THANK YOU JESUS. Now I just drive to the same place for everything and it's so freaking easy I could cry.
  • Speaking of locations, we also moved last November to a new house that could better accommodate our growing family. I was around 6 months pregnant and apparently still had energy and could move around like a normal human being... I hardly remember feeling that way now, but it seems to have worked out.
  • First pregnancy: delivered at 37 weeks, 4 days. Second pregnancy: still hanging on at 38 weeks, and unless the little dude has other ideas, we'll make it to 39 weeks. Fingers crossed.