When I converted over to an insulin pump roughly four years ago, little did I know that syringes would never go away.  I have written here before some of the reasons I miss my syringes and my insulin pen.  With injections there’s no unknown.  You fill the syringe, you grab some skin and inject.  When using an insulin pump there are a few unknowns and a mental checklist that you need to go through when something doesn’t seem right or your numbers are out of whack. 

[Source]

I sometimes long for the freedom of no tubing or infusion sets.  I wonder what life would really be like if i was cured.  How long would I continue to test my blood sugar after being cured out of habit or curiosity?  When I am in between infusion sets and showering it’s the best feeling.  I don’t have to worry about the infusion set getting attacked by the towels’ strands. I know I digress, so I’ll get to my point of this post.

There will always be syringes in my house for two very good reasons. 

1. They are a backup for the time when/if my insulin pump dies
2. I use them very effectively for correcting my blood sugar

Anytime my blood sugar is over 300 I will almost always use a syringe to correct it.  I have found through experience that an injection in a different area than the infusion set will bring my blood sugar down faster than a corrective bolus any day of the week and twice on Sunday.  I imagine it that when I am bolusing and infusing insulin in one area, it can tend to get pooled up before it is absorbed.  If I eat a lot of carbs, bolus and then find I am still high, I find it more effective to inject into a different site.

Another benefit of using a syringe is that you take out the unknown of a bad infusion site, pump problems, reservoir problems, bleed backs, gusher, etc.  I know that when I inject the insulin my blood sugar WILL come down.  If I enter a corrective bolus, it’s a crap shoot.  When my blood sugar is really jacked up, I might inject about 70% of the corrective dose while bolusing for the other 30%.

Maybe this is a no brainer and you haven’t even read this far into the post.  Maybe you don’t even have an insulin pump. Quite possibly you don’t even have diabetes.  But if you didn’t know, now you do. A box of 100 syringes has lasted me literally years and only set me back about a $20 co-pay.  It is so worth the money and you will always find some in my case or home.

If you pump insulin, do you correct the same way or do you rely on your pump?

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Pumping Insulin: Keep Those Syringes Close By is a post from: Blogging Diabetes

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After looking at the instructions for my Medtronic MiniMed infusion sets, I came across some things that I found quite amusing.  I hope you do too.

Warnings

"Remove the needle guard before inserting the infusion set." – Um, really?  Maybe that’s why I…. never mind. 

"The soft cannula must always be completely inserted to receive the full amount of medication." – So I can get a partial amount  [dose] if it’s not inserted?

"If the infusion site becomes inflamed, replace the new set, and use a new site until the first site has healed." – Really, so I shouldn’t stick it directly back into the site where I just had a gusher?

"For Paradigm users, do not use the infusion set if the tubing connector needle had been damaged." – Don’t they know it’s a personal challenge to unbend the needle so as to not waste the set.

"If infusing insulin, carefully monitor your blood glucose levels when disconnecting and after reconnecting." – Um, what else am I going to infuse?

On a more serious note, the very last paragraph says, "If infusing insulin, do not change the infusion set just before bedtime unless you can check your blood glucose 1-3 hours after insertion."  I would venture to say that 99 out of 100 times I will shower, change my infusion set and go to bed in that order.  It’s kind of a ritual every 3 days and always at the same time – at night.  I would also guess that many people are not following this guideline.

Medtronic, thank you for the laughs; It’s not often that you put a smile on my face, but this certainly did.

For more information from Medtronic about infusion site management, click here.

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Diabetes Humor is a post from: Blogging Diabetes

Canadian Pharmacy

For those readers that are newer to Blogging Diabetes, I will say that I’ve been on an insulin pump for about 4 years now.  The entire time I have been using a Medtronic MiniMed 715 pump.  In each infusion set package from Medtronic, there is a small round disk that clips on to the infusion site in place of the one connected to the tubing that is connected to the pump. 

When I was given a pump, no one ever explained anything in detail to me.  It was basically, insert the infusion set and prime it.  There was never any information about the mysterious disk or any complications to watch out for.  I guess it could be used when going to the beach to keep sand out, but I really don’t know for sure.  I even opened a new box of infusion sets to look at the directions to see if there was any information.  None.  Below you can see what the disk looks like.

Let’s run some rough numbers together:

Remember, I change my site religiously every 3 days and have never once gone to 4 days.  Sometimes I have had to change early, but let’s not take those occurrences into account for this example.

• 4 years x 365 days = 1460 days on a pump
• 1460 days / 3 days per infusion set = 487 infusion sets
• 1 = the number of disks I have actually tried to use

Seriously, I have only used one of these besides giving them to my cats, which makes for some good humor.  Milk top rings and infusion set disks are the best cat toys that aren’t really cat toys.  Not too long ago, Kerri wrote a post that mentioned some situations for using these disks, which were:

• Showering
• In ocean
• Intimate moments

When I have been vacationing, I have never used the disk and haven’t ever had a problem with being in the pools or hot tubs.  I have never worn the disk while in the shower.  Finally, I have never, ever……ever, put one of these disks on before or during an intimate moment(s).  Maybe I’m missing out on a new trend, tip or secret that the doctors never told me about.  Will that disk take things to a different "level"?  I’m actually a little scared to think of the possibilities I’ve been missing out on.  In all seriousness, the only reason I can think of to wear this in the bedroom is so the sheets or clothing doesn’t get stuck on it and rip the site out.

Does anyone have any solid information on the recommended or suggested use for the disks?

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Infusion Set Mystery Disk is a post from: Blogging Diabetes

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In the past I have written about insulin pump advantages and disadvantages.  I have been on a Medtronic insulin pump for about 4 years now and wouldn’t go back to shots without some serious money being involved.  All joking aside, I mind-mapped this post while enjoying some fun and sun on vacation.  There are definitely times that I wish I could be free of a pump, hence this post topic.  The third day “fun” that comes with being on an insulin pump can sometimes be a reminder about this lovely disease.  There have been emails to me from those that aren’t able to have a pump and still use injection therapy.  For them and to tell it like it really is, here are seven reasons why I could do without an insulin pump. 

Vanity – When you have a pager-looking like device connected to you 24/7 it can cause some anxiety in certain situations.  Funny aside – the scene from The Hangover where the guy breaks out the pager in Caesars was priceless.  Having the luxury of never dated while having diabetes, this hasn’t been too much of an issue.  However, if I was diagnosed young, you can bet that I may have a complex about my pump.  Ever go to the beach or pool with a pump, it’s a treat.  I even read about someone getting asked not to use a community pool due to diabetes.

Infusion Site Issues – Oh yes… the unknown, “is it my site, could I have a kink, am I getting insulin, is it absorbing” thoughts that swirl when one of those 200+ readings pop up.  Also, you have to deal with gushers [video], bleed backs, infusion sets losing stickiness and sometimes painful insertions.

Doorknobs – If you use a pump, you know exactly what I’m talking about.  For those of you that don’t, I’ll give a try at an explanation.  About 90% of the time I put my pump in my pocket.  The tubing comes out of my pocket, goes up over my waist band and to the infusion site on my abdomen or hip.  When clearing a doorway, the tubing can sometimes get caught on the doorknob and practically rip out the infusion site.  I have never actually torn out the site, but have been “woken up” a few times by a doorknob, which are usually accompanied by a few choice words.  Like it’s really the doorknobs fault…

Scar Tissue – This is an interesting one that I don’t really have a lot of experience with yet.  I can tell that a little scar tissue is forming where I typically put my sites, but it’s only been four years.  What happens when it’s 10, 20, 30 years down the road?  Am I going to be attaching my infusion sets to my neck, armpits and shoulders?  I try to rotate often and not use the exact same site, but it’s difficult to find new places.  You have to imagine a small tube being stuck into you for 2-3 days at a time.  Yes, the area heals after it’s removed, but when you go through about 120 site changes a year, it tends to add up.

Freedom – Showers, pools, hot tubs, locker rooms, gym, beach, sun bathing, rolling around in clean silky sheets, intimate moments, the list goes on and on about reasons it’s sometimes nice to remember what it was like before diabetes and the insulin pump.  I’m reminded of the freedom every three days when I take a shower and don’t have to worry about drying off and getting the towel threads stuck on my site.

Cost – It’s difficult to put a price on excellent diabetes control, but there is a price and it can be hefty.  When I got my pump a few years back, I think I paid a few thousand dollars with my insurance company footing the rest of the bill.  That’s no joke for people that are on a budget.  Not everyone has fat bank accounts with a few grand lying around.  Before pumping insulin, I was on shots for about six years.  I would venture to say that a few thousand dollars would cover the cost of my old syringes for probably 10-15 years.  Then there is the monthly/quarterly cost of infusion sets, reservoirs to load the pump, batteries and site prep supplies that can add up quickly. 

Pump Failure – In four years pump failure has only happened once and it was pretty scary.  Luckily I had [and have] a box of syringes on hand as a backup.  But let’s say I was on vacation or traveling in another country and my pump failed.  I would be eff’d.  Medtronic had a new one to me the very next day, which was about 16 hours from when I called, so it was a non issue at the time.

So that’s my list.  Did I miss any that you would like to add?  If so, drop me a comment and let me know.  Listen, I’m not going to trade my pump in just yet.  I do love it and the benefits, but it’s not all green grass on the other side.  If a nurse, educator, doctor or pump manufacturing rep doesn’t mention some of these issues, they aren’t being honest.  I’m all about honesty and telling it like it really is with diabetes.

What did I miss?

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Insulin Pumps – 7 Reasons Not to Get One is a post from: Blogging Diabetes

Canadian Pharmacy

I know I’m a little behind the news flash on this one, but I want to make sure that all my readers know about this recall.  Medtronic announced a voluntary product recall for all of the Paradigm Quick Set (mostly in U.S.) infusion sets that have a reference number of MMT-396 to MMT-399 along with a lot number starting with an 8.  I checked the 5 boxes I had on hand and every one of them are part of the recall.  Here is part of the press release from Medtronic.

"Medtronic, Inc. (NYSE:MDT) said today that it has initiated a recall of specific lots of Quick-set® infusion sets that are used with MiniMed Paradigm insulin pumps. An infusion set is a thin plastic tube used to deliver insulin from an insulin pump to a diabetes patient, and is typically replaced by the patient every three days. Affected infusion sets are reference numbers MMT-396, MMT-397, MMT-398 and MMT-399 with lot numbers starting with the number “8.” Medtronic recently discovered that approximately two percent of “Lot 8” Quick-set infusion sets (which represents approximately 60,000 infusion sets out of an estimated 3 million infusion sets currently with customers) may not work properly. The affected infusion sets may not allow the insulin pump to vent air pressure properly. This could potentially result in the device delivering too much or too little insulin and may lead to serious injury or death." (source)

Click here to access Medtronic’s web page regarding the recall with instructions on what to do.  It got a little fuzzy when I tried to figure out how to exchange my sets for new ones.  I called my supplier and they said I should be receiving something from Medtronic or getting a call back from them with further instructions.  It seems that Medtronic is pointing to the suppliers and the supplier is saying they are awaiting more instructions from Medtronic. 

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Medtronic MiniMed Paradigm Quick-Set (Infusion Sets) Recall is a post from: Blogging Diabetes

Canadian Pharmacy

In my last post, I discussed the need to code a blood glucose meter to the vial of test strips to ensure accuracy.  My question was, why did this need to be done?  Below is my e-mail to LifeScan asking this question with their response below my request.

“… My last post was in regards to test strips and the coding procedure that needs to take place. I currently use a OneTouch UltraLink meter.  The reason I am writing is because I found a large variance between when the code is correct between the strip vial and the meter versus when it’s not correct.  Furthermore, I don’t understand the need for coding especially when a wrong code can lead to significantly different results.” [Blogging Diabetes - Tony]

“In regards to your inquiry, as you are aware, if the code number on the meter does not match the code number on the vial of test strips, the test results may be false.

When the strips are manufactured, the membrane is passed through a chemical bath which coats the membrane.  This chemical coating is what causes the test strip to react to your blood sample.  Due to varying degrees of coating on the membrane which cannot be controlled and the biological variances of human blood samples, there is no established percentile difference from one code to the next.  This is why we recommend checking and changing your meter code to match your vial of test strips any time you receive a test strip vial with a different code number than what was used previously.” [LifeScan Customer Service - Jennifer]

I still don’t understand why there are some meters that do not require a code.  Did they figure out something that LifeScan has not?

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I want to sincerely thank you for your continued support and subscription. This blog is better because of you.

Why You Must Code Test Strips to Meter [LifeScan] is a post from: Blogging Diabetes

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This is a guest post submitted by Lorraine who is doing an excellent job managing her son’s (Caleb) type 1 diabetes.  I met Lorraine through twitter, which is an excellent medium to talk real-life diabetes.  From our first few conversations, I knew that she was doing a lot of things right for Caleb and keeping his A1c numbers near perfect.

I want to thank Lorraine for sharing her story and tips to help manage type 1 diabetes.  Thank you Lorraine and keep up the great work!  Caleb may be too young to understand, but someday he will thank you for all the hard work you put in to help him live a better/longer life.

* * * * *

Managing Caleb’s blood sugar, from a self-admitted neurotic mom

Background:

My son Caleb was diagnosed almost 2 and a half years ago at the age of 3 (almost 4). With so few non-D years behind him, and so many D years in front of him, I have made it my mission to bank as many years as I can with near-normal A1Cs in hopes to minimize those ugly complications when he is older. Caleb has been pumping for just over 2 years, since about 3 months after he was diagnosed. I never set out to achieve a certain A1C.  All I know is I do whatever I can to keep his blood sugars in range.  I am often unsuccessful.  But lots of the time we achieve what we want to. I have never been given any specific guidance on targets or acceptable ranges.  Caleb’s Endocrinologist has always reviewed his results and found them acceptable and not mentioned what precisely they “should” be.

Guiding Principles:

1. I check Caleb’s blood sugar about 12 times a day, including overnight.  Sometimes less, sometimes more.  I check, assess and act.  
2. Everything he eats, I weigh and measure whenever I am able.
3. I do not limit what or how much Caleb eats.  I manage it, but I do not limit it.  There are foods I prefer to stay away from, but I won’t ever tell him he can’t have something because he has diabetes.  Even at school and birthday parties, he eats what the others do.  It usually means 100 plus carbs for a snack and a few extra BG checks, but he smiles as he shoves the cupcake and other junk in his face and that makes me smile.  Everything in moderation – that goes for him and my other, non-D kids.
4. Caleb typically eats 3 meals and 2 snacks a day.  That frequency allows me to be a little aggressive on dosing when I have unknown carb counts.  If I have an uncertainty, I will check and hour and a half after a bolus and if it’s lower than I think it should be, it’s usually around snack time and I can just decrease the bolus of what he eats to mitigate that low without disruption to his schedule.  
5. Caleb seems to go through “waves”.  His insulin needs creep up, up, up….plateau, and then go down, down, down…plateau, and over and over again.  Perhaps all diabetics are like this.  I attribute the waves to growth, but who knows.  In order to keep up with the waves and still keep his sugars in range without constant corrections, I track all his dosing and stats in a spreadsheet.  I used this religiously for months.  As I have learned from it and things have become more predictable, I do not use it as much – only in periods of lots of unexplained BGs.
6. I keep a pretty close pulse on his basal rates.  If there’s a low or high 2 days in a row and I am confident that food is not an issue, I will adjust basal rates.  I know that .05 will have about a 30 point impact on his BG.  
7. Food – Pizza, Ice Cream, Chinese, Bagels, Pasta, anything fried – they all break the rules.  I have charted Caleb’s BG’s for months when he eats these foods and have been able to develop specific extended bolus’ for each.  I keep them in my spreadsheet and in my cell phone.  I continue to tweak them since things are ever-changing, but I at least have a baseline and don’t have to completely freak out when we indulge.
8. Super Bolus.  Of course there are occasions when that nasty 300 pops up.  I don’t mess around.  I find John Walsh’s Super Bolus to be very effective: bolus the calculated correction plus the amount of basal to be delivered for the next two hours.  Then turn off basal for the next two hours.  This front loads the insulin to bring the BG down fast, but prevents bottoming out since the basal is turned off.  This has been particularly useful when we are about to eat a meal that would be awkward to delay (like at a party).  But I am careful with this at nighttime – not quite as aggressive.  For Caleb, I find I need to add a little insulin for those high highs – his normal correction factor needs a turbo charge to tackle those numbers – but of course YDMV.

Those are the highlights.  I’ve been thinking about this as we go through our days to make sure I have everything covered.  I think a big thing is keeping on top of things at night, particularly since that’s about 10 or 11 hours for Caleb.  I check a minimum of two times while he sleeps, but in times of change or when he eats a challenging food, I will check more.  And if a correction is needed, I will always check 2 hours after no matter what.

* * * * *

One thing that quickly jumps out at me is the care and effort Lorraine puts in to managing Caleb’s diabetes.  She doesn’t just check and react.  There is much more planning, trending and analysis put into his diabetes management than I would expect most diabetics put in, me included.  The theme here is to not be complacent and just wing it.

If you are interested in providing a guest post, please contact me for more information.

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I want to sincerely thank you for your continued support and subscription. This blog is better because of you.

8 Tips For A Better A1c is a post from: Blogging Diabetes

Canadian Pharmacy

“Winner, winner, chicken dinner”.  I hope you all had a nice long and relaxing holiday weekend!  As promised, here is my vlog that answers the question, “What did I do for the first time after 4 years on an insulin pump”?

Thank you all for contributing and to the winner of the Amazon gift card (watch the video to see who won). 

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I want to sincerely thank you for your continued support and subscription. This blog is better because of you.

What Did I Do? [Vlog Answer] is a post from: Blogging Diabetes

Canadian Pharmacy

As we approach a nice long weekend here in the States, I wanted to pose a question to the Blogging Diabetes readers.  I’ve been on an insulin pump for almost 4 years now.  Just the other day, I had something happen for the first time ever on the pump. 

What happened?

Who knows, I might just throw an Amazon gift card at a random person who answers correctly.  I will probably post the answer mid next week.

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I want to sincerely thank you for your continued support and subscription. This blog is better because of you.

What Did I Do? [Question] is a post from: Blogging Diabetes

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About 10 years ago I started my diabetic journey taking pills to control my blood sugar.  Taking those pills only lasted a few months before my doctor determined that I was not producing enough insulin in my pancreas. I then switched to injections and went on insulin.  My doctor, who was simply a primary care doctor that I saw before going to the Joslin Clinic in Boston, told me I could eat whatever I wanted, I just needed to count the carbs and take enough insulin to cover it.

In my opinion, A big difference between a type 1 and type 2 diabetic can probably be found in the diet.  Those with type 2 diabetes typically need to control their blood sugar with diet, medication and exercise.  A type 1 diabetic doesn’t need to be as strict because they can just take more insulin.  Even now, I typically eat whatever I want with the exception of pop tarts, candy and very rich desserts.  So, you won’t see me picking up a huge bushel of cotton candy.  However, I eat pasta, pizza, some ice cream, french toast, burgers, fries, etc. without too much consideration for my non-functioning pancreas. 

I can eat basically whatever I want because the insulin lets me.  Do you think a person with type 2 diabetes would eat a whole medium pizza or that delicious dessert from the Capital Grille?  I doubt it.  Yet I can because I simply jack up my insulin to deliver the units to cover the carbs.  Is this smart?  No.

My point here is that taking insulin can give a type 1 diabetic a false sense of comfort and the feeling of normalcy (minus the injections or pump).  Eating a huge brownie covered in chocolate drizzle accompanied by a heaping scoop of ice cream along with 20 units of insulin is a bad strategy to enjoy that sense of normalcy.  I believe that a person with type 1 diabetes should follow a diet that a serious person with type 2 diabetes would.  Taking more insulin to eat whatever you want is dangerous for so many reasons.  I would bet that many people with type 1 diabetes take eating whatever they want to the extreme.  I know this is something I need to work harder on.  Being a diabetic is so much more than just counting carbs and taking insulin.  There’s a whole psychological aspect that isn’t discussed too much in the diabetic community or by the endocrinologists.

Want better blood sugar control and A1c results, cut back on the insulin, cut out the junk food and start exercising.  I’m not saying to eat lettuce for every meal, I’m just saying to seriously consider the amount of insulin you’re taking in to cover the carb intake.  Insulin should be a tool for a healthy life and not a free pass to eat whatever we want. [stepping down off the soapbox]

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I want to sincerely thank you for your continued support and subscription. This blog is better because of you.

The Dangers of Insulin is a post from: Blogging Diabetes

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