Michael Reviews Things: NovoRapid® FlexTouch®

It appears that Michael Reviews Things is one of my most successful ventures in my blogging career.  A little while back, I got a free product sent to me for review purposes. I'll get to that in the coming weeks, but for now, I want to review something else:

The NovoRapid® FlexTouch®

I've been back on insulin pens for a few months now and I'm generally pretty happy with it. I got the promo in the mail a while back and was intrigued. Not much has changed in the recent history of insulin pens, so let's see what's new.

OVERVIEW: lightweight, disposable - a sideways step in insulin pen technology.

The promotional material and main design feature seem to be most concerned with thumbs. The idea is that with most pens, like the NovoPen 4, the plunger pulls out very far and is hard work for our thumbs...?

A few precursors:
1) Who uses their thumbs to plunge?!? That is an epi-pen technique where you need the power of a strong jab, but I've always used my insulin pens like syringes: held between my thumb and middle finger, using index finger to plunge. This allows much more finesse and control, resulting in a better injection.

2) How many units are people really taking with insulin pens? The FlexTouch allows you to dose 80 units at a time, while the NovoPen4 allowed 60.... I'm a fat, insulin resistant diabetic and the largest injection I ever take is my 36 unit once-daily Lantus injection. Most people split their long acting insulin into two injections, so I am hard pressed to imagine anyone ever using the full dosage on an insulin pen!

Now, back to our poor thumbs..
To save us the hard work of thumb-plunging, the FlexTouch has a self-lancing system (I imagine all sorts of springs and levers inside...) so that your finger releases the system and it automatically injects the amount for you.
When I first injected, I was shocked at the speed with which it injected 13 units into my arm. First was the shock of, "that was fast and noisy," followed by the burning sensation from taking it all in right away (geez, buy a boy dinner first!).

One of the things I loved about the NovoPen 4 is the ability I have to control the speed of injection. I see what they were going for, but I see this as a big step backwards for the FlexTouch. I'd say that 8 units shot in quickly is manageable, but anything more should be slowed down. With the Flex touch, you can do it in little bursts, but you can't really control with any finesse. I really wonder how the FDA allowed them to make a product that could shoot out all 80 units in a matter of 3 or 4 seconds (it's really fast)! In addition to the lumps it would cause, and the pain, I can't imagine the absorption rate would be at all reliable.

For those of you thinking, 'Lay off, it's a new idea and there are bound to be some bumps to work out", shush, cause this isn't new. I remember using a similarly designed Lantus pen back when I lived in Ontario... 4 years ago. The technology hasn't really improved and the quality certainly hasn't either...

While I love technology innovations, I wasn't impressed then, and I'm not impressed now.

Before I finish, I should be objective as there are some benefits:
-The pen IS the cartridge, so you don't have to do any loading. Personally, this saves me all of 15 seconds that it takes to change and prime a new cartridge, but I can see it being helpful for children and the elderly.
-As a one-cartridge device, it's theoretically made to work for the length of one cartridge, so you don't have to worry about the eventual jamming that may happen if you have a long-term pen. (I experienced this only twice in the decade plus that I've been using insulin pens, covering tens of thousands of injections).
-Because they're not interchangeable, each pen is clearly labeled with the drug it contains. This can be incredibly helpful for those using multiple types of insulin.
-It is significantly lighter in weight than any other pen I've come across, and with the number of things a diabetic has to carry around on a daily basis, this is a big plus!

IN CONCLUSION:
I'm glad I tried it, as it reminds me that there are many different ways of managing diabetes. Bottom line - this insulin pen does not fit MY diabetes management regime. It likely will not be the ideal fit for those taking moderate-to-large doses of insulin, but could be an ideal fit for children and the elderly who lack the dexterity for a traditional insulin pen plunger. Lastly, though light-weight, it worries me that the pen feels a little cheap...

Thanks for reading. As always, these are just my opinions. I am not offering medical advice, just patient feedback.

Up next for review... my old flame, the AccuChek Aviva.

The response to the call for submissions has been great! It's not overwhelming, but it's certainly a good start.

My roommate and I went swimming tonight. Why do I ever stop swimming?!? It's one of the few physical activities that I'm good at.

With that said, I sucked tonight! Being around 2 years since I last hit the pool, I'm not surprised. I imagine we swam for about 45 minutes, ish, and I swam 1000m. I feel good, and excited to make this a regular occurrence, and I'm even planning on giving myself some direction:

Decades ago, I got my bronze medallion, so my goal is to get myself back into the swimming shape that I once was. I looked up the H2O proficiency requirements online and I'm gonna start with the Bronze Star level, then work my way up.

First goal is to swim at about a minute per lap (25m). I'll do 400m sets until I can do them reliably in 12 minutes. There's also a 100m requirement for under 3 minutes, using one lap each of: lifesaving kick, backstroke, breast stroke, and freestyle.

I'll use 2 sets of each of those as my swim workout: 100m + 400m, then a sugar break, then another 100m + 400m. That'll give me a kilometer, and by the time I can fit that into the half hour box, ish, then I'll be ready for more meters anyway!

The pool we went to tonight also has a workout swim which is about 2000m... I'm going to work towards that, because that would be fantastic to do once or twice a week.

Sugars were trending gently downwards throughout the swim, even with half a pack of lifesavers during, and a complete disconnect from the pump for an hour or so... I'm thinking I might have to have some slower acting carbs before swimming, and start a decreased bolus before starting the swim, an hour or so before....but I just hate starting exercise with higher sugars... oh well, it's experiment time!

Over the last few days, my sugars have been a wee bit all over the place. This is because I've been stressing over deadlines, and being sloppy with eating/dosing/carbcounting/etc... I told myself that today, I'd take the time to do diabetes well!

It seems like I can't remind myself to do this often enough - the main thing is dosing in advance of eating, and remembering to take my metformin near the end, if not directly after eating. Tonight, I had a 75 g carb dinner - my pre-meal BG was 5.6 and my 2 hour post-prandial was 6.1 mmol (suck it, Dr. Bernstein!).

I can, should, and will do this more often.

It feels good.

Welcome back, old friend

...or should I say, ENEMY!

I reconnected my insulin pump last night, and used it all day instead of my insulin pen.

Surprise, surprise, my sugars were between 14-17 mmol all last evening. I went to bed with my sugars still high-ish and woke up this morning at 3.2 - mmm, juice rarely tastes that delicious!

Anyway, after a day of elevated sugars, I concluded that it was a bad site and changed it a few hours ago, priming a few units into the new site AS I inserted it! In the case that my body is clogging the infusion set within moments of insertion, I'm not going to let it have the chance. I also started my basal insulin.

My sugars have been gently falling, so I'm keeping a tight eye on my sugars. I'm not sure whether that's still from the dinner insulin (3.5 hours old) or from either the priming or basal insulin from the new site. I'm hoping it's one of the last two so I can be sure that it's working. Nothing would make me happier than going to bed tonight knowing that I have a reliable infusion set going on.

For anyone wondering, I'm using the Sure-T set with the 6mm steel needle. Old school, I know, but it's quite comfy and I LOVE the short tubing!

I'm ready for a diabetes revolution! My latest A1C was 8.4, and that's simply not good enough. In fact, it's horrible. I'm doing everything I can to not feel like a horrible person - my essential laziness and apathy are putting my health at risk, and I just haven't been able to care (for longer than I'm willing to mention).

I've emotionally fought the issue of type 1 and type 2 diabetes through my formative years, being bitter that there's a similar condition out there that can often be avoided, or at least managed with healthy diet and exercise...

But look at me - I'm obese and lazy!

My TDD (total daily dose) of insulin is easily double what I should need for my weight - meaning I have hardcore insulin resistance, to the point that even if I wasn't type 1, I would have type 2 diabetes.

It's a catch 22 - the more insulin resistance you have, the harder it is to lose weight, for a bunch of reasons: 1)Insulin promotes fat. 2) The efficacy of insulin is greatly influenced by exercise (in complicated ways); it's extremely difficult to maintain stable sugars while exercising for me and I often have to use either food or insulin to correct.

It is depressing and ineffective when you have to intake more calories than you burn in order to keep your sugars stable! It's not just me, Kerri at SixUntilMe recently wrote about her struggles, and she's much fitter than I!

Long story short, I have an appointment with my endocrinologist on Monday and I'm going to broach the topic of introducing Metformin into my diabetes regime. It's a drug that is normally used for type 2 diabetes management, addressing insulin resistance rather than actually taking insulin. I'm hoping that this will help me to reduce the amount of insulin I'm taking. Also, if (as I suspect) my problems with new infusion sets is due to insulin resistance, my dreams would come true if the drugs solved that problem!

Anyway, I'd love to hear some feedback from any diabetics out there. I'll keep you posted!

Hiking and Diabetes

Yesterday, I went on my fourth hike since moving to Vancouver.

Armed with juice, snacks of varying GI values, lifesavers, and 60% of my normal basal dose, it was a well-behaved diabetes day. My sugars were higher upon waking (11.3), so I corrected and pre-dosed for my breakfast, which I ate nearly an hour later. Sugars were stable for the drive out and I started the hike at a comfy post-meal-pre-exercise level (9.0).

After half an hour, I was out of breath and out of shape, haha. Sugars were dropping and I was juicing. After this bit, a pack of lifesavers and a few handfuls of trail mixed saw me through the next 2 and a bit hours to top of the hike with sugars staying in a very happy place (4.8-6.5).

The above picture was taken from the Elfin Lakes. Calling it the 'top of the hike' is a little misleading, it's the end point, but not the top. You can actually call this hike 'uphill both ways'. The first half was about 65-35 (uphill-downhill), and the opposite when you turn back around.

I made my classic hiking mistake... "Surely my sugars won't spike from lunch because they've been evenly dropping while hiking...", but that's stupid. Lunch happens while you've stopped moving so your sugars sure do rise with the food!

[I know in normal life, I should alway dose at least 15-20 minutes before a meal, but I rarely actually do... On this hike, the difference between dosing before eating and after the sandwich would have made a huge difference.]

Starting on our way back, my sugars were 13.1, but didn't stay there long due to some corrections I planned on counteracting later. It wasn't even half an hour before I was under 10, at which point I had a granola bar and some lifesavers which kept me stable for the rest of the up. The last half of the hike was stable and good!

When we got to the car at the end, we celebrated with Apple Strudel, and then another when I realized my sugars weren't moving upward at all. It's a good thing I got my friend to drive home because I really needed those 70 carbs of strudel... 2 hours later, my sugars were still stable at 7.3!

The evening sucked - I didn't drink enough water so I was suffering from heat exhaustion. It baffled me because I didn't sweat anywhere near as much as I usually do on hikes, and I drank a good 2 litres of water. PLUS, there was no sun, whatsoever... maybe 15 minutes of sun the entire day. It was cloudy the whole time... but now that I think about it, my transition lenses were dark the whole time, meaning that there were some UV rays sneaking through! Also, I passed out early on, before I had taken my nightly Lantus... I woke up at 4am feeling not so hot, but my sugars were only at 11.4.

I am feeling great today, a little stiff, but it's all good!

Oh ya, the reason I was focusing on diabetes today was because my friend (and fellow hiker) Jim was asking about diabetes management things as they related to hiking and exercise. I answered his questions to the best of my ability, but there really aren't enough answers. Sometimes my sugars go up after exercise (like at lunch time), other times, they go down after exercise (back at the car) and I haven't been able to identify the pattern conclusively.

I've been more active this year than I have in years, and I'm getting better at managing diabetes in relation to it. The first hike and the first few Kung Fu classes were disasters where diabetes really got in the way. I've improved in as much as diabetes causes mild to moderate hiccups, and I look forward to the days that I do things regularly enough that diabetes is a natural, non-influential part of my exercising!

It seems I have squandered away the month of May without doing any of the work I needed finished. I have no real complaints, I've had a great time, but now I need to get down to business - lots of things to get finished/started in the next few weeks.

Diabetes-wise, things are pretty good. I tried to use the CGM the other week - after about 5 hours of "lost sensor" and "bad sensor" messages, I gave up. I'm pretty sure they're past the expiry date, so I'm not surprised, but the expiry dates on these things come up far too quickly! No one can afford to use these things too regularly, but you almost have to unless you want them to go bad , which they apparently actually do.

I only have one sensor left, after which I can't see myself having the funds to buy more, nor the motivation. The technology, somehow, is still infantile and unreliable. Yes, it can shed some light on trends and the intricacies of rising and falling sugars, but it takes an incredible amount of work and luck to get it working properly.

A week later...

Oopsie, I made it an entire week without posting!

Blogging goes in ebbs and flows - but even though it's been lower on my list of priorities lately, I have no intentions of stopping.

I'm loving the summer: Kung Fu, Frisbee, walking, soccer, and going for sushi have been some of the things keeping me distracted from composing lately...

My diabetes control was getting a bit out of hand for a while - when I took a step back, I realized it was because I've been taking insulin closer and closer to the first bites of meals. Now that I'm consciously aiming for 10-20 minutes before I start eating, the numbers are behaving much more nicely. It's a mixture of letting the insulin work and also double checking carb counting during that time! It's impressive/bad - how fast bad habits become routine.

Speaking of breaking the routine, I finally did something that I've avoided for a long time... I learned how to crochet. Earlier this year, my roommate tried learning to knit, but gave up in favour of crochet - which she picked up quickly and really enjoys. I am a die-hard knitter, so I mocked her and flauted the inferiority of her chosen handicraft. Nevertheless, I gave it a try.

I was a terrible student, impatiently ignoring most of her instructions, but eventually I listened to enough to get through making a granny square. After mild-to-moderate frustrations with the technique of crochet, I caught on and (within the first project) mastered the basics of double crochet.

I'm still not convinced that it's a worthwhile venture, but I'll stick with it for a while longer.

As I become more active during this beautiful weather, I am momentarily missing the insulin pump I was using this time last year.

And now the moment has passed.

Time never seems to align properly; last year, I was not very active at all, but now I am doing some kind of physical activity pretty much every day or second day. It would be great to be able to adjust my basal insulin, but that's just not going to happen!

I am going hiking on Tuesday, and since that takes up a substantial chunk of the day, I will be cutting my Lantus almost in half. Last hike, I dropped it from 36 units down to 25, this time I'm going to 20.

Today, I had to sit out of the last half hour of my Kung Fu class. After an hour, of chugging orange juice between exercises, I ran out of juice and my sugars were 4.2. It wasn't safe to continue, knowing my downward trend at the time...

I ate lunch not to long before, so I could have done with much less insulin for that meal, but then my sugars would have been higher going into the class, and I would have felt shitty.

It's a hard balance to find, but I'll keep trying!

Yesterday morning, I had a first appointment with my new Vancouver endocrinologist. The only complaint I have is that it was at 9 in the morning!

Obviously they don't know me very well. Really - first thing in the morning? hours before I normally wake up? What silly scheduling!

He was super nice and our diabetes aesthetic approaches are in line - something I've lost sight of recently:

Diabetes should be something that is incorporated into one's daily life. Considering it is something that you'll live with for the rest of your life, obsessing over it will cause more stress than it will benefit.

Over these last few years, I've been getting more and more caught up in the diabetes blogosphere which seems to be characterized by the control-obsessed minority if diabetics out there (no offense intended). I'm certainly not defending the considerable portion of the diabetic population who are ignorant of their own condition and don't put in the effort to make any improvements whatsoever, but I notice myself obsessing and it leads me - not to improvements, but apathy.

There are many routes to success in life and diabetes. At this point in the road, it's good to remind myself that the obsessive route isn't the one for me. The route of regularity is also not mine, at least not at this point in my life... I'll continue to search out my route; maybe I've already found it and just need the words to describe it. Who knows?!

I made it up and down the mountain and home again safely! The picture above was taken at the summing of Mount Gardner, on the helicopter pad.

I should have posted earlier when I was super positive about it. I'm still mostly super positive about it, but I'm getting exponentially sorer as the evening progresses. I think I'm going to down some advil and have an early night.

I had been worried about my sugars last night, but I woke up at 8.9 - a healthy enough number. I corrected and eventually had a timmy ho's breakfast sandwich to start the day off with protein. By the time we started the hike, they were down a bit and not long into the hike they were establishing that downward pattern so I started munching on the lifesavers.

Just under an hour in, I started eating a granola bar. My mouth was getting dry, I felt my sugars moving down and I was weak - I stopped and passionately told my friends that I was having serious doubts that I would be making it to the top of the mountain. I could not ask for better hiking friends. They reassured me and told me we could take as many breaks as I needed. I stopped, drank water, ate lifesavers and felt better. After a few minutes, I was happy with my sugars and we continued. A mixture of dehydration and lowering sugars does not make for a functional hiker.

Long story short, I pulled through and made it to the top, frolicked a bit, shivered because of exposed winds and impressed myself and friends at how well I did.

Diabetes: We hiked for almost 4 and a half hours. During this time, I took NO insulin and I ingested 2 packs of lifesavers, half a granola bar, and 1.5 sandwiches; about 115 carbs. My sugars never went above 6.7 or below 3.9. This, was even with the considerable decrease in Lantus, my background insulin.

Diabetes management is so much easier when you are constantly exercising vigorously. I am reminded of the summer when I worked in a factory - I barely needed any insulin aside from the background insulin.

Yet, another reason I should exercise more...

Anyway, I'm sore now, but it was well worth it. I look forward to more hiking in the new year.

NaBloPoMo

So, I've joined it.

Apparently November is a big month for things. That means I'll be blogging daily for the month...I used to do it, I'm sure I'll be able to for a month.

I got some progress done on my bassoon piece tonight, slow but sure.

Earlier today, I put in a Continuous Glucose Monitor. It's been a few weeks since going off the pump and I've very much enjoyed the freedom. With that freedom, I've become complacent, so I need to hone up on my MDI skills! Even though I won't use the pump for insulin delivery, I'll be inputting all the info through it so I can see everything nicely organized on the graphs...

Oh, wait, I can't!!!!!!!

If anyone from Minimed/Medtronic is reading : Why is CareLink not Mac-Compliant?!?

Also, while I'm complaining... BLACKBERRY, What do you have nothing worthwhile for diabetes?!? When I got my blackberry, I was told that the appsworld was new, but it would develop quickly - LIES!!!!!

I've followed some tech sites that compare the different diabetes management programs on the iPhone - there's many of them, but Blackberry, you suck at this game! And don't tell me that it's the software developers, not the company... Well, why are the developers not interested in you?!? Make them be!

It's also 4am and I need to go to sleep.

back to Old Skool

I've been using the Continuous Glucose Monitor (CGM) over the last week. I was hoping it would enlighten me as to what exactly is going on, but not so much. It just presents some of the mysteries more clearly.

I was using an expired sensor, so I shouldn't have expected perfection - it was actually more accurate than one of the sensors I used when I initially tried it- but as usual, I ended up chasing more frustrations than I was solving problems.

ALSO, not having your technology Mac /Apple compatible? NOT COOL Minimed/Medtronic - not cool! What is the point of having the CareLink stuff if I can't use it to analyze my information from this last week.

I'll have to use one of my friends' computers, but that is a terrible inconvenience for me!

I took an injection of Lantus half an hour ago. I took it in the bum (tee hee hee!), and it felt good. I haven't been able to use that area for infusion sets, because you sit on it all day; I forgot what good real-estate it was for injections. Also, the physical act of using a syringe is something I've missed - it felt good.

I can't even explain how excited I am to sleep without my pump - either figuratively or literally naked.

In other news, tonight I went to a delightful late Thanksgiving dinner with some friends from music school. It was hosted by a music theorist who has a columbian husband, so both of those demographics were well represented. It was tons of fun, great food, and good times all around.

A1C

I got my lab results back from early/mid September.

As usual, all of my levels are AOK except for the A1C.

I find an A1C of 8.4 to be very unsatisfying:

1) It's too high for all the effort I put in.

b) It's the exact same number I had last time! I don't even get the satisfaction of patting myself on the back for improving minimally, or self-loathing for getting worse.

It is probably the least satisfying because I've made a complete turnaround since starting the road trip in late August. I've only had one or two instances of my sugars shooting way up into the stratosphere when I change the site, compared to every time, before. I've cut my TDD nearly in half! I have to do the math, but I've been much less aggressive with my carb ratio, from 1 unit for 5 grams, to 1 unit for 7 or 8 grams of carbohydrate.

Nevertheless, these changes have only been in effect for a month, and that's not enough to significantly change the results of a three-month test. All I can do now is continue in this positive direction and hope for the best the next time around.

In other news, with the diabetes bloodwork, I also had some... err... other tests done - which all came back negative (phew)! Oddly enough, I've always romanticized the idea of going crazy from syphilis: how so many composers of the past died. Nevertheless, I suppose it is better to not die, regardless of how artistic the cause might be...

In the never-ending saga, I found out that by requesting my medical files from the doctor in London, I am no longer his patient, thus no longer eligible for Ontario coverage. The pharmacy in Ontario has indeed put my order through, thankfully. They will send it tomorrow and I will have my last free drugs until I am set up with B.C. Healthcare.

Let's hope they send enough to last until then!

2nd post in one night

Wow, 2 in one night - I'm awesome!

I've fallen in love with the strawberry flavoured black tea I'm drinking - it's amazing!

Diabetes over the trip has been interesting. I've needed less and less insulin - especially since getting to Vancouver. I might need to change my carb ratios, but there's just too much to think about to get things very organized.

ALSO, I need a reliable meter in order to make real changes.

[Time for a rant]

Who the fuck decided that measuring whole blood was a good thing?!? Especially without a reference chart! I'm not sure if they think you're actually supposed to treat these the same as plasma numbers, but they're not! I don't even know the brand of meter I've been using, but it's the medtronic sponsored one that communicates with my pump. When I first tested the meter, I noticed that my sugars were always about 2 mmol over ALL my other meters (3 of the 4 were super close, but not this one). I went through the customer support and they verified that my meter was working and that whole blood is usually higher than the previous type of testing. Long story short, I was told to just use the meter and trust what it said because they're results are more accurate than any other meter I've ever used.

The only time that meter has read under 7mmol this last week or 2 has been when I was sitting on my new kitchen floor right before chugging back a glass of orange juice, in a cold sweat and fumbling with the strips. My glucose at that moment was 4.4 (before juice). YA RIGHT!

The only reason I've been using the strips is because, moving across the country, I can't afford to waste the strips. I've been assuming that I should just add 2 to every number I get and that seems to work fine.

Anyway, I'm back on my favourite meter - I'm plugging it now - the LifeBrand blood glucose meter. It's super cheap (60% of the cost) and the meter is attached to the strip bottle and can be discarded after each use.

The only problem is the excessive amount of packaging that it comes in. You need utility scissors to open it up and then it's all jagged - basically it can save you the hassle of using a lancing device....

Ok, that's enough rambling. Good night!

I have been functioning on the principle that my body just needs more insulin while I'm sick, so everything else should be the same.

I tried to exercise at home yesterday, doing things pretty much the same as usual. I disconnected while getting ready, after testing and mu sugars are happy in the 6.3 region. Long story short, 10 minutes into the workout, I was feeling sloppy and weak so I tested. 2.8! Spilling the remainder of my fridges juice on my face and not into my mouth, I took refuge with a honey packet before heading downstairs to buy more juice (and oreos and diet coke).

I'm not sure if it's just because I have extra insulin going around inside me, or maybe it was because I had eaten and bolused for lunch only an hour or so before, but this was not a good situation.

I hate the fact that, while I want to exercise and get in shape, I seem to have an endless supply of excuses not to.

Excuses aside, I'm going to try again right now.

Eerily, I just tested and my sugars are 6.3 again. I'm going to disconnect AND eat an oreo or two and see how that works.

I'll post a little later this afternoon, maybe.

Doctor's Appointment

After three months of being on the insulin pump, my A1C was 8.6 - higher than it had been, but that was expected with the shitty control that starting the pump had caused.

In theory, those months are behind me. I should have a substantially lower A1C because I've been on the pump for a while and those problems should have been ironed out.

Today's A1C was 8.4. This confirmed my feelings that things haven't actually improved. With my sugars shooting up every 2 or 3 days, it's still causing the overall situation to be bad.

What does my A1C mean?

I'm 1.4 higher than the standard target for diabetes management.

That means I'm 14% more likely to have diabetes complications than they would like me to be.

That means I'm 24% more likely to lose a limb or go blind or kidney damage than a non-diabetic.

It frustrates me, because I was moving towards that target range when I was on MDI, but now insulin pumping is putting me back in the wrong direction.

Anyway, the worst part of my appointment was the fact that my endo had absolutely no knowledge of why my infusion sets might not be working for a few hours after inserting them

His only suggestion was that most of his patients only use their abdomen and they never have those problems. I explained to him that it happens in my abdomen as well, but that didn't change is suggestion.

This is unforgivable! I can understand that he might not have come across that in his own practice, but he wasn't even willing to think diagnostically about it - he just told me that I should talk to my pump educator, and that I should ONLY use my abdomen. That is a blatant contradiction to what every diabetes educator and pump information source I've ever read has said.

Passing the buck - sucks!

Infusion Site Review: Right Arm

I managed to find 5 infusion sites on my right arm which saw me through about 2 weeks.

Not completely related to diabetes... one day I became startlingly aware of how little upper body strength I have when I tried to do push-ups and failed miserably.  Since then, I've been doing them everyday before my shower, systematically increasing the number each time they seem easier.  I do them with my arms on the bathtub so they are easier because the angle is lesser (Yes, I realize that this means I'm doing girl-pushups, but I'm fine with that!).  Within a few weeks, starting at 5 pathetic ones, I can do 25, and still increasing.

I'm certainly not buff, but I'm realizing that my arms have more muscle mass in them than most other areas of my body.  Because a lot of the infusions sites hit muscle, a lot of them resulted in 'pooling' where it takes a few hours before the insulin is absorbed and works.  I only had one out of the 5 sites that did not have pooling, and that site was problematic for completely other reasons: adhesion!

The site that had no pooling and had really good absorption didn't even last 2 days.  It dislodged overnight and I woke up with ketones.  That site was on the back of my arm, close to the armpit.  I don't have problems with adhesives, so I'm thinking that this problem was because my antiperspirant was interfering - each time I applied, it would hit the plastic nub on the site.  Or, it could be due to sweat, which is also quite likely.

In general, comfort was ok.  The tubing has a way of creeping upwards, which can feel a little tickly when you have a bunch of tubing conglomerating at your armpit.  Because the tubing is so long, I have to wear an undershirt at night to keep it in place, otherwise arms and legs and other appendages might get caught in it .

In general, the arm went well.

I put in a new site last night in my right upper back.  I imagine I'll be able to get at least 6 sites out of my back, so here goes another few weeks or a month.

Life seems to be going pretty well these days.  The summer is already slipping by and surprise, surprise, I've done nothing.

I'm working, that's it.  The people at work are great and we're having lots of fun both in and out of the office.  The downside to that is that I'm spending a lot - too much money.

Part of me wants to be doing lots of great, worthwhile things this summer - reading books, listening to loads and loads of music and writing piece after piece so that I am really prepared to start a doctoral program next year.  The other, more powerful part of me, senses that after spending the last 7 of 8 years in university, I am about to embark on another 4 years - I need a little break.  I liken it to those weeks of summers growing up where there were no activities planned, your parents were working and you just had to amuse yourself - it was like recess all day long!

That's not to say that I'm completely wasting my time.  I'm still playing some piano, though the practicing has lessened.  I'm still learning the Scriabin piece as well as a Shostakovich Prelude and Fugue in B-Minor.  There are actually a lot of pianists at my office job, so it's fun to talk about piano rep and that kind of piano-nerd stuff.  

 

Diabetes control is pretty damn good.

I've been extra good about writing all the details of my infusion sets in my calendar book so that I keep a good record and can track patterns.  I've actually found more spots on my arm than I would ever have thought - half of them have had some trouble with pooling the insulin before absorption, but I am fine with using my insulin pen to avoid the BG jump.  I will use one more arm site and then I'll move to my lower back.

Things are looking up!

The weather is beautiful and downtown is bustling with people!

I picked up my personal copy of my thesis today.  It looks so professional and perfectly bound and all that.  I am very happy with it.  Oh yes, did I mention I got it bound in orange!?!? I LOVE IT!

I'm sure you noticed, but I was getting very upset with my pump and infusion sets.  I actually called the pump companies tech support line; I was at the end of my rope and if they didn't have a good solution for me, I was ready to go out and buy a bottle of Lantus right after the phone call.

I didn't get either, really, but I got a supportive dose of reality and a wonderfully friendly voice at the other end of the line. 

I had asked my nurses and doctors what the problem was with things, but they had no answers.  One nurse said she'd look into it, but I never heard back. [I'm not impressed with Ontario's Health Care, yet again.]  When I explained my symptoms to the tech support nurse, she definitively told me that I must be shooting into scar tissue.  She was patient with me and explained it over and over again until I understood and let down my stubbornness enough to accept it.

She explained: the reason the new sites don't work is because the insulin doesn't work in that area and it take a while for it to pool enough to spill over into a new area that accepts the insulin; steel needles vs canulas will not make a difference; site rotation needs to be my main concern.  She suggested a plan that will maximize the time that areas of my body will have to heal before being injected into again.  

Rather than going back and forth between left and right like I have, stick with one side of the body for a month and a half - if I can find about 15 different spots (at least 2 inches apart from each other) on each side of my body, then it will take a month and half to make it through each side, working logically like top to bottom.  By the time I go through the other side of my body, each site will have had 3 months since it was last punctured-more than enough time to heal.

Her logic was impeccable and that is the best way to appeal to me.  She pointed out that this is not an immediate solution; it will take a while to get into this and it won't cure previous scar tissue, but it will minimize the appearance of new scar tissue and work out for the best in the long run.

She said she would send me some samples, encouraging me to go back to the newer canula infusion sets.  I was overjoyed the next morning to realize that she had sent me 30 sets... that's 3 months worth!!  Now I'm in it for the long haul again.  I will stick it out for another 3 months from now and see if things are any better.

Of course, I will update as we go along!

It's been a slow week for blog-worthy news.

Switching to the steel needles has been good and bad:

The sugars have been more stable.  Changing the sites has had NO effect on sugars or absorption.  There was one site change that didn't take, but one out of twenty is not bad odds!

My stomach, however is not looking so hot.  I've been bad at remembering exactly when I last changed the site.  If I get too close to the 2 day mark, or over that, the site gets really inflamed.  Because I need to change the site so often, and I can only use my stomach due to needing 2 hands to disconnect, my stomach looks a little like a battle zone.

I ordered a different type of steel needle infusion set - I am expecting them in the mail tomorrow.  Hopefully, they will be manageable with one hand so that I can use my arms and lower back again.

I am actually starting to evaluate the insulin pump's presence in my life.  I honestly don't know how I feel about it yet. 

I HATE HATE HATE having it connected to me.  I thought that I would get used to having it at my side, but it drives me insane.  I can't even fully describe how it makes me feel; words aren't enough.  

Ok, I do know how I feel.  I hate the insulin pump and I want to rip it off of me and out of my stomach and throw it out of the window.  Fuck all these diabetics who talk about the freedom that they get from the pump.  Freedom is being able to take ONE Needle a day and know that even though your sugars won't be perfectly stable, you can survive for 24 hours without eating or bolusing.  The insulin isn't just a piece of technology that is attached to you, it is a manifestation of how diabetes takes up every waking moment of your life.

Ignorance was bliss.

Before the pump, things were going fine.  There was room for improvement, but I was doing well.  Now, this type-A diabetic personality has been introduced into my life - the people who are finiky about every moment of their day and their sugars.  I do not do well with that lifestyle, so the pump makes me aware of how delinquent I am as a diabetic.  

I've grown accustomed to the ability to lower my basal rate for exercise and other forms of strenuous activity.

Long story short, I will not switch off the pump just yet...

Why?

Spite and Money!

It was too much effort to reach this point, that I'm going to make it worth my while.

I have no coverage anymore, so I really just can't afford to go back to my old insulin.

But also, mostly spite.

In conclusion, I hate being diabetic these days.