Blog Entries With Tag: MDI


Posted: Feb 21, 2014

Most of you know, I started insulin pumping back in 2008 with an Animas 2020 after 40+ years with multiple dosage injections (MDI).  Sadly, with the problems over the years when I go on holidays with a pump – it often fails on me - and I have to use the loaner pump that all Animas owners with a warranty can take advantage of.  I also had always brought MDI back  up incase the loaner pump also crapped out on me (See NOTE1).

Cool picture of an aircraft

On a recent trip to Martinique, with my assortment of insulin products I use for my MDI adventures - I experienced a little scare when it came to doing my basal injection with Levemir (I decided to give this a go again - doing 3X shots a day every 8 hours rather than the usual Lantus 2X a day regime). 

When I went to give my 14H00 Levemir injection with the NovoPen Echo (my American readers - it's now available in the USA as of January 2014) - like always - I went to prime the needle for injection.

Nothing came out.

I primed it again with 2 units instead of the normal 1.

Nothing came out.

I then started to panic.  Yes, I did have another 1/2 unit pen needle - the Novolin-Pen Junior - which has my NovoRapid in it for my bolus injections - but my mind wasn't thinking logically of taking out the vial of Levemir and inserting it into that pen. In cramped quarters on a plane – I just really was wanting to be a Princess!

Princess Cat - that's me in a nutshell NOT

Along comes my night in shining armor - my DH - saying something he'd said before when I used to fly with my insulin pump. 

"Air pressure in the aircraft may make the plunger mechanism go wonky"

Hmmm, I then looked down in the window where you can view  the insulin cartridge in the pen - and yuppers - the piston rod had gone back up to the top - even though earlier in the AM shot (in the airport before we left at the ungodly hour of 0600) - it had been in the correct position.  The plunger had actually retreated back to it’s base!

So, I pull pen needle apart, and get the piston rod to behave the way it should.  The one thing with the "improved" NovoPen Echo - is the rod seems more flimsy than the Junior pen I've been using for about 3 years (the piston rod seems more strong).  We're thinking maybe it's due to the Echo pen having "dose memory" of how much was injected and abit of an ability to tell you how long ago it was done (it's not the most precise for time of dose). 

After that - all was fine - and on return trip 3 weeks later (sigh - good bye warm ocean breeze and dolphins) - it never occurred.  Still - it makes me wonder - does this happen that often with an insulin pump - that the plunger mechanism can rewind itself back? 

In the meantime, I’ve posted to @NovoNordiskCanada on Twitter about this glitch that happened – and I’ll keep you posted with their reply. Hopefully if all goes well - compared to how it went with obtaining a 1/2 dose pen delivery system will be easier than it was last year

NOTE1: Hmmm, this doesn't make an insulin pump sound very reliable does it - well - in my case - I sometimes think I've been jinxed - so don't worry - if you are new to pumping - just ensure you have every possible back up with you - incase something goes wrong – since without insulin – we are plain and simple - DEAD.  It's always better to be safe than sorry - and I can do it all in a carry on for a month  (I really should make a YouTube video on how I do this – it’s so easy - and trust me - I still bring more then I need even in a small space).  All the “legal drugs”  we have to tote along can take up space (what leave my sexy sandals behind?? NEVER).  Though some airlines now will allow an extra carry (e.g. tote bag that fits under seat in front of you) as long as it contains ONLY medical equipment (always check with your airline carrier first). 

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Posted: Feb 16, 2014

I wrote this back on the 13th of February (no - not a Friday ) - my 2nd day of a 3 week holiday in the French Antilles (sailing for 2 weeks - 1 week on dry land).  Have a laugh NOT - especially if you've done a similar thing - but in my case - this was my FIRST time in all my years as a T1 diabetic (I was diagnosed in 1967).  Live and learn - right?  You'll find a link to Zouk music further down - which I found I quite liked.

It’s just after 22h00 and I was all set to go to bed after my basal shot of Levemir.  I’ve done something I’ve never ever done in my life as a diabetic.  I’ve read about it in forums.  I’ve helped people through their fear of what they’ve done - many of us have stayed up late in the night to help them thru' it.  Sadly, due to where I am in Le Marin, Martinique ... I’m stuck without access to high speed Wi-Fi – so unable to get onto FB to post in the appropriate groups – to have someone help me feel more at ease as I play this waiting game. 

I'm feeling very alone right now without my DOC (diabetic online community) and D-friends nearby to talk me through my fears.

What have I done you are wondering?

I’ve just injected my rapid insulin used for meals and corrections to my blood sugar aka bolus  – but it should have been my slow insulin injection aka basal.  Crikey – panic set into me at that point very quickly.   Why it did not dawn on me at the time I did this – as the needle seemed dull (it had been used all day to inject into the I-port for my bolus shots and was bent out shape) – is beyond my comprehension.  Double crikey!!!

Alot has to do with STRESS (you will see this word ALOT in this post) - being on holidays - different routine – which seems to be a thing for me as I become older (plucking my grey nostril hairs out).  Not like when I was younger – when travel was so exciting – and I didn’t seem to worry about diabetes the way I do now.

What stresses you are all saying?  .... "You’re on holidays - we aren't - quit complaining!!!!"   Well, one of them was getting in some of the provisions for the catamaran we are chartering  with some friends over the next few weeks in the French Antilles (the shopping market was so packed, itt was like people were preparing for a tropical storm).  Of course, it was a Friday, and people preparing for “les weekend”.  STRESSSSS – did I tell you that I’m not a big lover of crowds?   In my little brain I was playing Zouk music - to stay sane with getting around the cramped store with shelves fast emptying out.

Along with getting the car back to the rental agency before noon when they close (and sometimes they close before – things you learn about places you visit).   STRESS – if only we could have had a full 3 days rental (it was a total of 140 Euros – which to most North Americans – is ALOT of money – but then taxi fare from Fort du France for 30 km distance to Le Marin – is 60-90 Euros – so win-win situation for a car rental despite the return time). So, trying to get all we had to do before it was to be returned ... STRESS.

Top it with with trying to find a restaurant in Le Marin that night which realistically in the North America wouldn’t require 2 billion days advance for a reservation -  STRESS!! Yes, life in a foreign country can be fun sometimes that often differs from what we’re used to at home – but  ....

NOT as fun as when a diabetic injects with the frigging wrong kind of insulin!!! 

STRESS!!!

Alright – it’s only 4 units of insulin that I’ve injected – for some of you it doesn’t sound like alot – but I’m very insulin sensitive.  On average – I take about 25 units a day of insulin I use (when on the pump).   With the MDI method that I’m using while on holidays – I use less insulin – and average about a total of 5 units of rapid insulin for meals/corrections – with the rest being taken care of by a basal insulin of about 12-18 units a day depending on my activity, etc.    In my case, 1 unit of rapid insulin – takes me down 3.5 mmol/l or 63 mg/dl – and my reading of my blood sugar (BG) just before I decided to go to sleep was 7.4 / 133.  Except I still have 2 units of rapid insulin on board (IOB) – due to a pizza and a few sinful cookies that had high fat (yes - a no reservations place near our boat - thumbs up to Pizz'amis Martinique!!).  So who knows what will be in store for me over the next few hours.

Yes, I am staying fully awake – and I’m composing this #dblog for posting when I get back home in 3 weeks.  I’m Fing freaked out by this error.  Have not even fathomed if I should take my Levemir shot or not (as my DH was saying before headed off to bed – with an insulin pump this would never have happened – one insulin – no mix up with injecting with the incorrect insulin).  I now finally after almost 50 years of diabetes – know what some of you – who have done the same thing – feel like.  PANIC!!!

I’ve already consumed the breakfast guava juice (it’s about 30 grams of carbohydrates) – inhaled a few Dex 4’s  – I am playing a waiting game of making sure I don’t go into la la land – but hoping I eventually can get some sleep – since we have to move our bodies out of the quaint little hotel we’ve been at here in Le Marin.  Walk down the hill to the marina in the AM – with all the foods we aren’t having delivered to the boat (yuppers – found a good deal for someone to get some of the bulky stuff in for us instead of us heave hoeing it). 

So, if I can post this on Diabetes1.org without access to Facebook – this is what I’ll be doing.  If not – you’ll be reading this later on – when I have Wi-Fi access again – that is of better speed – and nodding your heads in agreement .... Been there done that ...

I hope to never EVER do this again – and will faithfully check the pen needle BEFORE proceeding with the dart board practise on my behind with my basal insulin.

 

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Posted: Jan 4, 2014

Remember the movie with Daniel Lewis - My Left Foot? It was based on a true story about Christy Brown, who was born with cerebral palsy.  Christy could only control his left foot.  

As I started to try to figure out a title for this blog - my British sarcastic humour way of thinking brain - did what it always does - whether it's having a hypo or not ... breasts came into play - just like some of my previous blogs have done.  So I apologise to anyone who thinks I'm making fun of Christy's situation - and now I'll proceed on with the reason I'm posting this blog. 

Oh, and the nipple bit in my title is actually my i-port - which I like to play around with at times (does that make me kinky?) .  Over the past few weeks at get togethers - I've been asked about "why did you go off the pump, yadda, yadda, yadda".  For some reason, I start to feel my "nipple" and tell them the story.  I'm always educating EVERYWHERE I go - with abit of humour in it - and at the same time - telling them that without good control - diabetes is a serious condition to have - that has dire consequences if you don't take care of yourself.

I am loving my i-port - aka "nipple".  Using it for my NovoRapid shots - not worrying about injecting in an area I have already done - and have problems with healing.  This little baby solves everything (to read more about my previous trial with two i-ports - check it out here).

You can inject ONE insulin only into the port - so with my Lantus - I've been injecting the "old fashioned way" (no biggie with a 32 gauge 6mm pen needle).  I have a good fleshy area on my backside which makes for a good dart board practise.  After a few weeks of being off the pump (of course - I chose the holiday season - when there is LOTS of good healthy food around) - I thought I'd give Levemir a try again.

Dartboard with bright coloured needles

Why do a trial with Levemir?  Well, I did try it a few years ago (back in 2009) – but sadly developed an allergy to it – which caused lumps/bumps in the area injected and swelling in areas I didn't want to swell up! I had horrible BG control - it plain freaked me out with all that happened - due to being a bit of a control freak with my diabetes management. 

Fast forward to Dec 2013 – a friend of mine who decided she’d had enough of MDI (multiple dosage injecting) –went onto a pump (lucky person has 100% coverage for EVERYTHING) – oh did I mentioned that they’re in their 70’s – and they are uber techno cool? 

So, they had a box of pen needle vials of Levemir – though I did tell them – keep them incase something goes wrong with your pump.  They detested - being a human dart board for the past 20+ years was enough for them - so I took the vials – thinking maybe another diabetic who needed it could use them before they expired in 2015.  That person now happens to be me - Ms. Guinea Pig!!

Cat waving good byeI said sadly said "bye bye" to George Michael (my Animas 2020 insulin pump) mid-December for what now seems to be a ritual every year at this time for taking a pump holiday.   I started with Lantus originally – getting used to doing the X2 (every 12 hours) shots with the inbetween dart shots of NovoRapid (using the i-port)  for my meals and corrections.   Luckily, the notes I took earlier this year – unlike the previous time – where my record keeping was pretty lame  – the transition this time (who wouldn't get anxiety attacks going off their pump?) is much easier! 

Why did I decide to give Levemir a go again?  I have a T1D mate who I lovingly call the "Insulin Guru" who swears (politely) by this insulin regime of 3X a day (every 8 hours) - and they have an A1C of 4.9% (note - a lower A1C is not my goal - just having level BG's - in my happy zone is all that matters the most to me).  Because that insulin doesn’t work as long as Lantus – they feel splitting it up into 3 shots instead of the usual 2 (or in some cases – people only take their basal insulin once a day – though I wonder about their BG readings over a 24 hour period – IF they do basal testing that is).

The first few days – I was abit unsure if I was doing the right thing.  I took my total Lantus amount – and split it up into 3X – similar to Lantus – where I take more for my AM shot – less for PM shot.  So far, with my hormonal bursts (menopause / period / stress from holidays) – I’m actually not doing too badly.  My corrections with the doses to make sure I’m staying in my happy zone are working out alright.  I have tried to allow at least 3 days before I make any changes.

The one thing that I’m finding as I enter into my 2nd week experiment with Levemir – my BG’s seem to be doing less of the roller coaster ride.  Sadly, Lantus has a reputation of landing those of us who use it – into hypo fairy land – as it has a tendency to peak – and bang – you are low.  One of the reasons I had originally gone onto George Michael was because of the hypos I was having overnight and in the mornings.  Not conducive to work at all!!!  Levemir from the research I’ve done in forums as well as medical discussions with endo’s/CDE’s tends to show that this doesn’t occur with Levemir.  

Yes, you do have to be abit patient when you try any new regime that you may not be familiar with – I won’t lie to you about this.  I won’t lie to you either – that using a pump is way easier as it has the ability to do everything with one insulin – and ability to fine tune your basal requirements.  I’m finding the time to “think” about my carb count – despite the use of the InsuLinx (watch for a new blog on this soon).  I'm still writing in a log book (the meter sadly doesn’t have ability to do this).  So initially, it’s time consuming, but if it’s anything like last years 6 month holiday from the pump – it all becomes easier.  It's like tying up your shoe laces (wait – there’s Velcro for that right?).   

The other aspect of using the Levemir – is being a clock watcher (actually it’s my android that’s my savoir).  Timing of the shots – remembering to test my BG’s a few hours later – it’s getting used to this that is bugging me slightly - but I'm determined to make this work - despite getting up at the ungodly hour of 0600 to do my first Levemir shot - that's too early for this little work at home puss cat (my other shots are at 1400 / 2200 - this is the regime that works for ME that I set up for myself).

On the other side though – that’s good at least to me –

  • not being hooked up to a machine
  • no tubing (fast dressing/undressing - Whoo! Whoo! If you get my drift)
  • Wearing clothing that normally I can’t wear due to have the pump (this may change if I ever progress to a pump that has a remote – but still – depending on where you stuff the pump – it can lead to a bit of a bulge – and sorry – I have enough of those from fat deposits on me already) … I’m so vain ;)

So, how many of you use Levemir - and find taking 3 shots of it a day work for you as well?

 

*** For more discussion on the I-port - feel free to check out the forums at this link ***

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Posted: Nov 15, 2013

I just did my first Morning basal test – ever – in all my years of MDI (multiple dosage injections) and insulin pump control for my Type 1 diabetes.  I’d only ever done an Overnight basal test when I kept on experiencing hypos (low blood sugar) readings) during my beauty sleep and waking up bright eyed and bushy tailed (NOT).  Also, as a few experts point out – when trying to get a better grip on your basal regime – it’s always best to tackle the overnight one first.  THUMP!! – gold BLUE star to my forehead!

Good Little Bee by thisonlyexistsinmind.deviantart.com

Why did I perform a Morning basal test? Well, I’ve been starting to have more frequent lows a few hours after waking up – with or without a breakfast – or doing activity (remember – I’m trying to shed some weight here for heart protection).  It’s gotten to the point the last few months that my day is RULED by how my blood sugar (BG) is doing.  Often I’ll have tested prior to going out (remember – always to test your BG before hitting the open road) – and then within a few hours – I’m dropping like a brick. I used to think it was maybe due to stress of shopping (yes – most women like shopping – I detest it immensely – though if it involves hardware / auto or other manly diversions – then bring it on – I’m in).

Yesterday, when I was out getting weekly shopping done – I had to make a bee line back home before finishing off the tasks at hand.  I find this EXTREMELY annoying – and at that point – I really REALLY hate diabetes – and how it can take over our lives.  Planning to do something – takes back seat to the blood sugar fairy – and at that point – I feel like I’m ready for a straight jacket – since I don’t like feeling out of control.

Dude driving a little red car

So, the results of my basal test this morning?  My BG’s went down 1.7 mmol/l (31 mg/dl).  Not a great drop – but still – it dropped at the same time it seems to do – even after I’ve eaten a healthy breakfast – taken the correct insulin to the carbs I’m eating (that’s another test I have never done – and want to do after all the basal testing is done).  I’m learning with age (ahhh wisdom of the Old Type 1 Fart like myself) – that you never can say you’re a pro at anything (just like I can say about sailing, and other hobbies I do – I’m constantly learning new tricks of the trade).  I now know that I’m VERY insulin sensitive as I’ve gotten older (as a teen I was using up to 100 units a day of insulin – though that was after I almost snuffed myself with being out of control for a year and ending up in DKA coma – live and learn I say – and luckily for me – I survived).

Tomorrow, as suggested by Gary Scheiner from his 2nd edition book entitled  ‘Think Like a Pancreas’ – redo the basal test the next day if possible – using the reduced basal settings .  Along with the “bible” of ‘Pumping Insulin by John Walsh and Ruth Roberts‘(now in its 5th edition) – these are my CDE’s that I’ve always used to teach me how to use my insulin over the last 10 years.  With no help from my medical team in this area – I am lucky I can wing it on my own – of course – with much appreciated feedback from the D-OC (diabetes online community).  The world becomes a smaller place with all the help that you can find from other diabetic buddies around the world!

I’ll tell you – that double espresso along with toast and lemon marmalade and some cottage cheese at 12h30 never tasted soooooo good!!  Mmm, it’s now 14h12 – I’m now craving another espresso – time to go test my BG’s ...

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Posted: Jul 7, 2013
Image of high 5 cat from reallyfunnypictures.co.uk

I had attempted an overnight basal test on Friday - but that was a failure with going low (3.2/57) - but last night - with having tweaked basal rates abit was SUCCESSFUL!!  I went to bed at 6.2/112 and woke up to 5.4/97.  During the night around 5 AM I had gone to 4.2/75 - but according to Gary Scheiner's book 'Think Like a Pancreas' - he says staying within a 1.7/30 up/down range from your original starting BG (blood sugar) - I was in the good zone. 


I have to admit - I'd like to be abit higher overnight with my BG - more in the 6-7/108-126- - so will tweak basals eventually - but am so looking forward to having a solid sleep tonight - as last few nights have been very broken with getting up every hour.

I guess this would be where a Continuous Glucose Monitoring System (CGMS) would come in handy - I know of some US health centers loaning them out to patients - but when I asked my endo about whether this was possible here in Montreal - he said no.  Anyway, the good "old fashioned" way of testing with the blood meter went well.

So much more precise than the urine testing in my earlier days of diabets control as I'm sure many of you will agree on!

Curious - how often do you test your basal rates (pumper or MDI)?  I have to admit - I blog about it "how to do it" - but have never really done a full night one before until having had difficulties the past month with low BG's since starting back on the pump after my break from George Michael.

I know that due to not having a Certified Diabetic Educator (CDE) or endocrinologist (endo)  to show/tell me how to do these sort of tests - I've pretty well had to go with what I read in books that others have recommended within the DOC (diabeties online community).  I have to admit - this time I was using Gary Scheiner's book I mentioned above instead of the John Walsh book - 'Pumping Insulin'.  I actually found Gary's book abit easier to understand - he writes more from the heart with being a Type 1 diabetic (T1D) like myself - and a pumper as well.  Both books though are very good - so they have many dog earred pages!

Picture courtesy of Fiction Writers Review
                                                 Picture courtesy of Fiction Writers Review

There's a few more tests I'm going to be doing over the next few months - to get more use out of my pumps programming (e.g. I have a feeling due to my sensitivity to my insulin - that perhaps my carb ratio is set too low - there are tests in both books that talk you thru' how to perform this).  The pump as some people think doesn't mean you'll have better control of your diabetes if you DON'T use it properly.  The same applies to multiple dosage injections (MDI).  You are the brains behind these devices we use - they can only help - if you know how to use them - along with help from your health care team (provided they are up on all the latest and greatest).

I know some of you may think it's dangerous for me to be doing this on my own - but sadly - not all of us have the resources / services available to us - and this is the only route we can go.  I would LOVE to be able to have a CDE or endo that understood the fine tuning of the pump - but alas - I've not lucked in as of yet.  A few years ago my GP had referred me to an endo here in Montreal that does research in the diabetes field and works with pump patients.  Sadly, when I saw her (Dr. Natasha Garfield) - she told me that my A1C of 5.9% at the time was dangerouosly low if she was to take me on as a patient.  I had hoped due to her having a team of CDE's trained in the pump area - that I'd be able to go to them for help when I needed it.  So, I walked away with my tail inbetween my legs and carried on the way I always do.

The Cat that Walked by Himself - by Rudyard Kipling
The Cat That Walked By Himself - by Rudyard Kipling - picture courtesy of  -http://www.mainlesson.com

So, this is why I do my own thing - and again - some of you maybe in the same boat as I am.  So far though, I seem to be on the right track - despite the little roller coaster ride from time to time that we all have with this disease!
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