Wednesday, December 30, 2015

Back to MDI

For the past two months I've been back on Multiple Daily Injections (MDI), and I'd like to talk about the reasons. I had finally hit the stage I never  thought I would: total device burnout. I love my pump. He's a purple Medtronic 723 named Henry. I use him in conjunction with a Dexcom G5. I never, ever in my life (until recently) thought I would voluntarily give him up. So what changed?

Henry and I just hit our 13 year anniversary. Okay, it hasn't been the same Henry the whole time, but I've still been on an insulin pump for 13 years. That's half of my life. For 13 years I never took a voluntary break. The longest I was without a pump was 3 days when I completely wrecked my pump at camp. There were two other times I went without, but they were both less than 2 days each. In 13 years I had at most 7 days away from my pump, total. Other than that I was attached almost constantly to the thing for literally half of my life. Thirteen Years. I was starting to feel a little bit tethered. 

In the months leading up to our anniversary I was looking for reasons to not just throw the stupid thing into a lake somewhere. I have variable basal rates that Lantus can't address. Tons of people would kill to have the luxury of an insulin pump. It's awesome that I don't have to stab myself with a needle every time I want to eat. I'm really bad at the carb game sometimes, and I don't have to inject myself again when I guess wrong. My blood sugar likes to play by its own rules most of the time, and I don't have to inject myself yet again when my numbers are doing their own thing. 

All of the above were swirling around in my head, and then I had a thought occur to me (and it sounded suspiciously like my mother). "Nobody is saying you can never go back." I started to weigh the options in front of me. What did I stand to gain by going back to MDI? My skin, for one. My hips and stomach look like a battlefield. For another, I wouldn't have something logging my every carb and unit. My endo would only know if I recorded it for her, and nobody ever said I had to. The biggest thing was my physical freedom. For 13 years I've picked out my bottoms carefully to make sure they could hold the weight of my pump. If I didn't have a pump, that wouldn't be a problem. 

I called my endo to see about getting some pens. I had worked out my Lantus dose a few months prior when I destroyed my pump at camp. I knew I wanted to use pens because I was given a pen of Humalog and one of Lantus when I messed up my pump at camp because they had a few laying around. My endo was super confused as to why on earth I would ever want to give up my pump. My A1Cs were pretty good (6.4) with the pump, so there was really no reason to change. I listed my reasons. After a little back and forth, she agreed that it was ultimately my choice, and she wrote a 90 day prescription for pens and pen needles. 

Almost 2 months in, and I'd forgotten how much I hated MDI. This is hilarious to anyone who knows how hard I resisted getting a pump in the first place, but I think that's a different story for a different time. As I said before, I'm not always the best at the carb game and frequently have to correct a few hours after a meal. It's not my insulin:carb ratio being wrong; it's just me (sometimes) being really bad at counting carbs coupled with me being quite insulin resistant. 

Speaking of being insulin resistant, my Lantus dose is pretty huge. It's 60 units huge. No matter where I inject or how long I hold the needle in my skin after injection, some always comes back out. The amount that comes back out varies, and I don't know how much this is messing me up throughout the next day.

As it turns out, not logging everything can have its downsides. Like forgetting if I actually took a correction dose, and if I did, when I did it. There's some guessing that can be done, but sometimes I just can't be sure I actually took a correction or not. My memory is pretty bad. 

The people around me aren't fond of watching me stick a needle into myself. This isn't a huge deal for me, because my health comes above their comfort, in my opinion. I'm not a total asshole though, so it does weigh on me. For what it's worth, I don't care at all what strangers think of my injections. I really, really don't. 

I'm fairly insulin resistant and carb sensitive, so I end up injecting frequently. I mean, I have to take insulin for carrots. There are very few foods that won't mess with my numbers. The sheer volume of injections is annoying. 

I'd forgotten about the bruising that can accompany injections. Now my skin isn't dotted with old infusion sites. Instead it's mottled with bruises from many shots. Even in the beginning when I was a good girl and changed my pen tip with every injection, I still got the bruises. 

I'm not a wasteful person at all. I reuse just about everything I can, and try to not waste anything if I can avoid it. This adds annoyance when I get down to the end of a pen. Let's say I have to inject 15 units for dinner, but I only have 10 left in the pen. Do I waste the 10, or inject 10 and then another 5 from another pen? It's frustrating, but I can't stand to waste, so I will usually inject 10 plus 5. 

Remember earlier when I mentioned my variable basal rates? Yeah, that really has come into play. Because I'm still wearing the Dexcom, I can see exactly what happens when I try to use Lantus for my basal. I'll go to bed around 120, then dip down to around 70/75 around 3 AM, and be up to 250 by 9 AM. Then I'll spend a good chunk of my day trying to get my numbers back to where I'm used to seeing them- under 130 most of the time. This is the biggest reason I want to go back to my pump. It's not the number of injections I have to take, it's not the bruises, it's not the inconvenience. It's the fact that  I can't manage my basal needs with Lantus, and then it takes me hours to get back to a reasonable level. Because of this, Dexcom is now estimating my A1C to be 7.1, up from 6.4. 

All in all, I'm not okay with the way my care has suffered since switching back to MDI. I'm frustrated with the higher numbers I'm experiencing and I'm probably going to be back on my pump by New Year. 

1 comment:

  1. It's good to have options. Be grateful for them.

    As for the 60u Lantus dose, why not split it into three 20u injections at varying sites? It may not seem ideal for a number of obvious reasons, but it just might work better than what you've got now.