I Want An Insulin Pump…

I have really gotten comfortable with using the Freestyle Libre and now I am obsessed with Diabetes Technology. I have been reading up on everything and would really love to talk to my doctor about an insulin pump or an OmniPod (a tubeless insulin pump). I have a few reasons I would like to look into it more.

First, insulin shots hurt for me. I always hear other diabetics say “oh it doesn’t hurt, it’s just automatic, I don’t even feel it anymore” well I call bullshit on that… it does hurt. Well for me anyways. It hurts a lot. When I give myself an injection of insulin I react almost every time to the needle itself and to the insulin. I get big welts that look like mosquito bites around the injection site that spread out and are super itchy.

In talking to and showing my allergist and immunologist she diagnosed me with dermatographia and chronic hives about 6 months ago after about 3 months of torture everytime I took one of the 5 insulin shots a day I was taking. She at that time suggested a pump but was unsure how I would react to it. At the time I did not have any major reactions to adhesive just to punctures and scratches of the skin so she thought it might be something that might help.

I never did find out though because my endocrinologist said to just wait that they would not put me on a pump until I had completed at least one year of insulin therapy. I’m guessing because I was so new. It was supposed to be the same with the Libre, only it was 2 years of testing and managing blood sugar but my family doctor gave me a prescription anyways and Abbott did not ask and neither did my insurance.

Second, an insulin pump provides greater control and increased flexibility in lifestyle. In other words instead of having to go to the washroom before a meal, test my blood sugar (or mostly scan in this case), figure out how many calories I’m going to eat, calculate how much insulin in my head, prepare and give myself an injection all before I can eat and  in a 30 minute work supper break that does not give me much time to actually eat, all I would have to do is calculate the calories, input them into the pump and let it do the rest for me (from my understanding anyways). I would say that is a much better way to go.

At the moment I am not taking meal-time insulin only long acting (24 hour) insulin, however my family doctor said that if I continue to spike over 8 mmol/l after meals then the next time I see him (in one week) that I will have to start back on the short acting insulin and I have continued to spike, despite my A1C going down. So I am not looking forward to that. It means 4 times a day (each meal and at night) I will be injecting again. So really if that is the case maybe it really is time to really look into and contact my health insurance provider to see if it would be covered.

I know sometimes they will say no as well but if you can get a note from a specialist stating that it is medically necessary and not just more for convenience as in the case of the dermatographia then maybe they will consider it. I hear all the time about people lobbying their insurance providers for things that were denied and just keeping at it until they give in. I really have no idea how they do it though.

April Recap

I want to start posting doing a post each month about my goals for the following month and pick 3 goals that I would like to achieve for the coming month. I would also like to do a post as well at the end of the month of a monthly recap of 3 things that have happened in my life over the last month. I have created a category for each.

Here is a recap of what happened in April.

  1. Going back to work  – So I started off April on Short Term Disability after having my wisdom teeth removed at the end of March and getting a dry socket. I started back to work half way through April on the 15th. My return was uneventful other then the fact that I didn’t get paid for a week because someone at work didn’t get me changed from unpaid STD to paid STD after my claim was approved on time. I was supposed to get paid the extra week this past Thursday and didn’t. I called HR and they advised I would get it on my next pay on May 10th but I have rent to pay and bills coming out automatically. After talking to them they advanced me 60% of what they owed me on May 10th on Friday and I will get the other 40% on May 10th. At least we were able to pay everything on time and are not behind on anything but it still kinda sucked and required borrowing a little from my mom to make that happen. So now we have to pay her back
  2. Edward broke a tooth – So my husband somehow broke a tooth a week ago or so on a plastic bottle (like a pop bottle). No idea how really. He says he just hit it off the top of the bottle when taking a sip. He ended up going a week with a broken tooth. Luckily for him it didn’t hurt at all and no bleeding. It also didn’t end up costing much to fix surprisingly. Yay for 90% dental coverage! He ended up getting it fixed a few days ago and you can not even tell he did it. He also got a few cavities filled while they were at it.
  3.  I started taking the bus to work – Yep. I did. Nothing wrong with the car. It’s just to expensive to park downtown. I think I mentioned this in a post but to me its a big thing. I have anxiety and have panic attacks from time to time and buses have always been a place I have been very uneasy. I do not like crowds and I am also claustrophobic and when the bus is full (which thankfully it hasn’t been too bad due to the time I go to and from work) it makes me really uneasy. I have had panic attacks on the bus before and was of the main reasons I first got a car because I was so uneasy and felt trapped. For me taking the bus is a big step in overcoming all that. I have been medication free for years (well as far as my depression & anxiety, obviously I’m on insulin) and I was concerned I might not be able to handle it and was scared it might trigger bad memories but I am actually quite enjoying it really.

How about you, anything interesting happen this month?

Changing the Freestyle Libre Sensor

Today is sensor changing day. Technically it is not due to end for another 21 hours but my current sensor is coming off and the readings aren’t that great because I think the filament is maybe bent or coming out. That’s what happens when you catch it on a door frame if you are not careful

I decided I would do a video of changing it. Not so much as a how to as there are a ton of better ones out there then mine but just more of a “day in the life” kinda thing. I admit it was hard. I am really self conscious about my weight and was self conscious about making a video of myself but I did it anyways. Sorry about the quality.

Before we get started on the video here is a look at my diabetes case (if you are on the main page the custom excerpt strips the image, click the post to see images and videos):

 

Starting from the very left we have a Tegaderm then some test strips for my Libre itself in case I need to test my actual blood. Followed by a SkinTac wipe and 2 alcohol wipes. I keep those in what is technically my waste pouch area which I don’t actually use for waste, I have a old test strips bottle that works well for that

Next inside the zippered part I have 4 or 5 needles, my old glucose meter which I keep in case and some lancets for my old lancing device, next I have the lancing device as well as my Basaglar insulin pen. Bottom right is a test strip bottle from my old meter which right now has some left over unused test strips but when they are gone I will just use it for waste and above that is my Libre Reader. The case itself is the Kate Universal Supply Case  which is $24.99 CDN before taxes and shipping. I absolutely love and recommend it.

And now to the videos of me changing my sensor, since I can’t figure out how to merge them there is two videos:

I completely forgot to do another video when I activated it. We were out so I just activated it. All there is to it is pressing the on button on the reader and scanning the new sensor a message pops up asking if you would like to start a new sensor with the options yes and no (which is nice if you sometimes have the old and new one at the same time if you like to let the new one settle for 24 hours so you don’t accidentally activate it too soon), after selecting yes it asks you to scan again and then starts counting down an hour. After the hour is up you are ready to go and can start scanning

 

Insulin & Glucose Monitoring

I am such a baby sometimes. I hate pain. I hate pricking my fingers to test my blood sugar, hence the Freestyle Libre FGM (Flash Glucose Monitor) on my arm. There have been points in my journey so far with learning how to control my blood sugar levels where I have literally had panic attacks when trying to or thinking of checking my blood sugar  with my Contour Next One or giving myself an insulin injection. It’s not so bad now that I am only taking Basaglar once a day and only need to test when my blood sugar levels are changing rapidly  or don’t match how I feel and otherwise can just scan my arm.

When checking my blood sugar with my blood glucose meter instead of the FGM I found it quite painful each and every time I tested. My fingers were a mess as I imagine any diabetics who doesn’t use a FGM or CGM would be and who tests often. They were bruised and sore and sometimes when I pricked my finger and got no blood and so I would squeeze it would not only come out of the hole I just punctured but also sometimes out of old ones as well. It got so painful I would skip checking and wait until I felt really horrible before checking which is why I decided I wanted to see if Manulife would cover the Freestyle Libre and asked my doctor about it after his receptionist who uses it told me about it. Now when I have to use my old machine to test since I do it only occasionally I find I’m not as hesitant and somehow it doesn’t seem to hurt as much.

As for insulin injections I find that they really hurt almost all the time. If the needle itself doesn’t hurt going in then the insulin burns like hell when injecting it. Very rarely is it pain free. I only inject in my stomach because that was the only place they taught me to. I watched videos on my own of injecting into the outer thigh and in the back of the arms but to be honest I am not flexible enough for the back of my arms and am terrified it will hurt, which it might not since out of the 8 or 9 Libre sensors I have applied only the last one I did a few days ago hurt or bled, it did both. The other ones not one of them hurt or bled more then a tiny bit under the sensor. As far as the outer thigh I tried one leg once and thought I was going to pass out from the pain. Then again I am a bit of a wuss.

In the stomach the injections hurt most of the time but at least I am used to it hurting and know what to expect. They welt which is likely the Dermatogrphia according to the endocrinologist I was seeing and the allergy specialist. At least it didn’t end up being an allergy to the insulin like they initially feared. They also bruise often and I get large lumps. I am chubby around the waist area which I was told would lessen the pain but it doesn’t really seem to. The insulin I am on I read can burn a lot more then some of the others. It’s kind of hit or miss.

Another issue I find is I am really unsure about dosing and when to increase or decrease my insulin. My doctor started me on 50 units of Basaglar because I was on 60 of twice a day Levemir (I don’t remember how much in the morning and how much at night but together it was 60 units a day) and because of the welts which would itch something crazy so he switched me to Basaglar. After reading horror stories of it not working or major reactions to it or it burning like crazy which it can sometimes I wasn’t overly enthused but it does seem to have worked.

It worked to well at first, 50 units was too much. I think the 60 of Levemir was too much as well. I was told as a Type 2 diabetic I would require more insulin then a Type 1 typically as a Type 1 diabetic especially younger Type 1 diabetics are not insulin resistant like I am that they just don’t produce it and that I likely do but am resistant to it and therefor need more because my pancreas either doesn’t create enough or that it was not being utilized by my body correctly (or something like that). It’s all rather confusing to me.

Either way. I am still unsure of dosing. I decreased it myself as no one really told me to but I knew it was too much when I was having 3-4 or more hypo’s each day. I was going down as low as 2.4 mmol which is way too low and was frequently under 4.0 mmol. I find anything under 4.5-4.7 and I start getting symptoms of a low. Not sure if that is right or not but that is what it seems so I have decreased it down to 32 units each night before bed. I did this on my own by decreasing 2 units each night if I had 2 days in a row with more then 1 low. I just googled it to be honest. I mentioned this to my family doctor and he said 32 was fine and agreed to decrease or increase it by 2 units if I went to low to often (I didn’t count it if I did something stupid like forgetting to eat, etc). And up 2 units if I had mornings in a row that I was over 6 mmol when I woke up.

Right now I am staying mostly between 4.3 and 9.0. But I would like to try and get the 9.0 which is mainly after meals or if I snacked a bit to much down by controlling what I eat better and exercising more. I know that exercising which I admit I don’t do much of could change things more because I may be lower overall if I get more exercise throughout the day which I am by walking more.

I find it frustrating that I am not getting much support by my doctors. I don’t know if I have too many or too little people helping me honestly sometimes I think too many and to much is getting lost between them with no or little communication or if it is to little because the Endo is no longer following me since I am not pregnant and am where she wanted to get me to before getting pregnant so now she does not want to see me again until I am pregnant which is a whole other ball game and a whole other post for another day. If you are new to my blog and don’t know you can look back through some of my TTC posts. Even though there is more to it then what I have blogged since well it’s been a year and a half since my post a few days ago and the one before it.

Right now I feel overwhelmed with information I have gotten from reputable sources (I don’t look at the others I go to sites like the Mayo Clinic or the American, British or Canadian Diabetes associations and some of the other well known better sourced sites) as well as information I have gotten from support groups on facebook and blogs which I know to take with a grain of salt and to research and check with my doctor or pharmacist who is a diabetes educator and was trying to help me sort through some of my confusion this winter and last summer when I first started insulin.

I started out with NovoRapid first 3 times a day (meals) around this time last year and then they added in Novolin NPH twice a day and then they switched kinds and at one point dropped the NPH and just did the Novorapid again and then the added Levimir and said that I was controlling it enough and with the issues I was having with the welts and itchyness they said I could just do the Levemir and then at some point in the last 3 months switched that to the Basaglar.

I am happy with the Basaglar and hope that I do not have to start taking the NovoRapid again (the only one I do not have a reaction to) but I guess only time will tell. In 3 months I have to have my A1C repeated and if it’s high I will have to go back on it again. So hopefully I can figure out the eating right, the exercising, and the insulin and glucose monitoring. I would have thought after a year of insulin and 18 months of glucose monitoring I would have figured it out by now.

Insulin & A Family of Diabetics

So I completely forgot my insulin last night. I have an alarm set on my phone for 11 PM to take it but for some reason I had accidently shut it off which I sometimes I do. I usually catch it an hour or two later but I didn’t until the middle of the night so I never ended up taking it.

So needless to say I have been in the double digits most of the day today. not super high. Like mostly 9s, 10s and 11s. Missing one days not bad but if I miss more then I’m in the high teens. My highest yet since starting insulin last year was 23 and it made me feel so crappy. I was so lethargic and had to pee every 5 minutes, my head hurt and I was cranky and irritable. I get very cranky and irritable the higher my blood sugar goes. I’m glad I didn’t go to high today.

On the other hand trying to find the right dose of insulin is so frustrating. At one point I was was too high. My Endo wanted me to be in between 4.3 and 6.7 mmol. 4.3 fasting up to no higher then 6.7 1 hour after eating. But that was when I was taking mealtime insulin. Up to 5 shots a day. One injection of intermediate acting insulin in the morning and one in the evening. Then 1 injection before each meal of short acting Insulin. This was causing a lot of bad lows. I hate the feeling of a low. It absolutely terrifies me. I remember when I was a teenager like 16 or 17 we used to babysit a little girl who was 4 who was diabetic. My mom ran a daytime and her and I were educated by a diabetes educator on administering insulin, food education, how to spot lows and highs etc.

Back then it was a needle and syringe and testing urine for keystones etc. But I remember some of it. I used to babysit her on the weekends occasionally as her parents trusted me and I was careful and mature and my mom was literally the next street over. I remember her having lows. now I can appreciate as a child of 4 when she recovered how terrified she was. How she felt.

When I go low I sometimes feel it and sometimes don’t. Hence the continuous scanning of my Libre. If I feel it I get shaky and slow. I feel like I’m moving through a vat of molasses. Time stands still. I get confused and combative and hungry. So hungry. I want to eat the fridge. Not just what’s on it but the whole damn fridge.

The confusion makes me feel stupid at work. I forget my train of thought. I can’t concentrate. I have a hard time forming words and especially sentences. It happens a lot if I have a break or lunch scheduled and o get caught on a call that takes to long. And then my confusion makes the call seem longer and sometimes the customers get annoyed. What can I say “Sorry I’m having a hard time processing thoughts or understanding what your saying because I’m diabetic and my blood sugar is too low because you won’t stop asking me questions and I can’t take my break that I am now 15 minutes overdo for?” Can’t exactly say that…

That was mostly before my Freestyle Libre and I was also testing my blood sugar before and after every meal, at every snack and wake and bed time. It still happens often though even with it. But yeah, so many needles! I don’t know how many diabetics do it.

I remember sitting at the hospital with the diabetic nurse who was showing me how to use an insulin pen and I was literally terrified to stick the needle in. She jabbed herself with the demo one 2 or 3 times in the time it took me to do it once and no word of a lie… I was crying the tears were running down my face and I felt like an idiot. I hate hate hate needles. I wish I could say it’s easier now but even after a year there are times I have to really force myself to give myself an injection and I’m only doing it once a day now thanks to the new insulin I am on.

I don’t know what I’ll do if I have to go back on the mealtime insulin. A pump would be great but I don’t think Manulife covers it and the Nova Scotia government only covers it if your under 25. Which sucks. Maybe a move to another province is in order. At least I can move with my job potentially if we wanted to.

Eddie’s been a great help and support and cheerleader throughout my adjustment period. He’ll talk me into giving myself insulin when I’m ready to give up.

My parents on the other hand who have always been extremely supportive in everything I do or we do and who are both diabetic themselves have surprised me a little. My dad tells me I’m being silly and that it doesn’t hurt to give an injection. Even though he admitted it sometimes does and my mom well my mom seems to have just said fuck it all. She doesn’t check her blood sugar.

I think she does take her insulin which she actually started taking after I did but she bitches about it every step of the way. That insulin is stupid and that we should just be left alone to die in peace if we don’t feel like taking insulin or changing our habits and that the doctors push it on people who don’t need it etc. She’s really negative about it and then she gets on my case saying I shouldn’t be taking it and that I’m not trying hard enough to control it without etc. it’s kind of annoying. I worry about her and my dad he can’t remember and she doesn’t want to and me I want to do everything right but at the same time I don’t and I know I don’t. it’s so frustrating.