Just wanted to check back in. It took a while but on Thanksgiving, I finally ‘bit’ the bullet and went back on MDI. I had thought to do it earlier but the situation with Levemir no longer being available after being prescribed caused me to do further assessments as I was hoping to go on Levemir.
On Thanksgiving morning my pump was causing me problems again - 2 failed infusion sites, new insulin, new cartridge and still not bringing my bg levels down. After beginning to experience ketones my frustrations took over and I started the regime I had been planning.
Earthling, thank you SO MUCH for your graph! I used that to try and calculate how much and what type of insulin and when to inject. My overnight bolus amounts totalled around 3 units between midnight and 8 am while my day time amounts were 11 or 12 units so night time was only 1/4 daytime bolus amounts. I started with 12 units of Lantus in the morning with 4 units at night. Sadly, I spent overnight fighting off constant lows. So, I modified the amount to 13 U day and 3 U overnight - same problem. So, I went up to 14 U day and took 2 U units at midnight which was fine until 6 am when I started bottoming out again and continued into the morning (Lantus peaking). Finally, I tried just one dose of Lantus - 13 units and checked to see how long it would last. It apparently is effective for about 23 hours, so much better than it was when I first used it. I have stabilized at 14 U of Lantus and that seems to be doing the trick.
I used Earthling’s chart to determine when I needed the least amount of insulin which was between 4 and 8 am, so started the regime of 14 units at 10:00 am and then modified it to 10:30 am. My blood glucose levels do a mild drop around 6 am - which is part of my body’s normal rate and I had a basal rate for that on my pump - and then stabilize and only starts rising very gradually starting around 10.
The Lantus starts to take effect about an hour after I take it so any other rise in the morning I can address with mealtime breakfast humalog. I do find that I need more meal time or correction humalog in the afternoon after 3 or 4 pm for a few hours - and again, my pump mimicked that with my highest basal rates at that time.
I am actually still using my pump because I can use it to track IOB and what an appropriate meal time shot would be. I keep a cartridge in the pump with older insulin that is expired (and I will use water when I need to), keep it charged and then enter the carbs and the bg reading to get the predicted shot. I then tell the pump to ‘inject’ it (into the air) but I have the IOB that I can just check. I Use the Humalog Jr. pen so can dose humalog in .5 U. Using the pump as I guide I am developing an awareness of when I give the predicted amount by the pump ( my shots are .5. 1, 1.5 or 2) or if I need to ‘up’ that dose. I eat low carb so have only needed to have 3 units once so far.
So far, so good. My total daily insulin while on the pump varied from 18 to 22 units. My MDI total daily insulin runs 19 to 24 units combined and my control seems to be better. Yes, that’s right - I see the insulin working faster and doing what is expected when it is expected which was not happening with my pump due to absorption problems. Once I figured out the cause of the lows overnight I am able to manage my lows (which I consider below 85) with a few grapes, etc. I also am showing less variability so the only thing that has really changed is the delivery method as I am trying to duplicate what my pump did as closely as I can with the tools available.
Psychologically and physically, I feel better! I feel unencombered, don’t have to worry about finding a safe injection site that will absorb (much more territory available to me now), changing sites and cartridges every 1 1/2 to 2 1/2 days, and worrying if this high is a legitimate high or a technology failure high.
Sure, it was easier to bolus using the pump but I am getting used to doing the shots and they really are not that intrusive. I inject before each meal and occasionally a .5 or 1 U correction during the afternoon as needed. The biggest advantage is I feel safer without having to worry about unexplained highs and ketones and pump sites that don’t absorb and waiting the hours to find out if this is going to be another one of those times where I won’t get to sleep because my technology is not behaving, or the pump slips because the clip is loose or lying on it at night or it getting in the way while doing yoga, etc. I didn’t realize just how stressful that all was. After 12 years who would have guessed!
I have my next A1C in January so will be interested in seeing what happens there. So, thank you all for the support and I just wanted to say, I am glad I switched back although it is still only 2 weeks.
). The next ring out I plotted my bgs from my CGM, and outside the whole chart I wrote in insulin shots and food intake etc. at the time they occurred. Not sure if it can help you figure it out.
Life is weird!
