I recently had to deal with 3 site changes, on the same day with my pump. The first time I pulled it was after eating familiar food, I watched my BG climb. I did an IM which helped for awhile, and then without eating, up it went again. I pulled it. ( I use a medtronic pump and the sure-t infusion set). The infusion set was soggy, smelled like bandaids and blood emerged from the site. I thought okay, now I know why. Moved it to another site, since I had just put it in that morning and sure-t can be moved. (That’s one plus for them.) Birthday dinner with granddaughter and family, bg going beserk again. No dinner for me. A correction dose, thinking the site has to get warmed up. Down to range in a few hours. I’m starving. It’s like 9:30 at night. Ate a mini kind bar and a spoon of peanut butter which I bolused for and then off to take a shower. Climbing bg which did not make sense. Pulled it again-----blood again. I’m thinking okay, explanation okay but really. Then I decided to just start afresh with new insulin and a new infusion set because maybe it was a chaos combo. Got in bed and shortly thereafter dexcom goes off and I’m running high. It’s midnight by this time so off goes this set and blood again. Took off the new set, got a fresh vial of insulin out, and gave myself a shot of basal. (Thank goodness I had it with me. We were out of town for the birthday party and were in the hotel.) Correction with a syringe as well. I have been off the pump for a little over a week. I must admit, I don’t miss babysitting the pump although I do miss the convenience of it. I also have more sites at my disposal and I’m not putting up with a sore site just because it is working. Getting dressed is alot easier too. My control is about the same as with a pump. My last A1C was 6.0. Previous to that I had been under 6 for 3 years. I eat mostly the Mastering Diabetes diet with a few exceptions. I feel like I know more now than before when I was on shots, but still this is a new challenge. On the pump, I always bolused for protein, with an extended bolus, but many times I went low. With shots I am factoring other things in like no exercise, food, mood, etc. before I give that second shot. It seems like plant based proteins don’t really need it as long as I’m not sitting and am moving. Thoughts please. I appreciate any suggestions from MDI ers. I may go back to the pump periodically, but for now…
This made me laugh a tiny bit, I know it’s annoying dealing with bad sites. What made me laugh was the remark about it smelling like bandaids. I’ve always thought insulin smells like bandaids. I think it’s the preservative. But also modern bandaids don’t really smell like that anymore.
Many years ago I created a thread about what insulin smells like and there were so many different opinions, it was surprising.
Thank you for replying. Any thoughts on the protein question?
Long-time MDI’er here, with emphasis on the M. I think you’re thinking about all the right things to do it successfully. I add insulin for proteins of any kind, but I think you’re right that soy and related proteins have pretty modest effect on bg, and like all proteins and fat, delayed effect.
I guess I’ve been taking a very long pump “vacation” since I’ve had T1 for close to 50 years and have never used a pump. I actually bought a used pump to try with diy looping, but found I get good enough control using just a cgm so still haven’t tried the pump.
I don’t eat ultra low carb (keto), and I don’t eat ultra low fat (MD), but try to pattern my eating after a Mediterranean diet mix of carb, protein and fat without minimizing any of them.
Anyway, long story short, if you find you need multiple injections or get repeatable highs or lows with meals when MDI, consider expanding the number of insulins you use. I am currently using four different insulins every day to match my meal profiles. Basal (Tresiba) first thing in the morning, Humalog fast acting (lunch), Novolin Regular (evening meal), and Lyumjev (corrections if and when needed).
To address your specific concern, Humalog works fine for my smaller but higher proportion of carb lunch meal. But my evening meal is substantial larger, and has a larger proportion of vegetable fiber, protein and fat. And I found I was likely to go low soon after eating my evening meal and then require a second injection when I used Humalog for my evening meal. This has been resolved by replacing the Humalog with a single injection of slower onset but longer lasting Regular.
Probably will be different for you, but the lesson is that experimentation in timing and insulin mix is needed to find what works best for you if you continue and want to fine tune MDI.
Over the last 27 years of being diabetic, I’ve probably spent about half that time doing MDI and the other on either a Tandem or Omnipod pump. They all work fine and I can maintain an A1c of 5.8-6.0 regardless. And all three take work to manage effectively. So, I’m fickle and switch between pumping and MDI pretty much every six months and just accept that whatever it takes to keep me mentally and physically healthy is a good way to go.
As to protein or fat-heavy meals on MDI - they required some post-meal vigilance. Up front I’d give the usual I:C for the carbs eaten and then each hour post meal correct as needed. I’m such a fan of Sugar Surfing that not only will I’d delay eating until my CGM is below 90 but I’ll bolus hourly if I am above 160 at any point after eating an indulgent meal. On MDI I use Novolog and Tresiba. I also use 8mm needles and find that despite what the manufacturer states - they do make for faster absorption. Bottom line, I’d let my CGM determine coverage for whatever macros I consume.
Thank you all for responding. Mremmers, I might just do what you do and switch every 6 months. We will see. Jag1, you are smart keeping all those insulins straight. How do you keep them straight? I have some regular insulin too that I thought about using for protein but I haven’t used it yet.
My pump vacations were all unscheduled and short. I can switch between CGM and pump to BGM and MDI with very little reduction in TIR, now that I have my “numbers” nailed. My last A1C was 5.0 having dropped from 5.3 over 6 months. (I believe those tests are being affected by something undiagnosed else going; they should be closer to 6)
It’s good that I can “vacation” because my last CGM failure happened last week while I was on a physical vacation, the same day that i had a schedule site change and found the insulin in the hotel fridge apparently frozen within its Filo wallet.
Fortunately, my Plan D -going to Walmart and buying Novolin over the counter -wasn’t necessary. I had filled my pump with extra insulin and had enough to get back home doing just a cannula change. After doing that I thought to shake the Frio wallet and heard the insulin sloshing around inside. With some difficulty I warmed the outside of the wallet and pried the vials of Novolog and Lantus, my MDI backup, out. The insulin wasn’t damaged; I’ve been using it since to returned. .
My previous vacation was a pump failure requiring replacement a month ago.
I use Tandem’s version of Sure-T called True Steel. I had a lot of trouble with bad sites when I first started and by trial and error, found some things that help reduce my failures and improve the likelihood of my site changes working. Having a playbook, I never worry about equipment failures or site failures, don’t get stressed. I just follow my playbook. My Plan F is to stop eating and stay hydrated.
I install my cannulas with a loop between them and the tubing detach. I twist the tube so that loop lies flat but can move freely. That takes all the strain off the cannula and needle. I use abdomen sites that are protected by the rib cage and above and high enough that my belt doesn’t push my flabby stomach enough to disturb the cannula.
I’m an active sleeper and I can roll on the floor or work over a car’s engine without disturbing the cannula. I’ve never had a bloody infusion set. I sweated one out. I experience CGM compression failures in the same sites.
I use a site map. I had to map out my extensive “dead zones”. I don’t guess, I follow that map, systematically working across the territory.
INFUSION SITE MAP.pdf (306.5 KB)
I always move to a site that I haven’t used for more than 10 days and was good the last time I used it.
I don’t declare a site dead until I can see that manual boluses aren’t working at all. That takes at least an hour. I have sites where my TDD is 25% higher than my average.
I never change sites close to a meal. I do it after a meal’s peak should be past.
I always give myself a bolus of 1 unit after insertion and do not expect to see a response for an hour.
If I’m going high or staying high, when a site change is necessary, I don’t rely on the new site to start me down. I’ll take a bolus by syringe of half the last pump bolus that wasn’t working and give it in a location that’s too inconvenient for tubed infusion.
If I need to change sites between 2 and 12 hours after insertion, before reinsertion I check the flow through the cannula needle using my pump’s fill cannula routine. (For a pump that lacks that feature, a series of 1 unit boluses can be used.). I have had clogged steel cannulas. If one is clogged, I check the flow at the detach point, take a new cannula and fill it.
If a site fails more than 12 hours after insertion, I use a new cannula with the existing tubing. I fill it before insertion.
If a site fails after 2 days, I start fresh and change everything.
My lowest A1C was 4.6, when I had chemo for cancer. They told me the chemo reduced the lifespan of RBCs, so shorter time exposed to glucose.
No more cancer (been 10 years ago), and A1Cs correspond well with xDrip estimation.
I’m glad you’re free of cancer.
As far as my A1c I’ve been using Xftip+ since before I was on a pump and it’s estimate has been study around 6.2. Well my A1c has dropped from 6.7t o 5.0 over 16 months which makes no sense at all to me .
None of my doctors seem to think it’s a problem but then again once you have type 1 diabetes let’s always the first thing that they think of and for too many that’s where they stopped thinking . Until it’s a problem that they can’t ignore. I believe it’s called anchoring bias a form of perceptual bias.
55 years MDI with maybe 6 months “vacation” on Tandem pump, including Control IQ. The latter just weren’t for me, especially the set changes which I found extremely difficult. I agree with the writer above about using multiple insulins. For me, these include Fiasp, Tresiba and Afrezza (due to scar tissue).
Don’t bolus for proteins.
@ Yeagen, I think you’re pretty brave to take the pump break. I was MDI for almost 20 years when I went on a pump. Now, a few years later, I am terrified of having to return to MDI. I can’t imagine it, though I do keep my long acting insulin and syringes ready, in case of an emergency. I don’t like feeling this vulnerable.
It is frustrating when you have a mystery high after doing a set change, And, it always happens to me late night.
Hi. I have been using MDI for 64 years. I follow the Mastering Diabetes eating plan close to 100%. My A1c is always in the 4’s but I take B12 which lowers the A1c.
I usually have 2 or 3 weeks when my diabetes is easy to manage and then I will have to make a bit of a dose change and it will take a couple of days to become smooth sailing again. Then there are days when I am under too much stress, didn’t exercise, etc etc and I will have to make some changes.
When I started with MD I figured out the carbs for several meals and dosed using that info. I can eat a lot of carbs for each unit of insulin I use. Now I usually eyeball the amount of carbs and give a shot. I have never dosed for protein.
I try to stay between 65 and 130. It is very rare for me to get over 150, but I do hit the 50’s occasionally.
Since I have never worn a pump I can’t compare the two ways to use insulin.
Best of luck to you Yeagen.
I’m not brave at all. I was just super frustrated that night. I must admit being off the pump now for two weeks has been freeing not being tethered to something all the time. I don’t think I will ever give up my Dexcom though. Who knows what I will do in the future but it is nice to have a choice. My control is about the same.
Thank you for answering. I always read all your posts. You are truly an inspiration.
Wow, I am impressed. Thank you for answering. I have a Dexcom and I lean on it alot.
Glad you are free of cancer. Thank you for answering.
Thank you for the site map. I printed it out.
You are the voice of experience. I will probably try Regular at some point,
Thank you for replying. I appreciate your input.