Crashing The Diabetes Bike

bicycle-1515716-640x480I’m about five days into my MDI adventure (Tresiba and Novolog flex pens) and well… from the title, you can guess how it’s going.

It’s a little bumpy.

It’s not Tresiba’s fault. Or Novolog’s fault.  The flex pens are amazing (once I learned how to use them!) and throwing them into my purse along with the rest of my gear is simple.

It’s having to learn how to be a person with diabetes all over again in a more “traditional” sense. Not that I was sloppy, but I would casually bolus for meals and figure if I saw a rapid rise, I could dose a teensy bit to bring it back down within range. I would guess at carb counts, figuring I could always adjust later. Adding Invokana to the mix means that my carb ratios and correction ratios are also a little off kilter.

And the math. Oh, the math. I forgot about diabetes word problems:

If Christel’s fasting blood glucose level is 164 because she bottomed out last night and the cortisol is still hanging around in her system and she wants to drink a cup of coffee with half and half now and scarf down an English muffin (double fiber!) with peanut butter before she goes running at the gym an hour later, how much should she bolus?

(If you know the answer, please let me know, because I have yet to solve it correctly.)

I’m pulling packages out of the garbage to get the carb counts. I’m eyeballing fruit. I’m eating more protein because it’s less of a headache. And yet, my CGM graph still looks ugly.

Here’s the rub: One unit of insulin means a lot to my body. It loves it these days. So much so that if I inject one unit to correct a BG outside of my comfort zone, I can send myself into a severe hypo. Which I did this weekend. Flex pens are only for one unit dosing (or two unit dosing). Yes, you can purchase cartridges for a half-dosing device, which I may look into doing next month if this continues.

The second rub: From my years of pumping, I know that my afternoons are when I need less of a basal. Crash. I will be decreasing my basal Tresiba dosage to counteract the crashing. We’ll see.

Why am I doing this?

Normally, when it’s time to eat, I reach down while glancing between my CGM and my meal and bolus. These days, I head off with my phone (mySugr is awesome if you are doing a MDI regimen. Seriously. No better way to track injections and food and times and BGs!) to check my BG by fingerstick, think about what I’m going to be eating, calculating if I still have insulin on board and how many carbs I’ll be eating. Then twist that pen, inject, and dispose of the needle in a sharps container. It’s not 30 seconds…

John asked me why I was really taking a break when we were eating dinner last night.

I think I’m doing this for a few reasons: 1) I really need a break. 2) I need to know if something does go wrong with my pump that I can handle MDI and know what my dosages should be. 3) It’s teaching me to be mindful of what I am eating and doing. It’s teaching me what it means to have diabetes again.

I may explore the amazing Dr. Steve Edleman’s “untethered regimen,” which for me would mean I would continue to take Tresiba (which I do like very much, for when I do get it right…. my BG levels are beautifully stable) and then only put the pump on to bolus. (This would allow me to do those 0.4 correction boluses that I simply can’t do right now with the flex pen.)

I’m still riding the diabetes bike. Crashing is inevitable when you’re learning to ride again.

Words of wisdom, anyone?

 

 

9 comments
  1. Hi Christel,
    This is a suggestion. Stored within our pumps is a battery of information. Insulin to carb ratios, insulin sensitivity, basal rates per hour for an entire day are just a few. Some of the pump software allows us to print the settings. If you upload into Diasend, the program for the pump will also allow you to print out the pump detail settings. Hope this helps and as always have a great day.
    Dan

    1. Thanks – I have those. It’s an issue of my sensitivity ratios.

  2. Have you thought of only using your pump (settings already included) just to calculate how much insulin to take? That’s the only thing I use mine for these days.

    1. I have, but I’m having issues with the one unit dosing.

  3. Ask Endo for a pediatric pen. They can dose in half-unit increments. I’d be in a continual hypo fog if it weren’t for that! 🙂

    1. I am going to look into that. Unfortunately, my prescription is for the flex disposable pens at this point, thus the issues!

  4. We love our Humalog pen with the half units. If you are responding so quickly to the insulin I would dial it down a half until you find your balance (that is what I do with my daughter ). Thanks for posting this, it’s nice to know we can always go away from the pump and make it work.

  5. Could you switch to syringes? You can kind of shoot between the lines with those, play around with the meniscus, etc. I used to do a lot of that. Plus, they are so glamorous!!

  6. I got Type 1 in my late 50’s (!!!) and have been using BD low dose syringes with half unit markings ever since. Most of my shots (boluses) involve a half unit. I keep my carbs pretty limited so the largest dose of Novolog I’ve ever had in the past 15 years (not counting my bedtime Lantus of 11 units) was seven units. I’ve never been embarrassed to test and have a shot anywhere in public, or been bothered about carrying around my diabetes paraphernalia. I love not being connected to a tube and a machine all the time. My CGM tracings could (should) be better, but my A1C has always been below 7 and I just don’t want to have a pump. Good luck figuring it all out.

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