Tagged: tresiba

Experiments with Diabetes

ExperimentsNo one would ever call me flighty or fickle when it comes to diabetes. I’m not often an early adopter (notable exceptions: Tresiba and Invokana.). I like what I like, even when it may not be in fashion. But I do like diabetes experiments.

While I have met people with diabetes who began insulin pump therapy in the 1980s, I didn’t get on that bandwagon until 1999 – and even then, I didn’t choose the most popular pump on the market. I’ve had three relationships with insulin pump manufacturers in seventeen years: Disetronic (RIP), Medtronic, and Asante (RIP)… and I’ve been pretty happy.

Over the past few months, I chose to embark on a few diabetes experiments. Experimenting is important, right?

Diabetes is really one big experiment.

My insulin pump break was impulsive, but most likely needed for my sanity. I love Tresiba and what it did for my overnight basals. What I didn’t love was the inability to hit my target range with  MDI. I needed to take less than a 1/2 unit sometimes to bump it down into range and I couldn’t do that. My A1C crept up, as I expected it would. I went back to wearing my Asante Snap (yes, I still had supplies.). I felt like my experiment had failed.

And then summer. I wanted to wear bathing suits and pretty dresses and after years of stuffing my pump in my bra (awkward, because…) or in a thigh holder (also awkward), I went back to MDI. This time, I ate more just so that I could take whole units. A1C crept higher.

I even sampled some Afrezza, the insulin powder that can be inhaled. After about four days, I knew that I couldn’t do this on a daily basis. My throat was becoming raw. For some of my friends, it’s been a game changer; for me, while I love the idea, the reality is different.

It’s been six months of slack. And I know that I’m the only one who is responsible for ensuring I stay healthy so I can annoy The Kid and John in my old age.

New Experiments

omnipod by ThePerfectDI’m back on an insulin pump. A new one for me, although it’s not new in the market. And it’s hopefully the last of my experiments for a while.

It’s an Omnipod. And my Dexcom readings are stunning. (Not perfect, but 90% in range, so for me, that’s stunning.) It’s been a little over a week and I’m looking forward to trying new places that I normally couldn’t reach, like my lower back. The Kid is looking forward to pimping out more pods with her artistic creativity.

So, this is a new experiment, and one that I hope works for me until I get an AP that works for me.

Have you tried anything new this summer?

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?

 

 

Taking a Diabetes Break with Tresiba

unnamed-2It’s happening for the first time in seventeen years.

I’ve decided to take a break from my insulin pump.

Granted, we’re not breaking up permanently. I’m just going to see other insulin regimens for a little while.

I need a break.

After a “naked” shower earlier this week, which always leaves me feeling elated and extra clean (no worries about scrubbing and ripping an insertion set off), I wrapped myself in a towel and glanced over at the counter where the next round of “Who wants to play a pancreas?” waited to be inserted.

And I just couldn’t do it. 

The thoughts shot quickly and unexpectedly through my brain:

  • “How much longer will I need to do this?”
  • “I don’t know how much longer I can do this.”
  • “I don’t want to do this.”
  • “Nope. Not doing this.”

And then I walked away.

Diabetes isn’t a part-time gig. We all know that. I can’t just not show up and expect to live much longer, so when I walked away after that little internal hissy-fit, reality set in and more productive thoughts trickled through:

  • “So, what can I do to change the way I’m feeling about putting another insertion set in?”
  • “What are my other options?”

Seventeen years with insulin pump therapy have produced some of the best control I’ve ever had. It’s also been a pain in [insert body parts]. Always attached, always “almost” in the way. I have found that I hug my daughter differently based on where my infusion set is placed and where my pump is on my body.

I love my pump, but I need a break.

Tresiba

Nothing this major should be decided alone, although in the end, it’s me that gets to decide. My hissy-fit included a frantic text to my husband, telling him that I was going off the pump “right now!!!” and I was going to pick up a prescription of Tresiba. I had discussed it with my CDE a few weeks ago and we switched my “back up” insulin to it. (I have come close, but never had to use my back up insulin.)

Fortunately, one of us (hint: not me) is much more logical and rational. He reminded me that this was a major change and that he’d prefer to be around when I began the therapy change “just in case.” While I wear a CGM and mostly react to the alarms, I’m either home alone or just with the Kid most of the day. We agreed that I would wait until today to take a break.

Decision made, I put on my big girl pants (after all, I was still in a towel) and inserted my CGM sensor and my infusion set. Just to spite me, neither one hurt a bit or bled.

nph-1I have only used an insulin pen twice in my life. I had to read and re-read the instructions to make sure that I was doing it right. I instinctively rolled the pen in my hand to make sure it was mixed. (NPH, anyone?) Old habits die hard.

I just took my first injection of long-acting insulin in seventeen years. 

New adventure. New medications. New challenges.

But a break all the same. Wish me luck!