Right now, I'm on vacation. To be more specific, I'm on an insulin pump vacation.
Which, to be honest, it's not much of a vacation (still have the ole diabetes to contend with!).
What is a pump vacation? It's taking a break from wearing an insulin pump for short period of time. I'm not switching back to shots permanently, although I do know of people who have done so after taking a pump vacation. Sometimes it's done because absorption isn't working well due to overused skin "real estate"; sometimes it's done seasonally (the freedom to wear dresses and skimpy bathing suits, for example); and sometimes it's done in advance to prevent damage to an insulin pump, like for a rafting trip. Some people even do it every weekend!
My pump vacation started kind of by accident. When we last left off, my insulin pump had spontaneously combusted in Arizona while at a family wedding.
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As it turns out, the exact same weekend that my insulin pump broke, the insulin pump of my friend, Katie Clark, also broke! She signed up for a pump vacation, taking a respite from technology in favor of injections. When my new insulin pump arrived, I decided to take a cue from Katie and delay my pump hook-up a little longer in favor of a pump vacation.
With the summer season around the corner, I started thinking that others might be considering a pump vacation and I want to share my experiences thus far.
I should note that this is not my first pump vacation. In 2007, I spent four months attempting to do Dr. Steve Edelman's "untethered" regime, but it didn't work as well for me. Going "untethered" means using Lantus and using the insulin pump only for corrections and meal boluses. It's good for people who don't want to wear a "tethered" insulin pump, and who aren't sold on the patch pump either (at the time, patch pumps weren't even on the market!). For reasons unknown, I felt that being unplugged caused me to absorb insulin poorly, possibly from disconnecting so many times. My 2007 experiment lasted only a few months. I'm not entirely sure how long this 2012 experiment will last.
What I Like About MDI (Multiple Daily Injections)
I like not having something stuck to me. I have worn an insulin pump for 12 years straight, aside from that brief respite in 2007. It's not that I'm anti-tubing, but sometimes I'm just anti-technology. I don't always like feeling like a Borg. Most of the time it doesn't bother me, but every so often, having this "thing" hanging on me is just annoying. As soon as I switched to MDI, I reflexively tried to unclip my pump from my clothes before changing into my PJs. It really has become a part of me, but I won't lie, I sometimes hate it.
One thing that's changed is that I'm testing my blood sugars more often. Crazy, huh? People always say that you need to test more on the pump because you don't have any long-acting insulin in your system — so if something goes wrong with the pump, your BG level will skyrocket much faster. For me, changing up my routine has reinvigorated my commitment to test more often.
And I now take my insulin before my meal. I know I'm not the only one who struggles with this. I always thought having my insulin pump so close to me would make taking insulin on time easier. But that hasn't been the case. I'm a chronic "after meal" boluser, and that habit hasn't helped me.
Now, on Lantus, I keep my insulin and my glucose meter together in one case. I first test my blood sugar, figure out what's for dinner (which usually involves asking my husband, the family chef), and then shoot up. Then I put the case away and I don't have to look at it again.
Finally, I have more real estate to work with. There are some places that a pump set just won't work. It's much easier to rotate areas where I can inject on Lantus, and hopefully heal up some scar tissues that I've built over the last decade.
What I Miss About the Insulin Pump
I hate injections. Having to poke myself several times a day is just annoying. It's probably helped my eating a bit, since I'm less likely to want to inject for that extra cookie or apple, but that's also an annoyance. In the battle between injections and insulin pumps, insulin pumps win in the "ease of use" department, hands down. Plus, I bruise and mark easily. I have a nasty bruise on my abdomen that is just ugly and makes me feel at least as unsexy as wearing an insulin pump set.
I miss the precision of basal rates. On an insulin pump, you have all kinds of opportunities to automatically give yourself more or less insulin through changing your basal rates. On Lantus, you're kind of stuck with a flat line. In switching from the pump to Lantus, I can see how my body uses insulin differently throughout the day even more clearly, with some clear effects like the dawn phenomenon. I have increased my bedtime Lantus (I have my dose split) by three units and I'm still waking up over 200 mg/dl! What gives?
When I talked with my CDE, Gary Scheiner, author of Think Like a Pancreas and founder of Integrated Diabetes Services, about my adventures in pump vacationing, he mentioned that variations in your basal rates might mean breaking out the NPH. Despite the nickname "Not Particularly Helpful," Gary says, "If the usual basal program has a significant peak to it, it is best to use a combination of Lantus and NPH. If there's not much of a peak, Lantus alone should do the job." My basal rates don't have a significant peak, so it doesn't look like I'll need that strategy, but it's good to know NPH is good for something!
I have to compromise more on my doses because the diabetes math isn't as precise on MDI. Yes, I can inject in whole or half units, which for a fully grown woman is usually good. But it's trickier when dealing with really precise doses. It is slightly annoying when I have to figure out whether to round up or round down when the calculator tells me to bolus 8.743 units.
Figuring out active insulin (aka "insulin on board") is almost impossible on shots. I don't know how anyone does it, and haven't really figured out a way of doing it myself other than just trying to sit back and hope my blood sugars come down by my next meal. Gary says, "We sometimes take for granted that the pump does the adjustment for us." It's important to remember that insulin does not work immediately, and depending on how often you test, you might still have some in your system you need to account for!
And last but not least: I lost a bottle of insulin. You can't lose an insulin pump. (Well, not so easily anyway...)
So... have you ever considered going on a pump vacation? If you have taken one, what was your experience? And for those of you who are contemplating switching to an insulin pump, don't let this scare you! I still fully intend to return to mine. For me, it's vastly superior in the long run, even though it isn't perfect!