Pros and Cons, Do’s and Don’ts, X’s and O’s

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I could write a 200-page manifesto about the ups and downs of 2014 while insulin pumping and then transitioning to shots, but for the sake of not straining our eyes by reading a mile-long exhaustive blog post, here are some main points worthy of highlighting:

Pros of Shots:

  • I know with certainty that insulin is getting into me.  A reliable insulin delivery mechanism is something that I will never take for granted again.  There is something to be said for a good, old-fashioned jab with a syringe.  Plus, ketones have packed up and moved out for now.
  • The mental relief that this offers is difficult to articulate.  We are slowly but surely building back trust: a trust in insulin that it will do its job, a trust in eating a nutritious meal and knowing that insulin in my body will cover that food, a trust that I will not wake up in the middle of the night in a ketonic state, and- frankly and in violation of the “double negatives rule”- a trust that I will not not wake up one day due to ketones.
  • Trusting in the doctors’ knowledge:  While taking over twenty units of long-acting insulin such as Lantus after a decade of pumping might not be a big deal to some diabetics, for me it was a huge mental mountain to wrap my head around.  Multiple doctors chimed in throughout this process, thankfully.  One in particular yielded emails at all crazy hours of the weekend.  And the other reassured me over the phone that I would be okay, her voice calm and confident.  On the first day of injecting, I said a quick prayer and reminded myself that these doctors went through graduate and medical school and have been doing this for many years; I had to believe in their expertise.  So far, they have proven that they know their stuff!
  • Taking long showers without rushing to get out and reconnect to life-sustaining medical equipment.
  • Only one insertion (Dexcom) about every two weeks.
  • Wearing only one site (Dexcom).
  • Crossing a “Never Have I Ever” trump card off my list- at least if playing with other diabetics.  (I never liked that game, anyway).  “Never have I ever given myself an insulin injection in the stomach…”  Oh wait, I just did it three times today without flinching.
  • Finding the humor in the situation.  For example, shooting up at a rest area recently while a horrified mother spotted me and promptly peeled out of the parking lot, the wheels of her minivan screeching, after she unfairly assumed that I was a heroin junkie.  Far from it…
  • I don’t need a behemoth-sized-suitcase filled with back-up pump supplies when I travel.
  • Trying new things:  Even three months ago, I never would have consented to trying a different way.  I have the #doc and some very patient, compassionate doctors to thank for renewing my strength and for holding me up on the bad days.
  • Honesty.  This process has made me more upfront with myself and my doctors.  For years, I skirted around the issues, felt trapped in one method of diabetes treatment, and perhaps did not accept how multifaceted my insulin pumping problems had become.  No one likes to feel desperate, but I can see in my old blog posts, emails to pump reps, tears cried to my doctor, and so on that what I was doing on the pump was not working as optimally as it is intended to; hence, we needed to at least try something else.  A few weeks later, here we are…

Cons of Shots:

  • I’d be lying if I said I didn’t miss the pump (very strong emphasis on the “good pump site” days).  The stability in my blood sugar was better on the pump, but perhaps some of the severity of the recent “shots rollercoaster” is the fact that it’s only a few weeks into the trial and we have a lot of insulin dosing details left to address.
  • The pump is much more convenient.  Out of habit, I still reach down to my side to take a correction bolus with my invisible pump friend, only to find him missing in action.  I am in the process of waiting out an insulin pen prescription, and I hope that this makes things a bit easier in the day-to-day aspects of shots.  Currently, I prefill some syringes with typical Humalog doses or I manually fill the injections, making it a somewhat timely and tedious process.
  • Shots require more thinking.  I have to really focus when I draw up the amounts.  I quadruple-check that I have drawn up twenty-three units of Lantus, rather than Humalog.  (My doctor recommended using nail polish on the insulin boxes and bottles to help differentiate between them.  I know that there are colored lids, ties, etc., that you can also purchase.  The bottom line is that you want something that will catch your eye and make you focus on taking the correct type of insulin).
  • Where, oh, where, have my temp basals gone?  Plus one for the pump in that regard.
  • Once the insulin is in you, it’s in you for the day.  Currently, I take one Lantus dose daily, but we may transition to twice a day for some fine-tuning.  I am too high during the daytime, but at night I crash harder than a college kid at her first keg party.
  • Bruises.  Lots of them.  My hand-eye coordination has always been a bit defunct (i.e. my kindergarten teacher sent a note home telling Mom to have me practice cutting and coloring in-between the lines over the summer).  Perhaps this deficit is why I simply suck at shots.  It’s the opposite of “you can give it out but you can’t take it.”  Actually, I am pretty darn good at taking shots without any tears, but when it comes to giving them, the “stab repeatedly” method doesn’t work so well.
  • Lantus burns.  It’s not excruciating, but it’s there.
  • Socially, it’s either inject in public, or scurry off to the bathroom for every injection.  Because I find that I really have to concentrate when taking Lantus to make sure I’m drawing up the right dose, of the right medication, at the right time, I often take that shot in the bathroom at work so that I can have some privacy to focus.  I do not have much shame about taking injections in public, but it is more the “always having to have the diabetes conversation” element that I sometimes would rather avoid.  However, I have done many injections in my abdomen at work and in the local coffee shops, and no one has noticed.  On the plus side (I think?), my friends are eager to puncture my skin with a needle whenever they can have the chance; so far, I trust my mediocre injection skills over theirs.

Do’s of Shots:

  • Consult your doctor(s).  Consult the diabetic online community.  Weigh your options.  Take action if you are ready to try something new.
  • Write down all your pump information, such as basal rates and carb ratios, so that you have it handy if needed in the future.
  • Tell someone what you are doing.  Transitioning from the pump to shots after many years of pumping is scary and it is an educated-guessing-game under the guidance of medical professionals, as most diabetes-related things are.  During this time, there is a slightly-elevated risk that something out of the ordinary may happen, such as a severe low blood sugar due to an inadvertent insulin dosing mishap.  I emailed a few friends at work one day when I was not feeling well, on the off chance that an emergency did occur; I told them the name of my diabetes clinic and some basic information about my transition back to shots, on the very rare chance that I may not be able to articulate these facts myself to an emergency responder if a bad situation occurred.
  • This is another reason to have proper medical identification.  You can read more about this under disclaimers and disclosures, but MedicAlert has served me well for over twenty years.  I feel comfort in knowing that my medical and contact information is stored in their database, and that if I were ever unconscious an emergency responder would know that I was type one diabetic simply by reading the back of a MedicAlert medical identification bracelet that I wear at all times.
  • Restock on supplies: glucose tabs for the car, juice at the office, etc.
  • Understand that you may require more insulin in your boluses than you currently do on the pump.  My correction factors and insulin to carb ratios have changed significantly as we iron out the Lantus details.

Don’ts of Shots:

  • I do not regret trying shots.  My doctors and I were ready to do this in this moment.  In hindsight, however, I picked a rather difficult first week to test out multiple daily injections again.  Guys: You’ve been warned.  The next few sentences discuss female stuff.  #sorryimnotsorry 
  • A few days prior to the beginning of my cycle, my hormones seem to have an epic party where they are up all night chugging Red Bull and taking vodka shots within my body.  My blood glucose refuses to budge from its perch high atop the elevated blood sugar peak, despite increased insulin doses which are sometimes quadruple my normal amounts.
  • Dealing with this frustration on top of re-learning shots, as well as having planned a purposely-conservative Lantus dosage with my endocrinologist for the first few days just to be safe, created a high blood glucose dilemma for us.  I was stuck in the 300s and 350s for days on end, and was more or less feeling miserable.  Once the hormone block party subsided, things evened out a bit and I began to feel much better.  So, for the ladies, I would recommend planning around the week of your cycle if you are interested in transitioning back to shots anytime soon.
  • Don’t switch back to shots solely because you do not want to be attached to a medical device at all times.  To be honest, I have not felt an overwhelming sense of “freedom” being without the pump; in fact, I miss it for its good aspects quite a lot.  It was cool for like, a day, to have one less site to worry about while showering, but all in all, this should not make or break your insulin management decision.
  • Don’t throw in the towel quickly.  I’ll admit, I was ready to do so based on the first few days of non-stop highs.  I verbally committed while on the phone with my doctor to try for a week, and then I tweeted it out to make sure I held myself to that goal.  On the first week of the trial, the stubborn Italian part of me was not going to give up until Saturday, which would mark the full seven days of shots.  On Thursday, I emailed another doctor and asked the question that I wasn’t answering for myself: “So, I should try this shots thing for more than a week?”  She encouraged me to continue with the shots.
  • I was looking for her affirmation and for someone else to make the tough call, and I am happy now that she gave me the tough answer.  It was a difficult first week, but by the second week it was infinitely better.  Now on the third week, we still have things to tweak and my blood sugars are far from stellar, but I do feel better and there is insulin getting into my body.
  • The back to the basics, simple things about insulin are now appreciated more than ever.  I take a shot and I watch insulin do its thing.  In that regard, I am truly blessed to have access to this life-sustaining medication and to doctors who can tell me how best to use it.

X’s and O’s:

Consider this a big virtual hug to each of you for being my sounding board during a trying time in my diabetes journey.  Knowing that someone out there was reading this and perhaps going through a similar trial, receiving innovative suggestions to insulin management, perusing your blogs and tweets, and overall feeling the strong sense of community is what made the hardest part – taking the first step, or, in this case, the first shot – totally worth it.

My long-term plan is to continue this shots trial for another month or so and then perhaps switch back to the pump with reduced pump basal rates and some background injected Lantus basal as a precaution for faulty-pump-site days.

I feel blessed to have made so many friends in the diabetic online community and to have a health care team that has steadfastly worked to make me feel better.  One day many months ago, when my head spun from ketones-induced nausea after another failed pump site, I thought to myself, Maybe I should start a blog?  There must be someone out there who “gets it,” too?  Today, having been encouraged to fight for my health through the inspiration of the #doc, I lift my very light, no sugar coffee cup to you.

Thank you…

XOXO,

Ally

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16 thoughts on “Pros and Cons, Do’s and Don’ts, X’s and O’s

  1. So well written and thorough! Some suggestions: I have trouble with bruising and burning, too. It’s not your hand-eye coordination, but your lack of fat. If you switch to pens you can use the nano 4mm needle which is half the length of the shortest syringe needle. That should help some. Lantus burns more than Levemir; I understand it is more acidic. If you wanted to switch the dosing would be the same to start off with. Are you taking your Lantus dose before bed? This causes those overnight lows. When I did one Levemir shot a day I took it in the morning. There is the issue of it not covering as well for the dawn phenomenon. Of course we prefer only one shot of long acting a day but two per day gives better results. Truth is, shots suck. They hurt and are just disgusting. I know we’re not supposed to admit this, but I will here and now! There seems to be this rule that we have to say that we’re ok with shots… No, I’m not, but I can’t wear a pump any longer. I hope you will be able to go back to yours. Until then perhaps these additional points will help. 🙂

    Liked by 1 person

    1. Thanks so much, Jere. I loved every single word of what you wrote- it all rings so true. I just tried the 4mm pen needle for the first time today; I found that I am awkward giving the pen dose and pull the needle out too quickly. I need to practice on a stuffed animal this week. lol

      We are doing one Lantus shot at lunch time, as this is a consistently stable time in my schedule. But as you said, the day/night stuff is tricky so we’re going to try mornings and a reduced dose in the evenings, probably after Christmas. I want to just enjoy the day with my family and worry about fine-tuning diabetes stuff next week.

      Shots do suck, and, well, diabetes sucks, too. Shots are a means to an end in living well with diabetes, but a cure would certainly be nice! 😉 Merry Christmas and Happy 2015 to you! I hope that you are doing well health-wise. Thanks for all of your support along the way- I think you were the very first shots proponent for me, so I have you to thank for feeling a bit better.

      Liked by 1 person

  2. You’re welcome, glad I could help! Good point about pens: you need to leave the needle in place for several seconds to receive the full dose. Sounds like you have a good plan to implement after the holiday. I take a much larger dose in the morning than in the evening: 16U in AM, 6U in PM, spaced 12 hours apart.
    Have a great time with your family and friends! Merry Christmas and Happy New Year! 🎅🎄🎁🎉🎊

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  3. Great post, Ally, and you are certainly learning a lot of insulin dosing. I think that Lantus is more stable with twice a day dosing, but it doesn’t have to be 12 hours apart. But you’re probably right to just start with the basics and fine tune things as you go along.

    I still owe you my blogpost on the untethered regimen. I had it ready to post over a week ago, and then totally changed my decision on whether to continue with Lantus along with the pump. Suspense! I’ll probably wait until after New Year’s to post it because my holidays are busy and the DOC takes a snooze. The problem with all of these experiments is that at the end of the day we still have diabetes and it’s just not possible to achieve easy perfection.

    Keep up the good fight and Happy Holidays!

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    1. Thank you, Laddie! Can’t wait to read about your untethered experience, but in the meantime I’m glad to hear you will be taking some time to enjoy the holidays. The DOC and diabetes will still be here in 2015. 😉 At times this stuff is definitely PhD level analysis and trial and error. While I’m looking forward to trying Lantus and the pump later on, it adds another level of complexity to the mix, as I’m sure you understand since you’ve put this method into practice.

      Have a safe and healthy holiday season! And thank you for all of your support throughout my pump/shots journey.

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  4. Ally! I know we sort of already “talked” (can you call it that?) on Twitter. But, I just wanted to say that I loved this piece. I switched to the pump 3 years ago after 6 years on shots…Lantus and Novolog. So many of your new experiences resonate with me, and I particularly can empathize with the night time lows from the Lantus…especially since I was an avid runner at the time. Lows almost ruined running for me entirely because they made me gain so much weight. Waking up 47 at 3am doesn’t exactly lead to making good correction choices…*did somebody say graham crackers with frosting?*

    Anywho, one of the WEIRDEST little tricks I found with the pen needles, since the bruising on my outer thighs made me look like a sloppy drunk in a bad relationship with table corners, was the ANGLE at which I put the needle in my skin. I played around with it, and it wasn’t always the same, but sometimes if I tilted the pen ever so slightly from a horizontal, straight shot, I’d find a more natural opening in my pores (ew), to sneak the little bugger in there more comfortably, leaving me bruise-free!

    I also was a huge advocate for the broken up doses of Lantus. I know it’s a pain to add more shots, but it really helped ease my anxiety around just how much of it was being crammed into my system all at once.

    Best of luck with the rest of your adjustment, I hope it gets easier!

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    1. Thank you, Libby! I enjoyed talking with you on Twitter! Thank you so much for the pen needle advice. I will try inserting at different angles to see what works; sometimes I just get stuck in auto-pilot and doing things the same way, so I think you’re onto something here with trying a new way. I recently switched to a morning and an evening injection with Lantus and it has made a big difference. I also found that shorter pen needles are not necessarily better. My doctor gave me a few longer ones to test out this week and the bruising is gone and the insulin is getting into me, rather than pooling on my skin! (Yay!)

      Thanks again for the advice and keep in touch on Twitter!

      P.S. I love all of your analogies (coffee table bruising had me laughing out loud).

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  5. Insulin pens are very convenient compared to syringes. I’ve been on shots since 2012 when I was diagnosed but my daughter has been on the pump since 2009. One thing I haven’t gotten used to (and might be TMI) but blood on my panties from the shots I’ve taken then quickly pull up my clothes. I take my shots anywhere I’m at, most of the time. I feel like I’m not only a possible diabetes advocate but I am an example for my daughter (now 2 daughters). I don’t want her to be embarrassed by her diabetes or feel she has to hide. (But sometimes if I’m by myself I check my blood sugar and take my shot in the restroom.)

    We love Medic Alert too but you might also include a link to Road Id, I’ve heard good things about it and that is actually what information JDRF now sends in their newly diagnosed backpack.

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    1. Thanks for your comments. Oh, I totally hear ya on the blood smears on the clothing thing! In my opinion, you’re setting a great example for your daughter. I’ve always told people that once I was cool and confident about diabetes, others became that way, too. People inevitably get curious, but they’ll follow the diabetic’s lead on how to react to diabetes. Good luck to both you and your daughter!

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  6. True words, I like your wording better “blood smears on clothing”. Being an example for my daughter didn’t come easy. I had a few months of convincing my endo I was type 1 and ended up having to switch doctors (we had been tested through TrialNet). So I had time to think about it and how I wanted to handle myself. Kerri Sparling (sixuntilme) was encouraging when I heard her speak at a conference. The diabetic needs to choose how much to share and when. I think that’s ok unless you have an emergency like a serious low. 🙂 BTW, I came over from Laddie’s blog (testguessandgo).

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    1. Exactly- the ball is in our court as diabetics, and every person is different. I’m still working on the whole “How do I want to portray myself in terms of diabetes, and when do my blood sugars and/or emotions get the best of that person who I strive to be?” thing. We’re all human and it’s a work in progress. Your daughter will one day be thankful to have an involved Mom in her support system, I’m sure. Plus, having “good diabetes eggs” like Kerri and Laddie to look up to is another great thing in this digital age. 🙂

      Thanks for reading and reaching out to me! I look forward to reading your blog as well.

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