My 2-year-return-to-insulin-shots-anniversary came and went a few weeks ago. The anticlimactic day was all the validation I needed to know that this was the right choice for me. I no longer count down the days, weeks, or months on shots; they are my new normal until I switch things up again or diabetes is cured.
People probably wonder why I still harp on my defective insulin pump saga, and the truth of the matter is that one can talk as much or as little about trauma as one sees fit. Medical trauma is particularly cruel; our already-limited “control” further fades away as our cells cry out for insulin. I continue to harp on this because the wounds are still fresh, however many years after the triage. Yet the bandages of an engaged healthcare team have eased the pain, and I finally feel better.
Two years ago I feared that I would die of ketoacidosis while sleeping on my couch. I worried that the graduate school experience I had always dreamed of might slip between my fingertips. Or worse, that the mental desperation would become too much- that in my attempts to be heard my voice would eventually fade away.
Multiple daily injections (MDI) are not always pretty, but they are a guarantee that insulin is getting into the body. MDI is literally and figuratively another shot at life. (More to follow, but not everyone has this guarantee currently; they deserve a chance, too.)
Two years later and I have successfully completed my Master’s degree.
I flew to California twice to participate in Stanford Medicine X.
I didn’t die on my couch.
And I was too busy living to remember that it was my 2-year Shotoversary.
Many thanks to Jeremy of 70-130.com for his insightful piece on various insulin pump and insulin injections perspectives. I found it therapeutic to reflect on my journey from shots to pumps and back to shots again. You can read Jeremy’s blog profiling some #doc viewpoints here.
Black-and-blues are inevitable with multiple daily injections (MDI) considering the sheer number of times we must poke ourselves each year. None of this is natural for the body to endure, but it is necessary.
As I flinched while a nurse removed bandages from my back at a recent medical appointment, she paused and asked if she was hurting me. “It’s okay,” I mumbled, more concerned that my tough exterior was noticeably crumbling down than I was about any physical pain. After the initial diabetes diagnosis shock at approximately age 3, I bottled up my emotions in order to survive. We might need a stronger corkscrew to open the floodgates at this point…
The visible reminders of insulin injection bruises on my abdomen are an aspect of MDI that I grapple with emotionally. I am forced to admit that diabetes is right there looking back at me in the mirror, and that sometimes it does hurt me whether I want to concede that point or not.
Admittedly, this is a morbidly weird artistic endeavor. But I decided to have a little fun by altering a photo of Mega Bruiseasaurus, which has camped out on my stomach just in time for bikini season. The bruise’s purple hues became a sea turtle’s shell, and my jeans morphed into the water in the background. Inquisitive face, green limbs, and a pointy tail sprouted up through the hard shell, determined to show off the good stuff that diabetes sometimes clouds from our views. Bruiseasaurus is no longer the greatest creature in the jungle. Sally the Sea Turtle has marked her territory, too. She is the life of the party, after all.
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.