29 October 2014

From Blue to Pastures New: the Pros and Cons of MDI

So it has been nearly 3 weeks since I made the jump to Multiple Daily Injections, from the Insulin Pump, and I've had various messages from Twitter and so forth asking if I can do a bit of an evaluation!  

I didn't want to do it straight away, as I had to try and give both body and head a bit of time to get used to it all! I can't say with one hundred percent conviction that either of them have fully twigged onto it, but even so I felt that now would be a good time (for myself and for other people who were interested in the whole Pump vs MDI experience) to write an overview - I've divided into 'pros' and 'cons', and I'm hoping by the time I've finished writing that the latter won't outweigh the former by too much! I'll start with a little summary 'the switch' itself … 

I went off the pump on saturday. Almost instantly it felt like a weight had been lifted. My parents were already scheduled to come down and visit on the Sunday; it just so happened to be perfect timing. I really did feel lighter though; brighter. My mum commented on "how much better" I seemed, simply comparing me to how I sounded on the phone the previous day. 

Me and my main minion
That Saturday… I really wasn't well - I rang her from the sofa in my flat, barely able to summon the energy to get up, exhausted as i was from the prolonged highs. In the end I disconnected myself from the pump at around 3pm, after a complete set failure and BS readings in the low 20s, relying on hourly pen injections until I gave my lantus shot before bed. 

On Sunday, I woke up with the unfamiliar sensation of a hypo, and for the rest of the day my bloods were slightly high, but mostly good! It was a world away from the previous few days, and I was more communicative then I had been in a while! The fact that my parents brought along my other half significantly helped… whatever the weather my Millie moo never fails to bring a smile to my face! We enjoyed an Al Fresco (life of a dog owner) lunch in Carluccio's - I disappeared to the restroom to give my insulin shot, but have since done it in public without feeling too self-conscious; I do it very discreetly, but my rationale is that I would never tell a person around me to stop breathing, or a woman to stop breast-feeding - why should giving the insulin I need to eat, be any different? 

Since then, it hasn't been plain-sailing. The past two weeks has seen a hospital admission, numerous carb ratio and lantus dose changes, many tears but also smiles. This isn't a long-term plan; it is simply a temporary means by which I can get my pump back and working at full efficiency! I will always focus on that silver lining. 


I am all for "begin on a positive note", before realising that this consequently means ending on a not so rosy one; however, maintaining my 'silver linings' mantra I will try to make sure this is not the case!

1) there is the simple logistical bonus

From one of my favourite disney films,
'The Hunchback of Notre Dame'

photo credit: Reddit

… being untethered! I haven't actually noticed the benefits so much; it's more that I've eliminated the frustrations that often occurred when on the insulin pump. These were often simple things.

Sleeping, for example. For the last year or so my infusion sets were adamantly opposed to the entire left side of my body, meaning that I was continuously putting them into my right side. Slight problem here is that I like to sleep leaning on my right side, causing constant paranoia that I would somehow dislodge the set in my sleep. I still have moments where I get into bed and worry, only to realise… there's nothing there! 

This can in itself bring moments of wistfulness, and slight panic. Well how can this work? I remember giving my long-acting lantus injection on the saturday night, and going to bed I couldn't process in my head how it could possibly work! I was certain I would be woken up in the early hours of the morning with intense nausea, feeling like I could drink all the water in the Atlantic Ocean… but no. 

As logic and science dictate, this did not happen. It still does not stop me having moments, however - three weeks on - of stopping and worrying "well how is this possible?" I am so used to wearing something that keeps my blood sugars stable on an hour-to-hour basis, now here is this new insulin that is working, out of my control, for 24 hours… it's going to take some getting used to! 

2) Letting go

This would, in many circumstances, be a negative. After all, isn't one of the best things about the insulin pump the tighter control it enables? Well, yes. Except that, for me, it did play a role in the perfectionism that catalysed my eating disorder. I fixated on the smallest details; the daily insulin totals, basal (underlying insulin) rates, carb ratios and quantities. I got so caught up in my own head, trying desperately to control an illness that, essentially, is never going to be on the same page as you. 

With the injections, you can't have this degree of control. You have that one underlying shot, that goes up in 2 unit increments; considering that the pump goes to as little as 0.05 units, you can see the difference here! For my bolus (food) shots, again the unit measurements are far less precise; 0.5 is the smallest, compared to 0.1 on the pump. This has meant that I have relaxed my approach to carbs, in some respects. I scrutinise less, so in the longer term I feel this little foray into the world of MDI could be a blessing in disguise. I do give my insulin doses with less thought of consequence; it isn't perfect, but it is a step in the right direction.

I'm sorry… I couldn't resist!
photo credit: giphy.com

3) Knowing where I stand

For a good year now, with the insulin pump, I never quite knew what was what. I never knew for certain if the insulin was actually absorbing properly, my sites were becoming more and more scarred and, in the end, roughly half of my days were dominated by multiple set changes. To place it in context, my infusion sets prescription should last me three months; I went through this quantity in all of two weeks. Now, I know that if my blood sugar is high, I simply need to increase insulin.

I say "simply"; this is still a struggle for me. I hate the feeling of "dependency", and having become accustomed to seeing a lower insulin total the prospect of it going up is daunting; to try and, again, offer some context, it is quite synonymous with a fear of seeing a number go up on a scale. It links back to a hospital appointment when I was around 14, and a consultant told me my insulin dose was "too high". It has stayed with me, as much as I try to "let it go" (to use the words of Elsa!) I have an association with: more insulin = bad. Nonetheless, this links back to the second point: less control. I do not have that "daily insulin total" recorded on a screen, for me to agonise over. I only have my head, which in all honesty is too tired right now to remember those details, without a prompt!

4) I have a topic for my Creative Writing Journal! I'm basing my poems around the various experiences of "chronic illness"… original, I know.

All in all, there are benefits to MDI, but I cannot keep myself under the illusion that it is an ideal situation; it is simply making the best of circumstances I didn't really have control over. So onto the less than green side… 


1) The unlucky 13… becoming acquainted with Exeter Hospital! 

…aaand part 2!
photo credit: Reddit

I had my first ever diabetes-related admission. I had a good run to be fair - 13 years nearly! It seems it is an unlucky number after all… 

I went along to my routine weekly appointment with the GP on the Wednesday after the transition. That morning, I wasn't feel my freshest. The previous day had seen an all-time low (well, technically high!) in terms of my blood sugars; they just weren't coming down, no matter what I did. Moments after I walked in, the doctor said she could "smell ketones". For anyone with experience of diabetes, this 'k' word is enough to send shivers down your spine. 

Ketones occur when there is insufficient insulin in your body - given that my carbohydrate intake was admittedly not very high on the Tuesday, this was slightly concerning. For me, this was a side effect of still trying to get to grips with the new insulin regime. She tested for ketones and, sure enough, the reading was higher than it should be; not dangerously so, but what was more worrying was when she checked my blood pressure (too low) and pulse (too high). Simply looking at my face, she could concur that I was very dehydrated, and told me that she wanted me to go into hospital and be put on a rehydration IV. At first, I thought she must be joking; surely this wasn't happening? 

To put a long story short, what started as a day which would be filled by my creative writing seminar and a coffee date with a friend turned into me being put on an IV at Exeter Hospital, and told i would be staying overnight. 

It was a really quite sobering experience. The ward I was on included a patient who was suffering from lupus, septicaemia, epilepsy, pneumonia among other things - it really placed my own life and health into perspective. Seeing her, I realised how much I do have to be thankful for, and she really quite inspired me with her resilience. However, also on my ward was a woman who had been detained under the mental health act, and screamed in her sleep the entire night; it was extremely distressing to here, but my biggest concern was for the poor lady next to me (the one I first mentioned), who said she had had no sleep for nearly a week due to this noise. 

One other silver lining was realising just how truly wonderful my friends and family are. My incredible flatmates visited me twice on that Wednesday, and my mum drove down from Bath to see me and stayed overnight. Some other friends came round to our flat the day after with flowers, the last of which are still clinging onto life on our kitchen table as I type this!  Just the little things; messages from friends and so forth, really did mean an awful lot. With diabetes, it is to a large degree an 'invisible illness', thus hard to truly understand; to have the support I did helped me to feel less isolated with it all. 

I saw this quote on tumblr and it made me smile; always
try and be a positive force; it may just help someone near
to you, without you even realising it at the time.

photo credit: tumblr

Even still, I can only sugar-coat (pardon the diabetes pun) so much. Being on a drip was not fun, and for me there was a certain degree of pride involved. I was always the 'model' patient; I confess that growing up I took comfort in this. I was the girl who was given a sticker for setting an 'exemplary' example for her diabetes control and perseverance. However, as my doctor has stressed to me, this was not my fault, and I cannot allow myself to dwell on it and see it as a mark of 'failure'. It was a blip, it happened but it doesn't have to shape my next steps, or shadow them. She's the most wonderful reinforcement for my determination to keep going with the power of positive thinking!

2) It's not Blue

If I am being truthful, I could go on for many more numbers about the Cons of MDI. I could. From the moments when I am in a restaurant, or grabbing lunch on the go, and I realise I cannot simply reach for my insulin pump and press a few buttons. From the knowledge that my stomach will soon be covered in those little red dots and bruises again - one of the reasons I never wore a bikini in my teens. Thank goodness it's Autumn I suppose! On a less superficial note… it's simply that loss of control.

I don't like it. That, essentially, is the crux. Although this could turn into a positive, in terms of letting go of rigidity and fixation on numbers, that loss of precision means that everything feels so sporadic. I feel a bit like a hamster on a wheel, constantly running but my feet are always slightly behind. Nothing is ever quite in sync. Then again; when is it with diabetes? 

photo credit: tumblr

Nonetheless, as I mentioned in my last diabetes post, there is a reason I went on the pump at the age of eleven; a reason why I not so much stepped towards it, as fell into it. Turned to it as a 'last resort'. My body requires the varying basal rates; the peaks and the troughs the pump offers. It benefits from that tighter control that the injections just are not advanced enough to offer. My blood sugars are still not great; the last few days have been reluctant highs and it is so frustrating.  

On an emotional level, I miss the comfort of going to sleep and having that little blue box next to me. A decade together, it became a part of me and i feel really quite bereft without it. I have moments where it hits me, and I feel overwhelmed with it all.

because life is too short for pouting selflies...
This is not a long-term switch. My diabetes nurse told me that she has had patients voluntarily decide to revert back to injections… only to realise a couple of months down the line that this was an error! I would never choose to let go of my insulin pump out of choice. 

This is a short-term investment in my long-term health. My nurse said that, in a couple of months, I should give the infusion sets a go again. I can already see that the sites on my side have begun to heal; my aim is to be on the pump for Christmas day. I honestly cannot bear the thought of having to inject on that day. I am by no means trying to make out that injections are horrendous, or condemning people on them to a half-life! I am speaking from a personal point of view; from the perspective of someone who has been on the pump for ten years. It is my normality - it is what works for me.

Injections take diabetes unpredictability to a new level; this morning, I upped my lantus dose after a few days of consecutive higher readings. This morning? Much better! This afternoon? Higher than it has been; there is no logic. Nuts and milk become my best friends in this situation; a rather feeble attempt to justify my expenditure on cappuccinos! 

I remember in a post for diabetes awareness week, two years ago, the caption to one of my photos was "me and blue stuck together like glue". Well, I was very much speaking the truth there. That is how it should be; at least, for me it is. I want my battery-powered pancreas back, but to have it back at full voltage I must just ride out this little wave as best as I can. University helps me so much here. Exeter, to be exact; the people here, the degree I love, doing Exeposé (our student newspaper) - they are all included in those silver linings that I keep hold of; they are the things I will not allow diabetes to compromise!

photo credit: Meetville


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