MDI: Three Week Update

Who in the world would be excited about encountering multiple needles a day? I guess someone with an acupuncture membership and ME! I was pumped to go pumpless a few weeks ago, in exchange for Multiple Daily Injections (MDI) but during the few days after, I felt like a physical part of me was missing.

*cue sad violin*

I didn’t realize that although being MDI would be liberating without any wires, beeping, or site changes- I would be losing a tiny little box machine thing that had hung on my waistband for over 15 years.. The pump was a device that would cause panic in my chest when I forgot to reattach it post-shower and would make me feel vulnerable when I had to put my whole trust into it while it kept me…alive.

ANYWAYS. This post isn’t intended to be an ode to my insulin pump (which is really just on a time-out), the intentions are to share what I’ve learned in the early stages of my transition from insulin pump to injections.

To read about what initiated this transition, check out the reasons why I went on a “Pumpcation” here.

LONG-LASTING INSULIN

Long-lasting insulin can last up to 24 hours, with some brands lasting 48 hours. But I quickly found that around 12-16 hours after my dose in the morning, my Blood Glucose levels would slowly rise. This rise would happen when I was sleeping since I was taking my long-lasting injection around 9 o’clock in the morning. I then tried cutting my long-lasting into TWO doses – something I was not psyched on doing only because my schedule at night is far more busy than my morning and I worried I would forget. I split these two doses 50/50 and found the opposite to happen; I was slowly dropping.

I found a happy medium with a 60/40 ratio; 10 units in the morning and 6 units at night. Depending on how much exercise I did the previous day, the 6 U at night can be only 4 U!

BOLUS METHOD

I went from carb counting on the pump to unit counting with injections! When using the pump, I plug in how many carbohydrates I’ll be consuming and the pump then calculates the units for me. But on the insulin pen, I clock in the units. I know my unit to carbohydrate ratio is about 1:6, so I keep this in mind when injecting insulin for food. Before eating I start with 2 U, then see if that is enough based on how my sugars are trending and what the food is like!

My insulin sensitivity ratio (this is how many points one unit of insulin will drop my Blood Sugar levels) is 1:50, which is pretty easy for me to calculate in my head. BG at 300, need to go down by 200 points so 50 into 200 is 4 and voila! We got ourselves 4 U of insulin.

WHERE’S MY PUMP?

I’ve been dealing with phantom pump quite a lot since cutting ties with the little machine. I let my pump hang loose while sleeping (I just unclip it and let it lay next to me in bed, cute right?) so when I get out of I’ll locate the pump and clip it onto my bottoms so that way the it doesn’t yank on the wire. But my half asleep, pump-less self still attempts to locate the pump before getting out of bed.

I didn’t realize how much I relied on this pump for things outside the needs of diabetes until it was gone. The pump is like having a permanent accessory that not only keeps you alive, but gives you some light in the dark with it’s small screen and also has the time on there! In the mornings when getting ready, I don’t have my watch on yet and my phone is… well I never really know where it is, I always had my pump to tell me the time! Oh, the little things.

INJECTION SITES

One of my motivations to go on injections was the scar tissue that I felt developed from pump sites. Leaving the pump sites in for 3 days (the occasional 5, whoops) generated the build up of tough tissues around my favorite pump sites. I felt that with the syringes/pens the needle is finer than the pump cannula so scar tissue would be less like to develop. This might be true, but I was surprised with the amount of bruises and marks I have from the needles. All over my thigh and arms are tiny bruises (some bigger, where the long-lasting insulin went in)!

I also feel my injection sites becoming repetitive. My stomach is usually the most convenient since I can just lift up my shirt a little bit but I don’t want to overuse this real estate. I wear skirts with tights quite frequently so have been able to inject through tights (though not the most sanitary and probably not recommended, but better than no shot at all!).

TO SUM IT UP

This transition was NOT easy- the first few days being quite the challenge. I made sure to make the switch at a time when I didn’t have work or school so that way I could focus on my BG levels. I always recommend talking to your doctor before going on a Pumpcation to make sure it’s the right move!

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