Running On Autopilot.......

Usually when I can do something on autopilot it’s a good thing.  It means it has become a part of my routine and I can quickly get the chore done without investing too much brainpower.

But sometimes?  Sometimes running on autopilot doesn’t work so well.  Like this morning when I did my site change.  I estimate that I’ve done well over 1,200 site changes in my years of pumping, so I most certainly run on autopilot when I do them.  Remove the old site.  Rewind the pump.  Disinfect both my skin and the insulin bottle.  Fill the new reservoir.  Tap out the bubbles.  Connect the tubing.  Prime and confirm that I see drops of insulin at the end of the needle.  Remove needle guard.  Insert site.

Oops!!  That’s right, I missed a step.  PEEL BACKING OFF OF ADHESIVE!!!  My fresh new site immediately fell out because I didn’t expose the “glue” that keeps it stuck to me for the next three days.

Just because I’ve done something more than 1,200 times doesn’t mean I shouldn’t continue to pay closer attention during the next 1,200 times.  Because autopilot apparently doesn’t always work out so well…..

Why Don't You Change it Out?

“Ouch!”

From the moment I inserted the infusion set, it hurt.  Not a constant throbbing pain, but a soreness that spiked up every time something brushed up against it.

“That site still hurts?” Pete asked.  “Why don’t you change it out?”

I can tell you exactly why I didn’t.  This sore site was working really well.  You know what I mean, that blissfully flat graph on the CGM that can be so difficult to achieve.  There was no way I was wasting a good site just because it hurt when something touched it.

Let’s read that last sentence again.  There was no way I was wasting a good site just because it hurt when something touched it.  The more I think about it, the more I realize how weird the way I think is.  What rational person does not try to relieve something painful?  Why is wasting a site given a higher priority than my own comfort?  Good blood sugars are important, but isn’t being pain free just as important?

Honestly, the answer is no.  I had planned to keep that painful site in until today, when it would be time to change it out.  I did get a bit of a reprieve towards the end of the day yesterday when I started to struggle with unexplained highs that wouldn’t come down.  I decided the painful site was starting to go bad, so I swapped it out 12 hours ahead of schedule.

It’s nice to be back to an infusion site that doesn’t shoot stabs of pain every time it’s touched.  But I can’t help being annoyed with myself because I value a stupid infusion site more than I value my own comfort.

Diabetes Intuition . . . .

Ever just have a feeling about something?  When you know in your gut something isn’t quite right, even if you don’t have hard evidence to support it?  It happens in life, and for me, it especially happens in life with diabetes.  For example, let’s say I go out for dinner.  And I look at the plate of food in front of me and I look at the carb count given by the restaurant’s website, and I just know the information isn’t right.  Or maybe I’m at the endo and my basals are being tweaked, and I just know the new basal rates aren’t going to work.  (Although I must say, my endo absolutely respects and listens to my input.)

My diabetes intuition was blaring yesterday during my site change.  When the new site went in, I just had a gut feeling that something was off.  And I wondered, do I listen to my diabetes intuition or not?  On one hand, I’d hate to pull a perfectly good site because I had a feeling but no proof.  And if I had been wearing a sensor, I probably would’ve given the site a chance, knowing that my CGM would alert me if the site did indeed fail.  But last week I decided to take that sensor break, and I wouldn’t be starting my new sensor until this morning.  (I like to leave them in overnight before I put in my first calibration.)  Of course, there is also the option of just checking my blood sugar frequently for a few hours to determine if the site is working or not.  But I’ve been having a rough time lately, struggling with some major depression, and I just didn’t want to worry about increased sugar checking.  So, I decided the best thing to do was to go with my gut.  I pulled the minutes old site and inserted a new one.

It's times like these when I wish I had a diabetes crystal ball to rely on, instead of using diabetes intuition.  That would really be useful in our diabetes management, wouldn’t it?  Of course, even it it existed, our insurance probably wouldn’t cover it anyway . . . .

So when has your diabetes intuition kicked in?  And did you listen to what it said?

Sometimes it’s the little things . . .

Health Activist Choice! Write about what you want today.

When I started pumping, my Medtronic rep recommended trying the Quick-Set infusion set since it’s their most popular one.  They’ve always worked well for me and I’m still using them today.



One of the things that appealed to me from the start was the Quick-Serter, a device to help easily insert my infusion sets.  Sure, I had been doing injections for a long time, but for me, inserting a site was a very differently thing and the Quick-Serter helped make it relatively painless and  . . . well . . . quick!!  Some time later I saw a post or tweet or something from another pumper who was changing the type of set she used and she was looking to pass along her unneeded Quick-Serter.  I gratefully accepted, happy to have a spare.

Then one day I saw a post (I wish I could remember who wrote it) by a blogger who inserted his or her Quick-Sets manually.  No inserter??  The thought had never crossed my mind.  But I decided it might not be a bad idea to try it, because you just never know.  What if I didn’t have my Quick-Serter handy but needed to change my site?  So I hemmed and hawed . . . . I screwed up my courage . . . . and thwack I slapped my site on manually.  And it wasn’t so bad.  It was a bit awkward, but it really didn’t hurt any more than usual.  Satisfied that I had done it, I promptly went back to using my Quick-Serter.

For whatever reason, a few weeks ago I decided to do a manual insertion again.  And again.  And again.  My Quick-Serter has stayed nestled in my d-supply drawer.  I’ve found I really like inserting my sites manually.  It’s not that it’s easier.  It’s not that it hurts less.  It’s not that doing it either way is better or worse.  But manual insertion feels like a bit of a rebellion for me - Ms. Play-By-The-Rules Straight-And-Narrow Nerd-Girl.  It may be a little thing, but in some way it feels like a win!!  And any time you can score a win against diabetes it’s a good thing!!

Have you had any little Diabetes Wins lately??

** My Medtronic disclosure can be found here. **

Hard Core

For the almost three years I’ve been a pumper, I’ve always used the same style of insertion set.  The Minimed Quick-set.  I’ve never had any real problems with it and I like that it has three options of tubing length.  In addition, I always use my Quick-Serter to insert my site and usually that all goes well too.

Once in a while, though, the Quick-Serter gives me a bit of a problem.  Like last week, when the sticky stuff somehow got stuck to the walls of the Quick-Serter.  Instead of hearing a happy SHWOOP when I pressed the Quick-Serter button, I heard an odd FWOP as the needle went partially into me and the tape adhered to both me and the Serter.  I peeled everything off as best I could, reloaded it back into the Serter and tried again.  Of course, it seems that particular site had a mad crush on the Serter, because once again to clung to it for dear life.

So now I had a decision to make.  I could waste the site and start over with a new one.  Or I could try, for the first time ever, to insert in manually.  I decided to be very cheap brave and give manual insertion a go.  I took a deep breath and SMACK I popped the site right in.  It wasn’t all that bad.  It did cross my mind that three insertion attempts might have done some damage to the cannula, but that wasn’t the case and the site worked just fine.

When it came time for my next site change, I thought about the manual insertion I had done last time.  And I thought about how it might be nice to know I don’t have to depend on the Quick-Serter.  So once again, I did a manual insertion.  It went well, but it definitely hurt more than when I use my Serter.  But you know what?  I think I’m going to keep inserting my sites manually from now on.  Because in some lame way, it makes me feel kind of Bad-Ass.  And who wouldn’t want to feel a little more Bad-Ass?

Daring . . .

Yesterday I did something pretty daring.

I put my infusion site and my CGM sensor in my abdomen.  *gasp*


I know, I know, you are all thinking “Big deal, everyone uses their tummy.  It’s prime real estate!”  Well, not for me.  When I was on MDIs I used my stomach almost exclusively.  As a result, I built up a large amount of dreaded scar tissue.  Sites and sensors go on strike upon insertion there, bouncing off the scar tissue as if it were rubber and leaving me with a bleeding hole.  If by chance I do get a site or sensor inserted they don’t work well at all and get very irritated very quickly.  So I’ve avoided using my abs for the past two years, plunking all of my sensors and sites into my lower back and butt cheeks.

The thing is I can feel scar tissue starting to form back there too.  I’m running out of real estate fast.  So I thought I’d give the old tummy a try again.  After its two year break, maybe it will be willing to perform a little better?  The site and sensor went in just fine yesterday.  They felt very irritated all day but are doing better so far today.  My CGM readings have been pretty accurate.  And I think my site is doing okay.

Or maybe it “was” doing okay.  I woke up with a fasting of 67.  Awesome!!  But the Greek yogurt I ate for breakfast an hour ago has just set off my CGM high alarm.  I show a 170 with two up arrows.  My finger stick confirms a 190 with a .35u correction needed.  This is not a normal post-Greek yogurt reaction.  Paranoia tells me the site has gone bad already.  The (small) rational part of me says it could be a million other things, including the sore throat I woke up with this morning.  So I’ll try not to be paranoid, I’ll keep an eye on my CGM graph, and I’ll just wait and see . . .

How a Ping-Pong ball feels.

My fabulous morning (please note the sarcasm) was spent ping-ponging between phone calls to Medronic Minimed and my endo's office. But let's start at the beginning.

I opened my last box of infusion sets on May 24th. Like a good little diabetic, I got on-line and ordered my new supplies from Minimed.

Then I waited. And waited. And then I waited some more. The happy little e-mail letting me know my supplies had shipped was not in my in-box. After listening to me bitch worry, Pea called Minimed on Sunday and used the automated system to check my order status. It said my supplies would ship yesterday.

This morning, there still was no happy "your supplies are on their way" e-mail in my in-box. I have only two infusion sets left, so I called Minimed again. The automated system still said my order was processing and would be shipped . . . yesterday. I decided to talk to a live person to confirm that it had been sent.

Good thing I did. My order has not shipped yet. Minimed said they are waiting on a new prescription from my endo's office. They rattled off a list of dates over the past 2 1/2 weeks on which they talked to / faxed / called my endo's office.

Next up, I called my endo. My one and only complaint with his office is that a real person doesn't answer the phone. I worked my way through the automated menu and left a message asking what the status of my refill prescription was and if there was anything they needed from me. A few minutes later, the nurse called back and let me know that Minimed had been faxing the wrong request to them. It had all been straightened out and the refill order was faxed to Minimed yesterday.

Okay. I hung up and immediately called Minimed back. Worked my way though their automated system (again) and reached a real person. Explained the problem (again) and the latest status from my endo's office. The nice lady told me any fax received yesterday is in another department with hundreds of other faxes and could take a day or two to be sorted and processed. *sigh*

Is it just me, or is this whole situation really WRONG? If my prescription had expired and needed to be updated, why didn't Minimed let me know when I placed my order?  I certainly would have called my endo right away to get the paperwork they needed.  In the 2 1/2 weeks I've been waiting, they couldn't give me a status update? And now it will be a couple more days before my fax gets to the right department so my order can be processed and shipped?

I have two sites left. What happens if I have a repeat of Saturday and my site fails and needs to be changed out early? What if I have a repeat of two weeks ago and accidentally yank my site out in the bathroom? Luckily, a wonderful D-Friend has my back and offered to loan me a couple of spares if I need them. But how many diabetics have friends that use the same supplies and can help if an emergency arises?

I'm sorry, but I think this whole situation could have been handled much better. And when it's supplies that your life depends on, it absolutely should be.

In Case of Emergency . . .

I'm really good at planning. I can't help it. It's part of my nature. Or maybe it's just been ingrained in me after all my years with diabetes. But in any case, my head is always swirling with plans and lists, back-up plans, and In Case of Emergency plans.

With some surprise, I realized there is one part of my life that has been seriously under-planned for. Pump site changes. Don't get me wrong, I always have plenty of supplies available to change a site whenever and wherever I may be. But what would happen if, for some reason, I couldn't change my site out on my own. The chances of being too sick to change my site are slim, because I think if I was that sick, I'd be in the hospital anyway. But what if a knitter's worst night-mare happened, and I broke my arm or something. (Yes, in the case of a broken arm, I worry about the knitting before the diabetes. I can't help it.) I don't think I could do a one-armed site change.

I've mentioned this to Pea over the past few days. Since we'll have four days together over the Thanksgiving break, I want him to do a site change for me. From start to end. To make sure that he could if I needed him to. He doesn't want to do it. He's afraid of doing it wrong or hurting me. I don't think he could really mess it up, and I'm not afraid of a little pain. I think it's more important to be sure that, In Case of Emergency, he could help me.

Do you have someone who is ready to do your site changes if you needed them to? Have you long-time pumpers ever been in a situation where someone had to change you site out for you? Is it worth forcing Pea to do one, even if he's really uncomfortable at the thought?

Funny site

Nope, I'm not directing you to a web-site that will make you giggle.  I don't have one of those to share today.  Although I did get quite an eyeful yesterday when I Googled "tighty whities" in an attempt to check my spelling for a post over on my knitting blog.  (Do you use Google to check your spelling sometimes?  Usually it works out really well . . . . except for yesterday when it lead me to a blog that I'm not even going to link.  I'll let you use your imagination, or Google it yourself.)

Anyway, when I say "funny site", I mean my pump site feels a little funny.  It doesn't hurt, but it just doesn't feel quite right.  Kind of like it's pulling at my skin.   I've never had a site feel that way before.

My blood sugars have been okay.  Not great, not terrible, but okay.  I woke up a little high the past two mornings (109 and 122).  After breakfast yesterday I needed a .2u correction Yeah, that's point-two units.  Not bad, but I usually don't need any post-breakfast correction.  Then again, I punched in that my yogurt has 10g of carbs and I think they changed there recipe and it might be 12g now.  Today's post-breakfast was perfect - and I didn't have a yogurt.

My highest high since putting this site in was 175.  So I guess I'll let it ride.  It will be time to change it out tomorrow anyway.  So unless I start hitting 200's, I'll leave it in.

At what point do you decided a site isn't right and put in a new one?  Now that finances are on everyone's mind, do you give your site a little more leeway before deciding it's bad and changing it out?

Good to be away, good to be home.

Well, vacation is officially over. We spend a fun week in Colonial Williamsburg for a Family Reunion with my mother's side of the family. I was sure I had gotten a shot of the 25ish of us all posing together, but I guess my camera was hidden away when the picture was taken. Hopefully some relatives will upload their copies soon! The best I can do is a picture of me and my brother at Jamestown, with my aunt and uncle in the back.


How can you tell that's me, and that we are related? Why, by the way we are both desperately trying to ignore the camera (and Pea) in the hopes of not getting our picture taken!! Our conversation probably went something like this:
"Is he gone yet?"
"Nope, still there."
"Well for goodness sake, don't look - and certainly don't smile!"
"Why doesn't he just go take a shot of the scenery?"

As great as vacation is, it's good to be home. Am I the only one who loves to go away, but maybe loves to come home even more? It's always so nice to be back in my own house, sleeping in my own bed and using my own clean bathroom where everything is accessible and not stuffed in a travel case. If it weren't for the empty fridge and piles of dirty laundry, coming home just might be perfect.

Another nice thing about coming home is cooking my meals own again. Now, I love a good meal out as much as the next person, but it's always a bit of a challenge. Trying to resist the less-healthy menu options (and in my case, usually ordering them anyway), playing Guess the Carb Count, and punching in S.W.A.G. boluses with the hopes of covering the mystery carbs just right. After a full week of eating every meal this way, it feels good to come back home to food whose carb count I am 100% sure of.

But as vacations go, things went pretty smoothly Diabetes-Wise. Well, okay, I did get my first ever non-delivery message at breakfast on Monday, which caused a near freak-out. But I caught it when my blood sugar was only in the low 200's, and since I had put in a new site a few hours earlier I knew to just change it out. By mid-morning I was back where I should be. Oh, and there was the night I accidentally gave my site a good whack. It seemed fine, but I woke up a 2 am in the high 200's. Not normal for me. Again, I changed out the site, stayed up for an hour to make sure my blood sugar was heading back down, and woke for good at 7 am with a reading of 72. Crisis averted. The very hot weather and all of the walking we did while sight seeing even afforded me a few treats along the way. (Mmm, fudge, how I've missed you!) All in all, not a bad vacation.

But it's still good to be home.

Did the Sugar Fairy visit me while I slept?

A few mornings ago, I awoke a little after 6:00 to use the bathroom. This is a normal routine for me. I rarely need to make a bathroom run during the night, but by 6 or 6:30 my bladder has had enough.

I noticed I was more thirsty than usual, but wasn't too worried. I had cooked some home-made Chicken Tortilla Soup for dinner the night before and figured maybe it was a bit heavy on the salt. Surely that was the cause for my thirst, and not a visit from the Sugar Fairy.

But as I washed my hands, I felt something smacking against my shins. I looked down, horrified to find it was the end of my tubing. I was even more horrified when I couldn't get the "quick disconnect" to connect back into my infusion set.

I woke up Sweetpea (my husband, who hates to get up early) and asked him to help me connect the tubing, but he couldn't get it to snap back in either. Best I can tell, I must have rolled over on the infusion set in the night and smooshed it but good. (It was toward the back of my hip.) But what time did this happen? With an impending sense of doom, I tested my blood sugar . . .

3 . . . .

2 . . . .

1 . . . .

327!!!!!!!!

In retrospect, 327 wasn't THAT bad. It could have been much, much worse. It could have been "off the meter". But, as a newbie pumper in the midst of my first equipment malfunction, I promptly freaked out and cried to Pea that I didn't want to end up in the hospital with The Big K.

Thank goodness for Sweetpea. He told me to calm down, and began to gather my supplies from the dresser drawer. In the mean time, I took an injection to adjust. Within a few minutes or so, a new set was safely in place. And by mid-morning, my blood sugar was a nice (if a bit low) 71.

All in all, I was very lucky to catch it pretty quickly. But I'm still a bit nervous each night, wondering what exactly happened and if it will happen again. Has anything like this ever happened to you? (I use the Minimed Quick-Set.)

This . . . is . . . Jeopardy!!!!

For $100, the reason construction hasn't begun on a building.
"What is a site problem?"
Correct!!

For $200, why little Suzie can't see the blackboard in her classroom.
"What are sight problems?"
Correct!!

For $300, it is why that web-page just won't load.
"What are site problems?"
You are on a roll!!

And for $400, the probable cause of those floopy blood sugar readings in my last post?
(can you see where this is going?) "WHAT IS A SITE PROBLEM'?
CORRECT!!!

That's right. When I changed my infusion set on Thursday afternoon, I discovered what I think was the problem. As a new pumper, I'm still very much in the learning phase, but it was quite obvious something was wrong. I snapped a picture, but I'm not sure how much you can see.


If you look closely, above the red mark where the cannula was there is a small blister type thingie. I'm not sure if it had insulin or puss (ick) or just air inside, but I've never seen anything like that before when I remove a site. So, along with the dozens of other reasons my blood sugars may have been "off", we can add this one.

For now, I'll just focus on the wise words of my new blog-friend and "give myself a break". Things won't ever be perfect all the time, so we just do what we can and move forward.