Back to Basics (sort of)

When you live with T1D 24/7 and work in the field all day, what can you do for fun? Experiment, of course!

Last month, our clinical team decided to give up our pumps and hybrid closed-loop systems, and go back onto injections for a day. We called it “back to basics” day, but it wasn’t really all that basic. We still used our continuous glucose monitors (nobody was willing to give up CGM without a fight), and we had the option of using smart/connected pens with our choice of the latest injectable basal & bolus insulins. Expecting the worst, we stocked our pockets with glucose tabs and stashed plenty of snacks at our bedsides for our headfirst dive into the world of MDI (multiple daily injections).  Here are some of our experiences:

Anna took syringe injections of Levemir and Novolog.  It resulted in a monstrous glucose rise in the morning, like Godzilla rising from the Sea of Japan. Alicia’s Levemir produced a 60-point rise overnight on the first night. Later at dinnertime she forgot her Humalog pen, but reported that the extra daytime basal was just enough to cover sesame chicken. She went a couple extra days on injections and managed to get her overnight glucose to stabilize. Alicia appreciated being able to shower and dress without dealing with the pump, but found MDI just wasn’t worth the extra hassles.  She and Anna reported that they kept “groping themselves” for their pumps at mealtimes.

Kathryn was high all night on her first night of MDI and then dropped low at midday… and again at bedtime.  She did much better the second day though, staying in-range all day long.  Still, she reported missing a good night’s sleep. I took basaglar (generic Lantus) & Fiasp via pens.  My daytime control was about the same as usual, but my glucose exploded in the early part of the night (when my basal usually peaks).  Got back on pump & Looping exactly 24 hours and 3 minutes after taking the shot of basaglar (it took 3 minutes to set up the new pump).

Jenny was the last one to go… she really had to psych herself up to go back onto lantus & Humalog via syringes. She was stable but a little higher than usual overnight and dropped low with some light exercise in the late-afternoon. Let’s just say she wasn’t a happy camper. She set an alarm for 24 hours after taking Lantus to play the children’s song, “If you’re happy and you know it…” to let her know it was time to go back on her pump.

I think Anna summarized the injection experience best: “Less beeps, but more swearing.”

Hey, it could have been much more challenging if we had to use NPH (or Lente) and Regular insulin, follow an “exchange” diet, and check our glucose using nothing but fingersticks. But it was valuable for us all to take a step back. Because the fact is, not everyone prefers modern technology, and not everyone has access to it. We have serve people based on the therapy they choose, not what we prefer.

I hope you enjoy this edition of Diabetes Bites, chock full of research news, clinical insights, and fun stuff. And remember, no matter how you choose to manage your diabetes, you can do it a little bit better with some expert training & education. Please reach out if there is anything we can do to assist.

Together, there’s nothing we can’t accomplish!

Gary Scheiner MS, CDCES
Owner, Clinical Director

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Best Always,
Nancy

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