Jenny’s Journal:

31 years, 9 months and 2 days with type 1 diabetes has certainly allowed me to see and use the gamut of products for management. Along with these advancements, strategy to manage has also changed. For the most part as new developments come out there is less and less that we have to do “old school”. So, you may be out of practice or have never

What do I mean by old school you might ask? Going from Omnipod Eros to DASH is not old school to new tech. We have to think much farther back than this in order to see some of the tools that were taught years ago. Once we know and understand these techniques, even if they aren’t used on a daily or even monthly basis, it is an additional tool in that box of management strategies that can come in handy when your new age tech device goes kaput!

I’ve worked with people of all ages and everyone has their device or product that they feel most comfortable in using. Many people also have a backup for their devices – an old pump or a backup pump in case the one in use decides to fall in the toilet or give an internal error and just not work any longer. This is great, but what if you really have a tech failure? Something along the lines of the Dexcom Share failure we had months ago…or worse, a product failure while out of the country or on vacation without any extra device to replace it.

Do you know what to do with simple tools like insulin, a syringe and a glucometer to manage until you can get back to 2020 devices? If you do have these as a backup, do you know how to calculate and adjust without that fancy “bolus calculator” and record of Insulin on Board that is stored in that pump?

If your answer is NO :-0 , read on. Don’t feel bad. Honestly a lot of people start using technology like a CGM and a pump soon after diagnosis or some might (for a few with progressive clinicians) leave the hospital with a product in hand or already in use. You may have never been taught to use a syringe with a vial of insulin, how to draw it up correctly and how to inject properly. OR you may have not used basal insulin long enough to remember exact use.

A blast from the past: some “old-school” Diabetes management tools to have in your toolbox!

• Have on hand insulin syringes (half unit are available) or at least insulin pens (also available in ½ unit dosing from both Lilly and Novo-Nordisk)

• Dosing algorithms written down – Insulin to Carb ratios as well as correction/sensitivity factor

  • • Correct a high BG –
      • Use the formula: Current BG – target BG divided by your correction factor = correction insulin to give
    • Bolus for food –
      • Use the formula: Carbs counted divided by the Insulin:Carb ratio for that time of day
    • If you are eating and correcting BG – add these 2 calculations together.

• Note the dose of basal insulin your pump provides daily in the same place you noted dosing algorithms – in case of pump failure a basal insulin will need to be given in the amount of basal your pump provides in a 24 hours time period.

• Vial of basal insulin (several options on the market today) in the fridge…so you don’t have to run to the pharmacy at 2am!

• If CGM fails – yup, that is why you have that glucometer and lancing device. While it isn’t as “convenient” to test BG via fingerstick, it is still a way to get data and dose correctly.

  1. • Text the results to whoever needs the info if you still have internet connection
     • Test at the right times to understand how to adjust
       • Fasting, before each meal, 2 hours after each meal, bedtime as well as any other times around exercise or illness that might be needed.
       • If uncertain of overnight insulin action off a pump, set an alarm to get up 3 hours post bedtime to test BG and adjust if/when needed with carbs or correction.

• Use an App to help – I know, this isn’t “Old School”, but there are some good Apps that allow you to get bolus dose calculations and remember IOB when a pump fails.

  1. • RapidCalc Diabetes Manager is a great one.

• Urine Ketone Test strips. While blood ketone testing is the most optimal, if you have no strips or the meter isn’t working, the urine test strips are better than no testing at all.

If you can learn how to use these tools or have them as a backup it will mean a lot less stress when technology fails you at the least opportune time. 

My parents would have loved a pump that was smart with a CGM that told it how to dose insulin better along with information about how much insulin was left working since my last dose, but what we had was insulin, syringes and a 4-minute glucometer. My parents did an awesome job with the tools they had and I’m alive and well today even after years of using these old school methods that seem so lacking compared to what we have today. If you can use these tips and tools that kept me alive for many years before technology changed things for the better, then in a time of tech failure, they will likely save you a trip to the Emergency Department. Or at least they’ll help avoid a high level of anxiety from not knowing where to start.

As always, if you feel you need to learn some things about old school diabetes management in case of a zombie apocalypse or just a failure of technology, give us a call. Integrated diabetes services strive to provide education that will keep you healthy and informed so you can keep on enjoying life.