Yeah, about that 3-day pump vacation I had last week: To be honest, it was a little less “Pump Vacation” and a little more “Sudden MDI Freakout”. The reasons for that are ones you can probably think of, but since this was unplanned, I wasn’t really prepared. I was lucky to have done as well as I did, when you consider these factors:
To begin with, I started back on the Lantus for basal insulin. I was still using Novolog for boluses, just like I do in my pump. But it’s been quite a while since I’ve used Lantus, and it scared the crap out of me. Prior to pumping, I had some pretty horrific lows on Lantus, and that’s the first thing I thought of when I did my first basal injection. Here’s the biggie: If I’m injecting for my basal, I need to take exercise and what I’m eating into consideration. Too much (read: ANY) eating without a bolus injection means going high. Exercising without extra carbs or without previously altering the basal injection almost certainly means eating and drinking like a juice-addicted chow hound later on. There’s no such thing as “threshold suspend” when you’re injecting.
Oh, and injections. Part of the flexibility with pumping is the obvious freedom to bolus whenever you need to, without stopping what you’re doing and finding your insulin pen, getting a fresh needle out, and injecting. For everything you put into your mouth. When I had bloused for dinner, eaten, and then Maureen’s family decided to go to Dairy Queen or something for dessert, I had to decide whether I wanted to partake and inject again. I still had to decide whether I wanted to add to my carb count for the day. But part of my decision was based on whether I actually felt like doing another injection.
And the calculations. I’ll admit it… I’m a big user of my pump’s bolus wizard feature. The first time I needed to do a bolus injection, my BG came in at 78 mg/dL. You know what that means, right? Take the 22 mg/dL I was below 100 to figure how much to reduce my bolus so I wouldn’t go low overnight. To my surprise, I found that doing these calculations in my head was like riding a bicycle (in my head). The first calculation took a while, and I practically singed some brain circuitry, but the rest were really no trouble. Good to know I can still do simple math in my head.
But I also had to remember that I was in sunny, HOT Florida. When we went out with my pump on, the air conditioning in the car kept my pump cool, and then we’d quickly go into an air-conditioned building of some sort. But I needed to take the cooler along when I had the insulin pens, or leave them in my pocket the entire time. Which can be tough with a swimsuit on. In retrospect, I should have just kept them in my pocket anyway.
All of this is just a reminder that a pump vacation may seem like a fun idea when you first think of it. But if you don’t do some real planning, you may find yourself in sudden MDI freakout mode, just like me. Make sure you have your calculations down, you’re familiar with what your insulin of choice is capable of, and make sure your meal/carb intake is well planned as much in advance as possible. If you think of these things ahead of time, you can look at even the surprise pump issues with a little less freakout and a little more vacation in mind.