I ditched my Saturday AM gym workout in favor of a family hike with good friends who live in Boulder. I expected we would be gone all day and considered taking my back up insulin and needles, in the unlikely event I might need them. But it was hot – close to 100 degrees – and insulin needs to stay cool. We were out of ice and I hadn’t prepped my FRIO and I was concerned the insulin would get too hot in the car. So opted to leave my backup insulin and needles at home (and now you know where this story is headed).
We were hiking with small children, so as it turned out, it wasn’t the most vigorous exercise. But it was a stunning Colorado hike.
Afterward, we picnicked in downtown Boulder. As I was unsure what the hike had accomplished for me metabolically, I dosed conservatively, planning to check my blood sugar again in an hour and re-dose as needed.
I didn’t have the chance to re-dose. Instead, 15 minutes post-meal, my pump alarm sounded. That usually means one of three things:
- Check Blood Sugar / Just ate – too soon to check.
- Low Battery / Inserted fresh battery that morning.
- Low Insulin Supply / Replaced the infusion set and and insulin the night before.
The beeping was getting louder and more urgent. It now had my full attention.
I unclipped the pump from my clothing and consulted the screen:
Sounds fairly innocuous, right?
I tried to cancel the alert. No luck.
I tried to back out of the screen.
Again, no dice.
Suddenly, as though impersonating a Vegas slot machine, the pump began wildly scrolling through three-digit numbers – numbers so big it was downright uncomfortable to see them on a pump.
I excused myself and called Medtronic.
Within five minutes, a customer service representative was assuring me that my pump was still under warranty so Medtronic would send me a new one, for free. How great of Medtronic and what a relief. It made the next part easier to swallow.
Medtronic: If you don’t receive your pump by Tuesday, please give us a call.
Woah. Tuesday? (This was Saturday.)
Me: I hope I don’t sound unappreciative, but Tuesday is three days from now.
Me: Do you know that the pump is what I use all the time to manage diabetes?
Medtronic: Yes. You will have to move to your backup plan.
People with diabetes have lots of back up plans. We have plans for high-fat meals, plans for high-carbohydrate meals, for delayed meals, for exercise, illness, stress, unexpected lows, stubborn highs… But a backup plan for all-out pump failure? Nope. I didn’t have that. Plus, my short-term back up plan was at home in the fridge.
So, there we were in Boulder with our friends, the kids, and the dog we were looking after. How much active insulin did I have on board? I really didn’t know.
So we went home. And I considered how to be pump-free for three days.
Option A – Multiple Daily Injections (MDI)
MDI therapy generally utilizes two types of insulin – short- and long-acting insulin. The long-acting insulin stabilizes blood sugars between means, the short-acting one covers food. Insulin pumps eliminate the need for long-acting insulin because it works as a healthy pancreas does – continuously delivering micro-doses of background insulin. And that’s fantastic, but it’s also the reason I don’t have a prescription anymore for long-acting insulin. So, to temporarily implement an MDI approach, I would have to call my newish endocrinologist – the one I really don’t have a relationship with yet – on a Saturday for a prescription. A vial of lantus would cost $120. I’d use it for three days and throw it away (it lasts for a month when opened). Not ideal.
(Please read this disclaimer before reading on.) What if I could mimic the pump, giving myself little micro-doses of short-acting insulin throughout the day and night?
Had other PWDs considered this route? I went online found several pumpers who had apparently used this approach with some success. I decided to try it. Feeling that night time would present the greatest risk, I set my alarm for every two hours and gave myself teensy doses of insulin. The next night, I checked only every 3 hours. The night after that, I checked only once. It was tiring, but I stayed between 89-133 every night. I was glad to know I could do that in a pinch, but very, very glad when the pump arrived at my door Tuesday morning.
In the end, I am reminded how much I appreciate my insulin pump, the company that makes and supports it, and the DOC.