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Pump Break.

(No, not "pump broke."  That would suck.)

I wanted a little bit of a device break earlier this week.  After dealing with itchy Dexcom rashes and doorknobs tugging hard on pump tubing and just feeling a little excessively-robotic over the last few weeks, I wanted to disconnect and decompress for a few days, before upcoming travel forced familiarity (and for me, device necessity). 

Because I live in that "hope for the best, plan for the worst" cliche, I have all the MDI tools on hand at the house.  I carry a Humalog pen with me all the time (in case my pump borks), so there's always one or two of those on hand.  My endocrinologist keeps a standing prescription for Levemir at my pharmacy in case of emergencies, which I had filled for traveling purposes a few months ago.  (And I've had the same two shoe boxes filled with unopened bags of syringes under the bed for about eight years now.  They don't go bad, right?  Here's hoping.)

So earlier this week, I took off my pump before showering and, instead of reconnecting, I took my doctor-discussed dose of Levemir at 10 pm.  (Months ago, when I took another short pump hiatus, my doctor and I worked out what kind of dose to take for days off the pump.  For me, splitting my Levemir dose in half and taking it 12 hours apart seems to be what works best.  So I take one injection of basal insulin at 10 pm, and the next one at 10 am.)  And I dose for meals/correct highs with an insulin pen of Humalog.

I do like the device-free feeling.  Or at least the device-free-ish feeling.  (Still wearing the Dexcom and trying to figure out a way to wear the device without experiencing a rash.  The next few weeks have me traveling quite a bit, and I'm not willing to go without the Dexcom for extreme time zone changes.)  I have worn a lot of dresses without shoving the pump into my bra (severe lack of disco boobs), and workouts have been nice without my pump gently trying to pants me.  I am enjoying these robot-free moments.

And I do like how injections make me really think about food choices.  The ease of bolusing from the pump makes me more likely to reach for a snack, but knowing I need to inject for it makes me rethink certain choices.  I can say, with certainty, that I've made better food choices in the last few days as a result of deciding what is and isn't bolus-worthy.

Old school.

I don't miss multiple daily injections as part of my long-term routine.  I don't know if using the pump has made me a wimp, but I think the injections sting.  (Yes, I'm a baby.)  Remembering the insulin pen is easy, because I keep it in my glucose meter case, but last night I forgot to take my Levemir before bed, and was greeted at 6 am with a 404 mg/dL (I haven't seen a number that high in a long time, and I forgot how gross the super-high glucose headaches suck).  Thankfully, I was able to bring it down quickly with a Humalog bolus, but it was a reminder that my brain enjoys not thinking about insulin injections and is comfortable with/accustomed to the steady stream of the pump.

And I don't like injecting in public.  I don't have a problem with it, but I much prefer to take out my pump and bolus from there rather than take out a pen, expose a needle, and then expose a bit of skin to inject into.  I never thought I'd feel this way, seeing as how I did injections for 17 years before I started on an insulin pump, but I do favor the discretion of pumping, when it comes to being out in public.  ... I've become a delicate effing flower.

What I like most is having options.  I prefer the pump for long-term use, but I like that I can take it off when I need a little breathing room and can swiftly revert back to multiple daily injections in the interim.  (Especially since my doctor feels strongly about having all kinds of back-ups in place for pump failure, leaving me with the right tools for MDI.)  This pump break has been good, but I'm oddly looking forward to reconnecting. 

Because honestly, without the pump on, I have absolutely no idea what time it is.

Comments

My little guy ripped his site out last night at my parents house. My backup set in my purse had been used on another child's ripped out set the day before, so I was left with a needle and his reservoir. After giving the shot he exclaimed it didn't hurt at all, and later questioned why he shouldn't just get rid of the pump and use shots altogether. His body, his choice...but when your 8 years old and your mother has to come to school to give you shots twice a day and you might miss some recess/handball time because of it, in his eyes MDI isn't even an option. (No school nurses in this California town.) I appreciate this point of view, and in the future I'll make sure to embrace the pump vacation when it's asked for...if only for a few days, for freedom from door knobs and playground slides that like to take tubing hostage.

Although my MDI excursion isn't really by choice, we are in the same boat when it comes to food choices. I almost never snack now (not that it's made a dramatic impact on my weight....perhaps because I often snack on delicious Italian meat and cheese since those really don't impact my BGs....) and I am loath to give myself an extra injection for a correction. Because I agree with you again: some of those shots sting!

Yes, some shots sting. And I hear you on not liking to take a shot in public. My insurance will not cover a pump or pump supplies (or a CGM for that matter) because I'm T2 even though I'm on insulin.

I do shoot through my clothes more often than not, and I'll often inject into my thigh in a really crowded place. The reasons for these are because both draw way less attention than the alternatives. If you're wearing a knee-length skirt, it doesn't take much to lift a portion of it up to your thigh to inject without going through clothes at all.

Kerri, it is because of your site that I've realized I need to be prepared for anything. I was just on vacation last week in Florida when my pump decided to conk out on me. Luckily I had the foresight to bring backup supplies for MDI's. While I did experience a sense of freedom from the pump, I did not like having to take an injection every time I ate. Oh yeah, I also never knew what time it was!

I didn't even know "pump vacations" were an option until I found your blog. I went on the pump in middle school (about 9 years ago) and it was great for the first 2 years, but I was a dancer and extremely active so being hooked to a machine got in the way. Instead of getting that "free" feeling that everyone who's on the pump talks about, I started feeling tied down and limited. And honestly a few months before I decided to go off the pump I was just burnt out on diabetes in general! If I would have know about "pump vacations" maybe I would have stuck with it... I wish i would have stuck with it because now I'm wanting to go back on the pump and I have to jump through the hoops all over again! Love this post and love your blog!

Hey Kerri. I totally get this. There are times I want to be 'free' of my pump too. Only I never manage to split my doses well and always end up 24 hours in with fuzzy vision, feeling crook and desperate to get back to the groove. Makes me appreciate it again.
And totally agree with the injections stinging! I think they're incredibly painful compared to site changes etc!
Most bizarre!

AP

I hear you about not wanting to expose a needle in public (though I've done it anyway, in my MDI days). But exposing skin? I've shot up right through my pants without a second thought ... except for those bleeders or "leakers" (that insulin pens tend to sometimes produce). But I did it anyway, on a wing and a prayer, hoping it would work. Usually it did.

I wear a dexcom and experienced severe rashes from the adhesives (i'd itch around it so much it would eventually fall off). My CDE told me about IV3000 1-hand and I cut a hole in the strip for the sensor to go through and voila no itchness anymore. Thought I would share since it worked for me.

p.s.LOVE you blog.

I've been pumping for about 4 years right now and have taken a few pump vacations. I'm currently on one right now, and honestly, I'm grasping at straws for a reason to go back on the pump....
Bottom line, I'm so much happier, freer, and less neurotic now that I'm back on MDI.

In terms of shots stinging, I learned a little while ago that if you lean the needle against your skin, it predicts whether it'll hurt or not. If you feel something, don't inject there! Move it over a millimeter and you'll have a pain free injection in a better site!

Been on the pump now for almost 4 years. I have not taken a vacation yet and I don't think I want too.

I do have all my back up stuff in place. What concerns me is that I am loosing my math skills. Before pumping, I could look at an apple, count the carbs and bolus accordingly without a second thought. Now, the pump does it all for me. I feel that taking my pump off would not be a vacation.

I don't like the idea of digging deep in my brain and re-teach the calculations to myself. But I must.

The pump has soiled me. I don't even know what my I:C ratio is or what my basal rate would be without my pump. That's scarey.

I would rather go to some place nice for vacation.

A pump break! Never thought of that. Wish I had your endo- sounds like a great doctor with all the back up plans. Good luck with your travels and managing the bloodsugars!

I too am just finishing a pump vacation. I haven't taken one in years, but loved the change in clothing choices! I stayed off my pump for a full 5 weeks and really got into the routine of shots again, but found the control was so much harder without my immediate bolus option! In the end, I love being a pump user and the good options it's brought to my diabetes care, but a vacation every now and then just does my body good.

Although I have threatened to take a complete pump break, I never have. Love the convenient bolusing too much.

What I have done is use the untethered regimen, especially when I'm on beach vacations. I take 80-90% of my basal with 2 daily injections of Lantus. I use a basal pattern of just a minute amount of insulin on my pump. I mostly use the pump for meal and correction boluses, but I am also free to use a syringe and vial if I want to.

The advantage of the untethered regimen is that I can leave my pump in the hotel room/condo and can swim and play at the beach or pool with no concerns about my pump. Works super great for me.

I haven't been having problems with my Dex sites, but over the last 6 months I've been having more irritation with pump sites. I often change infusion sets after two days instead of three because of redness and swelling.

Did this a few weeks ago. It felt great to be free of dodging door knobs and ovens handles but it felt so weird because I have been wearing the pump for almost five years straight. I started pumping a week before my husband met me. He was rather mesmerized to see me without a pump attached. No tubing to run into. But it also showed him and my friends how frequently I take insulin boluses. It boggled him and them a bit.

Also, neither of us ever knew what time it was because we always just glance at my pump.

I flipped back to needles after 3 years on the pump (because I had those leaky cartridges - completely broke my ability to trust the pump and all the different components that make the whole system "work". That time it was the cartridges, but the next time it could be the tubing, the needle, the motor... too many variables. It took my A1C jumping from 6.7 to 8.6 within a 4-month range (it was being done monthly at the time) to scare me to the bones. The doctors, nurses and pump company (I won't name names) were all dancing around the issue and pointing fingers at everything except the pump ("the pumps go through such rigourous testing!" etc). Still very disillusioned with the whole experience. Scared me right back to the simple, straightforward things that I can trust: syringes. The simpler, the better. The fancier things get, the more likely they will break or fail. That may be fine for a DVD-player, but not for my diabetes-management. It's simply too important to me. Yeah, pulling out the dang syringes can be a bit cumbersome in comparison to pushing a few buttons on a pump, but I'm in full control and I can trust myself. And I personally really appreciate being disconnected and not feeling like a robot. But to each their own...

I relate to the most recent post by K quite a bit. I had a leaky cartridge or two in my twelve-plus years on the pump, but my big problem was occlusions in my sets. After ending up sick roughly every other day, I couldn't take it anymore. I was beside myself thinking that going back on shots was the worst thing ever... and now, four years later, I don't want to go back to a pump for anything. Doctors and everyone else try to talk me into it, especially since my A1Cs are not exactly ideal (I've been creeping into the 8s in the last year) but having to change infusion sets daily because of the occlusions wouldn't help much. MDI isn't to blame for my A1Cs, but it's easy for my medical team to blame it on that since that's their focus and their bias.

I agree with " K " ... no, Pump for me, thank you very much. There is NO freedom in wearing a PUMP... just more problems!! Even though I don't like shots, they are awesome compared to a pump... :) We all have what we like, and I like to have the "CONTROL" as K stated with my Insulin. I feel that if you live any type of ''active life'' - being a Pump Robot will not work...

Good to know I am not the only one with syringes stashed for years. Yeah...I don't think they go bad, but who knows.

Here's another pump advantage: I use it as a night light when I have to get up in the middle of the night!

haha! I used my pump as a clock ALL THE TIME! Including this morning at the grocery store when I was timing the very slow cashier... :-)

I don't miss MDI at all, I don't even long for days without bio-parts (not to say I don't still dream of a CURE makes them unnecessary...) But you bring up a good point. Bolus worthy food with the pump and bolus worthy with MDI are different and I would probably make more better choices if I was regularly piercing my flesh with metal...

Maybe something to consider down the road. For now I'll take the 5.9 A1C I'm getting as a result of my pump and CGM and CDE who looks at my numbers weekly.

Kerri, I'm curious if you do any "toddler proofing" before going back on injections? E.g. do you have a conversation about needles being dangerous without the cap, or do you just keep them out of reach from her? I've often wondered how I'll explain that one day.

It is quite interesting to know about your pump break. There is nothing wrong in taking such occasional breaks. But please make sure that it is just for a short duration. There cannot be an effective long-term replacement for the these sophisticated devices.

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