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Guest Post: The One Diabetes Rule I Always Follow.

Thanks to the magic of the Internet and how words can travel from CA to RI by email faster than a sneeze, I’m happy to be hosting a guest post from friend and fellow PWD, Christopher Angell.  (You may remember him from such glucose tabs as GlucoLift and such guest posts as the one about decAY1c.)  Today, he’s writing about the diabetes rules he’s willing to bend and the one he always follows. 

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When I was first diagnosed and started my testing and insulin regimen, I did everything by the book. I disinfected test and injection sites with alcohol swabs (no longer recommended). I used a fresh lancet for every finger stick, and I always removed and properly disposed of my pen needles after each injection. I was a model patient (except on those nights when I washed down a giant bowl of popcorn and a chocolate bar with a bottle or so of pinot noir…).

Over time, however, my diligence started to show some cracks. After one too many meals out where I fished out my Humalog pen only to realize I was out of needles, I started leaving my last used needle on, and only changing it right before my next injection, so that worst case, I wouldn’t have to skip dinner or run home and force everyone else to wait while I retrieved my supplies. After using that “emergency needle” one or two times with no adverse effect, I got more and more lenient, until I was only changing a needle when it started to hurt (or required noticeably more force to do its job). Then of course I figured that if needles could be treated like that, lancets certainly could too- they were far less delicate to begin with, since they weren’t hollow.

When I started on a Dexcom CGM, it didn’t take me long to realize that those expensive sensors could have their lives prolonged without consequence as well, and I was regularly getting more than 14 days out them (I still do). Unlike reusing the relatively cheap lancets and needles, that had a real financial advantage. I also quickly learned that I could save my skin some wear and tear by using sites other than the FDA-approved abdomen. In fact, now I can’t remember the last time I wore a sensor there.

Even insulin, I discovered, was often (though not always) good well after its expiration date, or its 30-day window after opening, and subjecting it to a life outside the fridge was usually surprisingly benign.

Now that I’m on a pump, I generally change my cartridge and tubing every 6 days. I still take Lantus as well, and use one needle for the life of each pen, and I’m confident that I will never have to buy another lancet as long as I live (even if I were to live for 1000 years). So to say that I play fast and loose with the usage guidelines of my diabetes devices is to put it mildly. I don’t do it to be stubborn, and generally speaking I don’t do it to save money (though that’s a welcome result). I do it because every second not buying, storing, or changing a lancet, needle, sensor, or pump cartridge is a second that diabetes hasn’t stolen from me, a second that can be spent sleeping, talking, eating, ANYTHING but diabetes-ing. And if I’ve learned anything from living with a chronic disease, it’s that ultimately there are no small things – over time they all add up. Those seconds becomes hours and days over a lifetime with diabetes, so they’re precious to me, and I will only surrender them to diabetes if I truly believe I’m getting something better in return.

Which brings me to the one rule I DO always follow: I never leave an infusion set in longer than three days. Why? Limited real estate. I already know that prolonged injection/infusion of insulin changes my body, and I can tell the difference between a site that has been in one or two days and one that has been in three. I know that over time, the ability for certain locations to absorb insulin can be compromised, and I know I only have so many locations. I also believe that the next substantial improvement in my treatment will be some version of a dual hormone closed-loop pump (quite possibly Ed Damiano and Steven Russell’s Bionic Pancreas). This means I will need twice as much serviceable tissue to enjoy the full benefit of that treatment. So I’m doing my best to preserve what I have. Spending that time now correlate to very real potential benefits  in the future.

In the meantime, I’ve found other uses for my lancets.

15 Comments Post a comment
  1. Lindsay #

    Great Post! I don’t do it to be stubborn and I definitely enjoy saving the money. AMEN! :)

    05/22/14; 11:41 am
  2. “I do it because every second not buying, storing, or changing a lancet, needle, sensor, or pump cartridge is a second that diabetes hasn’t stolen from me, a second that can be spent sleeping, talking, eating, ANYTHING but diabetes-ing.” YES! YES! YES!!!!! Otherwise we will all go insane :)

    05/22/14; 1:39 pm
  3. Your story is similar to my own. The one notable difference is that I am inconsistent with my site change frequency. I’m currently changing that though, for some of the reasons you mentioned.

    05/22/14; 4:03 pm
  4. beth #

    Thanks so much for saying this! I kind of know this, and i reallly know is actually has a massive impact, but i still choose to ignore it too often…. it helps to hear someone else say that it is actually true and i need to stop pretending it isnt (and change my set today…)

    05/22/14; 4:58 pm
  5. Kristin W #

    So……. what do you use those lancets for????

    05/22/14; 5:05 pm
  6. Brennan Cassidy #

    Chris Angel is my hero!

    05/22/14; 7:18 pm
  7. Sandy T #

    Oh my goodness, all of this is so very true. All those seconds really do add up. So frustrating. I do pretty much everything but take out my infusion set every three days. I’m still working on that one, but I have gotten better about it. And I LOVE the use of the lancet. Now I know what I can do with the 120 that I have that no longer fit my lancet device (because obviously when I use 1 a quarter I needed a new box when I was nearing the bottom, what a waste). Who needs push pins when you have extra lancets?
    Thanks for the great post!

    05/22/14; 7:27 pm
  8. Chris, yes, yes, yes and yes! Thank you Sandy T. for the lancet suggestion…but that would only take care of one box and I have lots.

    05/22/14; 9:31 pm
  9. DennisD #

    Chris, I’m right there with you about reuse / continuous use of needles, lancets and not sterilizing injection, infusion, finger-stick sites. That has been my practice for most of my 57 year T1D struggle – well, except for the first few years when I [or more often my mother ] would boil the horrid steel “horse-needles and glass syringe.

    05/22/14; 11:19 pm
  10. I never really considered that good site rotation/changes could play a role in my possible future with a closed-loop system — I’ve been following the Bionic Pancreas project pretty closely and find it equally fascinating and exciting. Thanks for this perspective!

    05/23/14; 7:47 am
  11. Susan #

    I just recently started pumping. How do you change the infusion site (3 days) and not the tubing (6 days)?

    05/23/14; 8:56 am
  12. Kaitlyn O'Hagan #

    It’s so reassuring to know that I’m not the only one flagrantly avoiding these diabetes “rules” without consequence!

    05/23/14; 12:09 pm
  13. beth #

    Hi Susan! welcome to pumping world…
    Changing one and not the other is one of those things that can def make your life easier but the med team dont always tell you about. It prob depends what pump you have and what set you have – I can do this with my animas with my inset 30s (where they are packaged separately) but is a little harder with some of the other sets. I just replace my set and then plug in the old tubing, and tell my pump to fill canula (but not rewind/load cartridge/prime tubing). If you have different sets/pump to mine then ask someone who has yours!
    beth x

    05/23/14; 1:50 pm
  14. Marie #

    A quick comment on reusing pen needles.
    When I was younger, it was actually the practice to reuse needles up to 3 times. Then, new studies came out. My educator showed me macro pictures of the needles after 2-3-4 injections and it wasn’t pretty. They realized that it was doing more damaged then they thought to your skin and increase the risk of needle breakage. The damaged needles were also increasing the insulin bumps – you know, those fake muscle on your arms. Since that day I have only reused a needles in emergency situation only.

    You can do a web search reused needles and find photos. Diabetes Health had an article on the subject.

    From there, make your own decision.

    05/31/14; 2:21 pm
  15. Jim #

    Great post. I certainly can relate as to how my diligence faded into a lax series of behavior shortcuts in several ways. I have had very tight control (according to A1C) for several years and I think that has lulled me into a false sense of what matters and what doesn’t. The really hard part if perspective: its not about how I FEEL today so much as it should be how I am building toward a more successful long term future. Perspective is hard. Your dialogue shook me into a good, healthy thought process on this subject. thanks! I am back to drinking the “kool aid as per T2D daily guidelines…

    07/8/14; 4:24 pm

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