It Wasn’t The Insulin… Literally


I figured out what put me in the hospital.

I actually figured it out a few days ago, but I was so embarrassed that I didn’t want to talk about it. After a short talk with one of my board members yesterday, I’ve decided that to hold back would be bad.  I feel I have a responsibility to share what really happened.

I made a really stupid mistake, and it cost me a lot of pain and misery.  While it’s too early to tally up the financial figures (I haven’t received any of the hospital bills yet),  I’m sure it cost me a pretty penny as well.

The thing is, I feel that I was a victim of my own over-complication.  I feel that the whole experience was my fault.  There’s that guilt thing again.

I was just trying to make things work for me. In the end, it was a perfect storm of circumstances, bad timing, and good intentions.

I have been using Symlin off and on for about a year and a half now.  I think that it helps me, both in reducing the post-meal blood sugar spikes and in making me feel satisfied with less food.  But I struggle with having to take shots again.  I’ve been pumping my insulin for so long that I’ve gotten spoiled by the convenience and comfort of it.  I know – crazy for a person with diabetes to bitch and moan about shots.

I put our problem solving skills to use and figured out a way to take advantage of the benefits symlin was providing without having to take shots again.  I started pumping symlin in a second pump (an old, out of warranty pump).

Now, back to Wednesday night.  I was planning my twice-monthly overnight trip to Iowa for work, with a morning departure around 4:00 or 4:30 AM.  I had already worked a very long day and was really scrambling to get everything ready. I was also trying to get to bed early.  I was zipping all over the house trying to prepare, and I realized that I needed to change all of my pump stuff and put in a new Navigator sensor.

If you are a pumper, your care team should have taught you to never change your pump stuff out at night before bed.  My experience is a perfect example of why.  Until this happened to me I thought that I had good reasons to change my stuff out at night.  After this experience, I will do all I can to break that 12+ year habit.

To make a long story short(er), I loaded a cartridge of symlin into my insulin pump, and a cartridge of insulin into my symlin pump.  Don’t ask me how I did this, because I really couldn’t tell you.  My mind must have been thinking about a million things at once.  They don’t even look the same (I only fill my symlin cartridge about halfway, but I fill my insulin cartridge completely).

The symlin didn’t really hurt anything.  It just wasn’t insulin.  What about the other pump?  The one with insulin in it?  I don’t wear the second pump around the clock, like I do with the insulin pump, but even if I did, the basal rates are set so low that it wouldn’t have saved me.

If I had been awake I would have felt “funny” and would have started to investigate.  I would have had time to notice my blood sugars rising, and might have had a chance to fix things before they got to the point of no return.  But because I was asleep, I didn’t even know anything was wrong.  By the time I woke up it was already too late.

What about my Navigator CGM?  Shouldn’t that have alarmed me that my blood sugar was high?  I had put a new sensor in that night so it was still in the middle of its 10 hour calibration window (during which it does not give any readings or alarms).  Bad timing would be a bit of an understatement.

I’ve changed a bunch of stuff in my routine to try and avoid this mistake in the future.  I’m going to do all I can to not change my Navigator CGM sensor at the same time as my insulin infusion set.  I’m going to do all I can to not change both pump sets at the same time.  Finally, I’m not going to change my sets at night anymore if I can help it (even though I swear it takes the edges off the high blood sugar problems I have on a new site).  That is my plan.  DKA is no fun, and I’ll do whatever I can to avoid blood draws from my knuckles again.

It is still a great idea to check expiration dates on your insulin, but I don’t think there was anything wrong with the bottle I had.  The stuff I loaded into my pump?  It wasn’t the insulin.

Pumping Symlin (part 4)

Q & A time!

Q) A question about your Symlin pump–do you use some basal Symlin as well as boluses at meals, or is that pump’s basal rate set to zero?

A) On my Symlin pump I run a tiny basal rate of 0.10u/hour.  This was based on advice from Gary Schiener (who pumps Symlin too).   Apparently Symlin is a little more prone to blockages or occlusions because it sticks to the infusion set material more than insulin does.  Running a small basal rate keeps the fluid moving enough to help minimize that.  I’ve not had a blockage/occlusion alert yet.

Q) Scott, am I reading correctly that pumping Symlin means one constant rate of 0.1u with no boluses for meals?

A) Before my meals I take a bolus of Symlin, above and beyond the basal (which is such a small rate that it really doesn’t do anything other than help prevent blockages/occlusions).  I take 10 units, which is the equivalent of the 60mcg dose on the pens, and try to get that Symlin bolus in 15-20 minutes before eating.  I also start an extended bolus of insulin through my insulin pump for the carbs in the meal when I actually start eating.  Again, mimicking what has worked for Gary, I run an extended (or square
wave) bolus for 90 minutes.  This seems to work pretty well, but (like everything else with diabetes) there is room for improvement.  There are also different situations where I need to time the bolus differently, and I’ll either stretch it out more or wait a while to start it.

Q) This is fascinating. Do you run out of sets? How do you deal with insurance?
A) I talked about this a little in the last Pumping Symlin post (part 3).

Q) Can you fill us in on the 2nd pump thing? Which model? Where do you put the 2 infusion sites?
A) I rotate both my insulin site and Symlin site (usually) at the same time.  I try to stick to a 3 day schedule, but may stretch it to  4 days to conserve supplies.  This is a hard balance because I don’t want to fight scar tissue in the future (from wearing each set too long).  I put the Symlin infusion sets in the same types of places that I put my insulin infusion sets.  A few configurations I’ve used so far is the insulin set on my upper rear end and the Symlin set on the love handle/side/lower back area.  Or maybe the insulin set on one side of my belly button and the Symlin set on the opposite side.  It really can go wherever you can put an insulin infusion set.  Today?  I’ve got my Symlin set in my lower back and my insulin set in my arm.

Q) Have you lost any weight as of yet?

A) I think about 4 pounds.  My weight fluctuates a lot, especially when I play basketball.  The first day of the week that I play basketball I usually lose a little over 5 pounds of water weight.  I play an additional 2-3 times more through the rest of the week, and struggle to drink enough to stay hydrated.  So, if I weigh myself on Monday (before any basketball) I might be 5-10 pounds heavier than if I weigh myself on Friday (after a week of heavy exercise and sweating).  I have not gotten into a routine where I weigh myself at a consistent time under consistent conditions, so it is hard for me to tell.  Does that make sense?  With that being said, I am trending down, so it is heading in the right direction.  Because I’m trending down I am not overly focused on the numbers.  I’m just going to keep doing what I’m doing and let it rock for a while.

Q) Do you think the pump will live much longer?  How old is it?
A) That is a very good question.  The answer is: I don’t know.  I think the pump will keep on ticking, but as we all know, stuff happens.  The pump is a little over four years old.  My two other old pumps still work (one is over 10 years old!), but I don’t have a steady line on supplies for them.   I guess I’ll cross that bridge when I get to it.

What other questions do you have?  Did I answer everything so far?  Let me know in the comments, and if there are enough I’ll throw up another post (otherwise I’ll answer them in the comments).