No Control

When you have type 1 diabetes and your blood sugars run high for a short period for no discernible reason, you have a checklist of troubleshooting tasks you have to tend to:

• Am I sick? Getting sick?
• Am I taking a medication?
• Am I stressed?
• Am I more sedentary than usual?
• Did I overtreat a low blood sugar?
• Did I underestimate the dose I last took?
• Did I forget to initiate that dose?
• Did I even receive the dose I initiated?
• Is my pump malfunctioning?
• Is my cannula (catheter) kinked?
• Is my tissue at that site not absorbing the insulin?
• Do I have an infected site?
• Did my insulin go bad?
• If it did go bad, is the whole glass vial spoiled or did it go bad in the pump cartridge?
• Are these my unlucky socks?

It's a ridiculous list. And there are times when you run through each point and find half of them that could be the culprit.

I removed this insulin from this pod,
but which of them was the culprit? I'll never know.

I propose that insulin manufacturers consider providing us with some kind of control solution or litmus test to evaluate the efficacy of our insulin.

It would be so easy to prime a drop or two from my pump onto a strip and see evidence that my cartridge insulin was compromised. It would be so easy to draw up a small amount from the glass vial and test it against a control that would allow me to see that I need to open a brand new vial.

Instead, we're asked to discard the whole vial and open a new one. Discard the whole pump setting and insert a new one. Start from scratch. If you can't isolate the variable, just CHANGE ALL THE THINGS.

It usually fixes the problem, but it's not at all economical. A vial of insulin costs me (or my insurance) an arm and a leg ($100+) and to toss one simply because you don't know and can't risk playing around with this shit is inefficient. I'd love to be able to call a pump company and say, "no, it wasn't the insulin - it was your apparatus" or tell Sanofi or Lilly or Novo that "yes, absolutely, my insulin spoils after ___ time in the heat or ___ time in my pump cartridge."

When I was pumping on the t:slim, it was clear to me that the insulin had changed because the color and consistency had changed, but insulin can go bad without those telltale signs. For two days at the Friends for Life conference, I might as well have been pumping water with my Omnipod. My numbers would not come down. A brand new pod and new batch of insulin fixed it, as it did again this morning after 12 hours of highs and 4 separate boluses of insulin and 2 injections. I'm finally below 200 mg/dL.

But would it be so difficult to develop a user-end litmus test for our insulin beyond using my own body as the test subject?

I don't know. But I'd like to find out.