Tidbits and Tricks

Today's Prompt: Learning. Share something you learned from another Health Activist (that everyone should know!).

First of all, I am not a licensed medical professional. I'm not trained to give advice on anyone's diabetes but my own.

That being said, I want to share a revelation that I picked up online that changed the course of my diabetes. It changed my blood sugar spikes. It lowered my A1c. I credit this piece of advice more than any other in getting my body ready for pregnancy. It changed everything.

It matters when you take your insulin.

Online we call it pre-bolusing.

The last few years, continuous monitoring has taught medical professionals a lot about how insulin works in the body. When the newest fast-acting analogs came to market, we were told we could take them right on top of meals. When my doctor started me on Apidra just after it was approved by FDA, we thought it would help me because I usually bolused after meals and this insulin would supposedly accommodate that habit.

Fast-forward to the days of continuous monitoring.

We now know that the "fast" insulins are not as fast as we thought. When taken on top of (or worse, after, meals), Humalog/Novolog/Apidra miss the post-prandial (post-meal) spike entirely. They should be taken earlier. I won't give advice on how early, as I think it can vary from person to person, but I know how many minutes before the first bite of food works for me at most meals.

The pushback I get from most people when I suggest pre-bolusing involves one of the next two arguments: 1) But what if I go low before the meal? and 2) But who knows how much little Timmy will eat? It's easier to bolus afterward.

I'll address each of these valid concerns.

Already Gone

I started pumping on the Tandem t:slim in October 2012, less than six months ago. Let me begin this post by saying that I consider myself extremely fortunate to have access to expensive medical devices like touchscreen insulin pumps. Not everyone is so lucky and not everyone has good insurance.

My endo reminded me today with a smile at my quarterly checkup that I had begged her to let me try this pump. I had high hopes. So it is with frustration, embarrassment, and a heavy heart that I put this pump back on the shelf.

I loved the innovation. Loved the employees with whom I have interfaced. Loved their responsive customer service. I won't tell you not to get this pump. I hope your experience is incredible.

It was not the right choice for me.

I've blogged here regarding the fact that Apidra insulin cannot be used in the t:slim. Cannot. Be. Used.

When I last blogged, I stated that I would be trying Apidra on a 48-hour rotation to see if I could have a functioning pump for that short of a cartridge lifespan. By hour 30, my blood sugar had skyrocketed. By hour 37, my insulin was spoiled. Cloudy. Gray.

Musical Chairs

There's a phrase in German for when you can't pick between two people you love - "zwischen zwei Stülen" or between two chairs, meaning that you have to pick a seat if you're going to sit down.

I'm in a room of empty chairs.

I love my old, use-it-when-I'm-frustrated-with-everything-else-in-my-life, 100% dependable, out of warranty Cozmo insulin pump. They're out of business now. I have been wanting to move on. She's been there for me. When I first got my A1c into the 6s. At the end of two pregnancies when my Omnipod couldn't hold enough insulin. She's my ugly little workhorse and I love her, but being out of warranty, I'd really prefer her to be my safety school. Not my primary path.