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Location: Minneapolis, Minnesota, United States

Diagnosed with Type 1 diabetes in April of 1980. I recognize the incredible mental struggle of living with diabetes. I hope to share my struggles, my successes, and everything in between.

Friday, April 13, 2007

Mixing Variables

I have so much on my mind. So many things I want to talk about, think about, write about. But time is what it is, and there's just not enough of it.

I'm behind on all of your latest news. I look at my bloglines "new post" counter for the OC blogs that I try to keep up with. The number is well over 200 (236 to be exact).

I love it.

While seeing that number so high is somewhat intimidating, it is also so very exciting to me to see so many of us expressing what living life with diabetes is all about. This invisible condition has a strong voice now - The Diabetes OC. You all are my heros. I gain so much insight, inspiration, strength, resilience, and courage from all of you. Thank you.

What's on my mind tonight? A few things really, that all come through the story of my day.

I was supposed to change my infusion site this morning, but didn't. Just didn't feel like it. I figured I could get through the day and deal with it later. I'm not a morning person, so mornings are just not a great time for me to make decisions like that.

"Hmmm...let's see. Sleep in an extra TWO MINUTES or get up and change my infusion site?"

So I slept in (for two effing minutes - totally not worth it). I had about 35 units of insulin left, and figured if I could go easy on the food it would get me through the day (I typically use about 75 units a day, with about 25-30 from my basal rate).

But I had a huge lunch (don't ask), and exhausted my insulin supply before 1:00 PM. I had insulin back at my desk, so I figured I would just do a site change at work. I rarely do my site changes at work. Just something about the whole "balanceitallonthetoilet" and "sanitary" not going well together...

Here's where things get interesting, and it also calls for a couple of tangents for background.
  • I use the Medtronic Quick-Sets (old school with the luer lock), and the "Quick Serter". A spring loaded insertion device that (when used properly) slams the needle bearing infusion set into place with (usually) very little pain and (usually) less chance of incorrect insertion. I had one at work that I had never used before, and there was something different about it - the set didn't sit in there quite right and I struggled with it for a while. I think I eventually got it in the device "well enough", but I can't be sure. That was one factor that complicated things.
  • I normally use Humalog insulin. Never tried Novolog. I happened into a bottle of Novolog and I decided that this would be a good weekend to try it. That was another factor.
  • I wanted to try a thigh site. I have NO idea why I was so set on trying something new. I have very little subqq" tissue on my legs. They are strong because they have to carry me & my stomach all over! They are not shapely legs, mind you. Just strong. But I found a spot that I thought might work.
So, here I am in the restroom of work, hiding out in a stall for privacy. I've got my freshly filled cartridge full of Novolog, my infusion set & tubing, my inserter device, and an alcohol swab. All balancing on various parts restroom stall. Some on the toilet paper holder, stuff on the top of the toilet tank lid, and both hands full. All this and with my pants down to my knees for access to where I want to place the site.

As I prep the site, then fight for a couple minutes with the infusion set and inserter device, I sit there with it cocked, locked, and loaded, pressed against my skin. I can feel the needle gently jabbing the surface of my skin. I only need to pull the trigger(s). But I hesitate...

I'm scared. I've never inserted here before. Will it hurt? Is there really 9mm of available soft tissue there, or will the needle and cannula slam into my muscle (which hurts like a sonofabitch to me...).

With this being only one very small example of the "Everyday Courage" we rely on, I pull the trigger. It hurt. The tape got all hung up on the sides of the inserter, so it was pulling the whole thing out as I tried to pry the inserter away from the tape and cannula that is supposed to remain.

"Well", I thought, "This isn't going quite as I had planned".

But I didn't want to give up on the site. I was able to get the tape loose from the inserter and pull the needle out. The cannula was, I thought, halfway in - so I just pushed down on top of the infusion set. Creepy feeling - in the new location. It just didn't feel right.

I connected up to it anyway and started up the rest of my lunch bolus. As the pump was delivering I prepared to remove the old infusion set. I stopped myself and thought I had better leave it in place in case there was a problem with this new leg site. I got a blockage alert on the new site within 30 seconds.

I reconnected back to the old site and finished bolusing. I took out the new leg site, and just my luck - a gusher. Bleeding like all get out. I grabbed some toilet paper and held it tight for a few minutes. It finally stopped bleeding. I was glad that I had not oozed blood all over everything.

So - I clean myself up, clean up my garbage, and head back out to my desk. Now pumping Novolog insulin instead of Humalog, and into my old site instead of this fancy new thigh site I was planning.

Nothing major so far, but something is different. I have been eating a lot today, but my BG's are not low, but a good, mid-100 number, with a bunch of insulin still on board ( I swear the body can sometimes tell when there's just too much insulin for what it needs). I'm not sure if my BG will stay there, or drop because of that insulin on board.

Why is all of this happening?

Is it the Novolog? Can it really make that much of a difference? Enough of a difference that if I were to switch to Novolog (I'm not yet seriously considering) I would have to probably re-evaluate all of my ratios and settings?

Or did I deliver a fair amount of insulin into my leg muscle in the bathroom? I believe that delivering into the muscle "does things" to the insulin absorption and efficiency (giving it a slight "supercharge"). It doesn't seem like that should be the case though, because that was early this afternoon, and now it's 1:00 AM. Plus, the amount of insulin I delivered prior to the blockage was not a significant part of my typical total daily dose. It should not be playing games with me so much later...

So what is it? I'm not sure, and I will probably not know until I do some more controlled experiments. I need to nail down the variables as best I can to isolate what it is that is making things happen.

  • No mid-day site changes (if it can be avoided - I want to change in the AM and at home)
  • No new infusion sites (NOT the best time for me to get crazy with it)
  • No crazy lunches just before (If you program your lunch bolus using the DOWN arrow ONE TIME to enter your carbs, you're eating too much...)
One change at a time Johnson. One change at a time.

Just stick with my typical routine that I am familiar with. I mixed in too many variables at the same time, and because of that I'm not sure what the heck to think. Watching things over this weekend will help me figure it out, but only a little. It will also take more than a single weekend to know if Novolog acts different than Humalog for me.

Moral of the story? Don't mix your vegetables! I mean VARIABLES!

16 Comments:

Blogger Johnboy said...

Scott, you did have a lot of variables at play there!

I switched to Novolog in January because the copay was lower as a preferred insulin on the plan. No difference for me.

Good luck!

4:22 AM  
Blogger Rachel said...

Greg started using Novolog (insurance reasons) a few weeks ago. It seems to be acting differently than Humalog, in his favor.

5:58 AM  
Blogger Scott said...

I've tried Humalog, Novolog and Apidra (I settled on Apidra for the time being). My experience was that Humalog works fastest (it peaks at hour 1 and continues for another hour, then it was done), but also has the shortest duration of activity. By comparison, I found Novolog painfully slow (no drop for at least 2 hours), but it also lasted about 6 annoying hours. Apidra falls in between them, faster than Novolog but lasts longer than Humalog. Maybe the third time is the charm for me?! You might want to try Apidra out if you're considering a change.

6:59 AM  
Blogger jill. said...

Wow, I can't imagine trying to do a site change in a bathroom stall! (let alone a new site..) But I did get a kick out of imagining you in there :)

Hmmm as for Humalog v. Novolog, I think Novolog works a little faster and a little stronger (for me anyway, but I've heard people say the exact opposite..)

Good luck! Hopefully you can figure all of this out one variable at a time :)

7:02 AM  
Blogger Minnesota Nice said...

Scott, Health Partners is my HMO, and last year they forced us to switch from Hum. to Nov. - no difference for me either.
Enjoy the nice weekend ahead!

9:13 AM  
Blogger Megan said...

My endo is always telling me one thing at a time! He wouldn't even let me switch to Lantus and Novolog at the same time, so I was taking Lantus and using R for my boluses for a bit (back in the day). I'll be interested to see how you like Novolog overall. It's what I pump.

9:21 AM  
Blogger Molly said...

Scott-

An absolutely great entry!!! I think because I have BEEN THERE! I laughed so hard (not at your expense--just because I have had the same experience) that I nearly had to turn my basal rate down for all the exercise! :-)

Thanks for sharing.

11:01 AM  
Blogger Sara said...

Two things:
1. I didn't even know you could press the down button when programming carbs - but holy cow - that starts at 300 carbs! What did you eat? :)
2. They changed the design of the Quick-serter because evidently people were having trouble remembering to press the top circle to release the infusion set from the serter. So anyway, they removed the part of the Quick-serter that held the set in place. It seems to me to basically just be a balancing act now. That may have been your problem.

11:04 AM  
Blogger Vivian said...

Great post. When Daniel changed from Humalog to Novalog it was a considerable difference. I guess these things are very individual.
Good luck with the new leg site when you try it again.

9:24 PM  
Blogger Kate said...

Gotta love it when there is too much going on to isolate what is working! I have been using the outside and top of my legs to help minimize the scar tissue that I get in my stomach. I do find it's harder to tell whether I'm pinching up muscle or fat especially since I've been working out. I also find that it's easier to find the fat sitting down so the upper leg is relaxed- not standing like you were in this instance. So, hopefully these tips help the next time you want to try a leg site:)

9:39 PM  
Blogger bethany said...

i've used novolog twice - once for 3 days and once for a whole week. for both time periods i spent the entire time on the couch crying from the horrible stomach pains it gave me. i also had horrible lows with novolog. but all my friends from camp use novolog and have no problems with it. so who knows ... and thanks - i got the package today.

11:30 AM  
Anonymous Scott M said...

I applaude your self-experimentation. Nothing wrong with trying out a new routine of insulin or cannula site, I say. I can relate to your "stall-juggling", it is not always a successful outcome. While I can't relate to Humalog(I was on it very briefly at early dx), I use Novolog and inject into the thigh all the time. Works for me because I usually bolus after eating a meal, and the quicker absorption is needed.
I have tried my calf the past couple days for a new injection site, surprisingly refreshing. Very little pain and quick absorption for small doses of insulin, which I like.
Good luck with your personal trials.

12:19 PM  
Blogger Nicole P said...

Scott - Jeez... You went for the hat trick with that one.

I LOVE Novolog. I find my sugars are different (lower) with the Novolog - and that I get barely any blockages with it - someone explained to me once that Novolog has less tendency to crystalize in the tubing...

And although I'm really sorry for all the trouble, something about this line made me giggle a bit - "They are strong because they have to carry me & my stomach all over!"

12:01 PM  
Blogger LORI said...

I hate it when the tape sticks to the side of the inserter...

I'm with Jill, I got a kick out of the visual of you changing your site in the bathroom stall! Better luck next time. :)

2:59 PM  
Blogger Lori Rode said...

Scott, great post. Thank you for NOT posting photos of this one. Your words were plenty vivid.

12:32 AM  
Blogger Chrissie in Belgium said...

Lots of variables - I have to tell you Scott, if I weren't laughing (only because I too have been there) I would be crying. So isn't laughing better?!

5:22 AM  

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