Pump Vacations

We’re back from our Seattle vacation, but I’m still kickin’ it on my pump vacation. Have you ever taken a vacation from your insulin pump? I’m taking my first pump vacation in 18 years! At first it was going to be just a few day thing. That was over a month ago…

I’ve been a Type 1 diabetic for 22 years. I’ve been on an insulin pump for 18 of those years. Ever since I was put on a pump, I’ve never spent an extended period of time off of it. Can you believe that? I’ve spent 18 straight years attached to a cord. I had never really thought about it like that, and never thought it was something I’d want a break from because of all of the benefits of being on an insulin pump.

I had been feeling a lot of diabetes burn out recently. A lot of my frustrations were directed at my pump, in general. I’d roll over at night and get tangled. Winston (my pup) would jump to play and rip my pump site out. I had a hole in my scrubs pockets and it kept falling out. (I have since then bought new scrubs :D). Really, these are all just normal parts of living with diabetes, but after 18 straight years, I was really ready for a break.

But what do you do when you need a break from a disease that you can’t take a break from?

I had heard about pump vacations, but I always struggled to get good control on injections, especially with my crazy schedule, that it didn’t sound like it would be a break at all. When the button on my Tslim broke and I had to plug it in to a USB charger to turn it on every time I needed to use it, I decided that was the perfect time to take a pump vacation. (I guess I didn’t have a choice at this point!)

It’s funny that my little pump vacation coincided with a lot of talk from the diabetes community on Instagram about pump breaks. Let me tell you as someone who had gone 18 years without taking a break from my pump: if you’re on a pump and feeling diabetes burnout and need a break, you should take a pump vacation.

It’s more than just leaving the cord behind for a few days. Even though you can’t just leave diabetes behind and spend a week at the beach like a regular vacation, it’s a change from the same ol’ same ol.’ It’s been amazing to go through airport security without a second thought, and to go to the bathroom without worrying about pulling out a leg site and to be able to do yoga without my pump slipping out of my leggings and falling to the ground. It’s also great for when I’m spending a lot of time at the beach or pool. Unless you’re on the Omnipod, if you’re in the water all day, you end up with a lot of time without a basal rate. This isn’t a problem if you’re on long acting.

No insulin pump falling on my head
Easy peasey at the airport
Finally got to wear this great dress with no place for a pump

Another important reason to take pump vacations every once in a while is to have a solid back-up plan for if your pump breaks. It’s smart to always keep long-acting insulin around just in case, but if you’re like me, 18 years is a long time to not know how your body will react to a different insulin regimen. The biggest thing I’ve learned through this is that Lantus is not the ideal long-acting medication for me.

I’ve taken single days off of my pump here and there for beach days, etc., and even tried doing a bit longer to get a good handle on how to dose Lantus, but I’d always go right back to my pump because I would flop schedules to work my night shift and have blood sugars all over the place. Lantus is a great medication if you have a consistent schedule, but there is nothing consistent about my schedule.

I was struggling with higher blood sugars during one part of the day and lower sugars during another on Lantus, when I discovered Tresiba. Tresiba is MAGIC!

On Lantus, I never had steady blood sugars or flat lines on my Dexcom, no matter how I messed around with the timing and the dosage. On Tresiba, I inject once a day, and I have steady fasting blood sugars in the 80s-100 for 10+ hours. It’s amazing!

Flat lines at work in the ER

The science-y stuff:

My husband with all of his pharmacist knowledge, was explaining to me why Tresiba helps to gain better control of blood sugars than Lantus. If you don’t like science-y stuff, skip this section. The Lantus solution that is in the bottle isn’t activated until it’s injected. Once it’s under the skin, it forms a complex and releases it steadily over the next 24 (ish) hours. (In my case, Lantus only lasts 22 hours.) In order for Lantus to work the way it does, it’s an acidic solution with a pH of 4, then you inject it under the skin into your body with a pH of 7, and that’s why it burns.

Tresiba, on the other hand, has a fatty acid attached to it, which helps it to form a complex under the skin when injected to release. Not only does it release the way Lantus does, but it also binds to albumin which circulates through the body. The chemical structure of Tresiba is different than Lantus too. It has lipid chains attached to it that result in steadier blood sugars and it also helps it to last longer in the body. You have a window of about 8 hours to inject Tresiba and it has some effect in the body for about 3 days. This makes it nice for having flexibility not to give insulin at a certain time, and also decreases the risk of going into DKA if you forget a dose.

Okay, I’m done with all of the science talk. I’m actually loving Tresiba even more than the pump at the moment. The great thing about the pump is that I can have different basal profiles and make adjustments based on my schedule and activity level. But I feel like I was ALWAYS making basal changes. I’d be off of work for a week and go back to work and activate my work profile on my pump and it would take a few days for me to fine tune it back to getting steady blood sugars.

I never put much faith in long acting insulin, because Lantus never could adapt to my changing schedule. But Tresiba is different. It’s been so nice to know that on Tresiba, whether I’m on a day schedule, working nights or traveling to different time zones, that it is able to still keep my blood sugars steady without me constantly tinkering with basal rates.

If you’re thinking about taking a pump vacation, here’s some tips:

**Disclaimer: These tips are not meant to be a substitute for medical advice. Everything on this website is based on my own personal experience and what works for me. You should speak with your health care provider or diabetes team before making any changes to your insulin regimen.*

When switching to Lantus (or Levemir), the dose is usually about the same as your total daily dose from your pump, which is all of your basal rates for the day added up. A good way to tell if your Lantus dose is correct is to see what your blood sugar is right before you’re due for the next dose of Lantus. It makes it easier if you’re fasting for a few hours before giving Lantus to rule out a high/low blood sugar from eating or short acting insulin.

A lot of people find that they need a few more units of Lantus than their total daily dose from their pump. It’s better to start off lower and increase up to prevent hypoglycemia.

When switching from Lantus to Tresiba, the dose is about 15-20% less. Tresiba is a little bit different, in that it takes 5 days to show if your dose needs to be titrated up. If you start with Tresiba and are running low, you can back down right away. If you start with Tresiba and are running high, give it a few days to see the true effect.

A hack that I discovered for meal dosing is that you can actually inject a syringe or pen needle into a pump site to reduce the number of pokes, but have the freedom of not having a pump attached to you!

I’ve also found a little trick to do extended insulin dosing at meals on injections (sort of). There are different absorption rates depending on the location in the body you inject. The abdomen has more blood vessels than the extremities and is warmer, so insulin absorption will be faster there than in the arms or legs. I have found for me, personally, my absorption of insulin is significantly slower if I inject in my arms vs. my stomach. But I use this to my advantage! If I am eating something with simple carbs, like fruit, I’ll inject into the stomach. But if I have something with complex carbs, like pasta, or a complex carb high in fat, something that I would normally do an extended bolus on my pump, I’ll inject into my arms to get a delayed insulin effect.

Pool days are a breeze on injections

Eventually I will probably go back to my insulin pump. The future of diabetes management is going to be insulin pumps with closed loop systems with a CGM. And I’m excited for that one day. But I’m loving and enjoying the freedom of being cord free. I love that I can dance around in the living room without my pump falling and crashing to the ground. I love walking through airport security without having to show my robot parts and wait and wait and wait for someone to come check it out. I’m loving feeling like just me without something attached all of the time.

So, greetings from my pump vacation, I’ll be back one day. Until then, maybe I should change my name to Have Insulin Will Travel! 😉

 

 

2 Comments on “Pump Vacations”

  1. I recently tried a short pump vacation with Lantus and hated it. I needed 5 more units of basal and it didn’t last 24 hours so I gave up. I asked my Endo about Triseba or Levemir and she gave me the wrap around. She also mentioned half life and needing more days on Lantus for the full effect. Interesting to hear your point of view. If I wasn’t looping I’d try harder to try again. Thanks for sharing!!

    1. Wow, that sounds so frustrating. That was a lot of my issue on Lantus too. It’s a bummer that your endo wasn’t open to Tresiba. It’s probably the best thing I’ve discovered since pumping. How do you like looping?! I tried it and gave up because I was having such a hard time figuring it out and having bad highs and lows.

Leave a Reply