The Art of the Pump Break
Memorial Day weekend was a good reminder to me that bathing suit season is coming up, and along with the obligatory five pounds I try to lose every year for this season, I also started thinking about summertime pump breaks. I don’t mind wearing my pump at the beach - people tend to take a look, raise an eyebrow, and move on. My OmniPod looks medical, so most folks assume it does something important, and that’s it. Occasionally, someone will ask what it is, to which I usually respond “I’m the bionic woman, it’s my battery pack.” More raised eyebrows. Ahem. Moving on.
There are times however, when I just want to be pump free for a weekend. I think most people with diabetes that wear a device or two relish a day without a plastic and metal device stuck to their skin. Aside from not having to deal with any questions or looks, it just feelsgood. Although we get used to our gear, it doesn’t mean we don’t like a little break now and then. For me, living in Southern California, summer weekends can mean lots of time in a bathing suit, which are the times when I’m most tempted to take a day off from the hardware (I actually have a CGM sensor tanline right now from a few weekends ago. My dermatologist busted up laughing when he saw the oval shape on my hip. Then he chided me for not using sunscreen. He’s right. Digression).
Although we are lucky enough to live in a time where we even have the option of taking a break, I’ve found that going back to a basal-bolus regimen of multiple daily injections (MDI) is tougher than it sounds. You’d think you just take a shot of Lantus, remove your pump, and voila, inject your rapid-acting as needed. No dice.
For one thing, I was on a split dose of Lantus before my pump. Although it claims 24 hour control, I did better when I took half the Lantus I needed for a full day in the morning, the other half at night. But, if you’re only taking a 24 hour pump break, it doesn’t make sense to split the dose because then you’re actually dealing with some varying amount of Lantus on board for 36 hours - which is a pain to regulate when you put a pump back on. So, when I take a pump break, I usually just do one full dose of Lantus for a 24 hour period, which doesn’t seem to cover me as well.
The other issue with going back to injections is that I’ve gotten so used to being able to take doses as small as one-tenth of a unit with my pump. I find that when I transition back to MDI, I kind of round up or down for my Humalog, or just deliver “blanket” doses at meal times. I also tend to correct “mild highs” less on MDI. When you can just press a few buttons, it’s easy to correct, let’s say, a 150mg/dL. I’m less motivated to fix that if I have to get out a pen and needle. However, this is less about using MDI though, and more me just being used to my pump.
One trick I’ve been using for all pump breaks recently is “lead-in time” with my Lantus. I’ve found that Lantus needs a little while to kick in, so I’ll actually take my 24-hour dose of Lantus about two hours before I remove my pump. This gives my basals time to even out before I go ripping out my pod. If I take the pump off right away, I always get an immediate rise in BG, which is no way to start a pump vacation!
Although I love to take a break now and then, I find myself taking fewer and fewer pump breaks than I did when I first got a pump. Off my pods, I seem to get a lot of high BGs, which boggles my mind since I had great control on MDI for 15 years, pre-pod. But again, I wonder if it’s more about me being used to the pump now and the whole split-dose-of-Lantus thing than anything else.
I’m curious to know if anyone out there has specific issues with pump breaks, and also if you have any tips for a smoother device vacation. And how often do you guys take a break?
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Comments
My first OB doc wanted to be in control of my insulin drip through IV the whole delivery and postpartum. I delivered at 10 p.m. and he left before writing insulin orders and ordering any food tray. I went 28 hours with NOTHING to eat but a few icechips. He said I would need hardly any insulin postpartum. After breakfast my BG started spiking and I told him I was putting my pump back on which I did. You can bet I switched OB docs with our second son. This guy let me take the lead with my pump throughout delivery and beyond. I did probably 18 fingersticks the day of delivery but did just fine (no CGM in 2000). Always be your own advocate. I wish I had spoken up the first time around.
Oh my goodness Jenni that is AWFUL. He clearly didn’t even know how Type 1 works. Unbelievable - and scary! Glad you got a new doctor the second time around!
Susan - I put the pump back on when I want to and then set a temporary basal rate of maybe 10% of what I would normally take, and then when the Lantus has timed out (past 24 hours from my last injection) I go back to my normal basal rates.
The ONLY time in the last 15 years I was taken off my pump for the birth of my first child (not by my choice) for one day until they could see that it was necessary for me to restart it. Kept it on during my second child’s birth and did just fine with adjustments. The thought of being without my pump scares me, although I’m sure I would do just fine with injections if I had to. Guess I’m just a creature of habit, and it’s a security blanket with the CGM.