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Lessons learned from insulin pump breaks

For those of you who follow me and my blog for non-diabetes reasons, I’ll give you a bit of background info. I was diagnosed with type 1 diabetes aged 3. Type 1 diabetes is an autoimmune condition in which the immune system attacks the insulin-producing cells of the pancreas. Insulin is a hormone vital to the process of transforming the food we eat into energy. Without it, death is certain. So in the absence of a fully functioning pancreas, those of us with type 1 need to take insulin on a daily basis to prevent our blood glucose levels becoming dangerously high.

For 15 years I managed this condition with daily injections of insulin. Then, 8 years ago, I started using an insulin pump. A quick look at some other type 1 blogs will soon find you the benefits of an insulin pump over injections. While it’s not for everyone, I have found it much more effective in managing my blood glucose levels. However, I have in the last 18 months taken 2 breaks from pumping and returned to multiple daily injections (MDI) for roughly 3 months each time. Here are some of the things these breaks have taught me about type 1, pumping, and life with diabetes.

insulin-pump2

1. Pumping is still better.

I have found the breaks helpful in reminding me why I started pumping in the first place. Using an insulin pump can be much more intensive than injections, and it can be difficult to stay on top of things. Switching back to MDI gave me a break from this intensity, but fairly quickly on both occasions the swinging blood glucose (BG) reminded me why the intensity on the pump is worth it. BGs are much more stable, life is more flexible, and on the whole I feel much better.

2. Pumping is, however, the lesser of two evils.

There is, sadly, no magic fix for diabetes. It’s a difficult condition to live with, no matter how you manage it. Pumping can be intense and throws in some extra variables. (Is my site working? Has the tubing blocked?) But MDI is more inflexible and causes me more hypos (low blood glucose). Neither is perfect. You’ve just got to pick whichever one works least awfully for you.

3. Pumping is less scary.

After I got into the swing of things with the pump, and before I took any breaks, I had a permanent, vague anxiety about what the hell would happen if my pump stopped working and I was forced to return to MDI until I got a replacement. This anxiety has now gone. I know I can manage things on MDI, I know roughly what doses I’d need, I know what works for me on MDI and what doesn’t. And so there is less pressure on pumping. If I’m having a nightmare with infusion sites and just can’t seem to get anywhere with it, I know I have a fairly comfortable MDI regime to fall back on.

4. It’s not all or nothing.

Before I took a pump break, I was absolutely horrified when I started to have a site or absorption problem. I’d keep taking correction doses on my pump, see my BGs keep increasing, and panic. I’d keep on fighting this battle until I got a site that worked (and then my BGs come crashing down, obviously). Now I approach high BGs a little differently, and allow injections to help me. One of the huge benefits of injections is that I have no doubt that the insulin dose went in. So when I’m faced with a high BG now, whether I suspect my site is problematic or not, I correct with an injection. This always brings me down quicker than a pump correction (I’m still theorising on why that is). It allows me some breathing space – I know the insulin has gone in and will start to bring my BG down, so I can focus on finding the cause of the high. When I do change my site, I’m much less anxious about it because I know injection corrections will see me through if the site doesn’t work.

5. I’m more flexible about balancing my diabetes with life.

Sometimes I’m quite happy to put in the effort of BG checks 8 times daily, checking basal rates and changing sites because it leads to better BG control and generally better health. However, sometimes life gets pretty crazy and I’m not able to prioritise my diabetes like this. Before my first pump break I would have got very upset about this conflict and found myself heading straight for diabetes burnout. However, now I weigh up the option of going back to MDI again for a period until things are calmer and I feel more able to put in the hours required of the pump. In fact, I’m considering MDI for the Christmas period this year so I can ease up on testing and thinking about it so much. And so I actually resent my diabetes less, because I feel able to put it on the back burner with MDI when I feel I need to.

6. Insulin is amazing – method of delivery is fairly irrelevant.

child-before-and-after-insulin

The above is an image that has always stuck with me since first I saw it – a young boy with diabetes just before the discovery of insulin, compared with the same boy three months after starting insulin treatment. It’s horrifying to think that there are people with type 1 diabetes the world over without access to insulin, or struggling to afford it (see #insulin4all). Fundamentally, insulin is the key to life for us – and I am exceedingly lucky to have access to it without concerns about financing it, thanks to the NHS. So while neither pumping nor MDI are ideal, and while I sometimes find it difficult to decide which works better for me at a given time, what matters is that I have insulin and my health. The rest of it can be figured out.

‘I can’t do this’

These are words I have uttered to myself countless times throughout my life, but particularly since I had my daughter. This, and a whole host of negative self talk, is often a theme in those of us who struggle with depression and anxiety. It’s a vicious cycle – tell yourself you’re incapable, you approach things with significantly reduced confidence, as a result consider yourself not to have succeeded as you should have, so continue to feel incapable.

I have found a key thing for me in fighting depression is to challenge this negative self talk. With years of counselling and mostly lots of practice, I feel that I’m fairly good at doing so now. So I thought I’d share my coping tactics in hopes it might help someone else.

Disclaimer: I am not a trained health professional and so by no means am advising anyone how to tackle their depression or anxiety – I am simply sharing what works for me. If you feel you are struggling with your mental health and negative self talk is a factor, please do see your doctor and articulate this to them – they should be able to refer you to someone who is trained, and/or to other services which may be of help.

1. Write it down.

Getting into the habit of challenging negative self talk is the trickiest bit. What I found helpful with this was to write down my thoughts (something I still do from time to time when I feel my mood dip). Often this is difficult to do in real-time – if your kid is melting down at a family event you can’t very well stop wrangling with them to get your pen & diary out – but doing it later works too, and this often means I’m more rational about it. I write down what I was doing at the time (this helps to identify triggers so I can be better prepared in future), but also specific thoughts, for example ‘I’m useless. I can’t even cope with my one kid at a birthday party’.

2. Challenge it.

To take my example from above – I am evidently not useless. I feed, dress and comfort my kid. That is exceedingly useful. And who says I’m not coping? Me? What makes me the world authority on coping? I did cope – I spoke soothingly to my daughter, I offered a hug, I took her to a quieter room. Just because these things didn’t completely stop her tantrums doesn’t mean I didn’t cope. She did calm, for a period, and then she got worked up again. She was obviously tired or bored or just not feeling herself. I offered her what I could. And while I may have felt my anxiety shoot through the roof, I did cope. We got through the party, came home, had a rest and we were fine.

3. Be Your Own Best Friend (BYOBF)

What would I tell my best friend in this situation? Would I tell them they’re useless, that they can’t even cope with simple things? Of course not. I am no better or worse than any other human being on the planet. I’d offer kindness and compassion to anyone else struggling with depression or anxiety. And I should also offer that to myself. So instead I tell myself that I did great to get through it, that my daughter was obviously having a bad day, that I did what I could to calm her, that I tried my best.

Tell someone they’re useless enough times and they’ll believe it. But tell them they’re marvellous often enough and they’ll believe that too. Challenging negative self talk requires nothing other than perseverance and lots & lots of practice. You don’t need to wait for someone else to tell you how well you’re doing – you can be that person for yourself.

4. Be kind to yourself.

When all is said and done if you’re the type of person who gets worked up in stressful situations and is prone to anxiety or depression, sometimes taking an hour or two to yourself to do something you enjoy can be the best therapy. If I’m aware that I’ve had a particularly stressful few days, I make some time in my schedule for coffee and a book, or a bath, or a walk (but always, no matter what, there is coffee). Sometimes I just need a little bit of calm and quiet, some space without any stressors, to ease my anxiety. Don’t feel like you’re not worth some self care time (see point 3 above). We all cope differently with stress, and some of us find it can really trigger our mental health to start heading in the wrong direction. It’s perfectly okay to need some time out.

5. Call bullshit.

Sometimes I just need to give myself a kick up the backside. When I find myself thinking ‘I can’t do this’ I know I’ve let my self talk slip too far and it needs to stop, now. Of course I can bloody do it. My daughter is almost 3, and it’s been me who’s taken care of her most of her life so far. She is a happy, chatty, active, healthy child. So of course I can look after her. In fact, if I’m being really rational about it and using the BYOBF tactic, I’m doing a bloody brilliant job – particularly considering the feeding problems she had as a baby and her ongoing food allergies. I’ve survived far harder things than a single toddler tantrum – so yes, on ‘I can’t do this’, I’m calling bullshit.

And I’m calling it for you too, dear reader. If you’ve uttered those words to yourself recently, you’re wrong. Look at what you have done, and see how capable you are. Of course you can do it.

 

If you feel you are struggling to cope, you can call Samaritans anytime on 116 123. Alternatively, check out the links on my About page for charities who can help, or see your GP.

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