After an insulin pump failure a few weeks ago I found myself falling back to the "old-school" method of diabetes management, Multiple Daily Injections or MDI. It has been around 20 years since I really exercised my MDI muscle so the transition was a little rocky! But now that I have the end in sight and a solid month of MDI diabetes management behind me I thought it would be fun to share a few things I learned during the revisit.
Of course we had to do a rocket lineup. Two of these may not be to scale!
1. My long-acting insulin dose was less than my basal
Maybe it's because I've never had to pay much attention to my basal insulin dose, but I was always under the assumption that I would simply give my total daily basal dose via long-acting insulin injection if I had to transition to MDI. This turned out to be a disaster, leading to several nights of low blood sugars and nearly a week of fine-tuning my long-acting insulin dose. Since there is only 1 injection/day it takes time to really dial in the dosing.
Prior to my insulin pump failure, my basal profile was approximately 25 units/day. But, I found when transitioning to MDI I had to knock that down to 20 units/day.
2. MDI will force tighter carb counting
Multiple injections every day isn't my favorite management scheme (obviously, since I have been on an insulin pump for 20 years)! So, in an effort to limit the number of daily jabs, I really focused on accurate carbohydrate counting, even busting out the measuring cups on multiple occasions!! It was important to get the dose as close as possible in order to avoid a correction injection (why does that sound like conjunction junction in my head?) later. See item 3...
3. I missed partial unit dosing options
After the switch to MDI I realized how often I bolused in partial units, or relied on the pump to give me micro-dose corrections. With MDI I was limited to a resolution of 1 unit (or 2 unit increments on my long-acting pen). When combining the coarse resolution dosing with the fact that there is some unknown amount of loss at the injection site, I often got frustrated when calculating how much insulin to dial in. It felt like too many variables, with error in each measurement.
Since my correction factor is 70 (1 unit of insulin drops my BG 70 points) that meant that I had to wait until my blood sugar was rather high (by my standards) before administering a 1 or 2-unit correction dose. The other option was to inject the correction but also eat a few carbs to avoid the low, which feels ....blergh.
4. MDI felt more visual 👀
Maybe it's just because the whole concept was still a bit foreign to me, but I often had to perform an injection "in public" which made me feel a little self-conscious. During this month-long period of MDI I had a few shifts in mission control and the timing worked out that I needed to take my long-acting injection on console. I'm sure no one really cared, but it felt a little awkward dialing up the dose and performing the injection while on camera and in such a "visual" space. My friends are used to seeing me pull out a little electronic device to correct a high blood sugar, not take an actual shot!
5. No tubes and 1 less site felt freeing
I wore pants without pockets and showered without unhooking! I went through TSA without a patdown or a bomb-swab on my hands! For me, I don't think those positives outweigh the control I am able to achieve with an insulin pump, but for a few weeks I really enjoyed the break!
Even though I would never admit this to my endocrinologist, I think the break from my insulin pump was beneficial. It forced me to reassess how I manage this disease and ultimately affirmed that insulin pump therapy is the best for ME (maybe not for everyone 😉). Is MDI your primary method or a backup plan?