Set It or Forget It

Wanted to spend my time this week blogging about an aspect of insulin pump therapy — or, more specifically, a feature of insulin pumps — that I used religiously with my Deltec Cozmo insulin pump but that I’ve neglected to use with my three-month old Animas OneTouch Ping. I’m sure it goes by various names based on model of pump, but I’ll just refer to it as the blood-glucose-reminder setting.

With my Cozmo pump, I never questioned whether or not I should have the reminder feature set, have it turned on. It was my first pump. I was new to the illness. So, yes, the reminder setting seemed smart; it was also recommended by my certified diabetes educator.

The way it worked, for those of you who don’t pump your insulin: After any bolus of insulin, regardless of bolus size, regardless of whether it was a correction bolus or a food bolus, two hours later (which is the time frame I set mine for), buzz buzz buzz buzz buzz buzz buzz buzz. Eight times; morning, afternoon, or — and what was really frustrating — after falling asleep (if, that is, I forgot to check my glucose after a snack and before going to bed, which happened frequently). The thinking is that you can see how the bolus is affecting the carbohydrates you put in your body for the meal, or if the insulin you bolused is sending your blood glucose too low. My duration of insulin action (how long the insulin takes to work all its magic) for a bolus of fast-acting insulin, is, more or less, three hours. At about that two-hour window, after a meal, I’m going to be slightly higher than my target range if all’s going well. Maybe 30 to 50 mg/dl higher. At least, if I’m at that reading, I don’t worry about anything.

Except the reminders. I worried about the reminders. Dreaded them. Hated that buzz (× 8).

Now I know that those of us with diabetes are told time and again that we can’t rely on how we feel to indicate to us what our blood glucose is. That’s why we have meters, test strips, and why those of us on insulin therapy are encouraged to check more than just once or twice daily. I’ll be the first to tell you that many times I think, “I must be going low,” when in fact, after checking, I’m around 200 mg/dl. I also know that there isn’t a routine (diet, exercise, sleep, etc., etc.) that’s 100% reliable. I can do everything I’ve done for the past month, or half year, or year, that provided me with consistent readings, but then the day I decide to forego checking my blood glucose (after doing everything per usual), and voilà!, I’m really high, or really low, and I have no explanation for it. Blame the weather. Blame the seasons. Blame any number of things that might have veered a tinch outside of my normal routine, because everything no doubt plays some small part.

Which is why when I got the Animas OneTouch Ping, I was confused at first when, after two hours, I wasn’t getting the buzz-buzz. After a few days, I further explored the pump settings and realized the reminder setting doesn’t default to on. I turned it on. But then, a week or two after that, I thought, “Hmm, you know, I was doing OK without the reminder. And I really enjoyed the freedom from the reminders’ buzzing. Maybe I’ll shut it back off.” I did. And to date, I am reminder-free. Sure, I’ll try to remember to check my glucose at some point after a meal, and sure, I mess up now and then and wind up with a high glucose or feel a low coming on. Then I check. Maybe I’ll lose a slight bit of control doing it this way, yet I haven’t had any critical blood glucose issues, and until I see a trend that indicates I need to turn the reminder back on, I’m going to leave it off. It’s so worth it to me to not have that buzzing going off four or five times a day.