THE UNTETHERED REGIMEN

The past seven years of my diabetes care haven't been stellar. My A1C's were way beyond my comfort zone and they hit all-time highs that I thought I would never reach. 
     
I consoled myself with the fact that I was dealing with Hyperthyroidism and needed to focus on fixing that before I could attack tighter blood sugar control. In my experience my thyroid levels are intrinsically tied to my blood sugar levels.
     
In January, I declared the thyroid problem fixed and spent the last six months training for my 4-mile leg of the Swim Around Key West. It was a hard six months of rebuilding a body that had been torn down to nothing.  I thought that my blood sugars would respond as well as my cardiovascular and muscular systems did. And they did get better, but not nearly as good as I had hoped.

While in Florida I learned that many of my traveling companions had given up the insulin pump in favor of Levimir and Humalog shots. This was mind blowing because I always considered the pump the only way. But these were well-educated, athletic diabetics who weighed their options carefully and chose to go back to shots. 
     
They were so convincing I had to take notice and ask myself if it was something that would work for me. When I returned from Florida I started to research the situation. I talked to my doctor (who was no help. He told me that the pump was the only way for me, but that I could take a pump break if I wanted.) 

I had concerns though. I am incredibly forgetful. I knew I would spend more time searching for my lost insulin kit than I would giving myself shots. And I would forget shots altogether. I have to stash extras of my thyroid medicine at work because I was sick of having to drive home during lunch because I had forgotten my morning dose.

 

And my schedule is always changing. I may plan to have a workout in the afternoon, but that may change when Shea reminds me that she has a huge report due the next day, or that Eli breaks his arm. So to plan a lighter basal dose of insulin in the morning because I expect to workout just wasn't going to work. 

But I could not stay on the pump full time either. I was having huge problems with my 2+ hour swims that would leave me without any basal insulin. During the swim it was no problem. I would come down to 100 and stay there during the whole swim, but the moment I got out of the water I was in for a seven hour HIGH. Even with a 200% basal and correcting at 150% my usual dose, that HIGH would not budge. Until exactly seven hours later when I would go plummeting to 55.

I was also having absorption problems. I knew my basals were right because I would have a few great days in a row and then I would have horrible days that would not respond to corrections. I use a limited area skin for my pump sites which I share with my Dexcom sites so the tissue there is a little sick of working so hard.  I thought I remembered a friend's son going on some sort of hybrid solution, so I texted him. He had been doing the "untethered regimen" put forward by Dr. Edelman. I researched it some more and realized it is the perfect solution to my problem.      

 

It takes the best of both worlds and combines them beautifully. I now take 75% of my basal through a Levimir shot in the morning and one in the evening. So I can tie in the shots to bedtime and waking up, making them easy to remember. I don't ever have to take insulin with me and since it stays on my nightstand, I never lose it.     

The other 25 % of my basal is through my pump which allows me to attain the huge differences I have in morning afternoon and nighttime basal rates that my body needs. It also allow me to detach the pump when I workout giving me just a 75% basal, which is what I would usually turn down my basal to during land based workouts. Now I have the basal in the water for longer workouts and the ability to time that to whenever I actually get to working out. It also gives me a backup if I forget my morning insulin shot. On my Minimed pump, I can have multiple basal profiles. So I kept my Pre-Levimir profile and if I forget my Levimir, I just flip back on the pump to the old profile.    

I still get to bolus through my pump so I don't have to pull out a syringe at the table. I like the discreetness of the pump. I have shot up plenty in public and have no issue with it, but I like not having the extra attention directed my way. I'd rather be the diabetic super spy.    

I started the new regimen July 2 and so far I have been very impressed with it. I have had days where my highest sugar was 180 which, for me lately, is incredible. I have had days in the past where I was in the high 300's for more than half the day. And I have yet to forget a dose. 

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    I like bring able to be at the beach for four or five hours without having to take on and off my pump to get wet. I now can jump in the ocean anytime I want without all the hassle. I have another month before I can test out the real results with another A1c, but from what I've seen so far, I think they might be back in my I-love-it range.   

 

And I think the process of switching things up has renewed my diabetic mind. I was excited about the challenge and the trial and error of getting my nasals right. And I like success. It has given me enough of a boost to take better care of myself.   When was the last time you made a big change to your diabetes regimen?