So after a good night’s sleep and an awesomely huge breakfast with unlimited coffee, I did some digging and am encouraged and horrified by what I did not know.
Doing the Lantus trial these last two days has been a big confidence booster for me. Part of what has made pod failures so scary is the thought, “If I can’t make this work, what the heck am I going to do long term? How do I limp this along? What if it all gets beyond my ability to pinch hit for it?” But when I had my pod failure on Tuesday as I was walking into the store, I calmly injected enough Novolog to get me through my shopping trip until I’d get home. That’s huge for me! And now that I’ve seen Lantus for admittedly just two days, that’s given me some great clarity for how to jump into it, how to jump out of it, and what to do while I’m using it. That is very confidence building for me. I know I can handle issues and keep life going safely through a variety of methods. They may not be pretty or convenient, but they’re safe.
So, the horrified part…
The thing that really pushed me to switch back to podding last night was seeing Lantus give up the ghost on my Dexcom. My blood sugar started climbing at 8PM and I was 90 minutes until my Lantus dose. And that takes 90 minutes to get going. And I had been pinch-hitting with shots all dang day long and was pretty well over it at that point.
BUT, and don’t FUD-judge me for this, I HAD NO IDEA THAT LANTUS DID NOT LAST 24 HOURS FOR THE EIGHT YEARS I USED IT. All of the research and reading and tinkering I had always done on my own…never freakin’ knew that Lantus gave up the ghost early. I also had never fasted on Lantus to see what it did throughout the day. No one ever recommended that. Going on the pod and basal testing with Gary Scheiner’s group is what taught me what my body’s needs were throughout the day. That’s HUGE knowledge to have. Especially when going back to Lantus.
My doctors never ever ever said, “Hey, your evening spikes might be from Lantus running out early.” What they did say was, “You need to carb count more carefully. You need to see the dietician again. You need to change your meal composition. You need to measure it twice. You need to be more careful with your dosing. You need to get on the treadmill longer/more frequently/etc.” And sometimes they’d also say, “You’re diabetic. This is just diabetes and there is nothing you can do about it. You’re trying too hard. Just accept it.”
And mind you, I did two high risk diabetic pregnancies with bad ass A1C’s the whole effing time. Without knowing that Lantus was the cause of my late evening spikes. There was nothing I could have done to fix that problem without better knowing the WHY behind the spike.
And I think this is where my irrational fear of lows has been coming from. I was solving the wrong problem that was unsolvable so long as I didn’t know that Lantus’ duration was the problem.
I think so often in diabetes we find what works for us and just stick with it because when you change one thing, it’s a whole house of cards. At least that’s how it’s been for my journey. Until FUD.
I went down to my basement this morning to see which diabetes binders I’d kept from my journey. I knew that I’d thrown most of them out after getting established on the pod.
Fortunately, I did keep both pregnancy binders. And holy hell, I feel so bad for that version of me back then. But I’m proud of her, too. She fought and worked like hell to get those boys here.
But every.single.freaking.fax.cover.sheet to my endo with my week’s logs through BOTH pregnancies say, “My blood sugar is less predictable at night because of my variation of meals for dinner. I continue to struggle with late evening spikes but will try to keep those in check with corrections and better planning.”
That. Was. Lantus. Running. Out.
Now I know that. Now that makes meal dosing much less full of voodoo. No wonder I’ve been so concerned about dinner doses all these years. I didn’t know what problem I was trying to solve.
If I were to use Lantus, I’d probably need 11 units up to around 14 units for hormones based on what I know now about my body. Looking through my pregnancy binders, I got as low as 6 units of Lantus (that happens through hormonal shifts in the first trimester). And I got as high as 21 units in my first pregnancy. And I got as high as…wait for it…44 units of Lantus in my second pregnancy. I was terrified that whole time of falling off of the consciousness cliff…but when you’re growing a baby and need to keep it under 130, you do what you have to do.
My endo in my second pregnancy recommended switching from Lantus to Levemir. But he was not at all strategic in how to do that like @Eric is. It was more of floating a balloon over like, well, take something different, but take it the exact same way, and just see what happens. To me, being in my second trimester was not the time to just say, “What the hell? Let’s do something different without any real explanation of what we’re solving and how this will solve that.” I figured I’d stick with the devil I knew (or thought I knew) rather than introducing an unknown one. And then I switched endos. And then she fired me as a pregnant patient saying we were “incompatible” because I would not allow her complete dictatorial control of my meal doses and Lantus doses. I’ve told you all how she fired me over my dosing for potatoes. And under her planning, I went two full weeks in my second trimester without gaining a single pound. That’s dangerous. She said that was my fault and sent me to a dietician. That dietician apologized to me for wasting my time because I already knew everything she was in charge of teaching me. So we instead talked about hospital administration politics and which endo I should try next.
I think it’s clear that I have been carrying around a lot of baggage that I didn’t quite know what it was from. But I feel like this experiment with Lantus has clarified the overwhelming majority of my fears surrounding dosing and lows.
A big thank you to everyone on FUD who has read anything I’ve written, encouraged me, lovingly said some diplomatic version of, “Maybe you’re freaking out too much” (which is totally fair), given strategic advice, and biggest of all, thank you to @Eric. He has taught me soooo much not only about diabetes management, but much more about living well and living compassionately for others. Thank you.
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