Wednesday, June 27, 2007

When to Break the Rules

When living with diabetes, there are the "right" things to do regarding treatment. All the things the doctor tells you to do and not do, the techniques the pump companies insist you follow, for example.

Thing is, in real life, times come about when the "right" way isn't going to work, and you're left without a decent backup plan. It is times like these that a MacGyverism can become necessary. (If you're not familiar with a MacGyverism, well, you'd have to be a fan of the TV show MacGyver...but basically, it means thinking up a solution to some problem on the spot with the tools at hand.)

I ran into such a case just yesterday. Mostly because I'm an idiot...but, unfortunately, idiocy can overcome the best of us from time to time. Anyhow, yesterday, I happily headed off to work, ignoring the fact that my insulin pump reservoir said I had all of 4 units left. Of course, when it says I have 4 units, it really means I have 14 units. But 14 units wasn't going to be enough to cover the fact that I had just eaten 40 carbs, and need to last out the day. But, since I only work 20 minutes from my home, I figured I'd see if I could make it.

Well, at 2:30 pm, my BGLs were tending high, and I got the dreaded empty reservoir alarm. But I still had a couple hours of work left in me. I dreaded having to head home, fill my reservoir, and come back again.

So, I broke the rules. I did something that isn't recommended. First, I disconnected my infusion set and rewound the pump. (Always disconnect, because rewinding a pump could actually suck insulin and/or blood out of you if you remained connected.) Second, I removed the reservoir/infusion set line from the pump. Then, using a handy-dandy ink pen (capped, of course), I gently pushed the reservoir plunger down, utilizing the remaining and otherwise unusable ~10 units of insulin left to fill up the tubing. One completely filled, I reconnected and used the pen to inject several units of insulin...being VERY careful to watch when I had run out, and the tubing started filling with air instead of insulin.

Then, I disconnected the infusion set again and retested a bit later. BGL was dropping, and I had enough insulin in me to last me until I got home.

Sure, the whole thing is not recommended. You'll never find a doctor or Minimed representative suggesting this technique. And, in fact, I would never recommend the technique. It was plain silly of me to have forgotten to fill my reservoir before I headed off to work. But, sometimes desperate times call for desperate measures.

Thing is, diabetics have to do this kind of thing all the time. You are living your life daily with a disease that is unpredictable, being controlled by humans who are even more unpredictable.

Of course, my insurance company refuses to pay for enough insulin to allow me to keep a spare vial anywhere. They will only cover precisely the amount I need. I guess they fear I'm going to sell any extra on the black market or something. Sigh.


Carol said...

Very true. Some of the rules are meant to be broken when necessity calls, and some never needed to be rules to begin with. Off the top these are some of the things I was told to do in training, but usually don't: change set every two days (ahem, let's try 4 or 5), change lancet with each test (once in a blue moon), always rub site with alcohol before taking a shot (n/a), always use IVPREP before inserting a site (never), always keep insulin in the refrigerator (only before I open it). I kind or resent being "educated" with some of those things as absolutes. Diabetes places a large enough burden on our lives without extra rules.

Rob said...

I saw your comment about not paying for more than the insulin that you absolutely need. Have you asked your doctor to change the prescription? I had the same problem & asked my endo to write the scrip for the numbers of vials I wanted, rather than the units of insulin. The insurance provider didn't balk at that. You can also try requesting the max amount that you consume per day, rather than the average amount.

RyanBruner said...


My endo actually has written the prescription for number of vials, but the insurance company wouldn't accept that. They needed to know amount of insulin used daily. They won't pay for any more than that.

Typically, I can get my three vials a month to last slightly longer than a month, but I never have enough to have a full vial extra.

Silly insurance companies. Little do that know that I purposely changed my blood tester in order to save THEM money on strips. (I see no point in making them pay more than they should, since it ultimately effects insurance premiums.)