August 3, 2005

The next thing

[continued from previous post]

Over the next few days I seesaw through lows and highs until I figure out the new score. Breakfast, which was 1:6, is now 1:9. Lunch has gone from 1:13 to 1:20. Dinner, 1:15 to 1:22. And my correction ratio, formerly 1 unit to lower the BG by 55, is now 1 unit for 80.

All of which will be moot when I return to the pill the following Sunday, but at least I’m back in control for the moment.

That Friday, I’m changing my set as usual. I go through the zillion and one steps until I’m ready to prime the tubing to fill it with insulin.

Charlotte beeps a lot at this point. She’s supposed to, to make sure I’ve remembered to disconnect the pump before I prime. If you prime while connected, you’ll infuse all sorts of unwanted insulin, a Very Bad Thing.

So she beeps as always. Good old Charlotte. But then, just before she starts the prime, she beeps very oddly. A strange sequence. And a strange message appears on her screen: A33.

I’ve never seen this before. I fetch the manual. Clear the alarm, it says, and if it continues to occur, call for assistance.

I clear the alarm. Charlotte’s screen goes completely blank, but restarts. Phew.

Funny, she wants to be rewound again. Okay. I rewind.


I clear the alarm again. She restarts, asks to be rewound again, and alarms again. And again. She is stuck.


I call Medtronic’s 800-number. I follow a push-button menu, expecting to be put on hold. I am not put on hold. A tech support guy answers, takes my name, and asks what my last blood glucose reading was.

Grrr. He wants to know if I’m having trouble with my pump because I’m running low & therefore confused. A reasonable, necessary, and patronizing question. “106,” I reply through gritted teeth. Then I describe the problem.

Mr. Medtronic Guy talks me through a diagnostic process that consists of doing exactly what I’d done before I called him. Charlotte remains steadfast in her refusal to leave the rewind cycle.

“Did you possibly drop the pump?” Mr. Medtronic Guy asks. “Or could it have gotten banged somehow?”

I assure him that this is not the case.

“I’m afraid we’ll have to send you a replacement pump,” he says.

I am shocked. Charlotte is dead? She is not even six months old. How could she be dead?

“It’s an internal communication error,” Mr. Medtronic Guy says. “Sometimes these things just happen. We don’t always know why. Do you have a backup plan for insulin delivery?”

I do. Will I get my pump back when it’s fixed?

No, that isn’t how it works. The new pump they’re sending will be mine for good. Mr. Medtronic Guy arranges the shipment, gives me some instructions, and apologizes for the malfunction, all in a timorous tone that suggests he expects me to erupt into rage at any second. His must be a lousy job.

I do not, of course, erupt into rage. I’m too busy trying to stave off panic. After the call, I instruct myself to breathe. It will be all right. I know what to do. It will be all right. Adapt, adapt. That’s what diabetics do; we adapt.

I’m starving. I renuke my dinner and fetch a syringe. Sixty grams of carbohydrate, no problem. I know my ratios like the back of my hand. I will adapt. I draw out four units of Novolog and do the belly stab.

Astute readers may notice a problem at this point.

I eat. I mourn Charlotte. How can she have broken after six short months? Are the pumping naysayers right after all? Is the technology not truly reliable? Have I built my diabetes care on a house of cards?

All that is well and good to ask. But here’s the heart of the matter: CHARLOTTE has broken. She’s dead. My beloved pump, whom I anticipated and welcomed and named and personified, my partner in health whose virtues I extolled throughout cyberspace, has left me. I’m alone with my diabetes.

If all this sounds more than a little neurotic, well, yeah, it is. You do what you have to do to get through the night, if you know what I mean. All that Charlotte business was what I had to do to get through the long dark weeks of adjusting to diabetes at age 33.

We all imagine contracts with the universe. I imagined that if I went on the pump in a way that felt true to me, I would be safer and happier. I was both of those things. Now I don’t know what I am.

But I am, at any rate, well fed. I call the pharmacy and get them to fill the Lantus prescription they had on file for me. I’ll need basal insulin to see me through until the arrival of Charlotte’s so-called replacement.

The pharmacy is just two blocks away, so I walk there, dragging my feet and fretting. I bring the Lantus home and call Mr. Brooklyn. He is startled: he’s put his trust in Charlotte just as I have.

“What do you mean, it broke?” he says. “How can it just break?”

As we talk I feel funny. It’s a slightly familiar feeling, like a low but with its own odd quality. A bit like the office-supply low of the tangerine chairs. It’s the feeling of free fall.

It takes me a few minutes, but then I understand: I took the hussy-on-the-pill dose of insulin with my shot. I should have taken the nimrod-off-the-pill dose.

I do the math. Slowly. I took 4 units for my 60 grams, using a 1:15 ratio. But I should have used 1:22.

I should have taken 2.7 units. Or, given the idiocy of my whole-unit syringes, 3 units and eaten 6 more grams of carbs.

I test and find some candy. 110. I had the insulin an hour ago. Yeah, I’m heading for a big ol’ crash.

I spend the next hour on the phone with Mr. Brooklyn, eating and testing, eating and testing. I keep myself out of the danger range, but the BG won’t seem to level off.

“I want my pump,” I tell him.

The astute reader will realize that this low has nothing to with Charlotte’s death and everything to do with my nimrodity, but I am not feeling astute at the moment.

After 55 grams of carb, the BG does level off. I am fine. But now I am terrified to use the Lantus. I don’t know what my nimrod-off-the-pill Lantus dose ought to be. And once you take Lantus, it’s in your system for 20-24 hours, period.

I could, and perhaps should, contact the endoc-on-call at my clinic. But I can’t imagine explaining that I am off the pill by accident, and my ratios changed, and then my pump broke, and how much Lantus should I take, please?

I know that I need very little basal insulin overnight, as I’m still honeymooning. I make an executive decision to skip the Lantus. I’ll correct periodically until the new pump comes, I decide.

I go to bed, trying to enjoy the feeling of not being attached to a mechanical device. I don’t enjoy it.

In the morning, I’m at 168. Unhealthy but hardly a disaster. I have to work a conference today, doing a presentation in front of 60 people. I decide to let myself run high. There’s no way I can stomach a big low on a day like this.

At lunchtime, I’m at 239. Whoops. I didn’t mean THAT high. Oh well.

The new pump arrives via Fed Ex, Saturday delivery. Kudos to Medtronic. I only needed three shots to see me through, albeit a bit shakily.

The pump looks just like Charlotte. Same color, same model. But it feels like a foreign object. I program it and am up and running within minutes. Then, following the instructions of Mr. Medtronic Guy, I put Charlotte in New Pump’s box to be picked up by UPS on Monday. It’s a tiny box, lined with foam. It’s absurdly like a coffin.

It's been a few days now. I still miss Charlotte; how weird is that? So far, New Pump does not seem like a girl. It doesn’t seem like my partner in self-care. It doesn’t seem like anything. It just does what it does.

I’m working on this attitude. I know it’s all mental. I need to live with this pump just as I needed to live with Charlotte. And New Pump is not, after all, inherently different than Charlotte. I’m the one who’s really changed.

The first thing

The first interesting thing that happened during my recent travels was that I lost my birth control pills. Well, all right. I did not lose them as such. I left them behind. But “lost” makes me sound like slightly less of a nimrod.

The reason I left the pills behind is that I was very, very nervous, because I was taking Mr. Brooklyn across the country to meet my family for the first time.

No matter. One can replace a lost prescription easily enough, right? Yes, one can. But it is a little more awkward when one’s brother tags along to the drugstore during the key pill-replacement window of opportunity.


I am sure families exist in which the (unmarried) adult children can acknowledge things like needing to refill a birth control prescription. Hell, mine may well be one of them. But I am not confident it is, and I wasn’t about to test the matter hours after introducing my sweetie for the first time. This was a bit absurd, as Mr. Brooklyn and I were sharing a room in my mother's home, but there you have it.

Off the pill I went, in the middle of the pack, which one is not supposed to do. Annoying and perplexing to my poor confused reproductive system, but whatever, I thought.

Ha ha.

The first couple of days went okay. The fam accepted Mr. Brooklyn with reasonable grace, at least in some cases (which is as good as it may ever get where Brother Violet is concerned). Mr. Brooklyn, naturally, was entirely charming. We returned to NY and sighed a collective sigh.

Then the lows started.

The first was post-pizza, always a dicey time. But I’d had this pizza before, and I thought I knew what I was doing with the insulin.

Two hours after eating, I was 69. Had some glucose tablets.

61. More tablets.

“I feel funny,” I said to Mr. Brooklyn. We were in an office-supply store, and I was sitting in a desk chair on display. It was tangerine orange and had a matching desk made of hard plastic. Nearby sat its counterparts in lime green.

Or maybe I was sitting in the green chair, and the ones nearby were orange. I really don’t remember.

“Am I too nice?” I asked Mr. Brooklyn. “Whenever we’re around your mother I think I’m too nice. She’s awfully tough.”

Mr. Brooklyn made reassuring murmurs about my personality and suggested that he steal some juice for me from the cooler at the cash register. No no, I said. I just ate a million glucose tablets. This next test will show that I am fine.


Mr. Brooklyn hurried off to do his thieving. I drank enormous quantities of the lemonade he brought back. We talked about how the glucagon was in my bag at home. (Yeah, left behind. Who carries glucagon when they go out for pizza?) Or maybe I only think we talked about it. I really don’t remember.

Then I was fine. 78, 96. Hooray. I thought I’d wind up in the 300s after all that lemonade, but no. 164 was as high as I got.

After a scattering of other, less dramatic lows over the next few days, I did some research. Did you know that estrogen and progestin, the hormones found in most birth control pills, increase insulin resistance in some people? I did not know this. None of my various “diabetes team” members ever mentioned it, though they all know I’m on the pill. Maybe it’s a rare phenomenon; I’m not sure. What it means is that when you’re taking these hormones, you may need more insulin to cover your food. And if you leave your pills behind like a nimrod, you may soon need to take less insulin. A lot less.

[to be continued]