Rethinking Your Insulin Injection Spot

I put my insulin pump back on the other day, after about a year without it, and had a couple of surprises. The first was that I forgot how the thing worked, the second was that I’ve had it for 4 years and the manual was still in the shrink wrap, the third was that there are bolus settings called “Square” and “Dual” and the fourth was that where you stick the needle makes a huge difference in the amount of insulin you need.

I decided to put my pump back on because my last two A1C’s have been pure crap, coming in at 7.1 and 7.2. I’ve never had an A1C over 6.2 before, and now I have 6 months of really poor blood sugar control that needs fixing, now! So, I dug out my pump, found a battery for it, and got it all set up and plugged into my side. What was interesting, was that I stuck in into my side so far over, that I had to have my wife tape down the cannula, because I couldn’t reach the site with both hands.

The site where I stuck it was also on a thin part of my side, where I don’t have any belly fat, so I basically stuck the sucker in my kidney or liver or what have you… It hurt like hell, and I had to hold my breath and try not to wriggle until it was taped down. Most of the pain went away when I pulled out the 8 foot long needle they use down the center of the cannula to get it to poke through your skin (called a trocar), and I’m pretty sure my liver and kidney will be fine with time.

Well, the pump still had it’s settings, and I remembered that I had cut the basal rate in half, in an attempt to use Lantus for half the basal, to cut down on the massive amount of insulin I was dumping through the cannula. I figured by using Lantus for 30 units per day of my basal, that was almost 100 units of insulin that wouldn’t go through that site. (If you dump a whole bunch of insulin into one hole, then you get an infection a lot faster.)

Well, I almost immediately started having insulin reactions, and over the next three days, I cut my daily insulin to around 50 units of insulin per day, and that was eating a 2750 calorie diet composed of around 30% carbs. That was a drop of around 100 units per day for me.

Part of the drop in my insulin needs was do to the fact that since I eat lots of protein and fat, my blood sugars peak after my insulin has been used or destroyed by my body. Well, since I read the book when I put the pump on this time, I read about dual wave and square wave patterns of giving insulin.

With a dual wave, you give part of it right now to cover any sugar spike, then you set the rest of the insulin to slowly be released over the next 1/2 hour to 8 hours. So, if I ate a bunch of dark chocolate, I could take a little bit of insulin now, and then set the rest to be dripped over the next two or three hours. that way the fast sugar is covered, as is the rest of the sugar as your body pulls it out of the fat…

The square wave is just the second part of a dual wave release. You can just set the insulin to be released evenly over a set amount of time. The square wave works good for meats and fats that give up their carbs slowly, or for people who have Gastroparesis.

So, between sticking the needle into my side, where there wasn’t any belly fat to slow down insulin uptake, and setting my insulin releases using the dual wave and square wave releases, instead of just dumping it all in my body and hoping the food and the insulin would both show up at the same place at the same time, I reduced my daily insulin usage by 100 units.