When our daughter was first diagnosed, we started on insulin pens. This is also how I started giving insulin injections when I was diagnosed in 2004. The pens are good for training and learning the basics of diabetes and forcing yourself to do math and think about sliding scales and correction doses.
In the long-run, for our family at least, we knew we wanted our daughter to be on an insulin pump.
Discussing with Our Daughter
This is something that we discussed with our daughter also so that she didn’t feel like it was being forced on her, but it was a simple conversation with her.
4 shots a day or one “shot” once every 3 days.
Her answer was pretty quick.
Giving her insulin early on after her diagnosis was difficult at times. We didn’t want to make too many changes to our life. We wanted her to continue to do the same things she was doing before she was diagnosed.
Eating Out
One of those things was eating out. We ate out usually 2-3 times a week. Usually one night for dinner, and 1-2 times a week for lunch. We did this because we were always out on the weekends and then we try to enjoy one night out a week together as a family.
Eating at a restaurant was tough because we never knew exactly how many carbs she was going to eat. We would look at the menu beforehand, and by before I mean, my wife would be looking on her phone in the car about 5 minutes before we pulled into a restaurant because it took us 30 minutes debating on what restaurant we were going to go to.
We also could never tell when the food would come out, so pre-bolusing was tough, but that is the same no matter if you are doing MDI or using an insulin pump. The difference is that we could just give her insulin at the table and not have to go to the bathroom and leave the table.
If she wanted to be able to eat a little bit more than what we initially bolused for or if we decided to all share a dessert, we could do it much easier with an insulin pump. It wasn’t going to require the trauma or getting another shot, but a simple few button pushes on the insulin pump.
Corrections
Another reason we wanted to use an insulin pump was for corrections. We found ourselves waiting until the next meal time in order to give a correction. If it was a large correction, we would do it, but we avoided giving extra shots as much as possible.
Waiting until the next meal to correct a blood sugar that was not too high, but something that we would correct now with an insulin pump, was not good management. Her A1C was higher and we knew we couldn’t continue on that path for the long run.
Snacking
Luckily, even before diabetes, our daughter was not much of a snacker. She didn’t just randomly eat throughout the day. She ate breakfast, lunch and dinner and sometimes would have a little snack somewhere throughout the day. But, she never just randomly was given food to eat all throughout the day.
That was a big plus for being on MDI, because we didn’t need to bolus any additional shots.
On her insulin pump, if she wants a snack, it’s easier to give a snack. Now, we don’t just give a snack because we can quickly bolus for it, we still follow our same rules. But, it is easier to go for ice cream after the park or having some cracker and cheese between lunch and dinner.
Check back for future blog posts on how living with an insulin pump has been for her.
Over the last 15 years of living with Type 1 Diabetes, I have been on Multiple Daily Injections, insulin pumps, continuous glucose monitors and have tried a plethora of diabetes products in order to help me find an easier way to manage my diabetes.
In 2018, I went off an insulin pump and went back to MDI because I felt like it was better for my own personal diabetes management. Since then, I have gone back to using an insulin pump, but, I take frequent breaks from my insulin pump and want to use MDI.
The number one thing that I miss when I go back to MDI is tracking of my insulin.
How much insulin did I take last shot?
What time was it when I took my last shot?
How much insulin is still on board?
What was my blood glucose level when I took my last insulin shot?
These are all things that I can easily answer when using an insulin pump, however they have always been difficult to do when using MDI.
Until now.
I heard about Companion Medical’s InPen some time last year and wanted to give them a try, especially for my insulin pump breaks. I thought that this product would help me answer all of those questions above when I’m taking my insulin pump break.
And I was right.
The InPen gave me the same type of data and info I need, just like I was on an insulin pump.
Full Disclosure - Companion Medical sent me an InPen for free and has sponsored this post. The thoughts and opinions in this post are mine and mine only.
What is the Companion Medical InPen?
Directly from the Companion Medical website, the InPen is:
A reusable injector pen plus an intuitive smartphone interface equals smart insulin delivery. Simplify your diabetes care plan.
Basically, the InPen is a smart insulin pen that connects to an app on your phone via Bluetooth and tracks how much insulin you gave during that last shot and will also track your insulin on board. If you are wearing a CGM, it can also grab your Dexcom data or any data shared within your Apple Health app. It is also available on Google Play, but I use an iPhone, so that’s what this review will focus on.
First Impressions of Companion Medical’s InPen
As I just stated above, I’m an Apple user, so when I first saw this box, it made me very happy. I get excited when I see a nice, clean, bright white box. Call it the Apple fanboy in me, but I get a great first impression any time I see that.
Once opening the box, it looked similar to other insulin pens that I have used in the past. It looked very similar to Novo Nordisk’s Echo. There are three colors that you can choose from (Blue, Grey, Pink). I chose the grey one because, well, no reason at all.
The first thing that I noticed about the InPen is that it is a little heavier than a regular insulin pen, but it was lighter than the NovoPen Echo.
Next, just like with any new toy, I had to start playing with it, so I turned the dial where you would dial up your dosage and I loved the way it clicked and easily turned. It’s important to be able to hear the clicks because sometimes I am taking a shot at night and it’s dark and I need to be able to count the clicks.
The last thing I noticed from my initial look was that it dosed in 0.5 units. For me, this isn’t that big of a deal because I use a lot of insulin, but this is huge for anybody who may need very little amounts of insulin or where the difference in 0.5 units can be life threatening.
Setting Up the Companion Medical InPen
The box came with a simple quick setup guide that made it very simple (see images).
The first thing to do was to download and install the InPen app on my phone. So, that’s what I did.
From there, you have to reset the screw which is used to push the insulin out. The hardest part about this was remembering which way is counterclockwise. Also, if you have fat fingers like me, then it was a little tough at the end to twist the screw back in. This would be one of the main things that I would recommend for them to upgrade in a new version is to somehow make this part more automated.
Once that was completed, the app took me through a demo of how the app works and where everything is located. I will add the screenshots below and each image includes a description of what you are looking at directly from within the app.
Some highlights of what I love about this are the following:
My insulin dose appears in two locations. My last dose will be shown in the upper left hand corner along with the time so I know when it was taken. Each dose that I have taken is then located in a timeline so I can see all of the recent doses.
This then calculates the Active Insulin or Insulin on Board. You can see this in two locations as well. It is a big/bold number directly in the middle of the screen, but you can also see a visualization of how much insulin is remaining from your last dose because the circle will turn grey.
The setup then required me to input some information that came from my doctor, such as carb ratios, target BG range, correction factor, insulin sensitivity, etc. In order to connect the InPen you also had the remove the cap and the cartridge holder.
Here is the InPen in action with my first shot. (Don’t mind the kid’s rocking chair in the background.)
Here is a screenshot of the logbook feature that the app includes:
I’ve used the InPen for about 3-4 days, which is the amount of time that an insulin cartridge lasts me. I would have done a longer experiment with it, but unfortunately, my insurance doesn’t cover insulin cartridges, so I was not able to obtain more than just one sample cartridge.
One cool feature that I like about the app is that since I prime my pen needle with 2 units every time I put a new needle on, the app tracks the 2.0 units, however, you can click on the dose and select the option to count that dose as a prime and not injection and it will remove the 2.0 units from the insulin on board calculator.
Now THAT is cool.
Reports Tab
Another feature in the app is the Reports tab. In this reports tab you can create a report from the last 7, 14, 30, or 90 days. You can see the screenshot below for a 14 day report (even though I only have a few days of data and some missed data).
I like that the report clearly states my average blood glucose level and my average Total Daily Dosage insulin levels. It also tells you what percentage of the time you used the recommended calculator dosage and how many missed doses. In this report, the missed doses are higher because I didn’t use for the full 14 days, so the data is a bit skewed (no fault to InPen, but of my own).
This report can also be easily emailed, printed, shared, and faxed directly from the app, which is very, very cool.
My Overall Thoughts – Highly Recommend
My overall thoughts and recommendations would be that I highly recommend the InPen. The number one reason why is because it gives you the tracking features of an insulin pump, without having to use an insulin pump. And, it does this all automatically.
I have used apps in the past that require me to input my dose and BG and that last about a day, if that, because it requires me to take extra steps, this does not.
It automatically connected to my phone and the information was right there at my finger tips when I needed it. The whole purpose of using apps for me is to save me time. If I have to open up the app and input any data, I might as well just write it down or not even use an app because it’s not saving me anytime.
Diabetes takes up enough of my time, the tracking of information should be done for me. And Companion Medical’s InPen does just that.
So, final review.
Two thumbs up.
If you want to try or use the Companion Medical InPen, it is a very simple and easy process.
When I was first diagnosed with diabetes back in 2004, I was on MDI for the first year and a half. In December of 2005 I began using a Medtronic insulin pump. I have been on one ever since. During those 13 years, I have taken plenty of pump breaks and used MDI for a few days, even weeks at a time. I would eventually just back to my trusty insulin pump.
After a lot of thought and consideration, I have decided to give up the insulin pump and go back to MDI full-time. There are several reasons for this, but before I get to that I just want to mention this. I think that MDI is looked at as a barbaric, old school method of management these days, especially with all of the amazing technology that we have, but since we all know that your diabetes may vary, it works for some people.
Overweight
One of my biggest issues is that I am overweight. Big time overweight. Because of this, I use a lot of insulin. Primarily because of the unhealthy food choices that I make, which has caused me to be overweight. In any given day, I may range from 180-220 units of insulin in just one day!
That’s 180 units of insulin going into one infusion site. There is absolutely no way that the infusion site can handle that much insulin in such a short period of time. This then leads to my sites leaking, not absorbing the insulin, and hard build ups in areas which then do not allow me to use them again as an infusion site for a long-time.
The primary solution here is to stop eating like an idiot and lose weight, but in the meantime, I have decided to go MDI.
One Bolus, Multiple Injections
With MDI, I can divide all of my shots to different areas throughout the day. For example, my Tresiba is taken in two shots, both at the same time, but I split the amount in two, one shot in the left arm, one shot in the right arm. That way, my body absorbs the insulin much better. Same goes with bolus shots. I am able to split them and inject insulin into different locations for the same meal. This helps my body absorb the insulin much better, not cause scar tissue to soak up the insulin, which all leads to better blood sugars.
With all that being said, my new game plan to manage my diabetes is going to be Tresiba, Novolog, and Dexcom (more on this tomorrow). I am also going to take a trial run of Fiasp, which is a much faster acting insulin. I sometimes don’t take my insulin until after I ate (lazy) or right before the meal, so this Fiasp reacts much quicker. I’ll have a full review of Fiasp after I can sample for a week.
Switching back to MDI is the number one reason why I stepped down as a MiniMed Ambassador. I could not continue to do that while not being on the pump. I feel like this is the best management for me and the best way for me to lower my A1C and spend more time in range!
Here’s to a new journey in life and I’m looking forward to sharing everything that I discover in this new journey with you.
Amanda and I have always been fans of local farmer’s markets. For me, I love the fresh food and small businesses that are out there hustling. I am a huge fan of homemade items that are usually sold at farmer’s markets, such as pickles, jellies, pepper jellies, baked goods, fresh veggies, etc.
Our local farmer’s market is located right next to the intracoastal waterway so it is a beautiful site as well. We had not been there in a while, so we decided to check it out and see if there were any new vendors. There were some new ones there and I knew it was going to be time for a BG check and some insulin because I saw some great free samples.
That leads me into what I wanted to talk about. During this time, I was taking an insulin pump vacation for the weekend and was just using a syringe and vial. Walking around eating free samples and not knowing exactly what I am going to be eating never worked out well for me when I was on MDI. When I am pumping, it is not a big deal because every time I decide to eat something, I just bolus for it with the pump and that’s that.
When I am on MDI, my strategy is a bit different. And in the comments below, or on Facebook, I would love to hear your feedback and your comments on how you handle situations like this.
In a situation like this where I am eating random items that are free samples, they typically are not large enough that I need to worry about a bolus. If I eat 3-4 free samples from different vendors and I feel like it was a significant amount of carbs, then I will simply stop and take a shot. If I know that I am going to eat something that is not a free sample, but an actual item (New England Clam Chowda at this farmer’s market is amazing!) then I will bolus directly for that.
The other issue is that depending on what you are eating (sweet pickles, pepper jelly) it is difficult to guestimate how many carbs are in a specific food. I honestly do not get mad if the vendor does not have that information. I just ask what they put in it and I do my best to guestimate. If I am wrong, then I correct, simple as that.
Usually after the amount of walking that we do at the farmer’s markets we go to (at least 2 miles altogether) the exercise helps burn off some of the food that I ate and helps balance out the blood sugar. Please note, I am not saying exercise is going to lower my blood sugar and I don’t need insulin, so diabetes trolls, stop right there.
Like I said above, I’m curious as to how MDI-ers handle situations like this? Would love to hear your feedback.
Since switching back to taking shots from a syringe, I was using Levemir that was being provided by my endo since I couldn’t get the insulin through insurance. I went a few days without any basal insulin and was tracking my blood sugar a lot closer than normal. What did I find? My control was a lot better than it was on the pump and with using basal insulin. How can this be? This goes against everything that I’ve learned about diabetes in my almost 10 years of living with it. Basal rates with the pump and basal insulin when on MDI.
I decided to continue down that path for a while. It’s now been about 3 weeks since I have gone without any Levemir or Lantus and usingly Humalog only. I have had more lows during this time because I take a few extra units at meal time to cover for the “basal”, but these lows are tending to occur right around the next meal time. How perfect is that? You’re blood sugar gets a little low right before you eat your next meal. I tried to do that while I was on the pump all the time and I just couldn’t get it to work.
There’s always a lot of talk about YDMV, Your Diabetes May Vary, and this is definitely a way that my diabetes has varied. In fact, I do not recommend trying this at home, or work, or anywhere, especially without talking to your doctor about it. My doctor is not thrilled about this decision I made, but she has said, “if your numbers are in range, then it’s a good, working plan”.
I have some travel plans coming up soon, my honeymoon, and I’m curious to see how this plan is going to work in vacation mode. Vacation mode means, over-eating at every meal, and adding a few extra meals during the day, no exercise, alcohol and fun.
If this is a way for me to better control my blood sugar, then I’m in!
It’s been approximately 15 months since the last time that I was able to go to my mailbox and pick up a 90 day supply of insulin from the insurance company, and damn it feels good. It felt great yesterday to call the insurance company and set up my mail order account with OptumRX, which this is my first time dealing with them, I’ve previously dealt with Medco with United Healthcare.
The customer service rep answered all the questions that I had about my new insurance and the costs and it was a very simple process to set up my account and get my first order submitted. Called the doctor and had them fax a prescription which I figured would take several days for it to be input into the computer and then another day for the order to process. That was not the case. I called my doctor around 10 a.m. and I received an email last night around 7 p.m. that my order was processed and had a tracking number. That tracking number showed that the package was already picked up and headed my way to south Florida.
The insulin pricing was a bit different then previous insurances that I used in the past. And insulin in a vial vs insulin pens were different as well. For example, the Humalog insulin vials were a tier 1, but the Humalog insulin pens were a tier 2. The Novolog vials were tier 2 and so were the insulin pens, but the insulin pen refills were tier 3. Apidra of course was a tier 3.
Just for my own curiosity, is Apidra NOT a tier 3 for any of your insurances?
Going from what I was paying out of pocket for insulin, which could have been a lot more if it wasn’t for some of the awesome people in the DOC, to only having to pay $25 for a 90 day supply, I cannot find words for the way it feels.
Next up is test strips. All of the supplies are covered under my medical and not pharmacy, so that’s a whole other story. The new year for insurance starts in November, so why waste money on a deductible now, when it will just need to be re-paid again in a month and a half. But that also means I have to stretch out the life of the current strips that I have.
No matter what, I will never complain about an insurance issue, the costs of supplies or a deductible or anything! I hope that I can eventually help others as much as people helped me get through this tough time.
***Update*** I wrote this post before I opened up the package. I received the package and went to Starbucks to write this post. Upon opening the box when I got home, the package contained 3 vials of Humulin N. I use 5 vials of Humalog a month, and have never used Humulin, so this is a big mistake. Then I remembered that during my last appointment two weeks ago, I spoke with my doctor about possibly using 10 units a night of Humulin to help with the morning highs and that’s where the confusion may have came in. So, although the pharmacy did not make a mistake and I have been billed for the $25 for the insulin that I will never use, I can’t really complain about them.
Well, it wasn’t really a weekend at Disney, but Orlando / Kississimme / Lake Buena Vista, but it’s just easier to say Disney. Amanda and I absolutely love coming to Orlando for a weekend trip because it’s not too far from our house and we love the Disney atmosphere, because, well, who doesn’t love Disney.
We decided to take a pre-mini honeymoon over Labor Day weekend to just relax and venture around Downtown Disney. This was my first trip to Disney (Orlando) not wearing an insulin pump. Every other time I went, I was on a pump and eating all the wonderful snacks and sweets there was very easy. Just hit a few buttons and bam, insulin delivery. Things were a tad bit different this time.
Our first night there, we decided to go to Uno’s, it’s one of our traditions when going to Orlando. If you have never been to Uno’s or have never have Chicago deep-dish pizza then you really haven’t lived your life to the fullest yet. I have come to the conclusion that there is no logical reasoning in how to bolus for this meal. It’s a “damn, I better take a shit load of insulin and just deal with the low if it comes later” kind of thing. (Remember kids, don’t try this at home, even with your parents’ permission.)
Not only was I not using an insulin pump, I was fresh out of insulin pens and was using the old school syringe and vial method of insulin delivery. The bathrooms in Uno’s was perfect for a dude who had to take an insulin shot in private. If I am drawing insulin from a vial with a syringe, I will tend to go to the restroom to do so, if it’s from a pen, I’ll shoot it up right at the table.
After Uno’s we decided to head on over to Downtown Disney, which was walking distance from our hotel, so I thought the walk would definitely help with the carbs and blood sugar dilemna that I thought I would be having because of that amazing deep dish pizza. Guess who’s blood sugar went low while at Downtown Disney after walking around for almost two hours? Guess who was also ordering a Mickey Mouse rice crispy treat covered in dark chocolate, then smothered in Reece’s Pieces and topped with a white chocolate swirl?
If there was ever a perfect time for a low blood sugar it was then.
The next day was all about the outlets. If you haven’t been to Orlando, they have three sets of Outlets, two of them are the nationwide Premium Outlets and they also have a smaller Lake Buena Vista Outlets. It’s usually Amanda’s goal to hit all three! Fortunately, for me, it was about 95 degrees all day and Amanda was over it after the first stop of outlets. I was also about over standing out in the heat and was feeling like I needed to eat because my blood sugar was trending down. Quick lunch at Joe’s Crab Shack raised my sugar a bit too high than I would have liked a couple hours after eating. (This exact Joe’s Crab Shack was robbed the very next day).
I knew that we were going to CityWalk at Universal Studios and would be out pretty late, so I don’t like not having a “stable” blood sugar before going out for a long night. This was definitely one of those unstable times, high morning, low before lunch, higher after lunch, high before dinner, etc.
After making pit stops to Margaritaville, Fat Tuesday’s, and Pat O’Briens, it was time to get some food. When we decided to eat at the food court in CityWalk, I didn’t realize there was no bathrooom and I have to go all the way downstairs and have a pretty long walk to get there, just to take an insulin shot, so I went against what I said earlier about not drawing up a syringe at a table. I not only had to take my bolus, but it was also time for my Levemir, so it was a double shot! No weird looks, so I would call it a success.
All in all, my last trip to Disney, without an insulin pump was not that bad. I thought that it would be more of a pain in the ass to draw up shots everytime that I wanted to snack, but I found myself just not snacking as much as I would have if I was wearing my pump.
Next up, the real honeymoon on a cruise, now that’s going to be interesting.
It’s been at least a month since I put the pump away in the closet and have been using insulin pens / syringes. It’s almost time for me to make the decision of which method I want to continue with and obviously, it’s not an easy one. Living with the pump for about 9 years, it had become just a part of me and it didn’t bother me that I had wires hanging out or that I constantly had something connected to me. The primary frustration was the fact that over the past couple of months infusion sets were falling off too easily and I was constantly inserting a new one. Read More
Today was my first day at the gym without using my insulin pump. There have been plenty of times where I removed my insulin pump while I worked out, but this was the first time while being back on MDI. My first thought was, damn this feels great to not have my pump in my pocket or bouncing around while I am running or riding the bike. I was also a bit nervous about it.
I am using my Dexcom along with MDI, so I feel a lot more comfortable on MDI this time around then I did 8 years ago…. I was also only diagnosed 9 months before that, so everything about diabetes was weird and uncomfortable at that time. Going into the gym, my Dexcom was telling me I was about 135 and the One Touch Mini was giving me a 150, not too far off, at least for me. Being at 150, I felt comfortable not needing to eat a granola bar or any other type of snack before I hit the gym, because I knew that I had my glucose tabs with me…… or at least I thought I did. Read More
First, I want to start off by saying, DO NOT TRY THIS AT HOME! No, this is not a Jackass or Tosh.O video, and no you shouldn’t try that stuff at home either, but just keep in mind, I am not a doctor, I am not a medical professional, I am just a dude with diabetes who can use a calculator.
As I’ve mentioned recently, I am going off of the pump for a few weeks, possibly longer, and will be using Apidra and Levemir pens. I cannot get in to my endo’s office for at least another week, but I want to start now.
I figured, no matter what basal dosage we come up with initially, there is going to need to be testing that is done, so I figured I might as well try and calculate an approximate basal dosage, but damn it sure came out to a lot of insulin.
I honestly don’t remember where I heard this, but I swear I heard somewhere that most people use 25% less basal when using fast-acting insulin in a pump as opposed to an insulin like Levemir.
So, based on that assumption, which like I said, is totally an assumption because I THINK I heard that somewhere, here is what my calculations would be like:
Total Daily Dosage for Basal = 56.25
Additional Insulin needed = 25%
Total Daily Levemir Dose = 70 units
I plan on splitting my Levemir half in the morning and half at night. However, 70 units sounds like a lot, but until I can somehow continue to lower my insulin dosages by losing a little bit more weight, I don’t care if it’s a lot of insulin, as long as it is keeping my sugars in check.
I haven’t started on this plan yet, but I’ve sent an e-mail to my doc to have her confirm this dosage to at least begin testing out the right basal.
Once again, do not try this at home. Consult with your doctor on any changes to your insulin intake.
It’s been at least a month since I put the pump away in the closet and have been using insulin pens / syringes. It’s almost time for me to make the decision of which method I want to continue with and obviously, it’s not an easy one. Living with the pump for about 9 years, it had become just a part of me and it didn’t bother me that I had wires hanging out or that I constantly had something connected to me. The primary frustration was the fact that over the past couple of months infusion sets were falling off too easily and I was constantly inserting a new one.