You Can Teach an Old Dog New Tricks

Riva Greenberg

| Sep 20, 2009

That old dog is me (thirty-seven years living with diabetes). There's a lot to be said for teaching someone who's lived with diabetes for years new ways to manage diabetes, and some new things that have come into the marketplace recently.

Because I work in the diabetes field now as a patient-expert and author, I am privy to new products, emerging research, a remarkable network of patients and experts, and an inside view of what patients and professionals are talking about. Having enjoyed this privilege for the past seven years, the other day I took stock of the many new habits I've formed and new products I use now that make life with diabetes better: less effort, more calm, happier, time-saving-and, yes, easier to manage.

Just two years ago I wrote an article for this magazine about how I no longer performed many of the tasks I was taught when I first got diabetes in 1972 ["Confessions of a 35-Year Diabetes Veteran"]. For instance, using alcohol pads fell right away in 1986 when I moved to Japan and my company clinic didn't have alcohol pads. When the nurse handed me a giant bottle of alcohol and a big bag of fluffy cotton balls (the only big things in Japan), I stopped swiping before a shot. Years later we learned you didn't need to and that in fact the drying effect from alcohol was undesirable.

Today, I'm reflecting on how many things I now do that I was not taught years ago, things that improve the quality of my day-to-day, and I'm expecting, future days. Here's my list of things I've changed: my tools, techniques, and life.

1. Insulin pens. I'm an old vial and syringe girl and always expected to be. But after my mail order pharmacy sent me Lantus in a pen rather than a vial by mistake, I said, "Alright, I'll try it." Now, there's no turning back. It's quick, easy, more discreet, and just feels nice in my hand.

2. Clickfine needles. Now that I'm a pen convert, I really like this pen needle innovation. Clickfine needles have a small yet distinct advantage that makes diabetes care easier, especially if you have any manual dexterity or vision problems. These needles "click" onto any diabetes pen and require no twisting to attach. Just makes my world a gentler, more comfortable place.

3. Dex 4 liquid glucose. It's 15 grams of fast acting liquid carbohydrate that works quickly like glucose tabs. Being liquid, it might be marginally faster than glucose tabs. It's easy to store and doesn't require refrigeration. Word of caution: Peel the plastic off the bottle when you get it home, so when you need it, you won't have to fumble with the plastic wrapper.

4. Rethink your medicine. I recently switched from rapid-acting Humalog to rapid-acting Apidra. Apidra works faster for me so I need less of it, and, if I'm in a restaurant, its speed allows me to take my injection moments before the first mouthful. That means I can actually see what's on my plate that I need to cover.

5. Start a new bottle of insulin or pen the first of the month. Since I don't use a lot of insulin, at the end of the recommended 28 to 30 days (the prescribed amount of time you should use your insulin), I would have so much left in the vial or pen that I'd forget to toss it. A week or two later I'd notice my blood sugar was running high and then, voila, it would dawn on me that my insulin had spoiled and I needed to start a new bottle. If you change your insulin the first of the month, you won't run into this problem.

6. Find your favorite meter. Mine has no bells or whistles, but two things it does have make my testing less stressful and more pain free. When meters first came out with "no coding" I didn't think it was a big deal, but now I love not having to make the extra effort to code my meter. My favorite meter is Bayer Contour because it has no coding and it uses the smallest amount of blood. This means I don't waste test strips or have to poke my finger more than once. No matter how little blood I get, it's enough for this meter.

7. Always leave your meter in the same place. Healthy habits help you expend less time and energy on diabetes tasks, and this is my #1 healthy habit. I always leave my meter in the same place on my kitchen counter so there's never a need to look for it, which means there's no excuse not to test.

8. Test and correct more. In the old days if my blood sugar was high between meals, I'd wait until my next meal to take a little extra insulin and play catch up. Today, I cover the high right after I test. That little extra effort makes me feel much more confident that I will have many more healthy todays and tomorrows.

9. Get more support in your life. I speak to patients across the country as a peer-mentor. Helping motivate and educate fellow patients is a very selfish joy for me. It has also brought a world of friends with diabetes into my life. Only now do I realize how lonely it was all those years I didn't know anyone else with diabetes. Today I experience the richness, innate bond, and understanding we all share being in this fellowship.

10. (Because no list can end at 9) Use caution when following this advice. Side effects may occur. You may find life, and managing your diabetes, easier.    

* * *

Riva Greenberg is the author of the book, "The ABCs Of Loving Yourself With Diabetes." Her new book, "50 Diabetes Myths That Can Ruin Your Life: And the 50 Diabetes Truths That Can Save It" will be available from your local bookseller in August, 2009.

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Categories: Blood Sugar, Columns, Diabetes, Diabetes, Insulin, Lantus, Living with Diabetes, Personal Stories

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Posted by gandalf888 on 1 October 2009

Good advice. I've had diabetes for 53 years now. Things have changed drastically. The one thing I don't understand is why can't they make a smaller bottle of insulin? The newer insulins (especially Apidra) can go bad so easily and can't be used for more than a month. I throw so much insulin, both Apidra and Lanus, away each month, it makes me sick! If it weren't so expensive, I guess it wouldn't bother me quite as much, but it is a terrible waste.

Posted by gandalf888 on 1 October 2009

That would be Lantus. I hate my keyboard.

Posted by rstryker on 2 October 2009

Great post. I think the pens are great for people who have to waste insulin. Each pen has only 300 units. Most people will use at least 10 units a day. Then there is not waste.

Posted by Anonymous on 2 October 2009

There have been some articles in the past about people confusing their insulins and injecting too much fast-acting. The pens are great, but it's helpful to keep one as syringe/vial for distinction. For me, Apidra is pen (easy to take wherever); Lantus is syringe (always at home, in fridge).

Posted by cde on 2 October 2009

For those of us who prefer syringes to pens and who use little insulin (less than 300 units a month of a given insulin), the refill cartridges used in the pens or the pens (with the integral cartridge) themselves (if they are disposable and the cartridge cannot be replaced or removed) make a lot of sense.

The dose of insulin can be withdrawn into the syringe from the cartridge (without injecting air to replace the insulin amount withdrawn) and injected as usual.

Here in México, I urge all my clients to buy the 3-mililiter cartridges (instead of the 10-mililiter vials) precisely so that A) they don't buy expensive insulin that they will have to throw away at the end of the 30-day life of the insulin (once opened) and B) they are assured of having viable insulin rather than irregular or unpredictable insulin working in their bodies.

NO ONE enjoys throwing away a costly product, so the cartridges remove the temptation to continue using the remaining insulin after the 30-day period and to think, "Oh, a couple days more won't matter."

Many of the pens are fine, but some are of no use if you take 1/2-unit doses of insulin because on the unacceptable ones, you cannot withdraw one-half unit or 2.5 units of insulin.

Dr. Stan De Loach
Certified Diabetes Educator
México, Distrito Federal

Posted by din209 on 2 October 2009

Great article -- I have had diabetes since 1981, and prior to going on a pump (5 years ago) I fell in love with the pen and had no trouble injecting discretely in public all over the world ... they were so convenient and easy to use and carry around! For me, coding a meter was less of an issue then finding one that was tiny, fit in my pocket, used a teenie sample and could easily be used in dark situations - I tried too many to remember and finally settled on the Flash - yes it must be coded, BUT, for me that is a insignificant issue compared to the benefits. My motto has and continues to be "compare and then rate diabetes products on the 'Hassle Scale' - where less is best!" :) - even the pump has its' set of hassles but in my current 'evolutionary state', they are outweighed by the benefits provided. To Be Continued!

Posted by Anonymous on 2 October 2009

As a diabetic of 60 years I have alot of changes in treatment methods but today Doctors are moe likely to listen to what
diabetics tell them about their feelins
and they learn alittle about how diabetws realy is so please everyone tell them and maybe they will get a cure.

Posted by rivag on 3 October 2009

To Anonymous who wrote he/she takes Lantus via syringe and keeps it in the fridge, once you start Lantus, you should keep it out of the refrigerator. You may want to double check that with the Lantus people but that's what I've always been told. I too take my rapid acting insulin via syringe and my Lantus via pen so I don't mix them up.

Posted by cde on 5 October 2009

rivag, refrigerated or not depends on whether one uses the vial or the cartridge for withdrawing and storing the opened insulin.

The opened CARTRIDGE should not be refrigerated at any time. The unopened cartridge should be refrigerated.

The VIAL, open (in use) or not, can be refrigerated or not.

sanofi-aventis, the pharmaceutical company that makes and sells Lantus/glargine, recommends (in the US product/package insert):

"Open (In-Use) VIAL: Opened vials, whether or not refrigerated, must be used within 28 days after the first use. They must be discarded if not used (up) within 28 days. If refrigeration is not possible, the open vial can be kept unrefrigerated for up to 28 days away from direct heat and light, as long as the temperature is not greater than 86ºF (30ºC)."

This recommendation suggests that while it may not be necessary to keep the open vial refrigerated, it is acceptable and probably wise to do so.

"Open (In-Use) Cartridge system: The opened (in-use) cartridge systems (OptiClik and SoloStar) should NOT be refrigerated, but should be kept at room temperature below 86ºF (30ºC) away from direct heat and light....

"Do not store OptiClik, with or without cartridge system, in a refrigerator at any time."

No explanation of the WHYFORE for this different treatment is provided.

Dr. Stan De Loach
Certified Diabetes Educator
México, Distrito Federal
(DM1 since 1969)

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