Having your insulin pump die while you're on vacation

There are a few law suits over this. Essentially, the claim is that they call it "prescription," but it has no prescription medications in it and isn't approved by the FDA to treat anything. So if you have an extra bag and sell it, this is OK since it isn't actually a drug, it's allegedly a price fixing scheme between vets and pet food makers.

- bring lantus pens

- bring a backup pump. If you've been on a pump for more than 5 years you've probably gotten a new pump because the old one went out of warranty coverage. I have 2 old pumps which still work in an emergency (although without closed-loop - they will still do basal and bolus).

- regarding being forced to prime 10 units of insulin out of the tandem x2 just to use the existing cartridge when the tube is already full of insulin. This has always annoyed me as well. If you are in a pinch or really don't want to waste insulin what I've done is take the needle part off a two-part syringe (assuming you have that kind) and stick the end of the pump tube (the coupling part of the pump site) into the hole of the syringe and prime directly into it. Then you can put the needle back on the syringe and inject the primed insulin back into your insulin bottle.

Your survival is ultimately your own responsibility. Prepare yourself for a few hard truths.

No one — including nurses and doctors who are not specifically trained in diabetes management — truly knows your situation.

I had a TIA. I was barely functioning, hospitalized, semi-conscious. Not a single person in the ER, nor during the entire week I was admitted, stopped to think that maybe I wasn’t mentally fit to manage my own CGM.

Always be prepared.

I once found myself in what my company had sold to me as a “hotel” in Germany. It was really more of a shack. I was having a severe hypo, glucose at 70 and dropping fast. There was no lobby, everything was closed, emergency services didn’t speak English, and I couldn’t even find a taxi willing to come out there.

I ended up licking sugar crumbs and biscuit dust that had accumulated over the years in the pocket of my suitcase.

Your CGM can fail. In fact, it will almost certainly fail while you’re on vacation on some Greek island with no signal.

You must know how to manage your blood sugar with insulin pens. Even with different insulin types. You need conversion charts. You need the phone number of your diabetes center so you can get proper instructions. You must be able to change an infusion set in the dark, slightly drunk, like Rambo — except this isn’t a movie.

You need to remember your insulin-to-carb ratio and be able to estimate the carbohydrates in a dish you’ve never seen before.

I’m lucky enough to be able to “feel” my blood sugar. More importantly, I can sense when I’m heading toward a hypo, and I do everything I can to preserve that personal superpower.

As we say in Italy, being diabetic is serious business.

My colleagues and friends see only the outside. They see a well-managed condition, an HbA1c of 6. They laugh when I tell some of the more extreme stories.

But they have no idea — absolutely no idea — how difficult our lives are.

Ours, and our families’.