Insulin Pumps

Three Month Pump-aversary!

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The very first thing Gwen emphasised to me last year was that using an insulin pump would not be any easier than Multiple Daily Injections. Boy, oh boy, was she right.


These past three months have been by far the most challenging I have faced since being diagnosed with type 1 diabetes six years ago. I have gone through site failures, occlusions, ketones, frustrations and burnouts that have lasted for several days on end. It has required enormous patience, a commitment to learn, and it has seen me agonise over many a decision. I have been through it all. I have poured my heart onto these pages over the last three months.

There have been a lot of low points that I have talked about quite candidly over the past three months. There have been a few times where I’ve reached breaking point. Times where I have found myself pacing up and down my room, deliberating over whether to rip my pump out and take a break for a couple of days.

But every time I have contemplated removing my pump, I knew that I really didn’t want to say goodbye to that added level of precision. I have never truly felt ready to say that this wasn’t for me.

Stability during the night is miles better compared to injections. I felt that when I was using Lantus, I could never get the dose quite right. I felt that I needed to eat a similar number of carbohydrates each day in order to achieve that smooth coverage I needed during the night. I felt that if I ate more than normal, my basal wouldn’t be enough to keep me stable through the night. Then if I were to skip a meal the next night, my basal would likely send me plummeting at 4am.

For the first time in my life, I have confidence that my basal rate keeps me stable. When I give a correction at 1am, it actually works and sends me back into range by the time I wake in the morning. When I go low during the night, it’s only through my own fault.

I could never seem to get my breakfast insulin dose just quite right. In the months leading up to the pump, I noticed that I would end up frustratingly high after eating virtually the same thing for breakfast each morning. Now my pump delivers extra basal insulin to cover the extra glucose that my liver dumps when I wake up each morning, and my breakfast insulin dose actually does it’s job!

Highs are also so much easier to manage with the pump. I remember stubborn highs that were so resilient they needed multiple insulin corrections that didn’t make any sense. Now with the pump, I know that highs are a little less sensitive to insulin. When my levels soar into the 20s, I can set a temporary basal rate of +200% to get things moving a little more quickly. When i think about it, I don’t think my levels peak above 15mmol half as often as they used to. And when they do, they don’t stay there for too long at all.

On pump day, Gwen reminded me that I was the kind of person who wanted that extra level of precision. I knew that I wanted to be able to customise my insulin delivery to match the hour of the day or a specific activity. I feel that my insulin pump has given me that.

The pump has given me an added focus and drive with my diabetes. I am working my butt off with carbohydrate counting, pre-bolusing and watching my portion sizes (which I could easily do without the pump, too). I guess what I’m trying to say is that my diabetes goals seemed unattainable on injections. With the pump, they do. Hence, the drive to keep up the hard work rather than being lazy.

I’ll hopefully have an a1c result at the end of today. I have a good feeling that it will likely be around the same mark as it was in May, and I’m pretty content with that. Over the years my a1c results have been ridden with too many peaks and troughs, so I’m pretty pleased that those peaks are a little less peak-ey today.

As I reach the three month mark on an insulin pump today, I feel like I can finally focus on some of my other diabetes goals, which feel far more in reach than they ever did on injections.

Thanks for all of your support and encouragement over the last three months. I really couldn’t have done it without you all cheering me on.

A New Member of the D-Club

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“Doesn’t your sugar levels go high if you eat too many sweets?”

This was a question that was posed to me over the weekend, as I reached over and grabbed a sweet from the table. 

“I’m low at the moment” were the first words I could get out of my mouth, resisting the urge to add more words until the sugar was sitting safely in my belly.

“I have type 1 diabetes. My body doesn’t produce any insulin.”

I pulled my pump out of my pocket, thankful for my newfound prop that keeps my flailing hand gestures at bay.

“This delivers all of my insulin for me. Technically speaking I can eat anything I want, so long as I give insulin to cover it. Obviously it is better for my blood sugar levels if I eat healthier foods, though.”

This person then went on to tell me that she had been recently diagnosed with early signs of type 2 diabetes, and that the lifestyle changes suggested by her doctor were easier said than done. That she wasn’t sure how changes to her diet would fit in with the rest of her family at home. As she questioned her need for the medication prescribed to her, I could see just how hard it was for her to accept her condition. It brought back my own memories of hiding my diabetes, unable to accept my new ordinary.

I curiously asked if she was testing her blood sugars at home, or whether she had seen a diabetes educator yet. As she told me ‘no,’ I nodded my head. The last thing I wanted to do was to try to give advice. The last thing I wanted to do was to act like I knew what she was going through, or what was best for her. Type 2 diabetes is completely different to type 1. Heck, one person’s diabetes is completely different to another’s.

Yet at the same time, I felt like I should have done more to help her out. I felt sorry for her, because her doctor didn’t seem very helpful or supportive. I hope I said the right things.

“I know it’s hard. It’s taken me ages to make changes that have lasted. I’ve had diabetes for six years, and I still have days where I don’t feel like I’ve got it right.”

All I really wanted to do was to give her a big hug and tell her everything was going to be okay.

Hopefully she sees in me that it will be.

Navigating Diabetes Through a High Carb Breakfast

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I have always found diabetes extra challenging to manage around big meals. I’m the kind of person who likes to try a bit of everything at a party. I try not to let diabetes get in the way of enjoying myself on special occasions like birthdays or Christmases, because they only come around once a year. Often the consequence of this has been high blood sugar levels that are tricky to bring down in the hours that follow.

One of the biggest advantages of having an insulin pump is the extra flexibility that it gives me to work around high blood sugar levels. With tricks like temporary basal insulin rates, the pump has definitely saved me hours of frustration in trying to bring my blood sugar levels down in the aftermath.

Yesterday my pump got it’s first taste of a high carb meal, as I took the wheels out for a spin over breakfast. I had been craving pancakes all week, so my order was going to be a no brainer.

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In anticipation of the extra carb load, I set a temporary basal rate of +100% to ensure that my mealtime insulin did its job effectively. I did this before I left home, so that the basal rate would kick in by the time I sat down to breakfast.

The cafe looked pretty busy, and I wondered how long I would be waiting for my pancakes. I guessed that I would probably need insulin to cover somewhere in the vicinity of 60-80g of carbohydrates, but I didn’t know for sure how big the serving would be. I decided to play it safe, and pre bolused half my insulin when I placed my order, and the other half when my meal arrived.

When I left the cafe, my blood sugar was 13 mmol. When I checked again at home half an hour later, I was 13 mmol once again. I noticed my blood sugar begin to creep up again at around the 3 hour mark, as I would expect for a higher loaded meal. I entered my blood sugar reading into the pump, overrode the insulin on board subtraction, and gave a correction dose. I kept the temp basal running, anticipating that I would need it to cover the delayed fat/protein spikes.

By around 2pm, my blood sugar was almost back in range at 8.3.

The majority of my numbers throughout the morning were around the 12-13 mmol mark, save for one brief peak at 15.7 mmol. To put that into perspective, a loaded meal like that has the potential to send me well above 20 mmol. 

Safe to say I was pretty damn pleased with my handy work.

Take that, food police.

In the Line of Questioning

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I went down to my local pharmacy yesterday to order some consumables for my insulin pump. Specifically, I had chosen a box of Comfort infusion sets (thanks for the suggestion, Laddie) in response to some of my recent site failures. I pointed out to the Pharmacist that I had not purchased this item before, because I knew that the computer would notify her of this.

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“Why do you need a different one?” She asked me.

I explained that I wanted to try a different kind of infusion set, because I had been having some site failures recently.

“Have you spoken to a diabetes educator? You’re not really supposed to be changing without their advice.”

I found this line of questioning rather bizarre, because prior to the recent NDSS changes in Australia I could easily jump onto the computer and order whatever I liked with no questions asked. Besides, would you really expect me to call my educator if I wanted to change the colour, or length of my infusion site? Do you really expect that the needs of my diabetes aren’t going to change ever again?

I think she was only trying to make sure that I was ordering a product that would be compatible with my pump, and that I understood that I would not be able to bring it back.

There is a lot of uncertainty at the moment while the delivery of diabetes consumables is shifting from online to pharmacies, and she was probably making sure I wasn’t being wasteful. There is a lot of fear and sensationalism being spread around on social media. Many are over ordering in response, leading to shortages in the supply of diabetes consumables.

I made it clear that I had done my research prior to selecting the product, and that I was only purchasing the one box because I wasn’t sure if I will like using this type of infusion set.

Pharmacist questions always make me uncomfortable. Even when I walk in there with the flu requesting Demazin tablets, they always question me about the symptoms I am experiencing.

I just try to remind myself that it’s a Pharmacist’s job to ask the hard questions. It’s their job to make sure that we are ordering the correct medications for ourselves. It’s their job to make sure that we are not being wasteful.

I’ve been buying diabetes consumables from my local pharmacy since I was diagnosed. Having a good relationship with them over the years has really paid off. They’ve given me insulin when I presented an expired prescription once. They eventually gave me the test strips after I was told I had purchased too many last year (I wrote about this here). They know that I have diabetes and they understand what I need.

If there’s one golden piece of advice I would give to Australians affected by changes to the delivery of diabetes consumables, it would be to find a local pharmacy and build a good relationship with them.

Answering to people that I’ve known for well over six years makes those hard questions a little less uncomfortable.

Sidenote: You can read more about the NDSS changes here.

Pump Doubts

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After a few infusion site failures of late, I’m starting to become really self conscious. After every new site change, I become really paranoid of whether it’s a failure or success.

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I poke my infusion site, trying blindly to detect a kinked piece of teflon that should be sitting underneath my skin. I prod around the infusion site on my stomach, trying to feel bruising and pain. I stand still while my pump is delivering an insulin bolus, waiting on edge to detect any stinging. I lift up my jumper compulsively, watching the colour of the skin underneath my site like a hawk.

I think about whether the skin tissue underneath my infusion site is strong enough to handle 3 days worth of insulin boluses. I frequently glance at my Total Daily Dose history on my pump, questioning whether it’s too high. I feel guilty for the carbohydrates I am consuming, for the sake of the subsequent insulin boluses that will have to go underneath my skin.

I check my levels like crazy after a site change, impatiently looking for signs that the insulin is heading successfully underneath my skin. I keep an eye on glucose movements like a hawk. In a moment of paranoia on Saturday, I even ripped out a perfectly good infusion site because the correction was taking too long to work it’s magic.

I draw dots on my stomach in permanent marker, in a desperate bid to keep on top of site rotations. I stare persistently at the real estate on my stomach, deliberating over just the right spot to place my new infusion site. I worry about how soon I will be able to re-use an area of real estate again.

In moments of site failures, I question whether this is really worth it. I think about results around my diabetes, and I’m almost certain that I won’t see any improvement yet. I’d be lying if I said I haven’t had fleeting thoughts that maybe this is not working for me. I worry that I won’t be able to make this work for me. I stand in my room for minutes on edge, pacing, deliberating over a site change or a shot of Lantus.

But when I think about going back to Lantus, I think about the level of control I will lose around my basal insulin rate. I think about how unfocussed I was on injections, blindly guessing and correcting all the time. I think about all of the time and investment I’ve put into this insulin pump, and I know that I’m not ready to pull away from it just yet.