Insulin Pumps

Pump Break II

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My current pump break is surprisingly different to the one that I took a year ago.

At the time, I was feeling full of anxiety over all of the lows I was having from physical activity. I was still relatively new to insulin pumping, and felt a little overwhelmed at my failure to get everything right. I wasn’t missing my pump one bit, and if it weren’t for the Christmas smorgasbord around the corner I’m not sure that I would have ended up reconnecting.

This time round I’m feeling purely fatigued from the device that I’m using. I’m fatigued from being connected all of the time, and from staring at basal rates and insulin on board all of the time. I find myself getting a little slack with my management, and not getting the most out of my pump. I’m already missing the convenience after just a week, so I’m not confident how long this break will last.

I was deliberating over whether to start my pump break in the morning or evening. I’d read elsewhere that 1) morning would make it easier to monitor my blood sugar in those initial hours, and 2) the effects of Lantus tapering off at the 18-24 hour mark are felt the least. However, I’ve only ever known giving Lantus in the evening. I was also hesitant to have insulin tapering off in the early hours of the morning while I was experiencing dawn phenomenon. So, I stuck with dinner time.

I started with 10 units, the sum of my total daily basal given by my pump. That night, I had about two helpings of Skittles to ward my way out of lows. Residual rapid acting basal insulin from my pump was also very noticeable in those first few hours before bed, and I’d probably create some lag time between disconnecting my pump and giving Lantus if I were to do this again.

The following morning I woke up with terrible insulin resistance, which carried on through much of the day. In the morning it was obviously dawn phenomenon to blame, while in the afternoon my Lantus was likely tapering off.

On night two, I dialled my Lantus dose back to 9 units and added an injection of 3 units the following morning. The evening lows continued, and boy did those Lantus lows feel different. Heavier? Deeper? More intense? It’s hard to describe.

From there my evening Lantus dose went from 7 units to 5 units to 6 units, while my morning dose has remained at 3. That gives me a total daily dose of 9, which is pretty close to the 9.7 units I was giving via my pump. It seems to be keeping me fairly steady while I sleep, so I’m really pleased with that.

My biggest challenge is the moment I get out of bed in the morning. I’ve doubled my insulin to carb ratios at breakfast to combat the insulin resistance. Just don’t make my mistake of putting off brekky for 2 hours and still using double the insulin dose! For the remainder of the day, my regular carb ratio of 1:8 and correction factor of 1:2.6 seem to do their job as per normal.

I’ve been doing all of this blind, aka without the help of a FreeStyle Libre sensor, which means that I’m really feeling the brunt of the pricks on my fingers. BGs have probably suffered in the first week – Lantus was causing some lows in the beginning, while high blood sugars aren’t as easy to manage without a pump. However, I’m looking forward to seeing how this week treats me now that the dust has settled.

At the moment, I’m absolutely loving the freedom from attachment and not staring at my pump every hour. Bolus insulin also just seems to be “working” better. During those last few weeks on the pump, I definitely felt like I was correcting high blood sugars after meals all the time. Having the same kind of insuin for bolus and basal on the pump felt “blurry” at times, if that makes any sense at all.

When I made my decision to start pumping two years ago, I told myself that injections were too clunky and simply didn’t work for me. But after 18 months on an insulin pump, I know that this is not true. So long as I’m prepared to make the commitment to learn and take responsibility for my decisions, I can make any method of insulin delivery work for me.

How long do I think I will stay off the pump? I am missing it already. But I’d like to think I’ll give it until the end of the month, at least.

Pump Fatigue.

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Not tonight, I thought to myself as I paced back and forth in my room on Thursday night.

It’s too late now anyway, reassuring myself of what I’d just decided against, knowing that I would be ready for bed in a little over an hour.

Friday evening rolled around, and I knew that I was ready to do this. But after a plate of Pasta for dinner, I knew I would need a combination bolus to cover it and decided against it.

Saturday evening rolled around, and I couldn’t think of a better day to finally do this. I grabbed a Lantus pen from the bar fridge, stuck a needle on, dialled up 10 units and injected it into my stomach.

I disconnected my insulin pump, ripped the infusion site from my stomach, and tried to remember the best way to tell my pump to stop screaming no insulin delivery every 5 minutes (answer: program an empty basal pattern).

I have grown tired of my pump in recent weeks.

The weather has quickly warmed up since November rolled around, and having a pump attached to me really adds to the discomfort while I’m sweating it out on a hot day. Which I’ve been doing a lot of lately, being under the pump at work and racing around like a lunatic all day. When my clothes are sticking to me, the last thing I need is an annoying pump line there too.

I can’t remember the last time I went for a walk in the afternoon where I didn’t think that I’d done more damage to my blood sugars than if I’d stayed at home. Pumped insulin is so much more sensitive than the injected kind. Yes, I know how to use temporary basal rates and consume carbs, but can’t a guy just go for a walk without it being some big orchestrated chaos? 

Infusion sites are beginning to feel like a real chore. They haven’t felt particularly comfy of late, and sometimes I can really feel the insulin sting on the way in. I find myself putting off changing a perfectly good site because I can’t be bothered dealing with a new one.

I guess my self care has also slipped in recent weeks. I haven’t been eating too well (translate: lots of trips down the chocolate aisle at Woolies), there’s been lots of slack guesstimates and my BGs haven’t been as great as they could be. I guess this lack of effort, combined with being overworked, has left me feeling exhausted at the end of the day. But I’m working on that. I also took it hard when I found out that I was unsuccessful at a job that I thought I would be perfect for.

At the moment, I don’t really want to be thinking about basal rates, insulin on board, infusion sites and the sense of urgency that comes with it all. I don’t need to be reminded of my diabetes every time I pull out my pump to deal with it.

I really think a change is what I need to clear my head and help me to feel a bit more excited about my diabetes management. Which sounds weird, I know, but doing the same thing every day feels absolutely monotonous. I’m also super grateful that I have the luxury of choices in my management, because not everyone in the world can afford insulin and basic supplies. Sidenote: check out T1International, who are working towards a world of #Insulin4All.

Also, I’m dying to go to the beach. Not that I can’t, but no pump sure does make it a hell of a lot easier…

Throwback Thursday: Thinking About An Insulin Pump

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Almost two years ago, I attended an insulin pump information evening. Today I’m looking back at that evening, and some of the reasons why I began thinking about pumping.

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Last night, I attended an information session on insulin pumping.

I’ve been on Multiple Daily Injections since I was diagnosed five years ago. I’ve never seriously considered an insulin pump, and I can’t say that I know too much about them. I’ve thought about going to one of these information sessions over the years, but it was just one of those things that I never got around to. Okay, truth be told I procratinated on RSVPing to those events until it was too late. Over and over.

I guess what motivated me this year was the fact that I am now a part of the Diabetes Online Community. I think, talk and write about diabetes every day. I feel more motivated towards my diabetes managment, just from interacting with you. I see so many of you blogging, tweeting, screenshotting and instagramming pump stuff each day. I want to understand it. And I want to seriously consider it as an option going forward.

Representatives from a few of the insulin pump companies were there to chat to before and after the session. I’ve never seen such eager salespeople out there in full force, desperately wanting our business. When our fantastic host asked for some sample tubing to show us, it literally seemed like a race to see which rep could get to her first. As I asked one of the reps if a meal bolus was as simple as inputting the number of carbs into the device, she began hurriedly cramming in as much information as she could before the talk resumed. I’ve never seen anything like it.

The topic of Continuous Glucose Monitors came up briefly. As I have written in recent days, Continuous Glucose Monitors aren’t subsidised by the government here in Australia. The cost of purchasing a CGM device and its operating consumables is excessive. While having a CGM may not matter to myself, I know that it could make a world of difference to young children and parents out there.

I thought it was rather interesting to hear the representatives in the room quickly removing themselves of any responsibility for those excessive costs. They urged us to write to our Members of Parliament. They urged us to lobby the government for subsidies towards CGMs and diabetes devices. As though it’s out of their hands.

These companies are responsible for the excessive costs of these devices. I hardly got the feeling that these people genuinely wanted to help me make my diabetes management easier. I so badly wanted to know if they even had diabetes themselves!

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Excuse ranty, 2015 Frank. In hindsight, that evening probably could have been designed a little bit better. The good news is that on Thursday October 12, Perth Diabetes Care will be hosting a tech evening, designed by people with diabetes. I’ll be speaking about my own journey with technology, all of the highs, lows and everything I wish I was told on that evening. If you’re in Perth I highly recommend you come along, have a play with the tech and meet other people with diabetes. Details below.

Cellnovo Mobile Insulin Pump Launches In Australia!

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The Cellnovo Mobile Insulin Pump officially launched in Australia last week at the ADS-ADEA conference (ADS-ADEA disclosures are at the bottom of this post). The pump is being distributed by Medical Specialties Australia, and subsidised consumables will be available through the NDSS from October 1. MSA’s Diabetes Division Manager, Aaron Cook, was kind enough to come and meet with myself and a few other consumers last week outside of the trade hall to give us the scoop.

The Cellnovo system consists of a small insulin pump that sits on the skin via a Velcro patch, in close proximity to the infusion set. Tubing is virtually non-existent. The pump is rechargeable, rather than battery operated, with each charge typically lasting 3-5 days. There is a second identical pump included in the box, so that the user can charge one up while using the other.

 

If you know me in person, you’ll know that I’ve dreamt of a touch screen insulin pump that I could control from my Smartphone (yes, I’m well aware of Looping and We Are Not Waiting). Frankly, the interface on my Animas Vibe looks like something out of the 1990s.

So for me, the real selling point of the Cellnovo system is the touch screen mobile handset that connects to the pump via Bluetooth. The screen is bright and colourful. There are menus for insulin delivery settings, bolus calculations, activity tracking and food databases. The handset also has a built in blood glucose meter, which uses Accu Chek Performa strips.

Aaron was telling us something about wax and pistons inside the cartridge (or possibly the pump) that allows for more superior and precise delivery of insulin infusions. Insulin cartridges can only hold 150 units of insulin, which may be a consideration for those on larger doses. I would rarely fit the maximum amount of insulin into my cartridge once air bubbles have been primed out, so this may be closer to 100-120 units of insulin. Your Diabetes May Vary…

There were a few choices of infusion sets, with 5.5mm being the smallest. Aaron informed me that all infusion sets are 90 degrees, which is an issue for me personally as I prefer my 45 degree angled ones. However, I was encouraged to hear that there are options for manual insertion rather than insets. 

Another consideration was the minimum basal profile being 0.05, rather than 0.025. To put this into perspective, my pump gives me the option of delivering 0.300, 0.325, 0.350 or 0.375 units of basal insulin per hour. The Cellnovo would reduce this to 0.300 or 0.350 units of insulin per hour. For some this might not be an issue, but during overnight fasting 0.025 does make a massive difference between a steady or a steadily dropping blood glucose level.

I’m also a little concerned about sleeping or lounging comfortably with the pump stuck to my stomach, so placement of the infusion site would be a big consideration. That being said, consumers overseas are happily wearing the Omnipod tubeless pump in similar fashion. Diabetes Educator Fiona was also questioning how well the pump would stick to the Velcro patch, however I thought that it indeed looked very tough.

Aaron describes Cellnovo as a medium sized startup company. They have been in the UK for around 2 years. Aaron is currently the only sales representative for Australia, and is basically travelling where the demand takes him. I am a little concerned around how well they will be able to handle customer service issues, although I am told this will soon change. Updated: I am told there will be a full customer service team in the office to deal with any issues. They are the same team who looked after the Cozmo pump.

It is really, really exciting that we have a new insulin pump option on the market. I can’t wait to hear from people who do decide to take up this pump, and whether it would be a worthy option for me to consider in two years time. While it won’t be for everyone, I believe that this might be just the thing that some have been waiting for.

Special thanks to Aaron for being so patient with a group of crazily excited people with diabetes and answering all of our questions. No, Aaron does not have diabetes himself…

From the left: Me, Aaron, my friend Tammy, fellow blogger Ashley and Victorian Diabetes Educator Fiona.

Excitement that only someone with diabetes would understand!

Travelling With an Insulin Pump

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My latest column is now up over at Diabetes Daily, and I’m tackling the topics of travel and insulin pumping.

When I first started on insulin pump therapy last year, I was given an overload of information in the space of a day and a half. At the time, I was still trying to get my head around the strange new device that was attached to me. I took all of the information packets away with me and tucked them into my diabetes file at home. However it wasn’t until I embarked on my first flight with an insulin pump earlier this year, that I began to consider some of that information in more depth.

You can read the rest of my column over at Diabetes Daily, so grab a coffee and settle in.