Insulin Pumps

Revisiting Gwen

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I know that the decision to switch to an insulin pump is not something that I should take lightly. I’ve been deliberating the matter for a while. I wrote about it earlier this week here. I also recently went to see my diabetes educator, Gwen, for some advice.

Gwen is a truly amazing person. You can read about just how amazing she is right here. Gwen’s stated goal was to arm me with the knowledge and skills to manage my diabetes, so that her position as my educator would eventually become redundant. And it sure did. The last time I had a session with Gwen was back in 2010, towards the end of my first year living with diabetes.

I knew that Gwen was always available to me outside of appointments if need be. I had her phone number, e-mail address, and I can even remember her squeezing me in once during her lunch break when I was anxious about too many hypos. I can remember giving Gwen a box of chocolates on the first Christmas after my diagnosis, because she had just been so wonderful during that first year of diabetes. I’ve seen her a few times in passing at the clinic when I go to see my endocrinologist. However, since transitioning from the ‘young adult’ to ‘adult’ diabetes clinic, I’ve seen her less frequently.

I was extremely nervous to go back and see Gwen a few weeks ago, after such a long time. In the car on the way there, I was reciting over and over in my head what I would say to her. Would she take what I needed to say seriously? Would she be supportive of insulin pump therapy? Would I talk to her about my blog, and my involvement in the Diabetes Online Community this year? Would she even remember me?

But walking into her office that day, my nerves were instantly settled. As she began reviewing our last session five years ago, she was so thorough. As she talked through the results of my last endo appointment and hba1c result, she was so familiar and so well prepared for me. As her patient, it felt as though that last session five years ago could have taken place just yesterday.

So, Gwen’s verdict on pumping, in a nutshell?

A pump is a big commitment.

Pumping is not any “easier” than Multiple Daily Injections.

However, a pump can give me more “flexibility.” A pump delivers insulin constantly in order to regulate glucose levels, as opposed to injections which are given at set times of the day. The rate at which a pump delivers insulin can be adjusted throughout the day to factor in activities such as work, physical activity and sleep. The units of insulin delivery on pumps are so precise that you can bolus for something as small as the milk in your coffee!

There are also a few requirements for pumping in Australia.

First up, I must have an appropriate level of Private Health Insurance for a period of at least 12 months, in order for the cost of a pump to be covered. Big tick there.

Second up, I need to show that I qualify for a pump. Translation: I have type 1 diabetes and I’m a good student who will show up to my education sessions. Big tick there.

Third up, a pre education session with Gwen (big tick there), where paperwork is completed and passed onto my endo for sign off (not quite there, yet).

Finally, pump fitting day followed by 3-4 daily sessions with Gwen in order to fine tune the pump. Sadly, there’s a 3 month waiting list at my diabetes clinic for this.

I’m really glad that I did go and get another perspective from Gwen that day. Gwen was plain thorough. She discussed the matter with the seriousness that it deserved, without trying to sway my decision either way.

So, as the session came to an end, I sensibly decided that I would go home and think about it, and come back in the New Year for another check in. Class dismissed!

To Pump, Or Not To Pump?

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A few weeks ago, I went to an insulin pump information evening. And I must say that I was quite keen on the idea after that night despite the politics of it all, which you can read about here. The promise of better control, long term health, insulin dose calculator, ease of insulin delivery and the statement that “very few people give these back to me and say that they don’t like it.”

But I’m not naive. I know that a pump is a big decision. I know that a pump is a big commitment. I don’t want to get a pump just for the sake of getting one, and then end up in no better of a situation with my diabetes management. I don’t want to get a pump with the mindset of being able to slack off and get lazy with diabetes. And it might not necessarily solve all of my problems. I’ve been talking about it at home, talking with friends in the Diabetes Online Community, and deliberating over the matter in my head for weeks.

My biggest struggle is achieving stable numbers consistently. There will be weeks where I seem to do it at ease. And then there are weeks where the numbers suffer, due to changes in my level of activity and the level of food that I eat. I seem to be adjusting my insulin doses every second day to get the balance right in the background. Lantus Adjustment Struggles are real. And they drive me crazy. There are times where my Lantus dose is more than enough, and other times where it’s just not enough. My hba1c level has been hovering around the borderline of “acceptable” for quite some time, but I’d really like to get it down further for the sake of my long term health.

In some ways, I feel that a pump could potentially offer that to me. I’ve heard nothing but good things about pumps from friends in the #DOC. But I also expect that the pump will be a big learning curve. It will be a lot of work. And I’m expecting a lot of frustrations in the beginning, at least. I’m concerned that a pump might make things more complicated. Potentially having control over more variables, such as basal insulin could do my head in. And, will a pump actually make my job as the operator of a broken pancreas easier? Or is it essentially a different way of doing the same thing?

At the moment, I do feel quite “free” with my Multiple Daily Injections. I take my insulin injections whenever I eat, and in the meantime my Lantus dose keeps me (relatively) stable for a whole 24 hours. I like the fact that if something were to happen and I couldn’t access my insulin, my blood glucose levels would be fine for a whole day.

I am a bit scared of being reliant on technology to keep me going. Relying on one, continuous source of insulin to keep me stable is scary. If that one source of insulin was suddenly cut off, or if my pump suddenly stopped working during the night, I could go into a state of diabetic ketoacidosis within hours. And I absolutely hate carrying junk in my pockets. An insulin pump would only add to that problem, as lame an excuse as it sounds!

A pump would certainly be more convenient, though. These 13 Truths About Insulin Injections would be no more. I would be able to administer my insulin at the touch of a button, rather than often waiting until the dinner table conversation has ended. The carb calculating function on the pumps look awesome. And, I wouldn’t necessarily be stuck with the pump. I could get it, learn how to use it, and then I would always have it as an option.

So, to bring this jumble of thoughts from my head to a close, I haven’t made up my mind about an insulin pump yet. I’m still thinking, I’m still researching, and I’m still talking about it.

Affected by diabetes? Join the Oz Diabetes Online Community for our weekly chat Tonight from 8.30pm AEDT (GMT+11) by following the #OzDOC hashtag on Twitter.

In Conversation With a Type 1 Mum

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Mum and I had a rather interesting conversation with a type 1 Mum at the insulin pump information evening that we attended last week.

I’m always drawn to stories of type 1 parents and younger children. I was diagnosed at the age of 17, where I was able to manage my diabetes independently most of the time. My parents didn’t have such a “hands on” role as they may have if I was diagnosed at a younger age. I guess, overall, we would both have completely different experiences in diabetes management.

Type 1 Mum was at the insulin pump evening for her 9 year old daughter, who was diagnosed with type 1 diabetes at the age of 4. She was also interested in a Continuous Glucose Monitor, as her young daughter would often neglect to test her blood glucose levels at school or fib about the numbers. Obviously at such a young age, her daughter does not fully realise the importance of why she has to test her blood glucose.

At school, her daughter had a close group of friends who all knew about her diabetes. This year, however, has proven more challenging with class groups being swapped around. The children will often share food at lunchtime, without fully understanding the implications of her daughter eating something like a lollipop. The school also has an aid in the classroom to help with blood glucose tests and insulin injections. However since turning 9, she is expected to be able to manage diabetes on her own at school. She is lucky, however, that the aids there for other children will also check on her at lunchtime.

Out of my own curiosity, I asked Type 1 Mum whether she regularly checks her daughter’s blood glucose levels during the night. She told me that she would normally test once during the night, at around 1am. Her daughter would normally sleep through the nightly blood glucose tests. If the result showed up low, they would “sleep-feed” her glucose tabs and juice boxes.

She also asked me about if I test through the night, being an older person. I told her that, obviously, for myself, I am very motivated to check my blood glucose levels. The decision to test during the night would come down to how confident I am that my BGL will remain stable. If I eat junk food in the late afternoon, I know that the fat will send my BGLs up after I go to bed. But there are other days where I have eaten well, and I am confident I will remain stable.

It was great chatting with you, Type 1 Mum. Best of luck with the decision you choose to make.

A cracking walk on a cracking #DOCtober Friday.

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No Responsibility From Insulin Pump Companies

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Last night, I attended an information session on insulin pumps at Diabetes WA. And this morning, I’ve got about a million things that I want to write about.

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. And to be honest, they were absolute vultures. I’ve never seen such eager salespeople out there in full force, desperately wanting our business. When our fantastic host Margie asked for some sample tubing to show us, it literally seemed like a race to see which rep could get to Margie 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. These companies are making a profit off of our disease. There are so many companies and product lines out there for that very reason. That vulture like behaviour occurs for that very reason. And 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!

I hope I haven’t taken anything away from the Diabetes WA session. It was fantastic and I have so much more to write about. Stay tuned – I’ll have more in the days to come.

At 10.41pm, I was cutting it close with yesterday’s #DOCtober photo. An exclusive look behind the scenes of the jacket I wore last night.

https://instagram.com/p/80lsx1A_bu/?taken-by=franksita