A Pumping Story
By Rebecca (rdraben)
"Rebecca was diagnosed with type I diabetes 20 years ago when
she was 12 years old. She had to give herself at least 4 injections
every day. On top of that, she had to prick her finger to
test her blood sugar many times every day. She had to decide
how much food she was going to eat before she ate it, and then she
was not allowed to eat any more food until her next injection." Okay,
I know that sounds a bit dramatic, but if there were a television
show about diabetics going on pumps and I was on it, that is how
I imagine mine would start.
I used Humalog in a pen before meals and I used NPH in a syringe
at bedtime. I used a syringe at bedtime because I usually
had to mix in some Humalog to correct a high or to cover a
Resisting the Pump
I never wanted a pump. Ten years ago a good friend of mine
in college kept telling me how much he loved his pump. I didn't
even want to know about it. Over the years, various friends,
acquaintances, and doctors have told me I would really like the
pump. I didn't think so. First and foremost, I didn't
want to be attached to anything. I also didn't want to devote
a lot of time to learning anything new because that would mean that
I would have to spend more time facing the fact that I had diabetes.
I also didn't want to sleep with the pump, shower with the pump,
or work out with the pump.
Then a lot of things changed in my life when I became pregnant with
my daughter. I started to focus on my diabetes so that I could
have the best control possible and I started reading the Diabetic
Mommy forum. I read so many messages from women who loved
their pumps. Still I thought, "Nope, it's not for me."
Then one day after I'd been reading these messages for well over
a year, a woman named Fantacy posted a funny remark that she loved
her pump so much, she wanted to be buried with it. Something
finally clicked in my head. Maybe I should at least consider
Caving to the Pump
I asked my endocrinologist about it at my next appointment.
He said that I could take a class at the nearby Diabetes Treatment
Center to find out if the pump was right for me. I decided
to do it because I had nothing to lose. I wasn't committing
to anything. So I went to the half-day class and learned about
pumping and carb counting. I was glad that I was already familiar
with carb counting because the class moved pretty fast.
This is the pump I chose, the Animas IR1200. This picture
makes it appear larger than it really is. It is about
the size of my middle three fingers.
After the class, the next step was to select a pump that I wanted
to test drive. We were given a choice between the Animas IR1200,
the Deltec Cozmo, and the MiniMed Paradigm. I had seen the
pumps in class and I also researched them extensively on the web.
I decided which features were important to me and compared the pumps
on those features. After narrowing it down to the Animas IR1200
and the Deltec Cozmo, I eventually decided that the Animas IR1200
was the best pump for me.
I scheduled an appointment with a certified pump trainer at the
Diabetes Treatment Center for my pump test drive. At my appointment,
she showed me how to use the Animas pump, an insulin cartridge,
and an infusion set. We filled an insulin cartridge with sterile
saline solution instead of insulin so that I could experiment with
the pump as much as I wanted and not affect my blood sugars.
Then we inserted an infusion set and hooked it all up. I was
allowed to take it home with me for 2-3 days to wear it and use
it as if I were really pumping.
Wanting the Pump!
Less than 24 hours later, after my first night, workout, and shower,
I called my doctor's office and told them that I wanted the pump!
I didn't mind being attached to it too much. I could easily
disconnect it for short periods of time (up to an hour), leaving
only a little plastic disc attached to me. I didn't notice
it while I slept, the infusion set didn't budge during my workout,
and after my shower I felt completely clean, even under and around
the infusion set.
This the infusion set.
This is the only part that is ever attached to my body.
I completely remove it and replace it every few days.
The infusion set disconnects easily.
The metal piece does not go under my skin at all,
but only into the plastic disc.
plastic tube is the part that goes under my skin.
It is flexible and I cannot feel it.
It took 6 weeks for me to receive my pump. When I got it,
I immediately took it out of the box and starting playing with it.
One week later I went to my endocrinologist's office and met with
a certified pump trainer to start pumping with real insulin.
We programmed the pump with my settings and then filled an insulin
cartridge, inserted an infusion set, hooked it all up and started
pumping! I took my blood sugar and bolused for the high reading.
We went for a walk to kill some time while my blood sugar came down.
Then she brought some of the doctors' catered food to me for lunch.
I checked my blood sugar, counted the carbs, bolused appropriately,
and ate. Everything seemed to be working well, so I was okayed
to go home and begin pumping on my own.
The pump just allows me to stick
myself less, right?
Before I started learning more about pumps, I thought that the main
advantage of pumping over MDI (multiple daily injections) was having
to stick myself only once every few days rather than multiple times
a day. But in reality, it is so much more than that.
In order to understand the advantages of pumping over MDI, let me
first explain a little bit about how a normal pancreas works and
how MDI and a pump each attempt to mimic a normal pancreas.
A normal pancreas releases a very small amount of insulin every
few minutes. This is called basal insulin. Then when
food is eaten, a normal pancreas releases a large burst of insulin.
This is called bolus insulin. With MDI, bolus insulin needs
are met with an injection of fast-acting insulin such as Humalog
or Novolog. Basal insulin needs are met with an injection
of long-acting insulin such as NPH or Lantus. Long-acting
insulins affect blood sugars slowly over time, in an effort to mimic
the way a slow drip of insulin from a normal pancreas affects blood
sugars slowly over time. The pump is able to mimic a normal
pancreas by doing exactly what a normal pancreas does. It
uses only fast-acting insulin. Basal insulin needs are met
by releasing a very small amount of insulin every few minutes.
Bolus insulin needs are met by releasing a large burst of insulin.
When I was taking NPH, I just had to hope that the insulin and my
body's need for insulin peaked at the same time and by the same
amount. But with a pump, I can adjust my basal rate to peak
exactly at the same time and by the same amount that my body's need
for insulin peaks. It is like taking a long-acting insulin
that is tailor-made for my body.
Since I don't have to take a long-acting insulin, there is alot
less guess work about how insulin is affecting my blood sugar at
any given moment. It is much simpler. I take a short-acting
insulin, it peaks after about 1 hour, and it is out of my system
after about 4 hours. When I was taking NPH, I never figured
out exactly when it peaked or how much was still in my system at
any given time. It just added so much complexity to an already
complex situation. Since discontinuing NPH, I have learned
many things about my blood sugars that I never knew before.
For example, I never knew that protein raised my blood sugar significantly
about 3 to 5 hours after eating. Now I know that.
When I was on MDI, I often realized a few hours after eating that
I had taken too much insulin and I was starting to go low.
Imagine my being able to go back in time a few hours and take less
insulin. Effectively, with a pump, I can do that! I
just turn off my basal insulin for a while. I never could
have "turned off" my NPH for a while! Now instead of going
low, my blood sugar remains steady or even goes up a bit.
Of course this doesn't work if I have taken far too much insulin,
but it works in many cases.
Protein affects my blood sugar significantly, but over a longer
period of time than carbs. With the pump, I can use an extended
bolus to deliver insulin over many hours as the protein digests.
With MDI I just had to correct my high after the fact because I
did not have the capability to deliver the insulin over many hours.
Correcting a high is so easy that I correct any and all highs, even
if I am only 10 mg/dl over my target. It is easy for two reasons.
One, because I only have to push a few buttons instead of taking
another injection. And two, because with MDI, my pens and
syringes only allowed me to give myself insulin in whole unit increments,
so correcting a blood sugar that was 10 mg/dl over my target would
have sent me low. With the pump, I can give myself insulin
in 1/20 unit increments and correct a high nearly perfectly.
I need less insulin on the pump. On MDI I took about 50 units
per day. Now I average about 35 units per day. It amazes
me. I still take almost exactly the same amount of basal insulin,
but my insulin to carb ratios have gone way up, so my boluses have
gone way down. On MDI, my insulin to carb ratios were 1:14
at breakfast, 1:10 at lunch, 1:7 at dinner, and 1:7 at night.
Now they are 1:24 at breakfast, 1:14 at lunch, 1:14 at dinner, and
1:16 at night. On MDI, I would often bolus as many as 16 units
at a time. Now I get nervous bolusing anything over 6 units
at a time!
One of my favorite features of the pump is the IOB (insulin on board)
feature. A given amount of insulin, whether delivered by injection
or pump, does not get used by the body all at once. For example,
it takes about 4 hours for Humalog to finish working from the time
it is injected/infused. The pump keeps track of how much insulin
I have bolused and how much insulin is yet to be used by my body.
Before I went on the pump, I took IOB into account, but only in
a very crude and inexact way. Now it keeps me from over-correcting
both highs and lows. It keeps me from over-correcting highs
because if I take my blood sugar 1-2 hours after a meal, I'm tempted
to take enough insulin to get my blood sugar down to my target range.
But now I'm finding that often I have already taken enough insulin,
I just need to give it some more time to work. It keeps me
from over-correcting lows because I used to eat and eat because
I didn't know how fast or how far low I was going. Now I can
check my IOB and fairly accurately figure out how long I should
suspend my pump and how many carbs I need to eat, if any.
Emotional and Social Effects of Pumping
This is me wearing my pump. If you look closely, you can see
the tubing running into my pocket. If I don't want the tubing
to show, there are other ways I can wear my pump.
When I was on MDI, I spent a lot of time and effort to achieve good
control. I took Humalog before each meal and NPH at bedtime.
I tested my blood sugar at least 4 times per day. I measured
almost all my food and counted the carbs in it. I analyzed my
blood sugar numbers every week, but my numbers never made a lot of
sense. For example, when my fasting blood sugars for the week
were all over the place with 2 numbers too low, 2 on target, and 3
too high, what should I have done? Although my HbA1c's were
good, usually in the 6's, my blood sugars weren't so good. It
was so frustrating to put forth so much time and effort, only to have
completely inconsistent results. I pretty much gave up trying
to figure it all out.
I think the biggest difference going from MDI to the pump is that
I feel like I've finally found the “knob” that turns my
blood sugar up and down. I'm in control and it makes sense.
I don't have the wild swings that I had before. It is quite
an emotional high to feel so in control and so stable. And I
feel like I finally have a blood sugar meter like the ones shown in
television commercials ... you know, the ones that always read 103!
Well okay, even now my blood sugar meter doesn't always read 103,
but you get the idea.
I love being able to bolus as I need it. I no longer have to
decide in advance exactly how much food I'm going to eat. I
think I used to plan for alot of food because I didn't know when I
was going to get full and the thought of being a little stuffed was
better than the thought of being a little hungry. Now I plan
for a smaller amount of food and then bolus again if I decide I want
more. As a result, I'm eating less. I've already lost
Being able to bolus discretely and bolus as I need it is also useful
when eating at other people's houses. I used to feel so rude
asking "What's for dinner?" and "Are we having any dessert?" before
running off to the bathroom. Now I just look at the meal as
it is served, pull my pump out of my pocket, and push a few buttons.
If and when dessert is served, I do the same thing again.
I think the biggest down-side to the pump is that it is a constant
reminder of my diabetes. Every time I see tubing coming from
my body, I feel like I must be really sick. After all, all the
people I know who have tubing coming from their bodies are really
sick. But I'm getting used to it. And I feel much more
positive about my diabetes now. So being reminded of something
that I feel pretty positive about isn't so bad. And I'm sure
I've added years to my life and that is worth almost any price.
I should have gotten the pump years ago. I sure am glad I didn't
wait any longer!
"Coming up next on A Baby Story ... Rebecca was diagnosed with
type I diabetes 20 years ago when she was 12 years old ... "
Oh, no, wai-wai-wai-wai-wait! I'm not having another baby yet!
... But hopefully when I do, the pump will help me have the
best control I can possibly have. I am looking forward to it!
Words cannot express my gratitude
to Bjay for creating diabeticmommy.com and to Fantacy for her humor
that finally spoke to me and to the countless other diabetic mommies
who recommended the pump over and over and over again. Without
you I would not be pumping today. You have given me the best
gift I could ever receive ... a longer and healthier life. Now
you all are going to have to put up with me and my posts for a very,
very long time! :)