Complications - Remember them.....It's important!

It's really funny how things happen sometimes.  I have another appointment with my endocrinologist coming up in a little less than a week, and I know that I am going to get an earful at the appointment.  Despite having my insulin pump, I have not been following my own advice.  I have said before that simply having the pump is not going to control my diabetes, I have to take an active involvement in making sure it is doing a good job for me.  To make a long story short, I have not been doing a good job.  I just had my HA1C test done yesterday, and I am dreading the results.  It is as if the "world" knows this and has been trying to send me a message, in a sense.  In the past two or three weeks I have met up with two new people who, upon finding out that I am a Type 1 diabetic, have shared with me some their experiences with people close to them who have had serious complications from their ill-managed blood glucose levels.  This might be one of things I needed to knock some sense back into me!  

Many of us who have been diabetic for many years (I am "celebrating" my 21st diabetic birthday this week) need a jolt back to reality every once in a while to remember what we are facing.  Sure, there are the short term problems like dizziness, slurred speech, confusion, and irritability, but what I want to rehighlight for you are the long term complications, those that aren't so easily (if at all) fixed.

HEART (AND OTHER BLOOD VESSELS):  Chest pain, heart attack, and stroke are all major and serious  problems that can occur.  In fact, by some estimates in North America, 65% of diabetics (Type 1 and 2) are killed by some sort of heart or blood vessel disease.  In fact, as a diabetic your chances of death from heart disease and stroke are up to 4 times higher than other people in the population

EYES: Diabetic retinopathy is a damage of the blood vessels in the eyes.  Almost 30% of diabetics age 40 and over have some sort of diabetic retinopathy.  This is the leading cause of blindness in North America, for people aged 20 - 74.

KIDNEYS: Your body's filtering system can be damaged with bad BG control for an extended time.  The results of which are kidney failure or end-stage kidney disease.  Diabetics account for almost 50% of all new cases of kidney failure.  

FEET: Nerve damage to your feet or poor blood circulation can lead to a loss of feeling in your lower extremities  leaving you unable to feel when problems persist, leading to a requirement to amputate your foot.  or leg!  More than 60% of non-traumatic lower limb amputations are taken from diabetics.

TEETH: Higher blood sugars result in more sugar in your saliva and lead to gum disease and plague build-up.    Roughly a third of diabetics have severe periodontal disease resulting in loss of attachment of your teeth to your gums!   

This post isn't ALL doom & gloom, though.  There are some diabetics who are able to escape without serious complications.  Studies seem to talk about different groups and percentages, but approximately 10-15% of diabetics can get through life without any serious complications of the disease.  Is there something special that they have in their genes that help them?  Is it their diet?  Is it care they received early in their diagnosis?  Is it care they have received throughout their diabetic life?  Studies are still being done, but the one thing that is agreed to is that their HA1C tests are consistently within acceptable limits (below 7.5 for sure, and the numbers get stronger the lower that number is).  

Which statistic do you want to be a part of?

Do Not Try This At Home

So this will not be something advocated by any health care professional.  Isn't that the best way to start a health related blog piece?!  I only share this story as a conversation piece, and because I feel in control of my diabetes and my body - possibly misplaced feeling of control considering how this story goes.

The other night I was laying in bed and thought I hadn't bolused for my late snack or, as I thought about it, my late night snack.  So I lay in bed and bolused for both.  Less than fifteen minutes later I was still watching TV in bed and felt myself getting a low blood sugar.  I dutifully went downstairs and tested, and I was low (4.0), especially just before going to sleep.  I ate my 15g of quick carbs and a granola bar.  Testing 10 minutes later my blood sugar was well on it's way up, so I headed to bed again.  Thought of a problem though....I just bolused another 5.4 units of insulin, which has hardly had a good chance to run through my system, so I will be very low overnight.

At that point I remembered I had given myself a bolus at super time, so I effectively gave a large bolus for no reason.  I REALLY did not want to easy any more to absorb the mistaken bolus I had taken.  My solution was to reduce my basal insulin amount to almost 0% for the overnight hours.  The result was a perfect morning BG of 6.2.  Times like this I wish I had a CGM connected to see what my overnight readings were.

Bear in mind I DO NOT RECOMMEND THIS COURSE OF ACTION!  There are many things I did wrong, but highlight the fact I am human.  Never take your insulin regimen for granted, know what you are doing, consider all actions you have taken and will take, and most importantly don't panic.  This could have just as easily happened on a traditional syringe therapy, as well, however knowing what options the pump can afford me, I was able to come up with a creative solution.

Beeps, sounds, and alarms.....oh my!

At times your insulin pump will sound like a badly tuned musical instrument.  Your pump will come with many beeps, sounds, and alarms that are all designed to help you give attention to your pump.....you know, like you will forget it it there! 

Your alarms will generally be the same sound.  The difference will be how long the sound goes on for, and may be accompanied by a vibration.  The alarm is then posted as text on your pump that you are to read/clear.  Here is a list of various alarms you can either set your insulin pump to give you warning of certain things, or preset alarms that you cannot turn off (for safety sake):

- low battery: your insulin pump does not run on love, it runs on a battery.  While your pump will have a visual meter (just like your cell phone), you know that people do not always look at that.  Your pump will alert you to the fact that your battery will soon die.

- dead battery: unlike your cell phone, your pump will tell you that your battery can no longer function.  It holds onto just enough life to alert you every few minutes that your battery is dead (well, almost dead), until it actually dies.

- low insulin: when you are getting low on insulin in your resevoir, your pump will alert you that you will soon need to get more insulin.  You can generally program at what level you want to receive this alert.

- suspended: when you take off your pump, for things like a shower, or other activity, you can suspend your pump so it no longer pumps a basal amount of insulin.  However, it can be easy to forget to unsuspend it when you reattach it (I know it can happen, because I am often caught by this alarm).  If you get the suspended alarm while you are wearing the pump again, you hit yourself on the head and unsuspend the pump.  (The pump doesn't know it is reattached to you, but rings every so often just to say "Hi".)

- BG reminder: you can set your pump to remind you to test your blood glucose levels at a set time after doing a bolus.  Your doctor will often ask for a post-meal BG, and your pump can help you remember to do it.

- temporary basal: when you set your pump to do a temporary basal amount, as opposed to the preset basal rate, your pump will give you a quick reminder saying "remember me, I am giving you a different rate!".

- auto off: as a safety feature, you can set your pump to turn itself off automatically after a set number of hours (mine is 12 hours).  This is meant so that if you find yourself (or someone else find you) unconscious in a ditch, unable to eat, your pump is not going to continue giving you insulin bring your blood sugar lower and lower.  In my case, if I don't bolus (or tell it what my blood sugar is) for 12 hours, the pump turns off and gives an annoying alarm!

Use the wizard!

Using a wizard is really a great and easy way to help get the most out of your insulin pump.  I am not referring to the Dungeons and Dragons wizards or the one from Oz, either.  Your insulin pump will come with something called a "Bolus Wizard", or some other name that basically means a program to tell you how insulin you should be pumping.

How it works is that you will tell your wizard what your blood glucose level is, and how many carbs you are about to eat.  You then hit a couple buttons and the insulin pump will tell you to give yourself a certain volume of insulin, and it will break everything out into how much insulin is meant as a correction for high blood sugar, how much is for the food you are about to eat, and will also compensate for that fact that you may have some insulin left over in your body that is still working, if you only recently did your previous bolus (with a couple hours ago).

All of the settings that you enter into your insulin pump when you first set it up, or on-going changes based on discussions with your diabetes professional, contribute to this "magical" function that tells you within tenths of a unit of insulin how much to give yourself (note my constant use of "give yourself", because ultimately you are responsible for what is taken, but use of the wizards helps you see how much you SHOULD take, assuming no other extenuating circumstances).

This wizard will be able to take things into account, like the day of the week, time of day, and if you have set up rules for these time constraints.  What it will not know is what you cannot tell your pump, such as the exercise you are about to be doing, or if you are sick.

All pumpers should use this feature when they first start using their pump.  I would suggest that most experienced pumpers continue to use this function.  It ensures you are giving yourself a consistent bolus rate for discussions with your doctor, and it is so quick and easy.

Technology is great.....but

I love technology.  I love my smartphone.  I love my computer.  I love my tablet.  I love to bank on-line.  I love that I have an insulin pump and software available to me that will help me track my blood sugars and see trends. 

However, my smartphone cannot yet make phone calls, send texts, or access my facebook account without me doing something.  My computer can't type my blog posts for me.  My tablet can't make Skype calls for me.  My bank account still can't manage itself.  My insulin pump and associated software can't manage my diabetes for me.

Never has this been more evident to me than over the past almost month.  Today I finally did an upload of my blood sugars and basal/bolus amounts, etc.  I had to blink a couple times seeing how badly I have done with respect to control recently.  Had I done this review a couple weeks ago I would have surely seen the slippery slope I was starting to embark upon.  This has given me another jab to get things going again (I seem to need them every once in a while).  My only saving grace is that this has not been caught right before a doctor's appointment where I have to show the details of my recent control.

It is so easy with technology to assume it will do things for you, but you have to realize that while the technology in life, especially the technology designed to SAVE YOUR LIFE, makes things easier for you, you still have to be actively involved in what it does and how it helps you.  Information is only as good as what you do with it.

Exercising With Your Insulin Pump

So, as I have noted in previous posts, I am trying to lose weight, a difficult task for sure.  With an insulin pump you will get quite a few differing suggestions on how to set your insulin basal rates.  The only common thread among the different regimes is that exercising with an insulin pump is certainly easier than traditional syringe therapy, once you get the hang of it. 

The first thing to know is that you should not simply remove your insulin pump when exercising, unless you are in sports that require it (you know, like sumo wrestling or deep sea diving!).  Even when playing contact sports, like football, you can keep your pump on, provided you have taken precautions, like having your cannula inserted somewhere unlikely to get pounded, and your tubing is safely tucked away.

Obviously important is to test your blood sugar before, during, and after vigorous activity, to ensure you are not experiencing low blood sugars.  With all the various diabetes educators I have had, I have rarely had anyone tell me to watch out for lows hours after activity.  I have found that not only will my blood sugar dip during and immediately after activity, but also up to 8 or 9 later (fun when you are asleep!).

Now, you will find many suggestions as to what basal rates you should change your insulin pump to during sports or exercise.  I have tried at least three different ideas on how to make things work, none of which have worked for me. This, like everything else that deals with a person's body, is highly individualized, and you will have to experiment for yourself.  As much as I would love to say "before going out for a 20 min. jog reduce your basal rate to 25% for 2 hours, and ensure your blood sugar is at least 6.5 before starting", I can't.  That is what works for me.  What works for you may be something close, but maybe your optimal basal rate is 50% or 0%. 

What I am truly trying to communicate, is that you have to try and experiment on your own.  Start conservatively and work your way towards what is best for you.  For instance, I started at 0% basal rate for three hours.  My sugars were too high an hour (and two and three) later, so I worked towards something that was optimal for me.  Make sure you do start conservatively, though.  You don't want to mix up the feelings of adrenaline with low blood sugars.

As a famous Canadian fitness team says, "Keep fit, and have fun!".

Diabetes Blog Week - Diabetes Hero

This Diabetes Blog Week has been fun.  I hope you have had fun reading the posts, not only by me, but by everyone involved in it.  I learned a few things!

The last topic for the week is about who my Diabetes Hero is.  My hero is you, me, and millions of others around the world who contribute donations to their local diabetes related organizations.  Without the help of all of us, many advancements and discoveries would not have happened, and many of us may not even be here today.  Fundraising and donations do not only occur in November (National Diabetes Month in many countries) but throughout the year, and in different forms. 

Whether it be through donating used clothes and household goods (through the ClothesLine program in Canada), volunteering your time, fundraising with the Diabetes Walk, or donating money, you should all stand up and take a bow.  While I am sure we far from a cure, we can certainly take solace in the fact that everything we do brings us one step closer.

Diabetes Blog Week - Something Good To Eat Wildcard

So today's Diabetes Blog Week post was supposed to be a picture blog, but I don't feel I have enough good pics to show about diabetes really affects my life, so I am going to grab one of the "wildcards" for the week - talking about something good to eat.

I have always loved a good weekend breakfast.  I will often indulge in an Eggs Benedict, however the normal serving that you prepare in the traditional sense can run you upwards of 590 calories and over 35g of fat.  This makes it quite the special treat.  What I do is a little different.  While I keep most of the ingredients the same (substituting a few better health choices, at least in my mind they are!), I make one big change.

I start with one English muffin, making it 100% whole wheat.  I add a couple slices of ham, and two large poached eggs.  This is pretty much the same, so far, as a regular Eggs Benedict serving.  The topping, instead of using hollandaise sauce is half a can of cream of mushroom soup. Personally I use Campbell's 98% Fat Free condensed soup (do not add water, just heat).  With these ingredients I come up with about 445 calories (or a quarter less) and about 20 g of fat (over 40% less).  For carb counting, that gives me 31 g of carbs to give myself insulin for (fibre count already removed).

I like it and it lets me feel a little less guilty about indulging.  :)

Diabetes Blog Week - What They Should Know

Today's Diabetes Blog Week topic surrounds what is something I, as a diabetic, want non-diabetics to know about the condition.  Seeing as how diabetes, if left improperly treated or undetected, can be such a dangerous condition, responsible for about a million amputations a year, 5% of blindness worldwide, and kills a person every 10 seconds, I want people without diabetes to know when they may have it.

I want non-diabetics to know what the warning signs are.  If you have some these symptoms, it could be a sign of diabetes and should be checked out by a doctor.  Many of these symptoms can seem harmless enough, and often are ignored.  My thought is don't ignore them, get it checked out.  Some symptoms of diabetes (type one or two) include:
- frequent urination
- sticky urine
- excessive thirst
- excessive hunger
- unexplained weight loss
- often fatigued
- blurry vision
- cuts or sores that take longer than usual to heal
- dry mouth

While recognizing that you have diabetes is not going to heal you, you can at least be treated by a professional and get the help you need to live a normal life.  That is my wish for non-diabetics to know about diabetes.

Diabetes Blog Week - Fantasy Diabetes Device

This Diabetes Blog Week thing is fun.  I am enjoying writing about these different topics, I hope you are enjoying them, too.  Today's topic is creating a fantasy diabetes device.  As much as I'd love to say a cure, or an artificial pancreas, I think those go against the spirit of the topic.

There are so many things to wish for from prickless blood glucose meters, to an insulin pump that can automatically detect what insulin you need without any user interface.  However, what I would love to see is an affordable adhesive CGM, that "talks" via Bluetooth to your insulin pump, or any other Bluetooth device. 

The first part of this device is the adhesive CGM.  Building on the the concept of a prickless blood glucose test, I'd like to see something like a band-aid that can be applied to any part of the skin that continually reads your blood sugar, ideally your actual blood sugar levels and not the interstitial fluid that CGMs currently test.

The second part is that this is a Bluetooth device, and make insulin pumps Bluetooth capable.  By having your insulin pump able to read your glucose levels you can see what your sugars are and you could adjust insulin levels appropriately.  The Bluetooth capability would also make it easier to transmit your data to your computer or mobile device so that you are able to track trends and see how you are managing your diabetes.

Above all else, though, and this is where the "fantasy" part comes in....make it affordable.  Current CGMs on the market are not affordable for anyone unless you have insurance coverage.  Most insurance (at least that I have seen) do not cover it CGM supplies, despite their obvious benefits. 

We can all dream, right?

Diabetes Blog Week - One Thing to Improve

So after yesterday's post exalting the virtues of my wife and how she helps me through my sugar lows, I now get to look at something I can improve, as part of Diabetes Blog Week.  If you read yesterday's post you will see a plethora of things that I can improve on.  That was actually the condensed list!  :)

The one thing that I know I have to improve on is something that I have just recently started to do.  That is losing weight.  Growing up, weight had never been a problem for me, but as I age, I guess my ability to metabolize all I was used to eating went away.  I have known it to be an issue for a long time, and even tried to fix it up through a weight loss program, and that was going well, or so I thought.  I was shedding the pounds, but my sugars were out of control.  Given some recent doctor visits and blood pressure readings, I know I have to lose at least 60 pounds.  Given the health problems that diabetics are prone to with elevated weight issues, I have to look after that part of my health, if not for my sake, then for my family's sake.

I have started by doing a few things to really bring my weight down.  The first is exercise.  I am forcing myself to go out for a run or walk everyday.  It sure did hurt the first week or so!  Secondly, I am recording everything I eat and checking my caloric intake.  Just simply the act of recording my food makes me realize how much I had been eating and that I had to bring that down.  So far things are working.  Now the task is to keep it up!

Diabetes Blog Week - One Great Thing

Today's post for Diabetes Blog Week is to talk about something that I (or my loved one) do well with respect to my diabetes.  As much as I would love to talk about the stuff that I think I do well, I wouldn't be there to do it if I didn't have my wife. 

I know I am a diabetic, I know that I am SUPPOSED to carry my blood glucose meter with me all the time, I know that I am SUPPOSED to test my blood sugar before driving, I know that I am SUPPOSED to carry some sort of candy or other quick sugar with me all the time.

With everything that I "know", you would think I would know better!  My wife has lived with me a lot less time than I have lived with diabetes, but she does know better.  She knows that I do not carry fast acting sugar on me at all times.  So whenever I am in need of a quick sugar fix, I know that I can turn to her and get what I need. There have been so many times when we are out for a walk, grocery shopping, or on a long drive, when I have had to turn to her and ask if she has any candy in her purse, knowing full well that she does.  In fact, she recently cleaned out some old purses from our closet and in each purse she found a baggie of candy!  Love you, honey!

Diabetes Blog Week - Find a Friend

So, the point of today's post (as part of Diabetes Blog Week) is to let people know about other sources of information, other bloggers who are out there and have something good to contribute.  Kim (of TextingMyPancreas) has been one of the "finds" that I have really enjoyed following.  She is a really active blogger and tweeter (@txtngmypancreas).  However, with almost two thousand followers on her twitter profile, she isn't exactly unknown.

Kim has been a type one diabetic for over 25 years, and really seems to have a great outlook on diabetes and how to handle it.  She uses a CGM and an insulin pump, and works with the DSMA Advisory Board, Diabetes Advocates, and JDRF, among other things.  Her posts are varied and entertaining. 

Head on over and search her posts by the posted labels on the right side of her page. 

Diabetes Blog Week

I've decided to do something a little different for next week.  Coming up that week is something that was created by a lady in New England, Diabetes Blog Week.  Running from May 14th to the 20th, she has set up a range of topics for diabetes bloggers to write about.  They range from feel good topics like "One Great Thing" to the imaginative "Fantasy Diabetes Device". 

I will try to get a post done for each day of the blog week in accordance with Karen's topic list.  I encourage you to go and check it out and see what topics you will want to read up on.  Here is a list of what blogs are to be posted each day:
Find A Friend - Monday
One Great Thing - Tuesday
One Thing to Improve - Wednesday
Fantasy Diabetes Device - Thursday
What They Should Know – Friday
Saturday Snapshots - Saturday
Diabetes Hero - Sunday
Something Good To Eat - An extra posting topic for any day of the week
Diabetes Creativity  - An extra posting topic for any day of the week

There are some really great topics there and I can't wait to go around reading some of the various blogs by different people.  I hope you find something helpful, too!

Can I accidentally bolus without knowing?

One of the concerns I had when I was getting my pump was how I might inadvertently give myself a bolus without knowing that I was.  My fear stemmed from the fact that you can quite easily give yourself a bolus with a few clicks on the pump.  I feared rolling over on the buttons in the middle of the night and the proper sequence of buttons getting pushed, or when the pump was in my pocket that the buttons might be pressed in that order, too.  Something else that probably contributed to my fear was the fact I had received a "butt-dial" from my sister-in-law earlier that week from her cell phone. 

Well, in much the way that cell phones today have screen locks, your insulin pump has the same sort of blocking functionality.  This was a function I knew that my Medtronic insulin pump came with, and before using the pump I learned the menu navigation to turn the function on and off.  Incidentally, I have only ever used this function once.

There are other precautions against accidentally bolusing in this manner, as well.  I cannot speak for other pumps, as I do not have a wealth of experience with them.   However, with my Medtronic pump, while the the buttons are open and exposed, they are designed in such a fashion that you have to apply a certain amount of pressure on the right part of the button.  I definitely can't apply pressure to the whole face of the pump and depress buttons at random (I tried a few different ways, with various body parts, as if I was asleep). 

Finally, while my Medtronic pump comes with an "easy bolus" function that allows me to receive insulin in unit increments with very few button presses, you are able to turn this function on or off.  A reason some people use this function is, for example, if they are in a meeting and know that for the food they are eating there they need an amount of insulin, but do not want to pull the pump out of their pocket or belt (or wherever it is).  You can simply hit the easy bolus button and get a bolus done without even looking at the screen on your pump.  This function, however, can be easily enabled or disabled.

In the end I felt really safe in the understanding that there was very little chance of me giving myself an unexpected bolus, and you should feel just as safe.

HA1C test

I am sure everyone here has mixed feelings when looking to their HA1C tests that get done regularly.  I just got back from having my blood taken for my test.  I am always of two feelings when getting this done.  On the one hand, it is a good view of how good my control has been over the past few months, and given the time I have had recently I think that I will see an improvement in my results.  On the other hand, there is always that dread that I am going to get a higher reading than before, and get a "talking to" from my doctor.  :(

While I am hoping to get into the low-7% range (somewhere that I haven't been a very long time), I know that it would be much better for my health to get down to a level of under 6%.  (For those of you don't have the conversions available to you at hand....a 7% reading would equate to an average glucose level of approx. 8.6 mmol/L or 154 mg/DL, and 6% would be 7.0 and 126, respectively.)  I had been well on my way to achieving the latter goal since my last test, however six weeks of turmoil at home has told me I will be lucky to get to the low 7% values. 

I do not know how things work where all of you live, but for my government to continue subsidizing my insulin pump, I have to show improvement from where I was when I started out on the pump, and continually work towards getting my blood sugars under control with respect to this test.  As everyone knows it is easier said than done. 

So, for everyone waiting to get their HA1C results, and feeling anxious about it, just letting you know that you aren't alone!  :)

Pimp My Pump!

Before I start this, I want to dispel any thoughts you have here that in this post I am doing any advertising.  I am not making any money by promoting the following companies or sites in this post.  The only place I make a few cents, is if you click on any of the advertisements on this page.

When you look at an insulin pump, you don't really see much.  It is a little rectangular box that you carry around with you all day.  Sure, it has a colourful button, or two, but that is about it.  Why don't you have fun with it.  No matter what insulin pump your choose, or currently wear, there are a wealth of opportunities for you to choose from for making your insulin pump as "you" as possible.

First off, with the pump itself, there are a variety of options available for both protecting it and expressing yourself.  You can go to www.skinit.com and choose an adhesive "skin" for your pump, that wraps around your pump and covers all the plain, boring parts of your pump (starting at US$15, these are priced really well, in my opinion).  Whether you are looking to support your favorite sports team, declare yourself a princess, or get your Popeye on, you will find a multitude of designs ready for you.  You can even design and upload your own pictures.  Some pump manufacturers even have their own skins, which are made of more sturdy rubber that does more protecting of your pump, and have them in available in a number of bright, flashy colours (Animas has eight to choose from).  Accu-check has skins in six colours which also allow you to attach a belt clip directly to the skin to attach to your clothing.

After you have covered your pump with a skin, you need to be able to carry your pump around with you.  Sure, you could simply carry it around in your pocket, but who wants to be so boring?!  Not when you can go to Angelbear and pick or design your own pump case (this looks to be a good site for finding case, or insulin pumps harnesses, or even clothing for your young child wearing an insulin pump).  Pumpwear also has a wealth of cases and clothing to choose from.  This site has a lot of good products for kids and adults.  Not only can you choose from a variety of cases, but for those of you want to hide your pump from view, men can get boxers with pockets, or women can get bras with a pocket for your pump.  Of course there is always Ebay to go to and find cases, as well.  A recent inquiry on the site brought up case with Thomas the Tank Engine, Justin Bieber, and a zebra pattern.  :)

Of course your Insulin pump manufacturer will also sell cases that you can wear in a variety of ways.  So far I have gotten by with only two cases to carry my pump with me.  One is a leather case that attaches to my belt, and another is simply a black fabric case that velcros around my waist.  However, seeing all these sites, makes me want something else.  Decisions, decisions!! :)

Whatever you do, have fun with it!  Take a look at these sites or find others on your own that will bring our your own personal style.

Changes to your Basal rate

One of the neat things about having an insulin pump is the fact that you can customize your pump to give you a basal rate of insulin to more closely match what your body would actually do.  I am not referring to bolus insulin levels when you are eating, but basal levels to sustain a healthy blood sugar level.  Your body does not act the same way all the time, if it did, a lot of things would be much easier, including the management of your diabetes.  When you wake up in the morning, your body may require a certain amount of insulin to keep your blood sugars under control, however, as the day goes on and your activity levels change, your body has a different level of insulin required to sustain your blood sugars.  Then in your evening hours, body requirements can change again, and one more time during the night when you are asleep. 

Under traditional syringe based therapy, you will be giving yourself one or two "long-acting" insulin injections a day that are meant to give you a steady stream of insulin over the course of 24 hours.  These rates cannot be changed or adjusted much (if at all) based on how that type of insulin works.  However, with the insulin pump, you can set multiple rates to cover the 24 hours in a day.  These rates will give you the fast-acting insulin that is in your insulin pump, but (virtually) continuously over the course of the day.  Myself, I use four different rates during a 24 hour period. 

The fine tuning of these rates are often done with regular visits to your diabetes nurse educator or endocrinologist.  Ensuring you have your insulin rates correctly calibrated for your food intake (i.e. your bolus rates) is important for your overall blood sugar levels (ultimately your HA1C tests), however, in relation to your entire day, your basal rates affect you the whole day, not simply for periods of eating (as your bolus rates do).  These rates are important to have done and done right.  Not only can the proper calibration of these rates ensure your blood sugars do not stay high, they will also protect you from going into hypoglycemia.  Basically what I am saying is, "Don't mess around them, unless you know what you are doing."

Disadvantages to insulin pumps

I am very strong advocate of using an insulin pump, for type I diabetics, although, I am not blind to the disadvantages that are inherent in them.  I will briefly discuss each of the disadvantages I can think of.  After all, when you are deciding if the pump is right for you, you want to be able to see both sides of the story.

1. Expense: Right off the bat, this can be a prohibitive factor for some people.  An insulin pump can run you $5,000 and more, and that is just for the pump.  Insulin pump supplies (for things like cannulas, tubing, and reservoirs) can cost in the area of $3,000, annually.  These costs are in addition to those that you will still have to pay for your other diabetic care regimes, such as blood glucose testing strips.  Many countries realize the cost that diabetes is going to have on the public funds in the near future in terms of health care for diabetes not managed as well as it should be.  For this reason, many places are funding the purchase of insulin pumps, allowing people (who meet certain requirements) to either pay nothing or a minimal portion of these costs.  Some insurance companies are also starting to come around and pay for the pumps, as well, in countries where the costs are not picked up by the government. 

2. Diabetic ketoacidosis: A shortage of insulin being supplied to the body forcing your body to switch to burning fatty acids and producing ketones (in high doses, ketones are poisonous).   Obviously this is also an issue under regular syringe therapy, as well, if you leave your diabetes unchecked and unmanaged.  The same thing can happen with an insulin pump if you leave your diabetes unchecked and unmanaged.  The risks of this occurring with your insulin pump relates to the fact that your insulin pump simply supplies you with fast acting insulin, so if you have no insulin delivery for a number of continuous hours, and let your blood sugar raise to dangerously high levels, you are at risk of ketoacidosis.  Reasons that your insulin pump may stop delivering insulin for hours on end include:
- your battery dying
- a kink or puncture in your tubing
- run out of insulin in your reservoir
- some sort of technical malfunction (these are mini computers, and something could happen)
Your insulin pump will have alarms for most of these items, and it is incumbent upon you to adhere to these alarms and pay attention to them.

3. Scar tissue build-up: I discussed this previously in that you must make sure you rotate the insertion points for your cannula.  This is a bit of plastic inserted under your skin, and your body will develop scarring around the site as it is inserted to your skin for up to three days at a time.  You must make sure you rotate your insertion point to avoid a build up of this scar tissue, which will hinder insulin absorption. This is true, however, for regular syringe therapy, as well.

4. Allergic to adhesive: some people will be allergic to the adhesive used by some suppliers.  This is generally not a huge issue as you can choose from other suppliers in most cases, and most pumps will offer a trial period of their pump at first and if you notice that you are allergic to the adhesive and cannot find another type of adhesive, you can return the pump and use another.

5. To be careful when involved in rough sports: Depending on the sport, or other activity you are involved in, you may have issues with the tubing or wearing of your pump, in that the cannula could get pulled out or get tangled up in your activity.  There are ways to ensure your pump and tubing are out of the way of "dangerous areas" or a host of other solutions you can either discuss with your diabetes educator or pump supplier.

6. Weight gain: this is the issue that I suffered from the most when I started on my pump.  In the months preceding my insulin pump adoption, I lost a large amount of weight, despite eating really anything I wanted to.  If you are reading this blog, you know a few things about diabetes and know that isn't right.  My blood glucose control was not good and my HA1C test proved that.  When I got on the pump, my blood glucose levels came under tremendously better control, allowing my body to properly process the food I was eating.  When I kept my same eating habits, my body held onto what I was eating, because of my better control.  I therefore gained a lot of weight.  However, I am now less likely to have future diabetic related health problems in the future.  Now I just have to worry about losing the weight again in a healthy fashion!

While it is true there are a few disadvantages to pump usage, overall, I still am very pleased with how relatively seamlessly the pump became an integrated part of my life.  I am lucky to live in a province in Canada where the pump purchase was paid for by the province and the supplies are subsidized.  Expense is really the biggest inhibitor of insulin pump adoption, in my mind.  Having that obstacle removed has added years to my life and improved my quality of life dramatically, of that I am certain.

Bolus Options

One of the neat things about an insulin pump is how you can choose how and when the insulin is delivered based on what you are eating, what you are doing, and if you are in a situation where you don't know what is going to happen with your meals.

On syringe therapy you will notice that even if you are counting carbs and you eat exactly the same number of carbs for days in a row at a certain meal, your blood sugars are never the same for a few hours after the meal.  Without getting into the specifics of it all, it generally has to do with something called the glycemic index, protein levels, as well as fat content in different foods. 

First, a couple definitions to start with.  An insulin pump will deliver insulin to you 24 hours a day (generally at 5, 10, or 15 min. intervals), and this is called a "basal" amount of insulin.  This acts as the more traditional "long acting" insulin in syringe therapy.  Then for meals (or times when you find yourself with a high blood sugar) you will give yourself a "bolus", or a spike of insulin to counteract the increase in sugar levels in your blood.  There are times that you will change your basal rate of insulin delivery, but that is for another blog post.  Today, I am looking at what you can do with your bolus.

Your diabetes educator will go over with you how to establish how much insulin to give yourself for the number of carbohydrates you are eating, or how to counteract a high blood sugar.  What I will look at here is what options your pump will have to use the insulin bolus.

Your insulin pump will generally give you three options for doing your bolus:
1. Normal/standard bolus: This type of bolus is the one that will be used most by beginner insulin pumpers. This is equivalent to giving yourself an injection of fast acting insulin.  The entire amount of insulin will get to your blood stream in the fastest possible time. Honestly, I default to this most of the time, myself, because it is easiest.  However, for people who are better in control and more fully understand the nutrition associated with various foods, this bolus will only be used for meals that are both low in proteins and low in fat.

2. Square-wave/extended bolus: This type of bolus will take the amount of insulin you wish to give yourself and evenly distribute the bolus over a certain time frame (again, something you control, and can be anywhere from 30 min. to a few hours).  This bolus setting is more used by advanced users, again.  You would use this setting if you were eating a high protein and high fat meal (like a steak or turkey and gravy).  Given that this type of meal would give a slow but steady increase of blood sugar levels, this square-wave bolus tries to match the insulin delivery with the sugar delivery to the blood stream.  The timing of how long to set the bolus for is best discussed with your diabetes educator and nutritionist.  This is also ideal if you are at a party and know that you are going to be eating a little bit all the time, but not really settling down for a full and proper meal.

3. Dual-wave/combination bolus: This type of bolus is exactly what it seems, a combination of the first two types discussed.  Again, this is used by an more advanced user of their insulin pump.  It is used in a couple different scenarios.  If you have a high blood sugar before doing the bolus, your pump will not allow you to simply do a "square-wave".  It will tell you that you must do some sort of insulin delivery immediately (to bring your blood sugar back in line with normal), and then will follow with the remainder of the square wave. It is also used if you are eating a high carb high fat meal (like pizza, chocolate cake, or pasta with a heavy cream sauce).  You can choose how much insulin will be split between the instant delivery and the remainder goes towards the square-wave for the time period you choose.

These different patterns may seem overwhelming at first, but it just take some practice and work with a nutritionist to understand what foods will have what effect.

Is an Insulin Pump just like having a pancreas?

To the chagrin of some diabetics using insulin, simply using an insulin pump is not just like having a pancreas.  When I started getting information about my conversion to an insulin pump, I had illusions of this sort of thing being available now (well, "then").  I had half-expected my insulin pump to know what my blood sugars are and for it to compensate based on that.  That is not the case, but some people/organizations say that this is not something that is too far off.

That statement must be tempered by a few precautions, however.  There are organizations working towards creating a "closed loop" system, whereby a CGM (Continuous Glucose Monitor) would transit glucose levels to your insulin pump and your pump would increase or decrease the amount of insulin being pumped into your body.  That seems like a relatively easy fix when you look at just that, because there are CGM's out there on the market and they do connect with insulin pumps.  However there are other things to think about in that scenario.  One item that quickly comes to mind is how the system would correct for things like exercise. Take the case of you taking some extra carbs before going on a run.  Currently, your CGM would show you having a higher sugar level and tell the pump to give you more insulin, and when you go on your run, you now have the insulin and the exercise "taking care of" the additional carbs in your system.  Therefore, a system that solely gives you insulin will never (in my mind.....non-expert, as it is) be able to be totally self-sufficient in functioning as an "artificial pancreas".

That leads to another precaution that comes to mind.  A pancreas' function is not solely to create insulin.  A pancreas also produces amylin (slows the digestion and the rate of glucose entering the blood stream) and glucagon (raising blood sugar).  For a fully functioning "artificial pancreas" you would need this system to be also able to at least give you both insulin and glucagon, in my opinion. In a pump form, that would require at least three probes inside your body (1: the CGM; 2: the insulin cannula; 3: the glucagon cannula).  

One more precaution to consider is that current CGM's (at least any I know of) only test the interstitial fluid (the dumbed down definition of which is the fluid found just under the skin) which only shows what the blood glucose levels are after a delay (studies differ on what this delay is, ranging from 5 - 20 minutes).  In periods of relatively static blood glucose levels, that is not too much of a problem, but in times of sharp increases or decreases, those minutes can be very important, if you are only using the CGM as a measure of blood sugars (something you can't do).

Having said all this, there are studies currently underway in Europe and North America (FDA recently allowed for some tests in relation to an artificial pancreas) to create something that would function as an artificial pancreas.  Advances are occurring all the time, and the "construction" of an artificial pancreas I have just discussed is only one way it is being looked at.   I'll leave it others to come up with how to build it, but being able to have one in my lifetime would be amazing!

Changing your infusion set

Note: for those of you who are new to the "insulin pump game" and are not sure what some of the terms are that I am using, please see a previous post of mine.

For those of you who have lived with your insulin pump for quite a time you know this procedure all too well.  For those of you looking at getting an insulin pump what follows is a description as to what you will be doing every third day (at the most).  This is an extremely long post, however it will take longer to read it than it actually takes you to change your infusion set...just being thorough! (Once again, remember I am NOT giving this as professional advice, but just my personal experience.  Nothing I say should circumvent what your diabetes educator will tell you....I am just giving you an idea of what it is like.)

What you need:
- insulin pump
- insulin (a rapid acting one)
- reservoir
- tubing (unless you have a tubeless pump)
- infusion set
- alcohol swab
- Polysporin (or some other antibiotic cream) - optional
- band-aid - optional
- cannula inserter - optional

I use a Medtronic MiniMed pump with a Silhouette infusion set.  Therefore my post will have details about this, but all insulin pumps will have similar steps.

The recommendation is that you change your infusion set every third day, and if you are lucky, that will coincide nicely with the amount of insulin your reservoir can hold, so you are changing everything at the same time.  One needle every third day is a heck of a lot nicer than up to 12 or more injections over three days on a traditional syringe treatment.

1. The first thing I have to do is take off the the infusion set that is on/in me.  In the picture you will see that I can unhook the tubing from the infusion set.

At this point I now have to take the infusion set out of my stomach (my preferred location).  While the set is attached to me with an adhesive, it fortunately does not leave a sticky residue.  When I peel the infusion set off, it pulls the plastic cannula out as well.  Extremely rarely will there be any blood.  (Of course the first time I tried it with my nurse educator, I bled for a few minutes!  Talk about a bad start!)  To reduce scarring, I use a dab of Polysporin before covering it with a band-aid.  The cannula goes in the garbage.

2. I then have to remove my reservoir from my insulin pump, which is done with a simple twist and another twist to get the tubing off of the reservoir.  At this point I also have to "rewind" my pump, so the plunger that pushes the insulin out of the reservoir rewinds back into the pump (this is done with a couple quick button presses on my pump).

3. I am now ready to start from scratch and get the new supplies ready to go.  I start by getting my reservoir full of insulin.  In the picture below you will see the reservoir as it comes out of the box.  It has top, middle, and bottom sections.  The top (blue) attaches to your vial of insulin. The bottom is how you pull back the rubber section inside the reservoir that holds the insulin.  The middle section is the reservoir itself, which goes into your insulin pump when it is filled with insulin.

You should pull back and forth (while twisting) on the bottom part so that the lubricant on the rubber inside the reservoir can loosen up.  Apparently it helps so that there is less pressure on your insulin pump to do the work, which could burn the motor over the course of a few years.

4. Before attaching the blue part to the insulin vial I like to pull back air into the reservoir to push into the insulin vial (much like with traditional syringes, to maintain air pressure inside the vial).  While the blue part is a "venting cap", I find it much easier to push air into the vial myself.  You then simply pull back slowly on the bottom of the reservoir to pull back insulin into the reservoir, ensuring to keep it vertical, so all bubbles go to the top.  You then may have to go back and forth a few times (possibly tap on the reservoir a little) to get all the bubbles out.

5. When the reservoir is full of insulin (no air), you can turn the vial right-side-up, and twist the reservoir off of the blue part (venting cap).  The bottom part of the reservoir also twists off of the reservoir itself.

6. At this point you can attach the tubing to the reservoir (where the venting cap was) with another simply twist.  You can also insert the reservoir into the insulin pump and twist it into a locked position.

7. Now you need to get your cannula inside you.  There are a number of infusion sites to choose from.  You can do it pretty much anywhere you used to inject insulin with a syringe, including your upper arms, thighs, upper buttocks, or your abdomen (my favorite).  If you choose to always put the cannula into the same area (i.e. only the abdomen) ensure you rotate around the area so that you do not get a build up of scar tissue, which will adversely affect your insulin absorption.

8.   Once you have chosen your site, clean the area with your alcohol swab.  Let it dry for a few seconds.  You can then load your cannula inserter, if you wish to use it.  As I noted in a previous post, I tried it a few times and do not like it.  I find it much easier to insert the cannula manually, although the inserter (which is basically a spring load device that shoots the cannula into you, much like your finger pricking device) can help getting to harder to reach areas.  The cannula (which is the flexible teflon tube that sits inside you) is shown on the left.  On the right, you will see how I get the cannula out of the box.  It has a needle inside the cannula and has the adhesive around it (the plastic you see in this picture is actually a protective tube that you must remove...it is so you don't prick yourself by accident!).

There are generally two backings to remove from the adhesive, one of which you take off before putting the needle into you (see the picture below to see the raised part of the adhesive which is removed first).  Despite my preliminary reservations, the needle with the cannula around it, goes into your body just as smoothly as a regular injection (seriously).  You can then ensure the exposed adhesive is applied evenly to your skin.  At that point you just have to pinch the two sides of the grey plastic part in the picture on the right and pull the needle out.  That leaves the cannula safely inside you.  You can then pull off the second backing from the adhesive and ensure the full adhesive is nicely attached to your body. 

9.  You now have to "prime" your tubing (if you have tubing).  Again, with a few clicks on your insulin pump, you will fill the tube with insulin, again so there is no air in there.  Next, you affix your tubing to your cannula (see the first picture in step 3.

10. Your final step is to prime the cannula, as that is currently full of air.  You simply have to hit one more button on my pump and it pumps in a set amount of insulin, enough to simply fill the cannula with insulin (this amount you will find in your cannula instructions.

Really long post, but it is really a quick process!

Sleeping with an insulin pump

Everyone sleeps differently....some people on their stomach, some on their back, some (like my little son) seem to travel all over the bed at night, some on their side, and some like to sleep on their spouse's side....of the bed!

This was one thing that I questioned when I started considering use of my pump.  I was told to just slip it into a pocket in my pyjamas.  That sounded easy enough, and I felt silly for questioning where I would put it.  (One thing I have learned is that there are no silly questions.)  Most of my pyjamas have pockets so I felt pretty good about it that my pump would not be an issue while sleeping.  As everything else in life, it wasn't quite that simple.  I have not had one night where my insulin pump has stayed in my pyjamas pocket the whole night.

So what happens?  I cannot tell you how many times I have awoken in the middle of the night with my insulin pump in the middle of my back.  I am generally a back sleeper, and I cannot figure out how my insulin pump crawls out of the depths of my pocket and out onto the bed sheets and somehow decides it can lift my not-so-light-frame up and settle into the small of my back.  Sometimes I move it out and put it back beside me, or if I am too tired I just leave it there until morning.

There must be a way to stop that from happening, right?  There are a few options, some I have thought of, some I have tried, and others that just won't fit my sleeping patterns I am sure:
- you could sew a button into your pyjamas (like a shirt button): if it is strategically placed, I am sure it could keep your pump securely in your pocket.  I haven't actually tried this yet, as I have yet to convince my wife to sew a button on there for me.  :)
- you could wear a pouch: I have a cloth pouch attached to a soft cloth belt that I can wear that keeps the insulin pump in place.  This pouch can be worn during the day or at night.  The problem I found with the velcro belt is that during the night when I move around I must move the velcro ever so slightly so as to bug and scratch me.
- I have heard of other people with long enough tubing that they are able to leave their insulin pump on their night-side table.  It may work for you, but not for me...I move around too much at night.

So, I continue to let my insulin pump fall out of my pocket every night.  I know that I have to look for it when I get out of bed in the morning and stuff it back in there. 
Is it a hassle?  Yes. 
Do I care that I have that hassle?  No.
Why?  I have never had the pump hurt me while I am sleeping (I have never had it hit me or my wife in the head!) and the control over my blood sugars trumps any teeny tiny minor hassle like this.

Do you have any other suggestions?

Insulin Pump dictionary

It comes to mind that I am talking about an insulin pump using words that not everyone may understand...especially if you don't have an insulin pump and are just considering one. 

Basal rate: the amount of insulin required throughout the day (acts like your "long lasting" insulins under a traditional syringe based insulin regime.  With most insulin pumps, you have a variety of basal rates that you can program for different times of the day, allowing for more personalized insulin delivery than the "long lasting" insulins.

Bolus: this in the amount of insulin that your insulin pump gives yo, usually when you are eating a meal.  Based on carbohydrate counting, and a "wizard" installed on most insulin pumps, your insulin pump figures out how much insulin is required, down to the tenths or even hundredths of a unit!

Cannula: a thin tube that sits under your skin, held in place held in place with an adhesive.  The cannula has a opening to which you attach the tubing that runs to your insulin pump.  This can be angled or be at a 90-degree angle.  The cannula is inserted subcutaneously with a needle inside the cannula....the needle is then pulled out, leaving the cannula firmly in place.

Extended Bolus: a feature included in most insulin pumps allowing you to bolus over a certain amount of time.  This is helpful in situations like when you are eating over a period of time, having a high fat meal, or consuming a very large meal.  An extended bolus can give an even amount of insulin over the time programmed ("square-wave") or give a larger dose initially followed by a lower steady dose ("dual-wave").

Infusion set: the adhesive patch that holds your cannula in place on your skin.

Insulin On Board (IOB): a calculation usually viewable on your insulin pump that shows you how much insulin is still active in your body (your diabetic educator will help you set this up).

Priming: the process of setting up your insulin pump every third day (at the most) to let the pump accept another reservoir and fill the new tubing set with insulin.

Reservoir: a small container in which you fill with enough insulin to last you up to three days.  This reservoir is placed inside the insulin pump and the insulin is pushed up into the tubing, and into your body through a cannula.

Subcutaneous:  just under the skin.

I hope this helps in your understanding of different insulin pump terminology.

Traveling with your insulin pump

Do you need to worry about anything when traveling with your insulin pump....particularly air travel?  No, in my mind, there is absolutely no issue traveling with your insulin pump. 

With my insulin pump I have flown domestically within Canada, to Hong Kong, to Indonesia, and domestically within Indonesia.  I have never, ever, had a problem with my insulin pump, but that doesn't mean I wasn't prepared for a variety of eventualities. 

Pre-flight:
1. for any flight, domestic or international, you want to ensure you have a fairly fresh vial of insulin in your insulin pump.  The last thing you want to do is have to try to change your infusion set while you are either in the cramped confines of your seat.....or in the toilet! 
2. For any trip, it is also a good idea to make sure you have packed extra vials of insulin, as well as syringes (or "pens" for injecting), as you don't want to be away from home and have your insulin pump break or get lost and you have no recourse for supplying insulin to yourself.  Remember, that not only will you have to bring your rapid-acting insulin, but also a long-acting insulin (like an NPH or Lantis).  Your diabetes educator or doctor can help you decide what you proper doses would be in that eventuality.  I generally pack some in my hand luggage, as well some spare in my suitcase, in case I lose one.
3. While I have never been asked for one, I have a letter that was supplied from my doctor indicating that I am a type 1 diabetic and need to bring with me insulin supplies, which could include syringes, testing supplies, infusion sets, and insulin.  I think it is a good idea, because bringing sharps on a plane can always be viewed as suspicious.  As I said, though, I have never had to produce this letter to authorities.

At the airport security check:
4. Of course you have to pull out your liquids on flights now, which will include your vials of insulin.  Ensure the prescription labels have the same name as that as is on your boarding pass.  There is no need to pull out your insulin pump supplies or other syringes.  Those will show up on the x-ray, and if they want to pull the supplies out, they will.
5. Going through the body scanner will have absolutely no effect on your insulin pump or the insulin inside it.  I have actually been behind people in line who have had an insulin pump on and have taken it off  would not put it through the scanner, insisting on a visual scan.  There is honestly no need for that, and I think it causes more issues than not.  The people I have seen who would not have their pump scanned, had their whole bags searched.  I simply walk through the scanner with my insulin pump in my hand, showing it off to the officers.  Every time, I have been asked if it is an insulin pump, to which I have said yes.  I have never had to say what it was, even flying domestically within Asia.  For those of you who generally keep your pump in a harder to get to area (to hide it more from plain sight), I would recommend for that flight to keep it in an easily accessible place, so that it doesn't look like you are hiding something....especially if you get patted down for some reason, and they find something under your clothes with a "wire" attached to it.

In Flight;
6. I like to keep my date and time settings the same as my place of departure.  This more refers to when you will be crossing multiple timezones.  As with any good diabetic, ensure you have an ample supply of food that you can eat, in case the meals in-flight do not coincide with your needs.  I also like to test my blood sugar every 2 to 4 hours of flying time, just to make sure everything is still good.

At your destination:
 7. I always change my date and time settings to my destination immediately, and also test my blood sugar every couple hours after the change.  Depending on what insulin doses your received and what you will be getting, you may have to adjust (bolus higher, or temporarily reduce some basal) your doses.

A long-winded response, but it all comes down to say, you don't have to worry about traveling with your insulin pump.  See your diabetes educator for a complete list of what you should take on vacation or what you may need, but have no fear about bringing your insulin pump through airport security or on the plane.

Is it going to feel like I'm "on a leash"?

One concern people may have about switching to an insulin pump is the feeling that they are effectively feeling like they are being "tied to a leash".  There is the thought that there is always this "thing" attached to them that they have to take care of, making them feel trapped.  There is also a perception that the insulin pump is going to be an unsightly look as it is always attached to you.  These fears are common, but quite unnecessary.

Let's face it, being diagnosed with Type 1 diabetes is always going to make you feel like you are tied to something.  You have to always make sure you have your glucose monitor, you have to make sure you monitor your food intake, you have to make sure you carry your insulin around with you.

Your insulin pump actually gives you freedom in some respects. First of all, your insulin pump is going to carry your insulin for you, so you are not going to forget to bring your insulin and syringe with you when you go off to school, work, or out for the day.  Next, you no longer have to pull your syringe and insulin bottle out in the middle of class, at your desk, or sneak off to the bathroom to give yourself any insulin. Once you are familiar with using your insulin pump, you could use the advanced features of your pump and simply keep your conversation going over lunch with your friends and let simply give yourself the proper amount of insulin without even looking at your pump.  The pump also allows you to eat what you want, when you want, and as long as you count your carbs properly, you will always be "injected" with the right amount of insulin.

As far as the "unsightliness" is concerned, your insulin pump will be as noticeable or unnoticeable as you want it to be.  There are a number of different pumps on the market (speak to your diabetes educator about the best one for you) but you can get pumps that come with tubing (to run from the insulin pump to the insertion site) or ones that basically sit right against your skin, therefore eliminating the tubing.  The tubeless pumps would allow you to have the pump sit right against your skin, and would be covered by clothing all the time, so you would not really be "advertising" that you have a pump.  Personally, I have a pump with tubing, and I use the longest tubing available as I prefer to have my pump in the same place (on my right side on my best or in my pocket) all the time.  The longer tubing allows me to have injection site all around my abdomen without having to move my pump.  I could have the ability, if I so wished, to have my pump hidden in my pocket with the tubing totally under my shirt and pants, by cutting a small slit in my pocket allowing the tubing to be in my pocket without being seen by the outside world.  I don't actually do this, though, as I do not mind having a small bit of tubing show coming out of my shirt going to my belt loop.  I have never received an odd look from anyone, in fact some people have been surprised when I actually showed them the pump and asked "How did I NOT see that?!).

If you are worried about being "leashed" to a pump either physically or metaphorically, you can't let that stop you from using an insulin pump.  As I said, it frees you up with respect to not having to carry some of your supplies around with you.  Additionally, there are many ways and places you can hide your insulin pump, if you are self-conscious about wearing one.  However, in this day of everyone wearing their mp3 player or phone on them somewhere, you really won't stand out.  I know from experience.

Does the insulin pump hurt at all?

If you are considering an insulin pump you have either recently been diagnosed with Type 1 diabetes, or you have already had it for some time  (Hello, Mr. Obvious.)

If you are newly diagnosed, read on, it really isn't that bad.  If you have been a diabetic for quite a while you obviously know about injections and the pain you get from that.  You know that the subcutaneous injections are not really bad at all.  I would say that for 95% of my injections (before I started with my insulin pump) were hardly felt at all, when I used new needles (DO NOT FOLLOW MY EXAMPLE).  I used to inject in my arms, legs, backside, and stomach.  For you "new" diabetics, it really is true...you don't really feel the injection at all.  The worst part, I found, was originally the expectation that it was going to hurt me.  In actual fact, the only time I felt pain was when I re-used my needles.  I used to use the same needle over and over again for insulin injections over the course of days.  I figured "the needle still looks sharp, so it must be okay."  It isn't.  Take a look at the following picture and you will see why that injection was hurting me as I used the needle more often.  Other reasons to dispose of needles after a single use are: multiple uses cannot guarantee sterility, the tip of a needle could break off inside your skin (ouch!), and the possibility of no longer receiving the exact dose of insulin you were trying to get.

When you are replacing the tubing and cannula (posts to come later explaining these), you are always using brand new needles (no way around it).  It feels absolutely no different than injecting with a regular NEW needle the "old" way.  I don't know why, but when I was first learning how to use my insulin pump I insisted on using a pull-loading device (much like your lancing device for drawing blood from your finger) that would "fire" the needle into my stomach.  I was warned against it, but still insisted on it.  I couldn't wrap my head around using the needle to insert that cannula manually.  Quite frankly that proved to be a STUPID move on my part.  Using the pull-loading device actually caused quite some pain in me (it may not in you, but I am only giving my experiences).

The only other time you feel a bit of pain is if your tubing gets caught on something and starts to try to pull out of your body (truly not as gruesome as I have made it sound).  The tubing is attached to your skin with a sticky pad (much like a band-aid).  The "pain" that you really feel is just the sticky pad pulling away from your insertion point.  Quite honestly it is more surprise than pain.

Finally, if you are concerned about pain with an insulin pump, don't be.  It really doesn't cause any pain.

Why would I use an insulin pump?

Control. 

I was going to end my blog post there, but figure that there may be a little more explanation and reasoning needed for this.....you know, to convince you. 

I was diagnosed with diabetes in 1991 and lasted about 15 years with relatively good control...or so I thought.  I had not complications, as all my eye exams were always great, and still had full feeling in all my extremities.  Then my life had some changes where I was doing more and more and concentrating less and less on my diabetes and control of it.  I moved around often and never had to stick with a doctor long enough to endure all their "preachings".....in retrospect that attitude could have been very bad for me.  Then I had a doctor in Ottawa who made sure I went to an endocrinologist and they saw my HA1C tests up really high....in the 12 or 13 range.  I was asked if I would consider an insulin pump, and my first reaction was "No, why do I need one?".  Simple answer was that my "control sucked" and I had to get it better controlled.

I had a couple reasons for not wanting it:
- vanity - I couldn't imagine having that thing attached to me all day
- tubing - I have young kids and could just imagine them pulling at the tubing
- saw it as an admission that I had somehow "failed" as a diabetic

My "reasons" (more like "excuses") were put to rest rather easily by the diabetic educator I was working with:
- vanity: insulin pumps are nowhere near as large as they used to be and can be easily concealed both by males and females (although I am not as intimately aware of how all that works!).  Quite honestly they could be mistaken for a cell phone (mine was) or some mp3 players.
- tubing: Many people my age apparently have the same concern and I was told that most kids do get the message that "this is medicine for Daddy, and you cannot touch it".  In practice, I was amazed at how well that actually did work.  There were questions at first, but I have never had my young ones pull at the tubing, not even once.
- "failing": What would be considered "failing" is me not taking care of myself and helping myself find better ways to control my diabetes (in turn, my health) so that I can be around for my family.

After the 12 % and 13% HA1C test results I had brought down my result down to 10% in the very next test.  It went down to 8% the next test.....within a matter of 6 months my chances for complications from  diabetes had reduced significantly.  I felt better physically, mentally, and knew that I took the right step forward in the control of my life.

The 8% reading is still not perfect, and I will later talk about getting that down even further.

My second attempt at this.....

So, my first attempt at blogging about my insulin pump failed rather miserably.  So why am I trying again?  I am doing it because this is a subject I truly believe requires attention and is something that others can really benefit from.  I can tell you that my insulin pump has saved my life.

For anyone who is looking at using an insulin pump to help control their diabetes, I hope this can help you decide if it is for you, or not.  Through regular blogs I will tell you about my ups, down, and accomplishments associated with my life with my insulin pump.

Talk to ya soon!