Why i pump...

Since I was diagnosed with type-one diabetes when I was 10 years old I have been using insulin.  First in the form of syringes and insulin vials and then I converted to insulin pens.  In 2011 when I had finished my second degree and was about to start my full time job as a Registered Nurse I decided that I would investigate alternatives.

I was really reluctant to make any changes because I was managing my diabetes really well, my blood sugars were stable and I was doing everything I wanted to do, if it aint broke, don’t fix it right?

Regardless, I started to get curious about the insulin pump so I did a bit of investigating and then decided to go to a Medtronic insulin pump information evening with my mum.  The information evening was especially great because a young girl stood up and did a speech about her transition to the pump, she was wearing a dress and did not look different in any way, and you could not tell that she had anything different on her until she pulled the insulin pump out from in between her bra.   I had also recently seen a great article in Diabetic Living Magazine through which I contacted the author who lives in the Northern Territory.  She is of similar age to me and really helped me to be more open to transitioning to the pump; she had been using it for about 2 years and she was happy to answer all of my silly questions; I am still distant friends with her today, maybe one day we will eventually meet.

Throughout my placements as a registered nurse I had noticed that carrying around my tester and insulin pens while working was quite difficult, and if they were moved at any time which they often were, it was quite stressful.  I had also noticed that I was regularly chasing my blood sugar levels while I was working rather than being able to control my diabetes.  As a nurse, the work and the pace is always so varied, you never really know what each day will be like.  This makes it hard to pre plan your day with insulin and get it right.  I recall at these times that I would either be going low and having to go into the kitchen and stuff my face with biscuits and juice or, later, going high and needing to do more insulin.   It was incredibly frustrating and I just thought that I needed to do something about it.

At the end of 2011 before I moved to the country for nursing I decided that I would apply to get an insulin pump.  I met with my endocrinologist who referred me onto the dietition and the diabetes educator, these are the hoops you will go through in order to get a pump, but it is worth it.

For years I had my own way of coordinating my food that worked perfectly with my insulin, but I went to the dietition who educated me further on managing my food by counting carbohydrates as this is how you manage your diabetes using the insulin pump.  Essentially for each individual person, a certain amount of carbohydrates associates with a specific amount of insulin to counteract that carbohydrate once it has been eaten.  For example, for me, it changes throughout the day, especially on night shift, but, for each 10 carbohydrates I eat, I give myself about 1 unit of insulin. It all sounds confusing but it is actually really easy because a lot of things you buy actually tell you how many carbohydrates are in each serving.   It becomes a little bit harder when you are eating out but after time with diabetes, it becomes easier.  You learn to know approximately how many carbohydrates are in the things that you generally eat, and I find that with other things you can just wing it and make corrections as needed.

After I met with the dietition I met with the diabetes educator who went through the process of getting my insulin pump organised.  The main thing to pick out was the colour, otherwise it was just a stock standard order dependant on how much insulin you generally use per day, and the diabetes educator helps you to get the right sizes.  Our meeting that day lasted for about an hour and I was shown how the insulin pump actually works, how to put all of the pieces together and how to insert the cannula into my abdomen.  The scariest thing at this meeting was the sheer force behind the device that catapults the needle and cannula into my abdomen, but as I found, and I’m sure you will, this does not actually hurt any more than the needles you have been inserting for years previously.  After this meeting, it only took a couple of weeks before my insulin pump had arrived at my door, then I had another meeting with my diabetes educator who helped me to make all the settings on my pump and get used to using the different functions that were available.

I had started using the pump about 3 weeks before I commenced working as a registered nurse full time.  In this time I was also organising a move to a place where I knew nobody and where I had never been before.  Despite all of the uncertainty, stress and change in my life at that time, I had no problems making the transition to using the pump.  Since starting using the pump my blood sugars have been easier to control; my Hba1c has come down from 6.8% to 5.9%.  I have found it really useful because I don’t have to carry around so many things when I use the pump; the insulin pump stays attached to me at all times and I only need to carry around my blood glucose meter.   This also really helps at work.

Even though the insulin pump suggests an amount of insulin to use with a meal, I still think about whatever my insulin compared to what I am eating and I often change the dose in accordance with what I will be doing after, what I have been doing prior to or what type of food it is.   Even with the pump I still constantly monitor my blood glucose levels with my Accucheck Mobile and I still have highs and lows.  I occasionally still have to eat to counteract a low, but this happens much less frequently for me while I am using the insulin pump compared to injecting.  The insulin pump does not make type-one diabetes simpler to manage and does not mean that you have either a really bad or really good type of diabetes, but it does make life a little bit easier.

I use the Medtronic insulin pump.  I have to change my reservoir and my cannula every 3 to 4 days, I use humalog insulin.  The Medtronic has only 2 hours of active insulin for me; this is slightly different for everyone.  Throughout the day I have my pump set to deliver a specific amount of insulin each hour.  These variations are in place because my blood sugar levels vary throughout the day; at 7 in the morning I need less insulin than I do at 4 in the afternoon.  You can also set different carbohydrate ratios, insulin sensitivities and different blood sugar goals which help to better manage your diabetes.   My insulin sensitivity and carbohydrate ratio’s also change significantly throughout a 24 hour period, but these settings can be attributed to the pump as well.  These changes are all pretty essay to adjust once you get familiar with the pump.

The insulin pump is smaller but wider than an iphone.  The cannula goes into your abdomen in the same spots that an insulin injection would be appropriate.  The beeper sized pump can sit anywhere on your person that you think is appropriate.  I have found that it sits well in between my bra, on the side of my bra at work for easy access, on the inside of my pocket with the clip on the outside so it is protected or facing inwards inside my underwear if i am worried about it falling off.  I have done things including rock climbing, hiking, lifting old ladies and men, and moving house and have never had a problem with pump getting in the way.  The only thing i cannot do with the Medtronic is swim, but you are able to unplug for two hours without there being too much of a problem as long as you are a good number at the start.  There are other pumps that are waterproof such as the animas if you are a big surfer or otherwise.

There are a few really cool things I can do with the pump that really help to better manage my diabetes.  Doing shift work is normally very hard when injecting insulin, but with the pump you can set a second program.  I have Program A for daytime work and Program B for night work; these two programs are basically the inverse of each other.  I also have lower carbohydrate ratio’s set for between 2200 and 0700 because I have found that my blood sugar level goes much higher with the same amount of carbohydrate during the night.  If I am eating dinner at night, for example at 0300, I usually have to do double the amount of my insulin bolus compared to during the day; I can also do this by changing my sensitivity to insulin during this period of time.

Another feature I have found really useful is that the pump only has two hours of active insulin; this is because the pump only uses short acting insulin.  If I feel like I am going low at work, I have found that I can suspend my pump completely, i.e. deliver no insulin at all, and my blood sugar level will start to rise without having had any food at all.  This feature is called setting a temporary basal rate.  This comes in handy in a number of circumstances, for example, when I am going to exercise during the day, I can set my pump to deliver 70% of my normal rate for 3 hours; this takes some trial and error but when you get it right it decreases lows experienced during and after exercise.

Having an insulin pump does not imply that you have complicated diabetes, despite what a lot of people think, and it also does not make managing diabetes that much different.  Logistically, the pump makes life a lot easier because you have fewer things to carry around and less to worry about misplacing or losing, it also lasts for approximately 3 days so spontaneous activity is no longer a nightmare.  Whilst I was really reluctant to think about using the pump for a long time, I am so grateful that I have changed over.  I knew that commencing work as a full time registered nurse while using insulin injections would be hard, and I thought that I would put on weight because I was always needing to chase my insulin, but by converting to the pump I have not been in this situation at all.  Insulin pump therapy is a big change, but one that countless people swear is worthwhile for better management of their diabetes and for a better quality of life.

For anyone that is curious about insulin pump therapy please feel free to ask me any questions.  It took someone to answer silly questions of mine for me to even consider it and I am so thankful that I came across that individual when I did.  Ask me anything, there are no stupid questions!