New beginnings on the Insulin Pump

So, here goes......this is my first blog as an insulin pumper.....do I feel different?? Well, apart from sitting at the laptop now wearing my new permanent attachment, not really, but it's certainly been an interesting first few days!!!


MONDAY 9TH AUGUST 2010 - Awake bright and early due to happiness, excitement, fear, nervousness and anxiety all rolled into one.  Got up and did my last ever injection which I have to say was a pretty surreal and momentous occasion!!! It was a really strange feeling to be doing my last injection after just over nineteen years of doing them day in day out. Mixed emotions really as in a weird way, although they can be a pain to do and are sometimes painful (especially lately) the injections feel "safe" and reliable and you know for sure that the insulin has gone into your system whereas with a pump you are reliant on a machine to do the work for you and as we all know, machines can malfunction from time to time. (On the pump there might still be the odd occasion when I will need to inject, if the pump goes wrong for some reason, but this was my last "official" injection).

It felt a bit like I was standing on the edge of a cliff ready to jump off into the unknown because I still felt like there was SO much I didn't know about using an insulin pump. Obviously the day at the hospital was going to clear all of that up but before we set off I felt more than a little overwhelmed by everything I was still to learn and my new way of life.

My DSN, Gill, has been and continues to be fantastic and she made me feel at ease right from start of the day.  First of all we went through all the bits and pieces in the box and had a look at all the supplies and things that go with a new insulin pump.  Next we went through the menus on the pump.  Gareth got to do all of the same steps along with me because Gill let him use her spare demo pump so he could see exactly how to use a pump too which was really useful.  

We then looked at basal rates and how to set them.  The insulin pump mimics a normally functioning pancreas by delivering insulin continuously over 24 hour periods, this is your basal rate and accounts for around one half of your body's total daily insulin requirements.  Basal insulin is delivered at a rate of so many units per hour to cover your body's insulin requirements between meals and at night.  Basal rates can be reduced when you are going to do some exercise so that your blood sugar does not go too low and can be increased when you are ill to stop your sugar levels going too high.  The Medtronic Minimed Paradigm Veo allows you to set multiple basal rates for different times during a 24 hour period.  Gill had calculated that I would start on one unit per hour.  This would just be a starting point and it is likely that I will need to adjust them at certain times of the day until I get the dose I need to ensure that my blood sugar levels stay on target.

Next we looked at how to give bolus doses.  Bolus insulin doses are given on demand when you eat or to correct a high blood sugar level.  You work out the bolus dose you need according to the amount of carbohydrates you are going to eat.  My current insulin to carbohydrate ratio is 2 units to 10 grams of carbs so for example if I was going to eat 20 grams of carbs I would need to give myself 4 units of insulin.  Bolus doses are also used to correct a high blood sugar.  To work out how much insulin you need to take to bring your blood sugar back down to your target level you need to know your insulin sensitivity factor.  Gill had worked this out for me.  To bring my blood sugar down by 1.1 mmol I need to take 1 unit of insulin.

As you can see there are a fair few calculations involved in this insulin pump lark!!! Once you tell the pump your target blood sugar range, your insulin to carb ratio and your sensitivity factor then it can work everything out for you but at first Gill wanted me to work it all out on paper so that I fully understood the calculations and what they mean.  Once I had mastered this we could start to use a function called the Bolus Wizard which, like I said, works everything out for you.  We did a few practice calculations on paper then it was time to learn how to fill the reservoir with insulin and connect the infusion set.

There are several bits of kit you need to have in order to get the pump ready to connect to your body.....a vial of insulin, a reservoir and an infusion set.  The reservoir connects to the top of the vial of insulin and you draw back the plunger slowly to draw up the insulin into the reservoir.  You have to do this really slowly so that you don't get bubbles in the insulin.  If there are some bubbles you need to tap the reservoir to get rid of them. 

Once you have made sure that the pump is fully rewound you insert the reservoir into the pump and you need to fill the tubing with insulin.  This is all done by following the instructions on the pump screen.  Apologies if this is hard to follow, its quite hard to explain all of the steps involved without this being like a copy of War and Peace, especially as I can't actually show you what I'm typing about!!!!

You are then ready to connect the infusion set to your body.  The infusion sets I'm using are called Mio's.  It is important to make sure that the insertion site is clean and that you rotate the site you are using each time you change the infusion set, which should be every 2 to 3 days. 

The big moment........I was about to get connected!!!! I chose a site and fired the cannula into my stomach and 'hey presto', I was connected.  (Firing the cannula into my stomach sounds a bit drastic but I couldn't think of any other way to describe it - again, it's difficult to describe something when you can't see what I'm talking about).  Gill shook my hand and said "Congratulations, you are now an insulin pumper".....WOW!!! I could hardly believe it was happening and I didn't know quite what to say!!!!

Then I got to use my new blood glucose testing meter which tells the pump via bluetooth what your test results are....it's all very clever you know!!!  :o

I was then let loose on my own and we went to have lunch and I had to work out the carbs in my meal and work out how much insulin I needed.  Bit daunting but with the help of the calculator on my phone we managed to work it all out and away I went......I had given myself my first bolus dose on my pump!!!

The afternoon was spent discussing what to do if I had either high or low blood sugars and when to go back to injecting if there was a problem with the pump. 

I was due to go back to the hospital on Wednesday afternoon when I would learn how to use the Bolus Wizard and would do my first set change.  Gill wanted me to contact her at 6.00pm and 10.00pm to let her know how things were going which was a great reassurance for me as I felt like I had some back up if anything did go wrong.

My blood sugars over the next 24 hours were a bit up and down but that was to be expected until things settled down.  It had also been a pretty stressful/emotional day so that can sometimes affect sugar levels too. 

Gill let Gareth take home her spare demo pump so we could both have a look through the menus again and familiarise ourselves with them without actually doing anything on my "live" pump.  Once we got home I persuaded Gareth to get connected aswell so he could see what it was like for me.  I realise its not possible but I think it would be great if all hospitals could allow partners/spouses of Diabetics and parents of children with Diabetes to do this so they can get a real insight into what its like to wear one and also so that they have as much knowledge as possible about the pump and how it works.

All in all, a very successful day and the start of my new way of life.  I know its not going to happen overnight and that there is some hard work to go into getting doses right to ensure I hit my target blood sugars and bring my HbA1c down to where I want it to be but I am really positive about the future and I am looking forward to seeing the great results and improved quality of life I know my new insulin pump can bring.

Oh, and one more thing.....I have decided to name my new pump "Posy" - so here's to a long and happy relationship with my new best friend.....Posy Pump!!!!  :o)