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)

What a Week It's Been!!!

Well, it's been a busy old week in terms of my Diabetes....

Last Wednesday was another session of laser treatment for Diabetic Retinopathy (which I did a huuuuuuge blog post on last week).  As usual, even though I have had quite a few sessions on both eyes in the last few years, I was terrified and got myself in a right old state beforehand.


Ever since the first time I had it done and I fainted I have had to have the anaesthetic injection in my eye before the laser session so I was quite prepared to have it done again, in fact, although it's not very nice and it involves them making a small cut in your eye ball, I would much rather have that than have to feel the pain / weird sensation that you get when your being lasered and risk fainting again so that they can't carry on and finish the session.  Anyway, the doctor, who I had never seen before (I hate they way it is a different doctor that does it every single time!!!) decided that she didn't want to give me the injection.  She said: "a lot of people tell me I'm very gentle with the laser" which didn't really make me feel any better but even though I said I really would prefer to have the injection she insisted that we would just "see how it went without it".....I was not happy at all and I started to panic even more.  To do the laser burns they have to shine an incredibly bright white light into your eye which always makes my other eye instinctively close, which then makes the eyeball that they are trying to laser move around....the doctor told me to try and keep my left eye open so that my right eye wouldn't move so I tried to explain to her that this is one of the reasons I always have the injection first so that it numbs my eye and it won't move during the lasering but all she said was "oh well".....Great!!


It didn't hurt too much for the first few burns but after about 5 minutes it got really sore and I started to feel faint and queasy so we had to stop....this happened another 2 times, by which point I was in a lot of pain (which can happen when you have had a lot of previous sessions) and felt very hot and sweaty and the room was spinning.  At this point she decided to stop.  I really did feel as though she hadn't done enough but knew that for her to carry on she would have to do the injection as I was in a lot of pain and she just did not want to do it.  I got the impression from the minute I walked in the room that she just couldn't be bothered doing the anaesthetic procedure for me.  I'm sure plenty of people can easily take the pain and discomfort of having it done but everyone is different and has a different pain threshold so I'm really not happy that she just fobbed me off and made me feel as though I was being pathetic!!!! Before she sent me off home she said "I've made a note that for your next  appointment you do need the anaesthetic doing first"......I do hate to say I told you so but....... 


Next time (31st August for my left eye) I am going to refuse to have it done unless they agree to give me the anaesthetic injection first and I do not want to see that same doctor again for laser treatment.


The next day was not nearly as horrible......it was my appointment at Stafford Hospital to start my insulin pump trial....how exciting!!! I was expecting to take 2 home for the weekend but when we got there we discussed the 2 types and decided that I would only take home the Medtronic pump.  We discussed how I had been getting on with the carb counting and how I had been feeling in general.  I have been having far less headaches than I used to, I am able to stay awake much later than I used to - I used to get in from work and could easily fall straight to sleep or go to bed at 8.00 pm because I was constantly exhausted and I have been having quite a few more hypos than I used to.  Before I went on holiday I had my HbA1c done and amazingly it had come down from 11.6 in March to.....wait for it......8.8!!!!!!! (For those not in the know already, the target they always tell you to aim for is 6.5 so I am getting there).  I am so pleased that it has come down by that much already.  I did expect it to have come down but not by that much (it might not sound like much but in terms of HbA1c results every 1% counts a hell of a lot).  This reduction would explain why I have been feeling less tired and been having less headaches.  See below for a description of what the HbA1c test actually is........


HbA1c Tests
The HbA1c test, indicates your blood glucose levels for the previous two to three months.  HbA1c (glycosylated haemoglobin) is a measure of the amount of glucose attached to the body’s red blood cells; it is present in everyone. The level of HbA1c in your body rises and falls in line with your blood glucose – the higher your HbA1c, the more glucose is attached to your red blood cells.   

Your HbA1c does not change rapidly because the red blood cells in your circulation last for around 3–4 months. Any increases and decreases in your HbA1c will happen over a period of at least 6 weeks. An HbA1c test is not the same as a blood glucose test. Your HbA1c test may be done using a blood sample taken from your arm or from a finger prick test.

HbA1c Targets
For most people with diabetes, the HbA1c target is below 6.5 per cent, since evidence shows that this can reduce the risk of developing diabetic complications, such as nerve damage, eye disease, kidney disease and heart disease.

Individuals at risk of severe hypoglycaemia should aim for an HbA1c of less than 7.5 per cent. However, any reduction in HbA1c levels (and therefore, any improvement in control), is still considered to have beneficial effects on the onset and progression of complications.

HbA1c Results
HbA1c results are currently given as a percentage. However, the way in which HbA1c results are reported in the UK is changing. From 31 May 2011, HbA1c will be given in millimoles per mol (mmol/mol) instead of as a percentage (%).  To help make this transition as easy as possible, all HbA1c results in the UK will be given in both percentage and mmol/mol from 1 June 2009 until 31 May 2011.

This new way of reporting results will just be a different way of expressing the same thing. For example, the equivalent of the HbA1c target of 6.5 per cent will be 48 mmol/mol. The fact that the number is higher does not mean there is more glucose in your blood.

So anyway, back to the pump trial....I had a quick practice with an infusion set for the Medtronic pump and then once we had had a look through the menus on the pump screen I was given all the bits of kit I needed to take home with me for the weekend.....infusion set, saline, alcohol wipe, infusion set inserter, the pump, reservoir for the insulin (saline for the trial) and off I went.

We decided to go to my Mom's to set up the pump and put in the infusion set so I could show her how it works (I was dying to show off my new "toy").  I had a bit of a 'faff' with drawing up the saline into the reservoir but after that it was all plain sailing and I did my very first insertion all on my own.  I was really surprised just how painless it was and then during the evening I was surprised that I managed to forget it was even there!!!!
 
Spending our first night sharing our bed with the pump was fine apart from me rolling on it a few times as the one I had on loan did not have a waistband clip on the back and I couldn't attach it to my PJ's.
 
On Friday I loved showing off the pump to people in my office and explaining all about it which has earned me the new nickname of "the bionic woman".
 
I had a bit of a play around with the menus over the weekend and gave myself "fake" doses of saline but that part of it (setting the basal rates etc. etc.) will be explained to me at the training on 9th August.
 
The only two minor "freak outs" I had were when I was in the shower and the pump was disconnected from the infusion set.....I knocked the infusion set a couple of times and for some reason that really made it hit home that I will have one of them in my stomach forever from now on.  For some weird reason I found it stranger to look at it when the pump was disconnected from the infusion set/my stomach and all that was left was the device lodged in my stomach...I'm not sure why this made me feel so strange but I guess it's just all part of getting used to this new "part of me" and my new way of life.
 
When I took the pump off on Sunday morning I immediately felt "lost" without it which I think must be a good sign as I must admit the part I had been mot worried about was getting used to being attached to something "alien" for the rest of my life so if I already feel lost without it that can only be a good indication that I will soon get used to that side of it all.
 
All in all the trial went really well, much smoother that I expected, and I am now really excited to get started on my own pump and start to learn all of the more 'technical' aspects of using the pump.  The trial was more about getting an idea of how it will feel to actually wear the pump. 
 
Today I contacted my DSN at the hospital to let her know that it went well and that I would like her to go ahead and order my (bubblegum pink) pump from Medtronic!!!!
 
http://www.medtronic-diabetes.co.uk/product-information/paradigm-veo/index.html
 
I can't believe that this time next week I will be "connected" and I will be a member of the "insulin pumping community".  I am so grateful for all the help I have had from my DSN's at my GP's in getting me referred, from my dietician at the hospital, from my new consultant and from my new DSN at the hospital.  It has been a very short "journey" from injections to pump and I really do appreciate how lucky I am to have even got funding for a pump, let alone get one so quickly.
 
All that's left for me to do now is think of a name for my new pump :o)
 
ROLL ON MONDAY 9TH AUGUST!!!!!!!