Two weeks in.....

It's now been just over 2 weeks since I got my insulin pump.  It's been......challenging, exciting and also, I have to say, pretty tiring!!!

I have been able to be in constant contact with my DSN (Diabetes Specialist Nurse), Gill, which has been brilliant and really reassuring to know that theres an expert on the end of the phone who can help with problems and panics.  I have been texting Gill each morning (at her request) to let her know what my blood sugar levels have been over night and also to make suggestions as to what adjustments I think I should make. 

I have been testing my sugars between 6 and 10 times per day which is much much more than I ever did in the past but it's necessary so that you can see exactly what your blood sugars are doing according to your doses and according to how much and what food you have eaten.  It is important to keep accurate and detailed records of all of your blood sugar test results, exercise, what you eat and other things such as being ill so that your basal rates and bolus doses can be altered accurately.  With accurate records you can then see patterns start to emerge at certain times of the day and/or when you eat certain things so you can then make the necessary adjustments.

Frequent testing is also essential because an insulin pump only delivers fast acting insulin so you don't have any long acting insulin in your system as a back up, therefore, if insulin delivery gets interrupted whilst on an insulin pump your blood sugars can go dangerously high in a pretty short amount of time so you need to know what is going on so you can treat high blood sugar levels quickly.

To test whether my overnight basal rates are correct I have been getting up at midnight and 3.00 a.m. to test my blood sugars - hence being so tired at the moment.  My levels have still been fairly high in the mornings so that means I probably need more insulin overnight.

I have been having a lot more hypos since starting on my pump.  Hypos were virtually non-existent for me in the past but now I'm having at least one a day which isn't fun.  The lows seem to be mid afternoon and a couple of hours after my evening meal so now we need to work out whether it's my basal rates that are too high at those times of the day or whether it's my insulin to carbs ratio before lunch and before dinner that needs to be changed.

I've had a few panics and dramas like when I managed to put the infusion set in a stupid place (where a roll of fat creases over when I sit down - Yes, I know that's not a very attractive image I've just conjured up for you - Sorry!!) and it was really quite painful.  I persevered with it but then at work I bent over to pick something up and the infusion set popped right out of my stomach...... Aaaaaaggghhh, I almost had a heart attack and went into total panic!!!  Then I managed to replace the infusion set without filling the tubing first because I was in a panic and wasn't concentrating on what I was doing!!

Changing the infusion set and reservoir has been fairly easy so far (apart from the daft mistakes I mentioned above).  At the moment I'm following the user guide to the letter each time I do it and it's taking me about 15 to 20 minutes but I'm told that I'll soon have it down to about 5 minutes!!!

Not doing injections is fantastic and has also been quite strange.  For the 1st few days it was a struggle to remember not to jab myself and it felt like something was missing!!! But it hasn't taken me long to get used to it and appreciate the fact that not injecting after 19 years is absolutely amazing and I never want to go back!!!!!

I've enjoyed showing off my pump and explaining to people all about it and how it works.  A couple of people at work have asked me "Whats that in your pocket?" when they have seen the tubing and I've been really happy to show them and tell them all about it.  I will carry on rambling on about my new bit of kit for as long as people are interested and want to listen!!!

So far, going from injections to an insulin pump has felt a bit like a full time job at times, trying to keep up with what's going on with my sugars and what I need to do with the pump, counting carbs and then remembering what to do when I need to change the infusion set and insulin reservoir and I've felt like my brains been in meltdown but I know it will be all worth it.

One small thing I don't like about being on an insulin pump is that I now have to carry around a load of extra 'D' related stuff!!! Insulin pump kit = Glucose tablets, blood sugar testing kit and record diary, pen, carb counting books, blood ketone monitoring kit and/or urine ketone monitoring strips, spare insulin pen (for just in case there are problems with the pump), infusion set, reservoir, vial of insulin, antibacterial hand gel, spare AAA batteries, Glucagon injection (for use during a hypo when you are unable to swallow glucose tablets or glucogel) and snacks (such as cereal bars)......I think that's everything!! Obviously it's only a minor irritation but it certainly requires a huuuuuuge bag to carry it all around in....perfect excuse to buy a nice new bag if you ask me!!!!  :o)

I'd like to say a big thank you to everyone who has asked how I'm getting on, offered tips and advice and who has just been there to support me during the last 2 weeks.  I have to say that the people I have met in the Diabetic Online Community have helped me massively with the transition from injections to insulin pump and it certainly makes things a lot easier when you know there are people you can talk to online and ask what you may think are daft questions.  There are always people willing to offer advice and help which is invaluable!!!  THANK YOU!!!

Also, a huge thank you to my other half, Gareth, who has been fantastic.  He has been there every step of the way for me, been to every appointment with me, put up with my moods and frustrations and he continues to help me with getting to grips with the pump.....I couldn't have asked for a more supportive partner!!! THANK YOU!!!! x x x
Last but certainly not least, I want to thank my Mom for being there for me from the very start of my Diabetes journey.....it's not always been easy, especially the teenage years when I refused to fully acknowledge my Diabetes.  It's only now that I realise how awful this must have been for my Mom and what a nightmare it must have been for her when nothing she did or said would get through to me.  I hope now that I have taken hold of this condition and accepted responsibility for my Diabetes I can  make her proud of me.  Love you Mom and thank you so so much for everything!! x x x

So to conclude, 2 weeks in, do I prefer the pump to injections??? Of course I do!!!

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)

Ten becomes Nine!!!!

I have just worked out that I have only TEN injections left to do before I go onto my insulin pump on Monday!! 

After 19 years of either 2 or 4 injections per day this is an amazing realisation.  Let's say I did approximately 10 years at 2 per day and 9 years at 4 per day, that's 20,548 injections since diagnosis so to think I now only have TEN left to do is mind boggling and very very exciting!!!!!! 

(Going onto the pump does not mean that I will never have to inject ever again, as there may be problems with the pump such as the tubing becoming clogged and I will have to keep spare injections for these instances)

Over the years when people have asked how I feel about injecting I have always said it doesn't really bother me that much, it's just something you get used to and at the end of the day it has to be done whether you like it or not. 

Lately though it has started to become really quite painful every time I inject and I've started to actually "think" about it before I put the needle in whereas I used to just stick it straight in (for want of a better phrase) without even thinking about it.  So now I think I would say that yes, injecting does bother me and for the first time in a long time it feels like a big deal to have to do it 4 times a day.  That's why the thought of just TEN more is so fantastic. 

Anyway, I'm off to do my Lantus, so that makes it just NINE more injections to do!!!!! :o)