BackgroundBefore I start telling you about my transition from multiple-injections to the pump, I think I should give a little history of my insulin therapy. After I was diagnosed on October 9, 1994, I started on two shots of Humulin 70/30. I believe the hospital doctors sent me home on it so my regular (new) doctor could start any regimen he saw fit. Well, I stayed on 70/30, with OK control, until January, 1996. I changed doctors because I wasn't happy with my control, and I didn't feel the doctor I was with was able to fit my needs.
To Three and Four Shots a DayIn January of 1996, I started three injections a day: I mixed R and NPH in the morning, a shot of supper R, and a shot of bedtime NPH. My control got better, but it still wasn't where I wanted it to be. I was high before breakfast, low before lunch, and high after lunch. At the beginning of March, 1996 I stopped the morning NPH and started a shot of R at lunch.
Taking 4 shots a day helped tremendously with my control. All except for the pre-breakfast, which was anywhere from 150 up to 250 mg/dl (8.3 to 13.9 mmol/l). I was taking 26 units of NPH at night. Raising my nighttime NPH from 20 to 26 in gradual steps had no effect on my morning blood sugars. Neither did changing what I was eating. Another problem that I had was the rigid schedule I had to keep in order to remain in control of my blood sugars. Waking up just an hour later or earlier than normal would ruin my control for the rest of the day.
I'm Advised to Try the PumpIn March, my dietitian first mentioned that I would be a good candidate for the pump, after she saw that I was testing 6 to 8 times a day. She also thought a pump would allow me to control my mornings blood sugars. So the next time I went to the doctor in the beginning of April I was going to ask her about the pump. In April, before I could ask my doctor, she told me that she thought it would be better for me to go on the pump. She told me that with my attitude of wanting to have tight control and willingness to test often, I would be an ideal candidate for the pump. I told her that I had been seriously thinking about the pump and that I would like to try it. Fortunately, my insurance paid for most of my pump.
She sent a letter to the company from which I bought my pump asking them to verify that my insurance would pay for it. I was expecting to hear back from them in about a month or so, but a week later I received my pump.
First Use and WorriesI went to the Certified Diabetes Educator (CDE) to learn how to use my pump. I had already figured all the physical aspects about the pump. The only thing I was nervous about was inserting the infusion set. I soon discovered that it is no worse than giving myself a shot. The only difference is that I don't have to do it as often. For about a week I only pumped saline to get used to the idea of having the pump attached to me all the time.
Having the pump attached to me all the time was the biggest worry I had. I wondered, How am I going to sleep at night? How am I going to go swimming? What about athletic events? Well, the pump has 42 inches of tubing, so sleeping at night poses no problem for me. I just slip the pump underneath my pillow and forget about it until morning. I have a waterproof and impact resistant case to hold the pump for my rigorous activities, such as swimming or other athletic events. The pump is lightweight and I don't even notice it is there during the day. It is the size of a beeper, and when I use the black leather case for it, it looks like a beeper. If I had a dollar for every time someone asked my why I had a beeper, the pump would have paid for it self many times over.
Basal Rates and BolusesThe pump has a slot in the back for the insulin cartridge, which has to be filled from a vial of insulin. I usually put in about a three day supply of insulin in the cartridge. The pump then depresses the syringe in 0.1 unit increments to give the dose. There is two kinds of doses the pump gives you: Basal rate and Bolus. The basal rate is the rate the pump gives you automatically. Most pumps allow you to set more than one basal if you need it, but I only have one set. The bolus is the equivalent of giving yourself a shot. It is used before meals and snacks.
My Control ImprovedI noticed an immediate difference in the first month of using my pump. My overall average blood sugar went down from 155 to 129 mg/ml (8.6 to 7.1 mmol/l) with just a few more occurrences of low blood sugars. (Low being in the 60's.) I rarely have a morning blood sugar above 130, even if I sleep in for four hours or so. I have been able to keep a much less rigid schedule. I don't have to eat my meals at the same time anymore. I can eat more often, which is good for me because I need to gain weight. Whenever I want to eat, I can just bolus myself a little bit of insulin to cover the food.
I have yet to remember to set a temporary basal rate when I do more exercise than normal, and that is about the only time I have hit lows. Also, I don't always remember to bolus before my snacks. Another annoyance is that sometimes the infusion set becomes plugged or crimped and has to be reinserted.
I won't pretend that the pump is for everyone, but I think it is the best thing I have done for control of my diabetes. For the first time since I was diagnosed, I really feel like I'm in control of my life. I feel more comfortable doing things with my friends. I don't have to worry about carrying insulin and syringes wherever I go. I can sleep in with out having to pay for it with my blood sugars. I am more confident that I will be able to beat this disease.
Brian can be reached via e-mail at [email protected].
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