Hi Nicole…Insulin Pumps
Hi Nicole…
I just wanted to let you know a great way to figure out if a pump is
right for you. I, too, was against getting the pump until I did more
research. After hearing so many people tell me they “loved” their
pump, I had to see if for myself. If you call the pump companies
(Animas Corp, Minimed, Delta Cozmo…etc), you can ask for a
representative to come out to your home to show you the pump in
person. For me, that was the trick. Once I saw how it worked and
understood the concept behind it, I wanted one. Also, the pump I got
was the Animas 1250 and on their website is an interactive pump that
you can play around with. (There are links available in this group’s
link section)
The pump can sound complicated but it is much easier than injections
(in my opinion). Like anything else, you have to give it time for
you to get used to just like when someone starts injections.
Figuring out the time and shots and carbs threw me for a loop in the
beginning.
I have posted an article below that I read just before I bought my
pump and it is SO accurate about the experience. Also, check out the
website to see the interactive pump. I don’t know how to put a link
on this posting but it is: www.animascorp.com and select
the “Virtual Pump” and then the “1250 model”.
Hope this information might help and who knows…maybe this group
might convert ya! 
Bye for now, Evelyn
**Sorry, the pictures didn’t transfer over but I found this story on
www.diabeticmommy.com**
A Pumping Story
By Rebecca (rdraben)
“Rebecca was diagnosed with type I diabetes 20 years ago when she was
12 years old. She had to give herself at least 4 injections every
day. On top of that, she had to prick her finger to test her blood
sugar many times every day. She had to decide how much food she was
going to eat before she ate it, and then she was not allowed to eat
any more food until her next injection.” Okay, I know that sounds a
bit dramatic, but if there were a television show about diabetics
going on pumps and I was on it, that is how I imagine mine would
start.
I used Humalog in a pen before meals and I used NPH in a syringe at
bedtime. I used a syringe at bedtime because I usually had to mix in
some Humalog to correct a high or to cover a small snack.
Resisting the Pump
I never wanted a pump. Ten years ago a good friend of mine in
college kept telling me how much he loved his pump. I didn’t even
want to know about it. Over the years, various friends,
acquaintances, and doctors have told me I would really like the
pump. I didn’t think so. First and foremost, I didn’t want to be
attached to anything. I also didn’t want to devote a lot of time to
learning anything new because that would mean that I would have to
spend more time facing the fact that I had diabetes. I also didn’t
want to sleep with the pump, shower with the pump, or work out with
the pump.
Then a lot of things changed in my life when I became pregnant with
my daughter. I started to focus on my diabetes so that I could have
the best control possible and I started reading the Diabetic Mommy
forum. I read so many messages from women who loved their pumps.
Still I thought, “Nope, it’s not for me.” Then one day after I’d
been reading these messages for well over a year, a woman named
Fantacy posted a funny remark that she loved her pump so much, she
wanted to be buried with it. Something finally clicked in my head.
Maybe I should at least consider it.
Caving to the Pump
I asked my endocrinologist about it at my next appointment. He said
that I could take a class at the nearby Diabetes Treatment Center to
find out if the pump was right for me. I decided to do it because I
had nothing to lose. I wasn’t committing to anything. So I went to
the half-day class and learned about pumping and carb counting. I
was glad that I was already familiar with carb counting because the
class moved pretty fast.
This is the pump I chose, the Animas IR1200. This picture makes it
appear larger than it really is. It is about the size of my middle
three fingers.
After the class, the next step was to select a pump that I wanted to
test drive. We were given a choice between the Animas IR1200, the
Deltec Cozmo, and the MiniMed Paradigm. I had seen the pumps in
class and I also researched them extensively on the web. I decided
which features were important to me and compared the pumps on those
features. After narrowing it down to the Animas IR1200 and the
Deltec Cozmo, I eventually decided that the Animas IR1200 was the
best pump for me.
I scheduled an appointment with a certified pump trainer at the
Diabetes Treatment Center for my pump test drive. At my appointment,
she showed me how to use the Animas pump, an insulin cartridge, and
an infusion set. We filled an insulin cartridge with sterile saline
solution instead of insulin so that I could experiment with the pump
as much as I wanted and not affect my blood sugars. Then we inserted
an infusion set and hooked it all up. I was allowed to take it home
with me for 2-3 days to wear it and use it as if I were really
pumping.
Wanting the Pump!
Less than 24 hours later, after my first night, workout, and shower,
I called my doctor’s office and told them that I wanted the pump! I
didn’t mind being attached to it too much. I could easily disconnect
it for short periods of time (up to an hour), leaving only a little
plastic disc attached to me. I didn’t notice it while I slept, the
infusion set didn’t budge during my workout, and after my shower I
felt completely clean, even under and around the infusion set.
This the infusion set.
This is the only part that is ever attached to my body.
I completely remove it and replace it every few days.
The infusion set disconnects easily.
The metal piece does not go under my skin at all,
but only into the plastic disc.
The plastic tube is the part that goes under my skin.
It is flexible and I cannot feel it.
It took 6 weeks for me to receive my pump. When I got it, I
immediately took it out of the box and starting playing with it. One
week later I went to my endocrinologist’s office and met with a
certified pump trainer to start pumping with real insulin. We
programmed the pump with my settings and then filled an insulin
cartridge, inserted an infusion set, hooked it all up and started
pumping! I took my blood sugar and bolused for the high reading. We
went for a walk to kill some time while my blood sugar came down.
Then she brought some of the doctors’ catered food to me for lunch.
I checked my blood sugar, counted the carbs, bolused appropriately,
and ate. Everything seemed to be working well, so I was okayed to go
home and begin pumping on my own.
The pump just allows me to stick myself less, right?
Before I started learning more about pumps, I thought that the main
advantage of pumping over MDI (multiple daily injections) was having
to stick myself only once every few days rather than multiple times a
day. But in reality, it is so much more than that.
In order to understand the advantages of pumping over MDI, let me
first explain a little bit about how a normal pancreas works and how
MDI and a pump each attempt to mimic a normal pancreas. A normal
pancreas releases a very small amount of insulin every few minutes.
This is called basal insulin. Then when food is eaten, a normal
pancreas releases a large burst of insulin. This is called bolus
insulin. With MDI, bolus insulin needs are met with an injection of
fast-acting insulin such as Humalog or Novolog. Basal insulin needs
are met with an injection of long-acting insulin such as NPH or
Lantus. Long-acting insulins affect blood sugars slowly over time,
in an effort to mimic the way a slow drip of insulin from a normal
pancreas affects blood sugars slowly over time. The pump is able to
mimic a normal pancreas by doing exactly what a normal pancreas
does. It uses only fast-acting insulin. Basal insulin needs are met
by releasing a very small amount of insulin every few minutes. Bolus
insulin needs are met by releasing a large burst of insulin.
When I was taking NPH, I just had to hope that the insulin and my
body’s need for insulin peaked at the same time and by the same
amount. But with a pump, I can adjust my basal rate to peak exactly
at the same time and by the same amount that my body’s need for
insulin peaks. It is like taking a long-acting insulin that is
tailor-made for my body.
Since I don’t have to take a long-acting insulin, there is alot less
guess work about how insulin is affecting my blood sugar at any given
moment. It is much simpler. I take a short-acting insulin, it peaks
after about 1 hour, and it is out of my system after about 4 hours.
When I was taking NPH, I never figured out exactly when it peaked or
how much was still in my system at any given time. It just added so
much complexity to an already complex situation. Since discontinuing
NPH, I have learned many things about my blood sugars that I never
knew before. For example, I never knew that protein raised my blood
sugar significantly about 3 to 5 hours after eating. Now I know that.
When I was on MDI, I often realized a few hours after eating that I
had taken too much insulin and I was starting to go low. Imagine my
being able to go back in time a few hours and take less insulin.
Effectively, with a pump, I can do that! I just turn off my basal
insulin for a while. I never could have “turned off” my NPH for a
while! Now instead of going low, my blood sugar remains steady or
even goes up a bit. Of course this doesn’t work if I have taken far
too much insulin, but it works in many cases.
Protein affects my blood sugar significantly, but over a longer
period of time than carbs. With the pump, I can use an extended
bolus to deliver insulin over many hours as the protein digests.
With MDI I just had to correct my high after the fact because I did
not have the capability to deliver the insulin over many hours.
Correcting a high is so easy that I correct any and all highs, even
if I am only 10 mg/dl over my target. It is easy for two reasons.
One, because I only have to push a few buttons instead of taking
another injection. And two, because with MDI, my pens and syringes
only allowed me to give myself insulin in whole unit increments, so
correcting a blood sugar that was 10 mg/dl over my target would have
sent me low. With the pump, I can give myself insulin in 1/20 unit
increments and correct a high nearly perfectly.
I need less insulin on the pump. On MDI I took about 50 units per
day. Now I average about 35 units per day. It amazes me. I still
take almost exactly the same amount of basal insulin, but my insulin
to carb ratios have gone way up, so my boluses have gone way down.
On MDI, my insulin to carb ratios were 1:14 at breakfast, 1:10 at
lunch, 1:7 at dinner, and 1:7 at night. Now they are 1:24 at
breakfast, 1:14 at lunch, 1:14 at dinner, and 1:16 at night. On MDI,
I would often bolus as many as 16 units at a time. Now I get nervous
bolusing anything over 6 units at a time!
One of my favorite features of the pump is the IOB (insulin on board)
feature. A given amount of insulin, whether delivered by injection
or pump, does not get used by the body all at once. For example, it
takes about 4 hours for Humalog to finish working from the time it is
injected/infused. The pump keeps track of how much insulin I have
bolused and how much insulin is yet to be used by my body. Before I
went on the pump, I took IOB into account, but only in a very crude
and inexact way. Now it keeps me from over-correcting both highs and
lows. It keeps me from over-correcting highs because if I take my
blood sugar 1-2 hours after a meal, I’m tempted to take enough
insulin to get my blood sugar down to my target range. But now I’m
finding that often I have already taken enough insulin, I just need
to give it some more time to work. It keeps me from over-correcting
lows because I used to eat and eat because I didn’t know how fast or
how far low I was going. Now I can check my IOB and fairly
accurately figure out how long I should suspend my pump and how many
carbs I need to eat, if any.
This is me wearing my pump. If you look closely, you can see the
tubing running into my pocket. If I don’t want the tubing to show,
there are other ways I can wear my pump.
The Emotional and Social Effects of Pumping
When I was on MDI, I spent a lot of time and effort to achieve good
control. I took Humalog before each meal and NPH at bedtime. I
tested my blood sugar at least 4 times per day. I measured almost
all my food and counted the carbs in it. I analyzed my blood sugar
numbers every week, but my numbers never made a lot of sense. For
example, when my fasting blood sugars for the week were all over the
place with 2 numbers too low, 2 on target, and 3 too high, what
should I have done? Although my HbA1c’s were good, usually in the
6’s, my blood sugars weren’t so good. It was so frustrating to put
forth so much time and effort, only to have completely inconsistent
results. I pretty much gave up trying to figure it all out.
I think the biggest difference going from MDI to the pump is that I
feel like I’ve finally found the “knob” that turns my blood sugar up
and down. I’m in control and it makes sense. I don’t have the wild
swings that I had before. It is quite an emotional high to feel so
in control and so stable. And I feel like I finally have a blood
sugar meter like the ones shown in television commercials … you
know, the ones that always read 103! Well okay, even now my blood
sugar meter doesn’t always read 103, but you get the idea.
I love being able to bolus as I need it. I no longer have to decide
in advance exactly how much food I’m going to eat. I think I used to
plan for alot of food because I didn’t know when I was going to get
full and the thought of being a little stuffed was better than the
thought of being a little hungry. Now I plan for a smaller amount of
food and then bolus again if I decide I want more. As a result, I’m
eating less. I’ve already lost 3 pounds.
Being able to bolus discretely and bolus as I need it is also useful
when eating at other people’s houses. I used to feel so rude
asking “What’s for dinner?” and “Are we having any dessert?” before
running off to the bathroom. Now I just look at the meal as it is
served, pull my pump out of my pocket, and push a few buttons. If
and when dessert is served, I do the same thing again.
I think the biggest down-side to the pump is that it is a constant
reminder of my diabetes. Every time I see tubing coming from my
body, I feel like I must be really sick. After all, all the people I
know who have tubing coming from their bodies are really sick. But
I’m getting used to it. And I feel much more positive about my
diabetes now. So being reminded of something that I feel pretty
positive about isn’t so bad. And I’m sure I’ve added years to my
life and that is worth almost any price.
I should have gotten the pump years ago. I sure am glad I didn’t
wait any longer!
“Coming up next on A Baby Story … Rebecca was diagnosed with type I
diabetes 20 years ago when she was 12 years old … ” Oh, no, wai-
wai-wai-wai-wait! I’m not having another baby yet! … But
hopefully when I do, the pump will help me have the best control I
can possibly have. I am looking forward to it!