Just before Christmas, I passed a very important anniversary in my life. It has been one year since I first started using my insulin pump. And truly, it has been a revolutionary change in the way I manage my diabetes.
Diabadass (Source: thebetes.net)
I was diagnosed with type 1 diabetes in February of 2001 – in fact, I didn’t even realize that I’m coming up on having been diabetic for a decade. It has been a bumpy ride. To begin with, I accepted the diagnosis and decided that I would embrace the lifestyle that goes with being diabetic. There were a lot of adjustments and changes that had to be made and so much to learn. For instance, I could not longer consume my favourite drink – Pepsi – and had to curb my junk food and candy obsessions. That didn’t go so well – it’s hard to break habits that you’ve developed for over twenty years. But the transition to diet pop and reductions in sugar and carbohydrates did become easier as the time went on. I learned how to give myself insulin injections using a pen device. I had to get into a habit of checking my blood sugar regularly, especially prior to eating. I had to learn how to plan my meals according to my insulin regime, which was at the time a couple of injections daily. I would take a shot in the morning, and before dinner, and those injections would cover the meals I would eat during the day. The problem was, if I was late eating or skipped a meal, the insulin would still be in my system and my blood sugar would drop severely. Low blood sugar is dangerous – in serious cases, there is potential to pass out, have a seizure, go into a coma, or it can be fatal. Diabetes is serious business.
Of course, letting your blood sugar get too high can also be dangerous. There are so many potential risks to almost every organ in your body – liver failure, kidney failure, nerve damage, blindness, amputation of extremities. Nasty stuff. Another problem is ketoacidosis, which can be fatal if left untreated – more on that later.
Regardless, I needed tighter control of my blood sugar than my current regime was providing. My endocrinologist and the local diabetic education centre discussed this with me and we decided that it would be appropriate for me to switch insulins and learn how to count carbohydrates. This would allow me to take insulin immediately before I was ready to eat, based on how much I would be eating. I would also take a longer acting insulin overnight to compensate for the release of glucose into my blood in the morning. It would also mean going from two shots to four shots (or more) daily. But it would allow me tighter blood sugar control, and I wouldn’t have to be on such a regimented schedule for meals. It was a little bit more freedom. And when you’re not free to eat whatever you want, you take freedom where you can get it.
My new insulins of choice were called Humalog and Humulin-N – I would inject myself with Humulin-N at night, and the Humalog would be injected about 5 – 15 minutes prior to every meal. Anytime I would eat less than 20 carbohydrates, I didn’t need to inject, but all other meals needed to be counted. My blood sugar control increased, but then, I got lazy. It became bothersome to remember to test my blood sugar before meals…and even injecting insulin on time became more of an annoyance than a necessity. Eventually my drug insurance coverage disappeared, and it became a choice of paying for the test strips (which were almost a dollar a piece) or paying for my insulin and guestimating how much insulin would regulate my sugar. I highly discourage anyone from becoming involved with this practice – there are always options out there to help diabetics (at least in Canada). I was just in the rebellious stage of my diabetes…the point at which I think all diabetics go through…where you just don’t care.
Eventually, I came to my senses. It took being rushed to the hospital in an ambulance and being placed in ICU overnight to make me realize that perhaps I needed to rethink this whole “rebellion” against my disease. Diabetes was going to be there with me, whether I liked it or not. But I still wasn’t ready to embrace it yet. My ICU visit was due to ketoacidosis – basically my blood was drowning in sugar. I was a little sick from a cold that had been developing over a week or so, and completely lost my appetite. Since I wasn’t eating, I didn’t need as much insulin to compensate – though I was taking extra because I was sick. Since I wasn’t getting enough insulin, any food I was eating was not being properly converted into usable energy, and my body started to wilt. I felt like I was dying from the inside out – and essentially, I was. Little did I know that ketones were building up in my body…getting ready to start eating away at the fat and muscle in my arms and legs in order to get the much-needed energy that was not being converted from the carbohydrates I ate. Through a positive feedback cycle, I would intake minimal carbohydrates, and not enough insulin, which would increase my blood sugar and cause more ketones to be released into my blood which would eat away at my body. My whole system was being acidified – gross, I know. You have no idea what it feels like until you’ve experienced it – I can’t even explain it!
Luckily, Ian had the presence of mind to call 911 – though he hung up when I screamed at him not to do so! Trust me…blood sugar deviations can turn even a nice little innocent girl like me into a monster. Regardless, they called back, and he explained the situation (and hopefully my state of mind so they’d understand why he hung up!). The ambulance came…I was admitted to the hospital overnight in a severely dehydrated state…I was kept under observation in ICU while on an insulin drip overnight…and was released the next day after being introduced to the absolute best endocrinologist I’ve ever met. I regularly saw her for the next six years, and in year four, she suggested I put myself on the waiting list for funding for an insulin pump. Best advice I ever received!
My Animas Ping - aka electronic pancreas
At some point during the year after I was put on the list, my application was approved for funding, and I started to attend meetings and meet with people regarding my pump options. For a few reasons, I decided I was most interested in the Animas Ping. One, it was waterproof…I don’t get out swimming all that often, but when I do, I’m often out for hours at a time – far too long to be disconnected from my pump. Two, it was remotely connected to my glucometer…I could test my blood sugar on the glucometer, and remotely send the information back to the pump to administer a bolus dose (the larger doses given to accommodate food eaten). This would be very useful for all those times that I wear a fancy dress to the ball and didn’t want to run to the bathroom every time I needed to give myself some insulin. Three, it looks like an iPod…in fact, it came in the same colour green as my iPod and my laptop! Brilliant!
The inset device that is injected under my skin and taped down for a few days...
In the first few weeks of having the pump, I learned how to load the cartridge with insulin. I learned how to inject different types of infusion sets. I learned how to program and adjust the pump. I learned how to account for blood sugar lows and highs. How to deal with sick days. How to keep my pump connected for exercise. How to live with more freedom.
Now, instead of four or more shots a day, I inject a new infusion set under the skin on my stomach once every two or three days…ideally. The blotchy skin on my stomach in that picture up there came from some allergic reactions that I’ve had to both the adhesive on the infusion set and the bandages used to cover the sites when I’ve removed the set. Those reactions have since subsided – phew! I really don’t need any other issues to contend with.
I have figured out a good rate of insulin flow for my basal dosage. The basal dosage is essentially the insulin that is delivered to me 24 hours a day. If I was not to eat anything for 24 hours, it is the insulin that helps regulate the naturally occurring sugars in my blood, usually released by the liver when the body detects that it does not have enough energy to do everyday things. I still test my blood sugar on a fairly frequent basis – though I trust my body to tell me when it’s low or high, and I’m getting to be very accurate these days. Carbohydrate counting helps me to determine what to input into the pump so it will calculate the required insulin. I’ve become quite good at using the combo bolus as well, which helps to stretch out your insulin dose if you’re eating a higher fat food – pizza for instance, takes a long time for the body to completely digest. By the time it’s finished releasing the last bits of carbohydrates into your system, the insulin for the meal has long finished working, and so the dosage is stretched to compensate for that time.
I have learned so much from the past year with the pump. I know of some people who have considered getting an insulin pump. Some found that they were able to control their diabetes using multiple injection therapy. But for those who want tighter control, and even more convenience, the pump is a welcome addition to the diabetes control team. So become a diabadass and pump it up!
Massively Attacked 