Chapter 11 - Insulin Pump

I had watched with interest the diabetes magazine articles about insulinˆ pump therapy for several years, but with three --sometimes four-- insulinˆ injections a day, I thought a pump would be a luxury rather than a necessity.

My endocrinologist thought that I would be an excellent candidate for the pump. When we discovered my insurance policy would cover the pump in full, I proceeded to order the Minimed® 508 as per her recommendation. Within two weeks I had received my pump and supplies but I had to await training. Previously scheduling a week's vacation, my training by the Diabetes Educator and RN Dorothy Stevens would have to wait another week. Dorothy and I hit it off on our first introduction. The training went smoothly and when connecting my pump for the first time I went directly to insulinˆ . Noel, on the other hand, had had her training the previous week but she was to practice with the pump using saline solution instead of insulin. Within a few days, she had graduated to Humalog.

This is the first time I had used Humulin insulin. It was recommended that I use Humalog in my new pump. The supplies that came with the pump consisted of alcohol swabs, IV Preps, a Sof-set inserter, reservoirs, and 24 inch quick release Sof-set Micro infusion set. It may sound complicated at first, but within a week I had it mastered. Now instead of multiple insulin injections every day, I am only required to change my Sof-set insertion site once every two to three days.

Wearing the pump just under a year, I've gained an even lower A1Cˆ (glycosolated hemoglobin) test without the extreme highs and lows I had been getting. Noel's test differences were even more remarkable than mine. We were now receiving a constant supply of insulinˆ around the clock. This is considered a basal rate. During certain times of the day a diabetic may require different amounts of insulin to keep a stable blood sugar reading. The insulin pump allows the programming of multiple (more than I'll ever need) basal rates. Between two o'clock and six o'clock in the morning, I need three-tenths of a unit less insulin per hour than at any other time during the day. After I've eaten the first time during the day, my basal rate needs to be increased for two hours by two-tenths of a unit per hour. Currently, I have seven different basal settings per twenty-four hour period. The pump also has a separate set of alternate basal rate settings. These allow me to modify basal rates for a short time period without modifying standard basal rates. When I have a cold, I require more insulin. During this period, I set my alternate basal rate settings two-tenths of a unit per hour higher than my standard rate.

With basal rate(s) set so that I have a consistent blood-glucoseˆ reading throughout the day, I then need to take into consideration my exercise and diet. With exercise, I can either take less insulin or eat more carbohydrateˆ . Being a good eater my preference is extra food. On occasion, however, the quick-release infusion set has allowed me to actually disconnect from the pump without removing the infusion set. I have disconnected during periods of heavy exercise, but most often only to bathe or shower. My current pump is not waterproof and cannot get wet. When I kayak, I have an accessory that is waterproof that shelters the pump within a clear plastic shell with a soft watertight opening for the tubing to pass through.

Diet requires carb counting and an additional infusion of insulin, the bolus. All food packages contain the number of gramsˆ of carbohydrateˆ per serving. To calculate my bolus, I multiply the grams of carbohydrate per serving by the number of servings I am eating, then divide that number by the number of carbohydrate that one unit of insulin takes care of for me. This number was defaulted when I first received my pump and then derived by experimenting with how much insulin was required to balance my blood sugar with a known quantity of intake. First starting on my pump, this number was eleven(11). Within two days I knew my body needed one(1) unit of insulin for every thirteen(13) gramsˆ of carbohydrate.

Here's an example: I intend to eat an egg salad sandwich and a glass of ice tea for lunch. Note - All carbohydrate values are fictitious! They are only used here for ease of calculation.

bread             egg             light mayonnaise             diet ice tea

serving size             1 slice             1             1 tspn.             8 oz.

Carbs/serving             24             4             9             0

# of servings             2             2             1

(24 * 2) + (4 * 2) + (9 * 1) = 65 / 13 = 5.0 My bolus for lunch is 5.0 units.

Now I know both "exchangesˆ" and "carb counting".

Almost all fast food restaurants have lists of carbohydratesˆ for all their specials. I don't advocate extensive eating at these types of places, but it's nice to go out with the grand-kids once in a while and be able to calculate the amount of insulin you need to handle the meal you're eating.

During the year I've been on my pump, I have come to realize that blood-glucoseˆ testing is even more important than when I was injecting insulin. We don't need to discuss low blood sugars that always have symptoms that are readable to a diabetic, but instead talk about the possibilty of high sugars, which are less discernible. Lengthy periods of disconnecting from the pump are dangerous. Even after heavy exercise I find my sugars starting to rise again within an hour unless I've reconnected. Unless I test on a frequent and regular basis, I would be less likely to recognize a high blood sugar until it was much higher than I would want it to be. There have also been times, especially on weekends, when my schedule is different than during the week, and I have forgotten to take a bolus. Within thirty minutes of ingesting food my blood sugars are already dramatically rising. Without testing, this can become extremely dangerous. My personal schedule of testing is as follows:

• upon arising (4-5AM)
• before breakfast (8AM)
• before lunch (noon)
• before supper (5PM)
• before bed (10PM)
• before driving (at least twice a day)
• when I feel myself going low.

Noel and I both enjoy attending an 'Insulin Pumpers' group. Just like Camp Joslin brings boys with diabetes together to learn and share their experiences, the pumper groups bring together fellow insulin pumpers. We learn of new pumps, new blood-glucoseˆ testing devicesˆ , advances in diabetes research and discuss things like different insurance companies or how to be prepared for traveling, etc. Our group has a great bunch of pumpers and is led by my Diabetes Educator Dorothy Stevens.

Note: MiniMed® has recently become MedTronics MiniMed®

Romans 6:13-KJV Neither yield ye your members as instruments of unrighteousness unto sin: but yield yourselves unto God, as those that are alive from the dead, and your members as instruments of righteousness unto God.