Not too long ago, I received a hero’s medal from Joslin Diabetes Center for having diabetes for more than 50 years. Now approaching 52 years with diabetes, I’m still going strong. I’ve had a few complications from diabetes, but nothing that has kept me from leading an active life. The complications I’ve experienced have made me more determined to maintain my present quality of life.
Recently, I decided to go on the pump. Why would somebody so used to injections and doing reasonably well make such a drastic change? I wanted to get better control of my blood sugars, and my doctor thought I might be a good candidate for the pump. The DCCT also revealed that if complications have started, they can be slowed and perhaps halted through intensive treatment. I was sold on trying a new type of control!
In making my decision to try the pump, I received positive support and technical expertise from the staff at the Joslin Diabetes Center at Morton Plant Mease Hospital in Largo, Florida. They have a terrific support group called Diabetes 2000. Not only do you get the best possible diabetes information and the latest news on new technology and treatments, but you can talk to others who have already gone on the pump.
A Question of Cost
Money was a concern when deciding to go on the pump. Pumps and all the paraphernalia that go with them are not cheap. We are talking thousands of dollars. Fortunately, with the support of my doctor, I was able to get full coverage for pump therapy and supplies. Others are not so lucky. To get coverage you must be persistent. Do not give up. You must pester your health support team to write letters on your behalf so that your insurance will cover you.
Some people think you snap in the pump, hit a button and it’s all smooth sailing. This is not true. Before I was connected to the pump, the manufacturer sent me two videos to watch. After I watched the videos, the manufacturer’s representative came to my house for a two-hour session with me and my husband. She laid out the pump and its formidable array of infusion sets, syringe reservoirs, batteries, alcohol swabs and antibacterial adhesives. The pump itself is really only a computer with a pump drive that delivers the insulin through a plastic tube. If you can program a VCR, entering commands into an insulin pump is a done deal.
I made an appointment with the diabetes educator, who had been in contact with my doctor to determine my basal rate of insulin. She made certain I had read all the information and understood it thoroughly. I had to learn how to count carbohydrates so that I could program the pump to deliver just enough insulin to cover the amount of carbohydrates that I would be eating at each meal (called a bolus). A registered dietitian can help you determine the amount of carbohydrates you should eat every day.
For the first two weeks, I tested my blood eight times per day to make sure the basal and bolus rates were correct. One day I had to skip breakfast, another day lunch and another day dinner (something I was never able to do in 52 years because of the long-lasting insulin I was taking). I did have to adjust my basal rate, but it has been working fine since then.
The first two weeks I was all over the place, with BGs ranging from 55 to 400 mg/dl. I called pump users from my support group and found they had experienced the same thing. My guesses at food portion size were wildly inaccurate until I started measuring them. I can now eyeball my portions, and I am remarkably on target.
I also had to learn how to disconnect my pump while I was exercising or my blood sugar would plunge down to dangerous levels. Now, when I go to a kick-boxing session or an aerobics class, I just click off my pump so that I maintain my proper target range while exercising.
Before I was on the pump, I was taking three shots a day of Humalog and long-acting Ultralente. Now, I use only Humalog. Since I’ve been on the pump, I have had no incidents of hypoglycemia, even though my blood sugars have been down to ranges that would previously have thrown me into a reaction.
To make the pump work for you, you must have a real devotion to self-care, a team of knowledgeable health professionals, and the support of family and friends. You have to spend a lot more time with the pump. It’s not the one-two-three of plunging a needle into your skin. The insulin pump infusion set takes time to change and insert. It must be changed every two to three days. One morning, I could tell my blood sugar was getting very high. I had the usual symptoms of frequent urination and unusual thirst. The infusion set had come out. Fortunately, I had an extra set with me, and I was able to change it right then and there. I also took a shot of insulin.
Another time, I went on an overnight trip. I went to show my cousin how I program the pump and the reading said “battery low.” I wasn’t sure how long it would last but I made it until I got home. Needless to say, I always carry extra batteries now.
Control Has Never Been Better
I feel I’ve never had better control of my diabetes than I have now with the insulin pump. My HbA1c is down five percentage points from several months ago. Hopefully, there will someday be a pump that also monitors blood sugar continuously and automatically adjusts the insulin. Until that day comes, I am thankful to be getting a better handle on my diabetes day by day.