Last month I had an appointment with my DSN (Diabetic Specialist Nurse) and dietician about moving onto pump therapy.
Pump therapy is used instead of MDI (multiple daily injections). An insulin pump is a small device that is used to pump insulin into the body continuously throughout the day and night.
First things first, the pump itself is a small handheld device (just a bit smaller than the iPhone 4, and a bit thicker). This can clip on to your pocket, your bra etc. The pump contains insulin in a reservoir, about the same volume as a standard insulin pen (I use NovoRapid, and that’s 3ml of insulin in suspension). It’s got some fancy buttons on it, and can track blood glucose readings if there is a CGM (Constant glucose Monitor, I’ll go back to this later). So I usually inject 5 times a day, 2 being my background insulin (to keep my levels steady when I’m not eating) and 3 to cater for meals. Background insulin when using a pump is referred to as a Basal Rate. When using insulin because I’m having a meal this is called a Bolus.
So this pump is attached to you by a cannula that is inserted just under the skin. this needs to changed every 2-3 days, as long as it’s functioning properly. This is inserted under the skin by and inserter, funnily enough. This is a plastic device that you push down on to insert the needle. When the needle is released, the cannula (a small plastic piece of tubing) is left there – this is where the insulin flows into the body from. Take the inserter away, and make sure the sticker medical stuff is stuck properly around it. Ta-da! All done 🙂 There’s an infusion set stuck to you 🙂
This may be slightly different from pump to pump, so I’ll update you when I have mine 🙂
So the pump is ALWAYS attached. According to doctors and DSNs you can maybe leave it off for about an hour (so you can shower, nothing worse than a smelly diabetic). If you leave it off for too long your sugars can rise incredibly fast. This is because there is no Basal rate. when injecting you don’t have to worry because the injections you’ve done in the morning and/or night are still working and making sure you’re OK. But the pump does this gradually throughout the day, for example one unit an hour. Without this Basal rate there’s nothing keeping your sugars in check. A bolus is for when you’re eating, so in order to calculate how much insulin you need to know your carb ratio and then press some buttons to send the insulin into the body.
I mentioned a CGM before. This is inserted similary to the infusion set and has the same sticky stuff 🙂 It constantly tracks your blood glucose levels and in some pumps it can be sent and displayed on the screen; this presents a very pretty graph for you to look at :). The pump I’m hoping to get is the Medtronic 640G (website is a the bottom if you want a cheeky look). This has the ability to link in with the CGM and when your blood glucose drops it suspends insulin delivery!! Therefore you don’t hypo! This would be a godsend for me in work 🙂 Busy night, don’t have time to check my sugars or deal with a hypo and BAM! The pump does it all for me!
The main thing about the pump is the lack of injections (It’s a beautiful thought!). I say “lack” and not “no injections” because things can go with the infusion set. If the cannula bends or kinks when it’s under the skin, then this can stop insulin from reaching the body, and yeah you guessed, sugars start climbing! Hopefully the pump will alarm you to this but if it’s only partially kinked, or if it’s come out of your skin completely and you don’t know about it this means that your sugars are not in control. So here it would be common to inject with a insulin pen to correct sugars, and then change the infusion set.
Another downside? You have to carry EVERYTHING around with you. And I mean everything. Infusion sets, insulin reservoirs, insulin pens, spare batteries, lucozade, needles, …………. I could go on. So in order to prepare for this I bought a new diabetes bag 🙂
My old one was just a pencil case which fitted everything in, but I needed a bigger one. I’ve also editted this one slightly, in order to keep everything safe and handy 🙂
So I’ve added a little net pocket with a popper to keep my needle ( So I’m not scrambling around for them all the time!). And the grey pocket with the orange top is to hold a spare insulin cartridge! The orange top is the top of the cartridge! I know it’s particularly neatly sewn, but it does the job 🙂
So there it is in all it’s glory, my new bag with all my supplies in there 🙂 and even contact information if (when) I lose it!!
I’ve got one appointment now with my dietician to make sure that I can carb count correctly. The pump is so precise when it comes to matching insulin to carb content, that I need to be able to do it properly otherwise bad things can happen (like hospital).
I’ll post a cheeky update when I know more!
And if you want to have a look pump therapy and at the pump I’m hoping to have, here’s some websites 🙂
Much love people, post soon.