Great expectations

By | 7 October, 2010
No, not that sort of pump

No, not that sort of pump

Finally, the hour draws near where I will reach the dizzy heights of the top of Lothian Health Board’s insulin pump therapy waiting list and receive a shiny new Medtronic Veo pump. As you can perhaps imagine, I’m rather looking forward to it.

However, before I get connected to my new machine and thereafter become half-human, half-cyborg, half-Matrix style automaton I thought I would jot down a few notes on what I expect to get from a pump. This is mainly so we can all have a good laugh about them in a few months’ time when none of them actually happen.

So, in no particular order:

Basal rates

Like lots of members of the pancreatically challenged horde, my insulin needs vary throughout the day. My insulin resistance in the morning is such that I need about twice as much insulin as I do in the evening. As a result, I always battle a high blood glucose peak after breakfast, which is a pain in the bum. Circadian rhythms have a lot to answer for, I tell you.

I hope a pump will ultimately allow me to up the basal rate early in the morning, allowing me to smooth off that irritating post-breakfast high.

Basal rates (again)

During the week I lead a relatively sedentary life. I sit on my back-friendly rocking-stool at my computer, only venturing out into the daylight to grab a sandwich at lunch time. I don’t even run for busses – it is, after all, not very dignified, is it?

However at weekends I am, sometimes, a ball of energy – long walks in the Pentlands, cycling, working through the long list of chores Katie has given me and so on. Hypos at the weekend are therefore much more of a problem. While it’s not entirely responsible for this problem, dumb old Lantus just doesn’t have the flexibility to cope with this sort of thing. Therefore I’m hoping by adjusting basal rates on the fly the pump will help give me more weekend flexibility.

Difficult meals

We all have our diabetic food nemeses – fish and chips, Chinese take outs, pizzas. Again I’m hoping I can employ dual wave boluses and wibble-wobble waves (or whatever Alison calls them) to combat difficult food misery.

More flexibility

Injections are bit crude really, aren’t they? The awful old Autopen 24 for Lantus can only do double units and the finest control you can get with a Humalog-filled pen is a half unit. Quarter units for really fine-tweaking are where the cool kids are at with pumps. This is going to allow me the ability to more finely tune my insulin intake. It does, of course, mean I’ve more things to fiddle with and thus gives greater potential for cock-ups. But overall, I think this is a plus.

The cyborg thing

There is a negative side too. Although I’m relatively confident being attached to a machine all the time won’t be an insurmountable problem, it will take some getting used to. Regular pump users assure me you quickly get used to being attached and I suspect they’re probably right.

Gadgetry

Finally, one of the very few benefits of diabetes are the cool gadgets we get to play with. And gadgets don’t come much cooler than the Veo. Shiny stuff always rocks (and rocks hard) so I’m looking forward to the pump also just merely because I’ll have a new toy. What fun!

25 thoughts on “Great expectations

  1. Donald Thomson

    Just joined the back of the queue so will read your updates with great interest! By the time I’ve finally got mine, I’m hoping to be clued-up in advance so I can learn from your cock-ups (may they be few and infrequent). Judging from your blog, you seem to lead the same sedentary lifestyle with the odd burst of weekend energeticism (?). Gardening, walking and car-washing-related hypos certainly are more frequent at the weekends.

    Reply
  2. Tim Post author

    @don172 – cool! How long a wait have they guestimated for you?

    Reply
  3. Stephen

    That’s ridiculous! I was looking forward to seeing my nurse on Monday, I hope she gives me a lower guesstimate than that! 🙁

    Reply
  4. Tim Post author

    @don172 – that’s the same as I was – at least it’s no worse than 18 months ago!

    Reply
  5. Tim Post author

    @stephen – waiting list vary around the country. Donald & I are in an area with a long wait. Your experience may vary!

    Reply
  6. Claire

    Hello, so I’m fairly new to Shoot Up and though an oldie in diabetes terms (T1 for 23 years) I’m a pump newbie too, I got my ‘shiny’ Veo 3 weeks ago.

    I can imagine that many would be horrified by this but, I actually turned down offers of going on a pump, about 4 times! (I know, and I’m sorry!!) Unlike you, I was way more scared than excited by the prospect.

    Not for want of trying, but I’ve never had an HBA1C below 10 and after adding to my ever increasing list of diabetic complications with retinopathy that required some fairly scary surgery earlier this year, I finally conceded that having tried everything I could think of, including CGM, changing insulins, changing doses, half unit pens and split dosing etc, I had to at least give the ‘being attached to a machine for the rest of my life’ thing a chance, if I was ever going to find a way of getting my diabetes under control.

    I opened my mind to pumping – read and researched and absorbed like a sponge…. and signed up on here 😉

    I hold my hands up – I like my pump! After only 3 weeks I already have better BG’s than I’ve ever had before.
    One thing I will say however, is while, like you’re expecting to, I am liking the pump and all it’s funky adaptable ways of coping with my ups and downs, (DP problem solved with variable basal rates through the night and complex carb digestion solved with dual waves), the main problem for me has been the cannula.

    For starters, hypo-allergenic it may be but I’m still allergic to the sticky bit, so get a red itchy patches on my tum. Tip from @charlie – tea tree, thank you! While it hasn’t solved it completely, it does help.

    While my BGs on MDI were all over the show, I somehow always managed to avoid DKA. I was only on a pump for 3 days before, Bingo! – BG of 34 and a nice bright purple pee stick. Sick, dizzy and generally not having a nice time. Turns out the 6mm Quickset cannula just doesn’t do it for me.

    DNS – “There are other options”

    Yay! So I tried the 13mm Silhouette. Now that’s a LARGE intro needle my friend! And after teeny-tiny pen needles, man-o-man it hurt when it went in, and then I tried to administer a bolus… I had to grip the desk it hurt so much just to deliver 3 units!
    When I gave in and took it out to replace it, the insertion site poured with blood and I was left with a large purple bruise! 🙁

    Next up the 9mm Quickset – and thankfully, so far so good (except for the itchy red bit).

    My advice, for what it’s worth, is within your expectations, or anyone else’s who is on the pump list
    – expect to have some scary moments like cannulas not being suitable for you or not inserting properly,
    – expect to have very disturbed sleep (testing every 2 hours, pump alarms going off, waking up half strangled by tubing etc) and expect your partner to have this too so expect to have to put up with them being as sleep deprived and grumpy as you!
    – expect to give up exercise until your basal rates are sorted (not a problem for some, but being a gym bunny I’m finding it pretty hard going without my treadmill fix and no one told me this beforehand),
    – expect to give up alcohol until your basal rates are sorted (they left this bit out of the pre pumping info too!)

    It does look however, like you really can expect to have better control of your diabetes though, so all of the above will be worth it in the long run.

    It looks like you’re right to be excited about getting ‘pumped up’ – good luck with it!

    Reply
  7. Tim Post author

    @bellebe – thanks Claire – welcome to Shoot Up. There’s some top tips there – I’ll take them all on board! 🙂

    Reply
  8. Mark

    Tim, the only advice I can give is to closely monitor your glucose levels for the 24 hours. That way you’ll have a baseline to work with and can make adjustments as necessary. Also, don’t panic in the early morning hours if your pump gets more cozy than Katie. That damned tubing can create quite a stir! 😀

    Reply
  9. Jay

    The book “Pumping Insulin” by John Walsh and Ruth Roberts, ISBN 1-884804-86-1, has lots and lots of good information about using an insulin pump, including how to initially estimate basals and boluses and then fine-tune them through methodical testing.

    Reply
  10. Tim Post author

    @jay451 – on @alison‘s recommendation I have that very book on my bookshelf at the minute. I might even read it soon!

    Reply
  11. Annette A

    Dont give up exercise while getting your initial basals set, otherwise you’ll end up with a totally unrealistic basal rate that you’ll have to do all over again once you reintroduce exercise! Just test much more often during times of exercise.
    Amazingly, I have yet to have a problem with my tubing at night. I do insist on wearing my pump on a cord around my neck, which means it moves with me but doesnt get in the way cos it’s loose. (And I move a lot at night. I also tend to get up, get changed, and go back to bed, All whilst asleep. (and not hypo either))

    Reply
  12. Tim Post author

    I was planning to log everything like crazy while I’m on MDI for a while pre-pump and then log like crazy post-pump, so I can compare, contrast and tweak. I don’t see how one would do it any other way. Crack out the spreadsheets!

    Reply
  13. katherine cromwell

    To be honest Tim its just like changing from one insulin type /regime to another its always test more and you evaluate rather than docs. Just remember the insulin has a greater effect and is accumulative expect highs and lows. I think the pump allows for greater control than ever before enjoy using it.

    Reply
  14. Tim Post author

    @stephen – it’s mainly in American, but they have put in conversions from mmol/l to mg/dL throughout. As far as I’m aware there aren’t any pumping books by British authors around at the minute.

    Reply
  15. Helen

    Hi Tim !
    I met you at the pump training evening – I also go ‘live’ on the 2nd!
    How are you feeling? I am sooooooooooo nervous/anxious/excited/terrified/could go on and on………lol

    best wishes – see you Tuesday 🙂 x

    Reply
  16. Tim Post author

    Hi Helen! I reckon I might have a few weeks of some pretty screwy levels and might have some exciting hypos or hypers – but nothing that’s likely to kill me! So I just want to get as much out of the training as possible and then see how it goes. See you on Tuesday!!

    Reply
  17. Helen

    Thank you Annette :-)…so far so good – not too wobbly results as yet – how are you getting on Tim? xx

    Reply
  18. Tim Post author

    Not bad Helen – kept getting lower and lower yesterday evening, so did a temp basal of 70% for an hour and ate a lot of fruit pastilles! Then peaked at 9.4 during the night and then crept back down to 6.4 – so being slightly odd, but nothing too wild!

    Reply

Speak your brains