Adjusting To A New Insulin Pump
Exactly one month ago I started using a new pump and continuous glucose monitor. The timing wasn't great as I'd hoped not to change pumps in the middle of my pregnancy, but I had little choice since the warranty on my beloved Deltec Cozmo expires in September.
I've posted before about my love/hate relationship with CGM, which really boils down to my overreaction to all of the information it provides. There were several things I liked about using the Dexcom but the fact that it required me to carry around another cell phone sized device kept me from wearing it consistently. When my belly pushed me into maternity clothes around 15 weeks and I rediscovered that very few maternity dress pants have pockets, I stopped wearing the Dexcom altogether. This fact alone encouraged me to switch to an integrated insulin pump and CGMS. Since the only one currently available is by Minimed, I chose their Paradigm Revel system.
To add further change to the mix, I also switched insulin brands at the beginning of the month. I've used Humalog for several years but had heard that Novolog begins to work a bit faster. With intensive insulin resistance in my near future, I wanted to try insulin that potentially would get into my system more quickly. So far, I have noticed only a slight increase in the timing of insulin becoming active with Novolog.
There are so many little issues that occured to me during this transition. First of all, I was struck by how outdated the design of the Revel system is compared to my old pump and CGM. Particularly, I didn't like how the needles that introduce the cannula and sensor are completely visible during the insertion processes! With the Dexcom and the Cleo 90 sets I used with the Cozmo, the needles are hidden and the insertion devices are self-contained. Using a separate inserter with a huge needle certainly took some adjustment. I told my pump trainer, "Good thing I didn't start pumping and using a CGMS with this model, I might never have gotten past the needles!"
But, I'm a big girl and a mother now, so I grin and tell Sienna that it doesn't hurt at all... which is usually the case.
A more significant issue is that accuracy of the CGM that's integrated into the Revel system. Compared to the Dexcom (and I haven't done a side-by-side comparison yet, that may be an experiment for the future), this system seems to really lag behind my real-time glucose levels. Since I feel my lows quite well, I'll notice that I feel low, test to confirm a low number, and eat something to raise my blood sugar; twenty minutes later the Revel CGM will alert me with, "Low Predicted." Not entirely helpful. In the month I've had this system, I've only worn the CGM sensor about half the time because of the accuracy issues and the aforementioned tendency for me to overreact to the information it provides.
Finally, I ran into an interesting issue with varying cannula lengths between my old and new pumps. With the Cozmo, I'd always used a 9 mm cannula. I never questioned the length; I'd just used what was sent to me originally. With the Minimed, they sent me 6 mm sets, so I gave them a shot. I really liked the fact that they didn't hurt going in and was really impressed by how sticky the sets were! However, after a few set changes, I noticed a six to eight hour "warm up" period before the infusion set worked to its full potential. I'd always experienced a couple hours of poor insulin absorption with my Cozmo sets, but now this period was lasting significantly longer. Upon consultation with my CDE and doctor, we agreed that the shorter cannula length was likely the culprit. It makes sense because injections start working very quickly and they're being injected much deeper than insulin through an infusion site. Interesting!
Admittedly, I'm not very technologically savvy and I typically don't embrace change all that well. Changing insulin pumps made me realize how attached I'd become to this little inanimate object that accompanied me everywhere for the past four years. There are aspects of the new system I prefer, like how it prompts you at each bolus to choose whether you want to deliver a regular, square wave, or dual wave bolus. I didn't use these features very regularly with my old pump and just the simple reminder helps me to think a bit deeper about the insulin requirements of any given meal.
Readers, have you tried various pumps and continuous glucose monitoring systems? What were your determining factors in picking a pump?