Taking a Pump Vacation
For many people, the pump has been the most exciting invention since insulin I remember as a kid going to summer camp and watching a counselor fall into the lake and leap out almost as fast as he fell in! He had been wearing an insulin pump feared that he had killed the pump. But with a hair dryer, the pump sprang back to life and disaster had been averted in the Maine woods.
Watching that experience gave me hesitation about wearing a pump. I love my active life and worried it was not appropriate for me. Plus, in those days, the pump was the size of a briefcase.
Then 5 years ago, my certified diabetes educator (CDE) felt my life would be much easier with a pump. My A1c hemoglobin was 6.8 and she thought it would ease the 6.8 A1c down to 6.5 or lower. The bolus wizard would make carb/insulin ratios easier to manage and the myriad of bells and whistles would streamline my management into tight control.
But, that hasn’t been the case.
In 3 years I have had 4 pumps. Two of my pumps ate right through batteries, one simply stopped working and one kept sending a “no delivery” reading. In each case, Medtronic was awesome at getting the replacement pump to my door in less than 12 hours. Then, there were issues with canula and tubing leaks.
The canula itself was another issue. I would bend the plastic needle and get a “no delivery” signal from the pump when I would use the quick set in my stomach. I tried the silhouette, but found that the holes took a long time to heal. Only recently have I tried a canula called the sure-T. It is a metal needle instead of a plastic tip and I found that I could use it in more places on my body. Eureka, the right canula for me!
Last Monday night, I started a new quick set and reservoir. By Tuesday morning, my blood glucose was in the high 200s and by 11 am it was in mid 300s. Not really knowing the cause, I increased the basal rate and waited. By 4 pm, I started having chest pain and I pulled out my bg meter to check - it was at 480. I was stuck at the office for another hour, so I increased the temp basal to 100% and worked on my last client of the day. When I got home, my blood sugar was down 260 and I assumed what I was watching had been hormonal or something within my body. By the next morning, though, my blood sugar was back up to 380.
I finally disconnected the pump from my body and ran my hand along the tubing. Sure enough, there was a leak. Leaks are often hard to detect because the amount of insulin passing through the line is so small that a leak is not a drop you can see. You have to feel it, and sometimes it’s even harder to know if the little bit of moisture is from your hands or the tubing.
Because of the high blood sugar, I was not feeling great and I decided I needed a vacation from the pump. I have not been able to get my A1c below 7, it has been stuck at 7.2-7.5. I have felt frustrated more than I have benefited while wearing the pump. Both my endocrinologist (endo) and my certified diabetes educator (CDE) had supported my move to have a pump vacation.
In my fridge, I had Lantus and Novolog pens from my endocrinologist, in case I ever needed them. I immediately started on Lantus and used the bolus wizard on my pump to help calculate the dosage of short lasting insulin for food corrections. By the end of the day, I had done 4 checks with my meter and my mean blood sugar 120. The target range my diabetes team wanted me to hit!
As a yoga instructor, it has been interesting for me to notice the physical freedom from the pump. My desire to get up and go for a run has sprung back into action. With the pump, I would have to create windows for running and if I missed it, I usually didn’t manage to run at all. I also noticed that due to the quickset, I had use my hips 98 percent of the time and they have been sensitive to the touch. Should I decide to go back on the pump, I will switch to the sure-T, for sure!
There are many things to consider when going from injections to the pump, or from the pump to injection. I plan not to give up the pump completely, but would like to be able to use both the pump and injections according to what feels appropriate for my lifestyle. Wearing a pump or taking injections is personal. I have friends who can’t imagine their life without the pump, but I think I’m lean more toward syringes than the pump at this point. There are things I have to remember to do, which the pump would automatically do for me.
In the next part of this series, I’ll write about switching from the pump to injections and let you know what I record for numbers and ease, or lack there of, for diabetes management.
Ann wrote for HealthCentral as a patient expert for Diabetes.