Laura's journey to insulin pump therapy

bad site....bad, BAD site!

2006-06-06T10:07:00.000-07:00

Okay, so I had a bad site that had to be changed yesterday.

I had a regular site change day before yesterday and all day yesterday I was fighting high readings (thought it was from what I'd had for dinner the night before). Nothing over 280 mind you, but I thought it would've been taken care of after the first couple of corrections, using the EZBG program to be sure I did the right amount.

Last night, when getting ready for my shower, I noticed it was itching, but not red or swollen. I took off the dressing to get a better look at it and noticed that a good portion of the little pad surrounding the site was wet (not soaking wet, but damp, so probably a slow leak, or only from boluses). Immediately I changed the site. Right before bed, and then again two hours later, I had to give myself a small correction, then about 3:30 AM I awoke with a low.

That fixed it, I've been running fine all day..... just kinda scared me.

wearing tight jeans

2006-05-27T08:33:00.000-07:00

Okay, so I remember asking some fellow pumpers if wearing tight jeans would be a problem, since I prefer to place my set on my lower abdomen and I like to wear my pants kinda tight (I have alot of tummy fat, and wearing tight jeans helps to hold my tummy in).

I use 9mm insets with IV Prep and IV3000 frame delivery, to make sure I don't accidentally rip out my sets, since I tend to lean against counters and such when I'm working. It's worked great so far; no crimping or waking up with my set dangling, no highs from occlusions.

Life's been great this last 5 weeks ...
Except when I wear tight jeans.

It's a discomfort thang. The entire area under the IV3000 gets irritated and itchy. I know I'm not allergic to the stuff, because when I'm not wearing tight jeans, I don't even know it's there. Even if the jeans are fitting so they barely rub against my skin it doesn't do that, only if the jeans are tight, and then after I take off the jeans, until I finally change the dressing.

So, I gained some weight when my endo increased my insulin on MDI right before he up me on a pump. So, I'm trying to lose that weight right now, so I don't have to go out and buy new pants when I know I'm gonna lose weight pumping, anyway (since I'm not having to feed my insulin, anymore). So, I have a couple of pairs of "lose" pants I'm trying to wear in the meantime. So, I have to try and not wear my tight jeans too much in the meantime. So, it's discouraging, because I'd really rather be wearing my tight jeans (especially to work!).

Anyway, venting over. If anyone out there in cyberspace has any suggestions that might help, please let me know.

testing basals

2006-05-12T10:30:00.000-07:00

The last couple of days I've been testing my basals.

I had good readings all morning and so I skipped lunch, everything went pretty smooth, all were within my target range, right up until right before dinner (when it dipped down to 73, so still not bad). I had a normal dinner and all my readings were good after dinner at bedtime and then that next morning, so I decided to skip breakfast and see how that went. It was great! I will try to do dinner soon, but I kinda screwed myself on dinner last night (pasta w/ creamy sauce), so I'm gonna wait til I'm sure everything's going well before skipping dinner.

Next I need to whip my weekend basals into shape, so I can test them as well. I already know they're gonna need some work....

weekends

2006-05-10T05:37:00.000-07:00

Hi, sorry I haven't logged on in a few days.

I've been thinking about this lately. Last weekend was my first true weekend since starting, since the first actual weekend I was on duty at work.

When I first started using my pump, I noticed that the basals needed to be set much lower for the hours I was at work, especially before lunch. I've always been a morning person, and assumed that perhaps my metabolism ran higher in the morning.

Saturday, I slept in and my BG was a bit high, so Sunday I raised my basal just a tad and it was still higher than i like it to be. I was adjusting all day, it seemed, to keep it under 175. Monday when I got up at my usual time it was still up a bit, but not as bad. I am definitley going to try running a higher basal on the weekends. Maybe try going back to what my CDE thought I should be running on all day long (which is still what I run on from 2PM to 1AM). I'll see if that helps. If it's too much, I could always doing temp basal reduction for when we're out running errands, or maybe take it down a notch, but I'm thinking that will help to keep me from going out of wack on days when I'm not running around at work all day long.

day five

2006-05-02T10:08:00.000-07:00

Slightly decreasing the basal from 7:00-11:00 AM seems to have done exactly what I had hoped for. It was perfect at lunchtime today. I'm gonna leave it here for now, see how it looks over the next few days. Maybe next week I can try testing it by skipping breakfast one day, lunch the next, and dinner the following day, to see if the BG levels stay steady.

day 4

2006-05-01T10:37:00.000-07:00

Still chuggin' along. No problems. I'm going to decrease my basal just a tad from 9:00-noon, because it seems like I still start going low about 10:00 (not as severe as before, but still, I'm trying to keep it as even as possible), but things will hopefully go back to "normal" after lunch.

day three, cont

2006-04-30T18:10:00.000-07:00

I changed my site for the first time today. So far, it's working out fine (happy dance, happy dance).

day three

2006-04-30T08:51:00.000-07:00

Well, I had a high after lunch, yesterday. Still under 200, though, but rather disturbing. I think I misfigured my carbs, since I ate out. I corrected and was closer to target by dinnertime, but it was discourging.

My results have been a little high all morning today. I had to give myself another correction after breakfast. I am supposed to change my site today, so hopefully that will help (either way, I stand to learn something).

I told my CDE that I might have to call her when I do my first site change. Hopefully, though, if I'm not rushed I'll be fine.

day two

2006-04-29T07:32:00.000-07:00

I'm trying to "tweek" my basals so I don't have as many lows as yesterday. Since I'm absolutely terrible at math, and my numbers weren't too far off, I'm just gonna change them a little bit at a time until I get it where I want it. Since I'm on-duty this weekend, it's just like a regular workday, anyway. Once I think I have it set, I'll try the thing where you skip a meal and check it every 1 - 1 1/2 hours, to see if it says steady. In my Animas Workbook, I found some "Pump Flow Sheets" in the back where I can keep track of what I'm doing so I can see what works an what doesn't.

I need to go register my pump, online, now.

day one

2006-04-28T08:12:00.000-07:00

Hey, so my CDE is awesome. She's Type 1 and has been following my progress with the lack of dawn phenomenon and other weird stuff. She tends to give me some guidlines and then lets me have some room to work with, since I know my body better than anyone else ever can.

So, we started out with I:C ratio 1:8. So far, that seems to work okay, except I may have to bump it down (or up?) a bit for breakfast. I don't know, it's been kinda low all morning. I'll wait and see if it does the same thing tomorrow that it did today.

We set the basal at 1.1 per hour, except from 1:30AM-6:00AM, it's only .9 That may need to be extended to 10:00-10:30AM, though, since I've been a little low all morning. Again, I'll see if it repeats tomorrow.

So far, no really low lows, and no highs. It's been holding between 70 and 135 (the 135 was post dinner last night).

today's the day

2006-04-27T10:32:00.000-07:00

I leave in an hour. We're going to hook up Lil' Bit and then I'll be shown how to use 'er. I'm excited, but not affraid or nervous or anything like that.

I skipped the lantus injection this morning. My BG, usually kinda low before lunch, was 183 so I took a little extra novolog. Hopefully it will be closer to "normal" by the time I see my CDE. She wants me to bring everything with me that came in the box, and also a vial of novolog.

pump supplies

2006-04-26T10:29:00.000-07:00

So, my rep told me the only thing I would have to get from the pharmacy is the insulin. That's not entirely true. There were no IV preps and no IV dressings in the box, outside of the single sample of each included with my pump kit..... Kinda frustrating.....

Got a call in to him right now.

it's here!

2006-04-25T11:11:00.000-07:00

Well, my pump is here.

Too bad I can't just go home and play with it, but I have to stick around for a meeting, so I can go over my paper for the conference next week. My meeting is in an hour, so I need to concentrate on that for awhile and then do my end of the day stuff before leaving.

I'm just so excited. Happy day for me and Lil' Bit!

Learned something about placement today

2006-04-22T13:04:00.000-07:00

So, I've been on this CBGM for nearly 48 hours and I think I will be a bit more careful about how close to the waistline I will wear the insets in the future. I told the CDE to put it above my waist, and she did, but it's just above my pantsline with the lead pointing down, and my waistband keeps rubbing on it. And even were it not for that, I sweat so much that it's kinda uncomfortable for it to be located just below my breast and just above my waist, at least during warmer weather. Speaking of warm weather, the sticky thing that she put on top of it has started to rub, too, so I hope it lasts another 1 1/2 days, she wants me to try and wear it til I see her again Monday, but I still have to shower two more times between now and then.

I think as soon as my pump gets here, I'll be asking about different kinds of infusion sets. I would like to try the Orbit 90 and the cleo, and there may be some other good alternatives out there.

CBGM con't

2006-04-21T05:34:00.000-07:00

Well, it's interesting. It was fine going in, no worse than a needle with no bite. Right after she hooked it up, though, and I sat up again, it was like there was a pimple right there, nagging me if I irritated it too much.

So, I had to figure out a couple of things; don't wear the monitor on your waist right there under the probe, don't have the probe near your waistband, I'm glad I didn't have her put it under my tight pants, (speaking of tight pants) I probably won't be able to wear my cannula under them until I get used to how it feels.

It takes awhile to enter all the stuff into the monitor. Hopefully, after doing this a few times it will be faster, since I can't possibly spend all day foolin' with this thing. I mean, I do have work to do....

Interesting that my BG was 287 when I went to bed, I took no insulin to correct, and it was 47 this morning when I got up. I can't wait to see what happened.

It's probe is only supposed to work for 72 hours, but I'm going to have it til Monday morning, so she wants me to leave it on as long as it will let me (I won't see her again for about 90 hours). We'll see, I guess.

CBGM

2006-04-20T05:52:00.000-07:00

I'm getting hooked up to a continuous blood glucose monitor today. It'll monitor my BG for the next 72 hours, so we can better plan my basals when the pump gets here.

I shall have to remember to tell my CDE that the pump got shipped last night (!), we'll need to go ahead and start pump classes right away, since it will be here on Tuesday.

pump's on order!

2006-04-19T13:20:00.000-07:00

I talked to the Animas rep at lunchtime.

My pump should be here in 5 days. It's going to cost me about $1400 ($350 deduct + 20%), which they'll let me payout. He said they'll send me a bill and I can work it out with the billing dept, but they're going to go ahead and send it.

:-D

www.insulin-pumpers.org

2006-04-14T10:18:00.000-07:00

So, I've been thinking about this alot lately. First off, go visit this site; http://www.insulin-pumpers.org

The thing is; if I hadn't come across this site, I may have never decided to get a pump. I knew no one that wore a pump, and I was so affraid. Mostly because it was unfamiliar to me, but also I think, because I was programmed at a very early age to be ashamed of my diabetes.

My father (mostly Irish) grew up in a very poor family. Back in the 1950's, his youngest sister was a teenager with diabetes. She didn't have a glucometer, or even disposable syringes. She didn't know about beta cells or glucagon, or counting carbs, for that matter. Mainly, she was told to take insulin when she ate. She (like many diabetic children who grew up without a pump) was always feeling so restricted by her diabetes. She soon discovered, though, that if she ate a bunch of "junk" she could take more insulin and her reaction wouldn't be as bad. One day, she took too much insulin and went into a coma. She never recovered.

I was born early on in the 60's. The fate of my father's sister still looming over the family cast a shadow over my childhood. It was discovered that I was "borderline" (I hate that word, by the way) when I was 3 years old. The doctor had my mom put me on a strict diet and was told that as long as I adhered to it, and kept my diabetes in check, I could live a long productive life.

It was a horrible childhood, for many reasons, but that shadow of my disease was forever reminding me that I was not like other children. I could trick-or-treat, but I couldn't pig out on the candy. I could go to parties, but I couldn't eat anything. I could exchange valentines cards, but I could not have any candy hearts, or easter bunnies, or ice cream cones, or anything else that normal kids have. When it was our turn to bring the snack for school, it had to be apples, or something like that, which, of course, only accentuated my affliction.

When I found out from my doctor, in my later 20's, that I needed to go on insulin, "just to give my poor pancreas a break", the doctor said, I felt as though I must have failed somehow. So, I worked, for awhile, to do "better" with my diet, while my mother was in the background insisting I "not tell my father, because it would kill him". So I learned to hide it. Taking my syringe and vial into the bathroom to take my shot, fasting before I went to the doctor's, so maybe my BG would be "normal". I was able to pretend everything was fine for many years, sometimes keeping myself on strict regimen, other times not so strict.

February 17, 2004, I was admitted to the hospital with diabetic ketoacidosis, with a BG over 900.

I had caught this stomache virus, probably from someone at work. I was nauseated, and feverish for days, but the stomache thing lingered, long after the fever left me. For weeks I was miserable. I was miserable. And, as was my practice, when I was feeling misreable, everything else in my life evetually began to suffer from it. One day, about 3 weeks in, I was home sick and suddenly threw up. I don't normally throw up very easily, so I took this as a sign to call the doctor. My doctor wasn't available, but the clinic had a PA that would see me that day. The PA scheduled me for an upper GI and sent me to the lab. I was to return in two days. That night, before bed, I called my partner (we weren't yet living together, but had set a date to do just that) and told her I was very tired, and so I was just going to stay home and rest til the next appointment. The next day, after trying to reach me all day, she finally got the manager to to bust in a window (because the door was bolted form the inside), where they found me unconscious.

I woke up two days later in the ICU.

My doctor wanted me on a pump as soon as I got out of the hospital. The thought scared me. This would surely mean that I had failed, as I would need some machine to do for me what I was incapable of doing myself. I told him, most emphatically, no. So, he kept an eye on my HGA1C (which usually hoovered in the high 8's to low 9's), until the day he told me his residency was coming to an end and he was leaving.

I had two other doctors after him. they each told me I needed to get on a pump, but I refused. Finally, my present doctor said she was going to send me to an endo, and said "see if you can tell him no". Seeing as a really liked my doctor, I thought I'd better do some research ahead of time, so I might have a good defense handy when I went to see this endo. It took a month to get the appointment. Before I went to see him, I had already convinced myself it was the best thing I could do. I went in trying to convince him why it was necessary to get me on a pump as soon as we possibly can!

I want to be able to say (like Patty LaBelle) that "I have diabetes; diabetes does not have me". I want to be that woman in "The Diabetic Woman" who has done whatever she can to take care of herself, dispite all the other forces pulling at her; her family, her career, her health, she'd done whatever she could to take care of herself above all else going on around her.

So, I saw the doctor 5 weeks ago and he told me it would be at least 3-4 months before we could start talking about a pump. I saw his CDE twice and she convinced him that it needs to happen now. So, when I saw him this week, he said as soon as you know which one you want we can start the paperwork.

I did alot of research on my own. I did internet and literature searches. This site I found, insulin-pumpers.org, has helped me so much. It's like having a support group that I don't have to leave the house for. I can be open and honest with people who have been there and done that. I can be proud of myself for going as far as it took to take care of me. And I can proudly proclaim that I have diabetes, diabetes does not have me.

I should be getting that pump soon. The pump rep has got the papers and it's in the works. I want to thank all the kind, generous people who keep coming back to the insulin-pumpers site to hold our hands and prop us up, who encourage us as we encourage them. And I want to thank all the admins for going the extra mile to keep it all up and running so that we can continue to keep each other going.

animas rep con't

2006-04-14T09:55:00.000-07:00

So, I got back with the animas rep yesterday and he just wanted me to know that he got the paperwork from my doc's office, and he's waiting on the medical necessity form before he can tell me how much it's gonna cost me. He said BCBS is fine with it, they just won't release my coverage til they can have a copy of the letter.

So, that's it. Just sitting here on my hands... waiting impatiently...

He said I'd be hearing from him every few days, while this is going on. Just so he can give me progress reports. I don't know, that might drive me crazy, being constantly reminded that it's in the works.....

Animas rep

2006-04-13T10:21:00.000-07:00

So, I got a phone message from the Animas rep (my CDE faxed my paperwork this morning). I'm so anxious, but I can't seem to reach him. Maybe he's at lunch right now as well. I'll try again in a little bit.

letter to my CDE

2006-04-11T10:52:00.000-07:00

Hi ______,

Well, sorry about the crazy voicemail yesterday. I was running low all morning (40s and 50s) even though I was eating every time I tested, when I actually expected to run high, because I was so stressed out from preparing for that paper I was going to go over in the meeting before lunch. I finally just ate a huge snack before the meeting (if I remember it correctly, it was 2 sugar packets under the toungue, a bunch of peanuts and then a package of twix, one right after the other) and took a regular coke in with me, in case I felt myself going low while presenting.

I didn't need the coke, when I left for lunch it was 107, and since I'd been snacking all morning I decided to skip lunch, and my shot and just have a banana before going back to work. I was fine the rest of the day.

So, imagine my suprize when after being fine last evening, I am continuing to be fine today (guess I figured it would hit me eventually). It was 81 mid-morning so I had some peanuts and it was 79 right before lunch. I hate to have to tell you this, but I didn't correct and then take my insulin before lunch. I'm tired of all that eating and I put on 7 lbs last month ,so I had 40 gm of carbs for lunch (about 1/2 - 2/3 what I usually have) and skipped the insulin. If it's running high later, I'll have a little extra, but I just can't continue feeding the insulin. It's too exhausting.

Sorry, I hope this doesn't sound *too* much like I'm complaining, I really just wanted to give you an update, since I hadn't talked to you yet.

hectic day

2006-04-10T15:03:00.000-07:00

Had a very busy day today, especially this morning. Had to present a paper just before lunch.

All morning long my BS were low - low - low. The highest was 56 and the lowest was 45. I kept eating, but it just didn't budge. My normal routine would keep it the same but just would not bring it up.

About 15 minutes before I was supposed to go in for my talk, I tried to call my CDE to see if she had any suggestions. I got her voicemail. I found out later that she wasn't in today.

Here's what I did just before the meeting; I put two sugar packets under my toungue, one right after the other, ate some peanuts, then bought a twix bar. I took a bottle of regular coke in with me, just in case I started feeling low again, but didn't need it. I was so full from eating all morning that I decided to skip lunch and my regular lunch shot. When I checked my BG at 1:00, it was 104.

Can't wait til I get my pump.....

Which pump?

2006-04-09T12:24:00.000-07:00

Well, just a quick update.

Since I had the two demos to take home for the weekend, I have discovered that the Animas is much easier to navigate than the MM, at least for me. Add that to all the other pluses and I think that's the one I'm going to go with.

Other pluses (in case you're not sure);
larger, easier to read screen
carb king
dedicated backlight button
uses any leur-lock infusion sets

PS; I've been practicing wearing it with the little coozies I've been making out of spare thread....

2006-04-06T11:41:00.000-07:00

The doc says I've done everything they asked of me, and there are still some things they cannot do to tweek my BS, so as soon as I decide which one I want, they're gonna start my paperwork.
The CDE sent me home with their demo Animas and Paradigm and said I could bring them back after the weekend.

Interestingly enough, after seeing my BG readings for the last month, he says, "looks like you have the opposite of a 'dawn phenomanon' during the night. Perhaps your liver isn't secreating sugar, or one or more of your stress hormones isn't working right, but you BG just seems to drop throughout the night without rising before morning." That's exactly what I had told someone not too long ago, that I seemed to have the opposite of the dawn effect, and they didn't believe it. The doc says it's rare, and he'd never known anyone that that happened to. And after just last night, at the MM class, he told me noone ever died of low blood sugar, that your liver always kicks in eventually before it gets too low! :-P

In two weeks, they're going to hook me up to one of those continuous blood glucous monitors, that MM is in trials with, and then start me prepump classes, in preparation for when my pump arrives.

2006-04-06T05:35:00.000-07:00

Pumping class was interesting.

I got to see a MM up close and see how tiny the type is on the screen.

I learned some more about counting carbs and the effects of fat on glucose absorption. It was interesting and informative.

I see the endo today....

Pumping class tonight

2006-04-05T10:46:00.000-07:00

4/5/06

I have a minimed class tonight at 6:00.

About a month ago, my doctor had me see an endocrinologist and we're preparing me to use a pump. I'm excited about it.

I have been going back and forth about whether I should get a MM715 or an IR1250. The MM has a lot of good features, but uses propitiary sets, the Animas has different good features but it's not propitiary, so I could use any sets I want to.