Pump start, 2006
This started out as a comment to Chris’s blog post yesterday, asking for stories on how we were first transitioned in to using a pump. Because I rambled a bit longer than is appropriate for a comment (as I tend to do), I decided to share it here. Have your own pump-start story? Please post it over there, on A Consequence of Hypoglycemia.
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From the time my first pump-ever insulin pump arrived at my door to the time I got to pop in the battery and start using it was about a month. BUT – there was good reason for that. I was preparing to go on a European vacation, and then was starting a new job when I returned. For obvious reasons, I didn’t want to “plug-in” and leave the country, and also for obvious reasons, I didn’t want to start my new pump on Day One, Week One of the new job; thing would be too hectic and I wanted to be “settled in” for a bit. So I waited until Day One of Week Two to begin my training. (Meanwhile, during that month, Medtronic had introduced the first pump with an integrated CGM – the 522 – leaving my brand-new-never-used model obsolete. I figured it was just bad luck, and didn’t know enough to see if I could trade mine for the newer one).
The CDE from my endo’s office, who is also a Type 1 and also a “certified” Medtronic trainer, came to my apartment to train me and get me started on saline. Previously in the office, she had counseled told me about what a pump can do, but not yet on how to make it do it. This is what the training was for.
We went through the lessons on how to go through the various menu options. I tried two QuickSets – the “default” Medtronic infusion set – that I found painful and removed rather quickly, before trying (and eventually trading in my 3-month supply with her for) Silhouettes. Looking back, I wonder if I was just being too sensitive, because my now-educated mind can’t grasp how the big angled needle could hurt less than a smaller, straighter one. But I’ve never used a QuickSet since those first two, and I used the Sil for years before eventually moving on to the Sure-T and then the Mio.
I don’t remember a whole lot about the training other than that, at one point, my CDE/trainer set a bare alcohol swab on the corner of my dining room table. It left a permanent mark which I was reminded of often, but – in honesty – it was an old crappy table that we got rid of before moving to our present house. Also, she had put the fear of God into me over not getting insulin delivery and quickly going into Diabetic Ketoacidosis (DKA) without long-acting insulin on board – a fear that still lingers with me today. I could go from absolutely-fine to dead in an hour, I was led to believe.
During the week, I pumped saline at whatever basal rate the doctor had calculated for me, using some formula based on my current Novolog and Lantus doses, down-scaling it by some percentage because (a) pumping is apparently more efficient, and (b) fear of hypos.
This calculation was, in honesty, the first time I ever realized that when it comes to insulin, a unit is a unit is a unit. I had always taken NPH and Lantus in doses that were higher than my Regular/Humalog/Novolog, but figured it was because of a difference in potency somehow affected by the time delay. Adding up short- and long- acting insulin to come up with a daily total was, to me, like adding pounds to inches: total nonsense. But I learned that 24 units a day of Lantus is the same as 1 unit of (whatever) per hour for 24 hours, which probably would have been a bit valuable had I known it 25 years earlier.
Anyway, for the next week (week 2 on the job), I used the Bolus Wizard to fiugre out how much Novolog to inject via pen. I learned about corrections and Active Insulin (Insulin-on-board) and ratios and all that fun stuff. But I still injected, rounding to the nearest unit, based on what the pump told me. And I still portioned my meals in increments of 15 carbs so that I could correlate it to an injectable amount of insulin. Actually, I continued to that for about a year because it was the only way I knew how to count carbs. (And, to be honest, does anyone really know how to count carbs, or do we all just fake it all the time?)
After a week of saline, it was time for the real deal. I didn’t have another appointment set up, but I did have a sheet of directions. My endo had given me a “sample” vial of NPH at my last visit. The night before I was to switch from saline to real insulin, I was to take an injection of NPH (at some amount he calculated), since the NPH’s 8-hour lifespan would last me through the night, leaving me clear to start pumping insulin in the morning. (What a waste of a perfectly good vial of insulin – just for one shot, I remember thinking. But everybody hates NPH anyway; nobody’s going to miss it).
I remember that purging air-bubbles from insulin is a lot different than purging them from saline; though I can’t remember which is easier or harder. But I plugged in, called (or got a call from) my trainer/CDE in the morning, and hopped on the train to work.
She had me testing something like every half-hour and calling her every hour and faxing her blood sugars (yes. Fax.). It drove me up a freaking wall. Remember I was still new at my job (Week 3, Day 1) and wasn’t comfortable taking so much time for personal matters.
My blood sugars that morning ran in the 300s. She was terrified that I was going to go into DKA and had me pee on a ketone strip several times that morning. She also wanted me to change out the site, which I resisted. The truth of the matter was that (1) I was always in the 300s at that time of morning (Dawn Phenomenon sucks), (2) my basals weren’t anywhere near tweaked to accommodate that, and (3) they had down-scaled my insulin so much in the name of “safety” that I wasn’t getting nearly enough.
But eventually, with some patience (because that’s what’s needed for highs to come down – PATIENCE!) I got through the day. And the next eight years.