Well I got the real stuff in the pump last week – insulin I mean. I think I’ve mastered the changing of the giving sets and re-priming the pump. Still coming up with a few teething problems, like going to a meeting and realising that my shower earlier that morning had loosened the tape around the giving set, so having to nip into a supermarket to buy some micropore tape to stick it back – the tape is staying in my bag in the future, just in case!

The beeping from the high or low warnings beamed from the continuous glucose monitoring (CGM) sensor has lessened, and remarkably my blood glucose levels have settled. Originally my basal rate was set at 0.75 units per hour but I’ve increased that to 1 unit per hour as I was needing frequent correction doses – of course I’ve checked this with my DSN to make sure I wasn’t making any mistakes. My sensitivity is: 1 unit of insulin will reduce my blood glucose by 2 mmol/L – I only know this because Margaret (my very patient and understanding DSN) worked it out for me. I had used this prior to going on the pump but it was pure guesswork, not a clever equation.

I put my first order in for all my pump supplies this week and it worked like clockwork – a next day delivery! Usually it takes 48 hours but it was my first one so I got the delivery quicker this time. I have decided to have the supplies delivered to work for convenience.

Everything has gone relatively smoothly, my only disappointment so far is that I did not appreciate that the CGM sensor did not give an immediate glucose result on request. It only gives a visible result if there is a high or low warning, so a finger prick test using a meter is still needed. I guess I thought that the CGM sensor would save me having to do finger pricks. I have used another CGM sensor the past and that did give you the ability to press the button and check the blood glucose result in real time.

Regards

Debbie

All my colleagues at work are incredibly interested in what’s going on with my new kit, so my tummy got a real viewing this morning. During the morning I’ve had to do a calibration blood glucose test and being reminded that was blood glucose was predicted to go low – the lower limit I have the pump set at is 5 mmol/L but maybe I need to lower it slightly. My intention at this point in the day is to have something to eat to keep the alarm from going off again or having a hypo, then probably at some point over the weekend read the manuals. I’ll let you know how it goes …

I went for my pump training this afternoon – OMG what a lot of information to take in! I thought I was reasonably intelligent but I felt overwhelmed by it all and really questioned whether or not I was doing the right thing. It took two and a half hours to go through the immediate information that I needed to use both the pump and the sensor in combination. I was so glad that I opted for the trial with saline for a few days to get used to the two gadgets.

The actual insertion of both cannulae did hurt more than a conventional injection, but only temporarily. But in for a penny in for a pound. I slung everything in a carrier bag and shot off to a meeting that I was Chairing, still dazed by the amount of information I was trying to remember. I did not have time to sit down with any of the manuals and consolidate the new information. So the meeting starts, and during my introduction when I was asking everyone to make sure their mobile phones were switched off etc., a beeping could be heard – unfortunately it was coming from me via the pump! Well, I don’t know why it’s beeping because I haven’t read the manual, so frantic button pressing then followed in an attempt to silence this new gadget. My attempt failed on a number of occasions, so the audience put up with my introduction and a short presentation with a background accompaniment of intermittent beeping. I made a swift exit after introducing the main speaker to silence the beeping, and to try and find out why the beeping had started. I eventually discovered that the beeping was an alarm, which I had set earlier, to alert me of a high reading. Well it just got higher, probably due to the stress!

When I got home from the meeting it was 10.45pm and I was pretty tired, so the manuals remained unread. My next dilemma was where do I put the pump when I go to bed? I don’t want to unsettle too many of you by too much information but I don’t wear a nightie, so where do I put it or attach it to? An unhelpful suggestion from my husband was “buy a big pair of knickers with a pocket in!” I did sleep in a pair of smaller knickers and attached the pump to them, but again what happens when you go to the loo? The tubing doesn’t actually reach the floor so I had to unclip it before I could sit down. All these practical issues are not in the manual I’ve discovered. I guess in time I will find suitable strategies to overcome these.

I have activated the bolus calculator function on the pump, and this is really clever – well I think so – because I can put in my current blood glucose reading plus how much carbohydrate I’m intending to eat and it will calculate how much insulin I need, including any correction dose needed – WOW! The pump told me I needed 2.6 units, and with the press of a button it delivered that amount (of course this was still saline). I only had the option of giving 2 or 3 units with my insulin pen. How impressed was I! I probably sound really naive to all you nurses who initiate pump therapy, but remember my previous knowledge was near non-existent.

After having type 1 diabetes for just over 36 years I have toyed, on many occasions, with the possibility of trying an insulin pump. My major concern has always been “Do I think I could cope with having something attached to me 24 hours a day, and could I be bothered doing all those finger pricks?” The answer to myself has always been “NO!”

I have never had any major problems with my diabetes, more minor ones, but I guess that is matter of perspective. I decided last year that I needed and wanted to tighten my HbA1c level and tried with the aid of a continuous blood glucose meter to achieve this. I did manage to reduce my HbA1c by 2%, which was great, but at what cost? Well, the costs to me were increased hypo’s, which in turn brought an increase in my weight by over a stone. Those of you that know me will agree I am curvy enough without adding to the curves! The weight increase also makes me feel annoyed because it’s not easy to shift. Now that I am older, for me body image is less of an issue. Unpredictable hypoglycaemia and the associated weight gain are much more of an issue. I also travel a lot, often on my own, and self-preservation is key since I enjoy life to the max.

I decided, after talking to other pump users, that maybe this would be a good option to try to improve my HbA1c but without the unwanted hypoglycaemia. I go for my pump training on Friday the 10th of July and I’m am really looking forward to it. The nursing team at the Queen Elizabeth II Hospital in Welwyn Garden City are going to be my tutors. I haven’t discussed how they feel about teaching a knowledgeable peer, but I intend to ask, because I always struggle with this myself, trying to think of them as a person with diabetes rather than a healthcare professional with diabetes. The fact is, I know very little about pump use because I’ve never been that interested in insulin pumps before. I know that I am going to be issued with a new insulin pump, plus I am going to try, simultaneously, a continuous blood glucose sensor, which will automatically send my blood glucose results to the pump rather that having to do numerous finger pricks. I may well get technology overload but I’m going to give it a try to get the most benefit out of the pump system.

I’m going to be writing this blog, documenting the pros and possible cons of pump use and sharing the patient perspective with anyone who is interested. I’m happy to answer any questions anyone may pose, but I’m also happy to receive any tips from established pump users to make my experience more enjoyable.

Regards

Debbie Hicks