Lessons to be learnt

In my last post I mentioned that my levels had been a bit high, which I found massively frustrating.  My target range is set pretty aggressively at 5 - 7 mmol/l, giving a target average of 6.  Something I wouldn't have dreamed of whilst injecting, I'd have been hypo'ing too much to consider aiming for that.  Anyway, I was running a bit high and everything I checked seemed good.  Bubbles were purged, cannulas were changed, but still I remained a bit high.  I only 'fixed' this when I changed the entire infusion set, cartridge and insulin.  I suspect that the cause was that the insulin had started to 'go off'  I've had this before with a pen, so I guess I should have known better.  As soon as I was on the new cartridge and insulin from a new vial, levels were right back where I wanted them, seeing readings around and just under 6.  This, although frustrating, was a pretty good learning experience.  I'll know for next time!

I've also experienced my first mechanical malfunction, as my wife rolled over in bed, caught the infusion tube and it lifted the cannula just enough for it to come out.  I definitely felt it come out and the cannula poking at my skin was somewhat irritating.  So was this happening in the small hours of the morning!

Had another hypo in the last week.  It was around 2am and I was 3.8, so not that low, but still technically a hypo.  Treatment for a hypo used to be fast acting glucose (I use Gluco Tabs) followed by something longer acting (cereal, bread, etc.), which isn't really ideal, but we all have to work with the hand we are dealt.  Treating a hypo on the pump is much better.  Take a test, see what level you are and then the meter suggests how much fast acting glucose to have.  Gluco Tabs are 4g of carb each, so as the meter suggested 12g of carbs, that was 3 Gluco Tabs.  A test 10 minutes later read 4.9 and that was it. Job done and back to sleep.

My pump has been beeping and vibrating at me this morning.  It's running low, currently with only 11u of insulin, so it's time to fill up a new cartridge and change infusion sets.  This whole process was a bit daunting at first, but it's pretty simple and doesn't take that long to do.  The longest bit is probably purging the bubbles, speaking of which, they still have a habit of appearing from nowhere!

We are not alone

Life continues with the pump and it's been a constant companion.  I don't find it annoying  at all, instead it feels somewhat comforting - always there, doing it's thing....

Generally levels have been god, except the last couple of days when they seem to be slightly on the higher side.  This seemed to coincide with the last cartridge change, but everything seems to be working fine, I'm just slightly high.  More investigations I think!

I was slightly surprised to see someone on the train the other day with a pump - he had it on his belt in exactly the same place as I do.  I felt like a right plum, but I kept staring at it.  Not sure he noticed mine.  I found it quite fascinating to see another pumper out 'in the wild'.

Had a 'diabetes check' with the GP practice nurse.  This came about due to the massive confusion that me changing my prescription to 'vials' from pen cartridges.  I suspect that she may have never seen a pump before as she was certainly intrigued by it, what it does and how it does it.  There were a few questions I didn't expect such as 'so how often do you use Lantus now'.  Erm never, unless the pump breaks.  The constant drip, drip of basal seemed to baffle my audience for a bit, so I took the pump out and said 'at the moment it's giving me 0.95 units per hour as a basal dose'.  The reply was a bit odd.  'Is that normal for you?'.  Errrr, well it is now, for this particular hour of the day unless I'm running a Temporary Basal Rate.  I reminded her that I gave one big lump of Lantus every 24 hours before, certainly not giving precise fractions of a unit hourly with a pen!

This week is a but full-on at work, but I've got next week off and it's nice not to have the faff of injections, enables me to carry on working for an extra few minutes - not sure that's a good thing.

There is another good thing that's happened as a result of going on the pump.  I seem to have managed to lose a bit of weight, which I put down to eating less, 'cos I'm not going low.

:o)

Hotels and things I've learnt

This week, I had a training course in a hotel.  Turns out it was a very nice hotel and this meant nice food and drink, and lots of it. Time for some self discipline!  This was also to prove to be my biggest test with the pump so far with variable size portions and things made with probably way more sugar than would be done at home.

The first day I was running a bit high, but the second day I was pretty much where I wanted to be.

This did mean a lot of tests though, 17 over the 32 hours I was at the hotel!  Still it's all good practice and having the pump certainly made things much, much easier than pens and injections!


Now, there are lots of things you get taught when you go onto a pump and lots of things you find out for yourself, here's some of the things I've found during my journey......

• An 80cm infusion set tube is just long enough that when you go to the loo and sit down, you don't have to unclip  the pump from your belt or remove from a pocket.
• You really need to check that a cannula loaded into the insertion device is properly in place as, if not they can get jettisoned from it pretty much spontaneously.  Obviously they will then fire themselves, needle first, at the closest person, then stick themselves to the floor!
• I'm a hairy chap and pulling the cannula and the sticky pad bit off takes a chunk of hair with it.  However, this isn't as bad as the itching from hair regrowth if you shave the hair off before putting a cannula in.
• Guitar plectrums make an ideal tool for prising hairs trapped under the sticky cannula pad out.  If you leave them, they tend to 'tug' when you move about.
• If the pump extracts itself from a clip / pocket, the tube is strong enough to keep the pump attached and will swing away quite happily without incident
• Bubbles can seemingly appear from nowhere - it really is worth checking for these regularly

I'm still getting lots of questions, the most common at the moment is 'does it do everything automatically then?'  Well, no it doesn't, which seems to confuse most people, but I don't mind.

This weekend, it's Friday, and I have the day off, so it's the weekend already for me :o), brings a trip to Wembley for the England game, a seemingly full day at work on Saturday (arse!), another gig and, seemingly, a lot of rain.

But first, a trip to my GP who seems to be somewhat confused with a minor prescription change - I need my insulin in vials, not pen cartridges now.  This seems to have completely baffled them and I need to go in as a letter from the hospital and me writing 'Humalog insulin vial' on the repeat prescription is apparently 'not enough information'.  After all the changes I've made going onto the pump, I really didn't expect this to be one of the challenges!

Days 14 - 16

The weekend saw a variety of things going on, including work, watching Chelmsford City FC actually win for a change, a badminton match, a walk and a hyper.

The hyper saw me hit 16.9 for reasons that I can't quite fathom, but corrective doses sorted it.  I suspect it was a combination of bad carb sums and bubbles in the infusion set.   Otherwise my levels have remained pretty constant and no other peaks / troughs, which is ace.

Today saw me return to the hospital for a quick catch up on how things are going and suffice to say, everyone is pleased with progress so far.  We've also lowered my target range down to 5.0 to 7.0 mmol/L.  I can't really go any lower than that otherwise I'd by hypoing most of the time.  I'm happy that progress has been good enough to get down to these targets so quickly.


It's the little things, or should that be the long things?  I have found that an 80cm infusion set tube is just long enough that when you go to the loo and sit on the seat, there is just enough tube available so you don't have to remove the pump from belt / pocket!

The next two days sees me at a training course in a posh hotel.  This should prove interesting!

Day Thirteen

Day thirteen,unlucky for some....  Not sure if it is for me, but then I'm not thinking straight as I'm doing a 12 noon to 10pm fasting session to assist with getting my Basal levels dialled in.

All I can think about at the moment is food!

Anyway, an update on badminton & having the pump in the 'mp3' pocket in the shorts.  It was all fine, the pump didn't bounce about, nobody noticed it was there (or if they did they didn't mention it) and there were no dramas.  A TBR of -40% was used in the end and it seemed to be just about right, so I'll try it again on Sunday when I have a badminton match to play.

Sorted.


I've had another look at the stats and I'm pretty chuffed with what I see

The trend (the black line) has come down and appears to beginning to stay down.  The spike on 30th September was, I think, due to a cannula giving up on being useful, but all other days look good to me.  If it wasn't for that happening, I'm pretty sure that the trend line would be firmly planted towards the bottom end of the target range.

my multitude of BG tests each day are falling within a narrower range and, interestingly, my previously normal morning BG increase seems to have gone.  Meal rises are also now much, much reduced, which I think is partly (possibly mainly) due to being able to use MultiWave and Extended Bolus.

A varied weekend awaits me, including a midnight to Midday fast tomorrow, I guess I'll just have to stuff my face at 10pm!!

Day Twelve

Another day, another bunch of questions, mostly the same ones, but I did have a new one which was asking about the cannula sites.  They asked if it stays in the same place forever.  of course, it doesn't so I explained about how it has to be replaced every three days and you can't reuse the site, so you move it to somewhere else.  This sparked a bit of confusion and led to the statement 'but you'll run out of places to put it!'.  Ahh, perhaps I didn't quite explain that one properly!  The inquisitor was then told that you move it around and you do re-use site, but not immediately.

People still seem to think that I'm now massively hindered in my day to day life because of the pump, so to prove them wrong I'll be going to physio for a knackered back in a bit, with the pump attached and later will be playing badminton for a couple of hours.  I must remember to crank down the basal rate for that later - I think 35% less as a 'see what happens' value.

But, what to do with the pump whilst I'm playing?  Well, luckily I have a pair of shorts that have a small pocket in the back.  They're running shorts really and the pocket is really designed for keys, cash, small mp3 player, etc. but it just happens to be the perfect size for my pump.

Does my pump look big in this?

OK, it sticks out a bit, but who cares?  I certainly don't.  I just hope it doesn't move about too much.  There's only one way to find out!

Day Eleven

Bubbles.

I see bubbles, well, more specifically one bubble and I'm not sure how it got there.

How did that get there?

Anyway, it was easy enough to get rid of by some strategic tapping and running the 'Prime Infusion Set' routine on the pump.  It kind of satisfying watching the air work it's way along the infusion set tube.

Levels have been good today, ranging from a low of 4.3 to a high of 9.2 after eating.  Average so far today is 6.1.  I'm happy with that!

In a bit I'm off to another gig, and will be stuffing as much as I can in my jeans pockets, which won't be easy.  I think I'll seek out some cargo style trousers at some point - plenty of pockets!

Day nine / ten

Day nine and it's cannula & infusion set change time.  On my own!  I was slightly apprehensive that I'd probably cock something up, but it turned out to be a quick, easy and cock-up free activity.

The photo shows what was needed.  The pump (with old infusion set still attached), new cartridge, cannula & infusion set, insulin and the cannula inserter thingy.

The whole thing only took a few minutes and no bubbles were introduced :o)

Later that night brought the first hypo since going on the pump, only a mild one, but it does mean I get another coloured wedge on the 'Target' pie chart on the meter.

So far, not a bad set of results and levels are improving all the time.

Interestingly, a fair few people seem to think that going on the pump is terrible and some kind of life limiting experience.

Well it's not.

Contrary to what they may think, I personally think it's bloody brilliant and it's not a hinderance so far.  I'm intrigued why they think it's terrible and almost like a millstone round my neck.  The only think I can think is that they really don't know what a Type 1 diabetic has to do to keep on top of the disease anyway.  A pump really does make things much, much easier to control.  Being attached to the pump 24x7 isn't a big deal.

Tomorrow brings another gig test for the pump as I return to The Underworld in Camden