Priming the (Insulin) Pump (Part 2)

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This week, Eric continues with Part 2 in an ongoing series of entries about his recent transition to using an insulin pump. (Read the first entry here.) In this entry, he begins at the beginning. He’ll start with what led him to switch from injections to a pump. You won’t find him actually pumping insulin in these blog entries for a few more weeks!

My first exposure to the idea that I could even use an insulin pump came when I took my four-week Type 1 diabetes education course (“diabetes boot camp”), offered by the University of Michigan Health System. I was about two weeks into living with diabetes, and although I’d heard about something called an insulin pump, it was an option that I assumed was a year or so away. I was trying to get a grip on all of the information coming my way, and the “insulin pump” was just one more bit of info to be tabled for a later date. Or so I thought.

My wife joined me for the education classes, and neither of us knew what to expect. We thought that we’d be in class with other diabetes newbies, and that I’d be one of the older Type 1s in the room. Nope. The other students were years into their lives with diabetes—several of them were in their 50s and 60s. For the most part, they were in class to get a pump—they needed to refamiliarize themselves with proper self-management and gain a greater understanding of what was involved in pumping insulin before their health-care teams would put them on a pump.

The first three classes were relatively pump-talk-free, however. The certified diabetes educator (C.D.E.) and the nine or ten students spent three weeks going over diet, how to accurately count carbohydrates, adjust insulin ratios, what the complications of diabetes are, how to avoid those complications, as well as what the differences were among the myriad diabetes drugs and insulins. We also skimmed the surface of the many, many theories about how to live well with diabetes. The CDE also gave over a pretty decent amount of time to answering questions—there are no stupid questions, right?—and to correcting many diabetes misconceptions.

The instructors were vigilant about postponing insulin pump discussion until the final week of class (because we all know that pumping is only part of managing diabetes well). At least, they tried. But they soon capitulated to the pump buzz and answered questions and even participated in pump discussions. People were excited about getting an insulin pump, and it was an excitement I found contagious.

My first impression was that an insulin pump would make living with diabetes simple. Not really. While a pump has numerous benefits, we were assured that pumping was not a set-it-and-forget-it kind of thing. An insulin pump, I soon learned, requires a keen understanding of self and of self-management—that is, if you hope to gain a greater level of control. You monitor your blood glucose just as often—if not more—than you might with injections. And, as always, there’s that annoying diabetes blood-glucose paradox: As you obtain lower blood glucose levels and strive to lower your HbA1c another percentage point or tenth of a percentage point, you invite the potential for hypoglycemia to creep closer and closer to your doorstep.

You have to be on your diabetes game with an insulin pump.

By the fourth week and the last class—which focused solely on insulin pumping—I had become more than intrigued by my fellow students’ coffee-break discussions about insulin pumps, by the CDE’s answers to the pump questions, and by the endless bragging by the oldest member of the class (who’d recently acquired his pump and couldn’t refrain from showing off his new toy). During the final session, the CDE brought out a box of pumps for us to look at and play with, four or five different brands, along with infusion sets, vials of insulin (filled with distilled water for demonstration’s sake), and the glossy marketing folders the pump manufacturers dole out like candy in hopes of luring you to pick theirs.

I love gadgets, and here was this multithousand-dollar, cell-phone-sized piece of rather amazing technology that could, in effect, be my pancreas. As a newcomer to Type 1 diabetes, and as someone who didn’t have any complications yet, I wanted to achieve tighter control, wanted to get my hands on the best possible care I could. A pump seemed like one of the tools that could help me accomplish that—and as a bonus, it could also relieve me of having to take four injections a day as well as give me more freedom in when I ate my meals and whether or not I slept in on weekends. An insulin pump came with a tidy laundry list of many of the little freedoms a person with diabetes can regain.

So after only a month with diabetes, I decided I wanted to start pumping. But I was a bit naïve. I thought getting a pump would be easy. I want a pump, so all I have to do is tell my doctor and they order the pump and I go on a pump. Simple, right? Wrong. Even if you’ve had diabetes for years, deciding to go on an insulin pump is not like running to the drug store to buy a bottle of aspirin. There are many hurdles, and I had to make it over quite a few of them.

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