Priming the (Insulin) Pump (Part 5)

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Finally! This week, Eric attaches his insulin pump. This entry finds Eric spending an hour with the certified diabetes educator (C.D.E.) as he learns what to do for his first infusion. If you want to read entries 1, 2, 3, and 4 in this series, you’re more than welcome to.

I had to wait about ten days between getting my insulin pump in the mail and my appointment at the diabetes clinic with the C.D.E. I was not to attach the pump until my appointment. For the first few days after I received my Deltec Cozmo pump, I played with all of the settings, knowing that I couldn’t screw anything up. I used distilled water in the syringe and experimented with basal rates and with giving boluses, as well as with how to load the pump. It’s pretty simple: (1) load, (2) fill cartridge, (3) fill cannula, (4) set reminder.

The night before my appointment, I was instructed to give myself only half a dose of Lantus (insulin glargine) so that by the time of my appointment/attachment in the afternoon I’d be ready for the basal dose that the pump would administer. There is no long-acting insulin with a pump, only the basal dose delivered throughout the hour—using the same fast-acting insulin that is used for your bolus.

Linda, my C.D.E., didn’t think it’d take the entire hour we had scheduled for my pump attachment, and she was right (it ended up taking about 45 minutes, though). Kathryn, my wife, accompanied me to the attaching. We set the pump’s basal rate, which for me at that point was 0.3 units per hour, and we also set my insulin-to-grams-of-carbohydrate ratio at 1:20. (Three months later, my basal has kicked up a few tenths per hour, and my insulin-to-carbohydrate ratio is now 1:16 and changing every few weeks as my pancreas gets over its “honeymoon.”)

Once the pump was programmed, I learned how to load it with insulin and how to attach the infusion set to my body. The steps for loading and attachment do not—for the most part—need to be done in any particular order. Maybe you choose to clean your site with antiseptic and attach (or “shoot” or “stick”) your infusion set to your body first. Or maybe you get the vial of insulin out and assemble the cartridge, stick the needle into the vial, draw up your insulin, attach the infusion tubing, load it into the pump, and then fill the tubing and the cannula. Maybe you mix it up. It doesn’t matter. The thing that does matter is that the initial overwhelming confusion of it all becomes old hat after three or four site changes. (It’s recommend that you change your site every three days, although regarding changing your cartridge, the verdict is out from what I’ve heard; some people will use up all of their insulin, while others replace their insulin every time they change sites).

Pretty soon, most of my other questions were answered.

Would I need to shave my abdomen or other hairy places where the infusion set would attach? (And by the way, the abdominal region and around the love-handle side is the only area where I do attach.) No.

If I missed changing the site by a day or so, would the site get infected and would bad things happen? No.

Would the tubing, which seemed incredibly long and unwieldy at first, crimp up and stop infusing? No, rarely.

Would it rip or break? No.

Would it get caught on things, in things, around things? Yes. On cabinet knobs, chairs, toilet paper rolls, seat belts, belts, and any number of things that can snag errant extra tubing when it falls out of your pocket or pump holder. Oh, and pets, too. It hasn’t happened to me, but I’ve met people whose dogs’ paws have gotten caught in their tubing, or whose cats have pawed at or chewed through tubing. Yep. That happens.

How would I keep my pump, the pump itself, with me? Timbuk2 cell phone holder (green, medium), because it’s got Velcro and it’s quick. The insulin pump holder that came with the pump was too hard and painful and wore like a poorly designed cell phone holder. The Timbuk2 is soft and it’s made pulling the pump out so much nicer.

Would I get used to going to the bathroom with the pump? Yes. And it’s then that I realized why the infusion tubing was as long as it was. If the pump’s on your belt, just spend a moment thinking about the logistics if the tubing reached only from your infusion site to the belt.

Would it kill me to take the pump off when I took a bath for 30 minutes? No.

What would happen when I slept? Not much. The pump sits in my shorts pocket, or falls out beside me. It’s no big deal for me. The only problem is when I forget the insulin pump is beside me on the couch or in the bed—when I get up and walk away and it stays behind until the tubing reaches its stretchy limit and, like a stubborn cartoon character, rubber-band slingshots at my leg. Which hurts.

In short, making the transition to the pump at first seemed like a big deal. In truth, it probably was. Yes, I mean was. The pump is a great step forward in my self-management. But my worries? The transition was much easier than I thought. For the first few weeks, I thought maybe the injections weren’t so bad. The pump was so obvious, so there. Now, though, I look back on injections and the constraints that having to inject insulin placed on me with mealtimes, sleep habits, exercise, and uncertainty with blood glucose numbers. I would be incredibly reluctant to return to four-a-day injections.

Two days after attaching the pump, my wife and I traveled to Toronto for a short midsummer vacation. I’d worried that I’d have too many difficulties, but in truth, even at that brand-new stage in my life with diabetes, it wasn’t so hard. I was careful about my carbohydrate intake and just checked my blood glucose an awful lot, and the pump motored along quietly and smoothly without complication.

Oh. One more thing: Am I tired of writing about my insulin pump yet? Not necessarily. But you guys tell me: Are you interested in continuing to read about what it’s like for me and the transition to my pump? There are any number of diabetes-related things going on in my life week by week about which I could choose to write, and no doubt wearing a pump would be a part of it. I’m curious, though, if those of you who were commenting early on are still reading, or if you’re sorta kinda blah about the pump stuff. I would guess that if you already have an insulin pump, reading through this series may be less than captivating.

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