Pumping

I started pumping on January 12th. (Look! It's pink!) A week and a half ago. So why haven't I blogged about it since then? Well, frankly, I'm still not sure what I think about it. For those who don't know, I have been on an insulin pump before. And it and I didn't get along so well. I started pumping in 1996 and it was one of the first old-school Disetronic pumps. It lasted for about 5 years but in late 2000, early 2001 I had gotten completely sick of (and jaded by) the pump and desperately needed a break from it. I switched back to shots, thinking it would be temporary, but loved the change and felt like I had been freed! I've been on MDI's (multiple daily injections) ever since with A1C's in the mid-low 6's and had no desire to change!

A lot of people who know anything about diabetes were pretty surprised when they realized that I wasn't on the pump. I tell them my A1C and they tend to zip it. But truly, it's the in thing to do, thought of as the top-of-the-line way to manage Type 1 diabetes. The only way, according to some. And, at first, I loved mine as much as everyone else seemed to love theirs. It took my A1C's from being in the high 7's and low 8's to being 6.2 after the first 3 months out!! But over time my A1C's started to slip again. They weren't as bad as they had been but they settled back into the low to mid 7's and didn't budge.

And I knew why. I was a teenager and hated my diabetes. I used my pump as a quick fix. I'd be noshing on something at a party, take out the pump, beep-beep-beep, and think "OK, that'll do it." Not really counting my carbs. Not really paying attention to my boluses. Doing just enough so I'd feel ok and be able to put the pump away and forget about my diabetes again. I'd like to say that I'd matured by the time I was in college. Saw the big picture about my diabetes and wanted to take control again. But if it were just that I could have stayed on the pump. (That maturity came eventually, but it was later when I was in nursing school.)

No, by that time, I was just friggin' sick of the thing. The sites were huge and painful to put in (no inserters back in the day and all the sites went in at a 45-degree angle . . yuck!). And, as a result, I did it as little as possible, leaving sites in until they were practically falling out (5-ish days or so on average, sometimes longer). Usually by the time I'd change it, my old site would be red and puffy and leaky. I even had a nasty infection once. Unfortunately that didn't deter my laziness. On top of that, the whole set change was an obnoxious process that, again, I hated doing. So it seemed like I would put it off and put it off until, of course, I'd get an "empty cartridge" alarm at a most inconvenient time.

And speaking of alarms, OMG! It seemed like every other second that thing would alarm about something or other. "Low Batt." "Low Cartridge." Or the dreaded "Occlusion" alarm. Looking back, I'm sure I got those all the time because my sites were awful but at the time, I only focused on how annoying it was. It seems like there was always a part to the pump that could break, get empty or need replacing at any given time!! Tubing, cartridge, battery, insulin, site, etc, etc . . . . And that's whole lot of crap to carry around all the time "just in case."

Not to mention having that damn thing attached to me all the time! As a girl, I maintain my right to be indecisive about my outfits. Well, it's quite annoying to have something attached to you when you are walking around naked or mostly naked, trying to figure out what to wear. And I remember always having to stand close to the bed, dresser, nightstand, etc so that I had something to hold my pump. And when I say "close" I mean within 23 inches, because that's how long my tubing was (and is). Um, don't know about all the other ladies out there, but sometimes I have to bend over, or flail or kick a knee out to get into something and it doesn't always allow for me to be within 23 inches of a piece of friggin' furniture!! And then of course the pump drops off of whatever is holding it and tugs on the site or maybe even yanks it out! Ugh.

Alright, that's enough kvetching. Can you tell that I was just so very over it? I really liked not being attached to anything, not having alarms and the comfort of knowing that as long as I had at least one syringe and a bottle of insulin, I was good to go. Plus, after those ridiculously huge needles I was using for my sites, the little syringe needles felt like nuthin' going in!

But here I am on the pump again, on the advice of my MD (re: pregnancy planning). The first couple of days I felt like total crap! My sugars ran the gamut from the high 200's to a shaky, weak-knee'd low of 30 in the middle of the night. I hated going from knowing exactly what to do to fix a low or a high or how much to bolus for a meal. . . . to not having one freaking clue. Do I change my basal or my carb ratio? If I change my basal which hours do I change? Sure, I could make a well-educated guess, but who know if it'd work? All this trial and error while my sugars are just standing there laughing at me. And I feel awful when I'm out of range so I spent several days feeling like crap never knowing what my blood sugar was going to do. And the whole being attached to something thing was driving be batty again. I was hoping since it took so many years to get on my nerves the first time, it wouldn't be so bad to start out with. Uh, no.

But, to my utter shock and amazement, I've kinda gotten used to it. It took about 3 or 4 days but my blood sugars started settling down and I'm slowly finding ways around being annoyed by the pump being attached all the time. And, can I just say, how much, much, much more comfortable the sites are now? Holy geez? Back in the day, my sites would itch and sting and drive me nuts, even when they were new! But I can barely even feel these new sites! Big improvement. Also, the first few days I had no clue how to wear my pump when I was in PJs. I mean I don't have PJ's with pockets so where do I put it? My Disetronic used to have a clip built into the back of it but it didn't really hold on to anything, so I never used it. I gave the snap-on Animas clip a try on my 2nd or 3rd night with the pump and it works like a charm!! Plus this thing has way better software, love the meter remote (seriously, love it!) and it's super cute!

There are still things that annoy me about it but it's much more bearable than I thought it would be. Overall I'm getting happier with it by the day. I'm still not sure if I'll stay on it after the pregnancy is over but we'll see. I also have a few more things that I need to adjust to with the pump and a few more hurdles to deal with. I'd love some advice from anyone in the DOC on pumping. I'm sure you guys have figured all this stuff out and I'd love to skip all the trial and error!

Things I'm still trying to get used to:

1. Wearing a dress or a nightgown. I haven't even tried this yet because I have no clue where I'd put the pump. I don't own any of those pump-wear products and don't really love the idea of spending all that money on them. The Animas has a remote control meter so I guess I could put it in my bra since I won't have to go digging it out when I need to bolus. But I'm not so sure how it would hold?? Any advice??
2. What to do when I'm naked?!? I know this is a weird subject but seriously when there is nothing to clip the pump to, what's the easiest thing to do with it? Do you just hold it? (Thing is, I really don't like only having one hand to work with when trying to get dressed . . . ) Disconnect it? Let it drag on the ground?
3. Do you always trust the "insulin-on-board" feature? Sometimes I think that it's giving the IOB way too much credit and not recommending a high enough bolus for my blood sugar. Sometimes I'm right and I need to bolus over and over again to get my sugar to come down and sometimes I'm wrong and it works fine based on the math done by the pump. It's weird for me to let it do all the math for me, though. It's nice in some ways but I'm just so used to guessing my own "IOB" that I don't know that I always agree with the pump. What about you?
4. Where to put sites? Back in the day it was mostly abdomen and occasionally flank. Now I'm rotating between abdomen and flank about 50/50. But I know that it's become more popular to rotate them to arms, legs, etc. And I'd love to try my arm but are there any issues with tubing length or getting tangled in clothes etc when you use the arm/leg sites?
5. Last one! Sleeping. I keep waking up because the pump is all tangled around me or I've rolled over on to it and it's uncomfortable. Any suggestions?
   

I'm sure I'll think of more questions, but I think that's it for now. Thanks for listening to my rant and thanks in advance for any advice!

~Layne