Starting to see the pumping light – by Helen May
Two weeks in. I still don’t like the look of my pump and would like to chisel out a pump shaped hole in my chest to hide it in. However, I am starting to think there may be some value in a pump over injecting.
When I first started to hear about insulin pumps, I couldn’t understand why it would be any better. I wondered whether the better diabetes control came as a result of more attention from the diabetes consultants and nurses. It was the Diabetes Blog readership who helped me to see the light when I wrote a post in Defence of My Trusty Pen. I finally understood that a pump would allow me to vary my basal.
This ability to vary my basal insulin was the Unique Selling Point of the pump. Before I pumped, I took Lantas once a day as my basal insulin. The purpose of this was to “mop up” the background glucose and had an activity profile of approximately a straight line over 24 hours: it assumed that my background glucose was constant throughout the day regardless of how much exercise I did or how much stress I was under or how ill I was.
In reality, my basal insulin need goes up and down during a “normal day”. For example, I need more insulin at night when I am inactive (apparently “stealing the duvet” is not counted as an activity).
But the true variation is seen when I exercise. If I do a long activity such as a 10 mile walk, I need less insulin. If I do short repetitive activities such as weights, I need more insulin at the time but less insulin afterwards (probably because I’ve used up my “glucagen stores”). With Lantas, I had to manage this by a top up bolus to reduce my BG close to (but not at) hypo levels and eating more afterwards (when I was too tired).
Last week, I took my pump with me to the climbing centre. (I didn’t have much choice since it is attached to me.) Usually, after about 90 minutes of climbing, after I have warmed up and tried a couple of difficult routes, my energy levels start to drop. I need to take a break, a BG reading (which is always very high) and more insulin. But even after the break, I struggle to challenge myself on scary or steep or sparse climbs. Then, once, I get home at just after 10pm, my BG starts to fall. Or rather, my BG starts to plummet and I often hypo before I go to bed or during the night.
Last week, I took advantage of the functions on the pump and temporarily increased my basal by 30% to compensate for the expected BG rise. After 90 minutes, I stopped for a break only because my climbing partners wanted a cup of tea: I could have climbed for longer. My BG was higher than I would have liked but less than it usually is at that point. So I took an insulin top up, drank my tea and started again with some routes that I am usually make me nervous. I completed them with only a little bit of nervousness. When I finished my BG was heading downhill so I had to chomp on a couple of Glucotabs. But I could reduce my basal for the night to ensure I didn’t hypo.
This was my first climbing attempt on a pump and it needs a little adjustment to minimise the high BG in the middle and low BG at the end, but it shows me that there is some value in being attached.
Next week, I am flying to Philadelphia for work. This will be another pump challenge and I will update you on how I cope with a different regime, time difference and airport security whilst on the pump.