How often do you change? – by Helen May

Helen-May-letterbox-150x150Andy’s blog about his research into his next pump was very interesting. His conclusion was interesting. And so, too, were his criteria for the decision-making. They were interesting because they were different to mine. I have written before about my frustration with the size and look of my pump: although I know it keeps me alive, I would rather my lifesaver was not so obvious – maybe I’m vain or maybe working in IT has made me more aware of smaller technology and more elegant user interfaces.

But I digress. Today, I wanted to write about the size of the vial. Andy mentioned that he wanted a vial that was large enough to last for three or four or, ahem, fives days. What this equates to in respect of the volume of the vial is dependent on individual requirements: how many carbohydrates do you eat each day and how sensitive are you to insulin?

Although I don’t keep close tabs on my daily carb intake, I know I am certainly not on a low carb diet. Whilst, working from home gives me the opportunity to eat something apart from sandwiches for lunch every day, my breakfast is always yoghurt and fruit and I enjoy pasta once or twice a week. However, I am sensitive to insulin, especially when I have been exercising so my basal insulin is relatively low.

My motivation for changing my pump set is a combination of Convenience and Necessity.

Convenience is a consideration for me because I am concerned I may make a mistake: my canular may not have gone in straight, the tube may not be correctly attached to the vial, I may forget to prime the pump correctly. If this happens, I want to be in a situation where it is easy to make a correction. I do not want to be driving, on a busy train, in a meeting, at the climbing wall or asleep (or just woken by a beeping pump). So I plan ahead to ensure I am will be in a situation where I am able to make another change two hours later.

Often it is necessary for me to change my pump. No matter what barrier creams I use, the adhesive on the canular can start to itch. Although I use inset 30s which go in at an angle (I assume of 30 degrees), sometimes, I can feel it in my stomach, especially when receiving insulin. I assume this is when the canular has gone in straighter (at more than 30 degrees, maybe). If the adhesive starts to itch or the canular gets uncomfortable, it is necessary for me to change my set again.

Typically, I last two days between set changes. I try to organise myself so that this is after I shower on a day when I am working from home. There is a risk that I could be on a conference call when I notice a problem, but I can make my excuses or continue the call (it’s surprising what you can do when no one can see … I have been known to paint my toenails). Occasionally, if I know I am going to be travelling, I make the set last a little longer. I may delay the set change until the evening or even for another day. Three days has been my longest.

I don’t enjoy the set changes – they are probably one of the biggest downsides to having a pump, but as a result of my carb intake, insulin sensitivity and itchiness, I use less than half a full vial of insulin between changes. So back to Andy’s requirements, if I could choose, I would look for a pump with a vial as small as possible.

In the near ideal world (in an ideal world, diabetes would not exist), I would like to change my pump set as rarely as possible. But I would also like my pump to be as small as possible. I have read about some ongoing research to make the insulin more concentrated so, perhaps, this requirement will be possible soon … as long I can find a non-itchy adhesive and learn to constantly insert my canular at the optimum angle.

Back to the title of this post – how often do you change? Is it normal to extend the time between set changes? Am I overly worried about planning to fix mistakes (it has only happened once in the nine months since I got a pump)? Does anyone have any suggestions to stop the adhesive itching?

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