Learning to live with an insulin pump – by Tom Startup
The rays of the morning sun, filtered through the blinds, caress my face. My eyes flicker open and I turn to look at the alarm clock: 8:27 am. “Ah, a lie-in” I think. For a few lovely moments, I close my eyes again and savour the bliss of a silent house. My five-year-old son George normally wakes up to go the toilet at 6.30am, so this really is a lie-in for us. And it’s especially delicious since I no longer have to get up to inject my long-acting insulin.
In the past, I always found that by the morning my Levemir would be running out, and if I lay in, my blood sugars would end up in double figures. But now, my trusty little pump makes sure there’s no insulin drought. I sit on the edge of the bed and test: 7.8. For me, that’s a pretty good start to the day.
I’ve been using an insulin pump – the Medtronic 640G – for five months now and after some initial wobbles, it’s gradually becoming part of my life. At breakfast, I sit down to scrambled eggs and toast; I enter the carbs into the pump, and it automatically calculates my bolus, I press another button and whoosh, I’m done. Not having to get the pen out, put a needle on and stick it into whatever part of my body feels least like a pin cushion that day is a great relief.
Bolusing with a pump feels more like sending my body a text
Later that morning I’m at a friend’s birthday party with George, and there are some sandwiches and cake for the adults. I feel peckish so snaffle a couple. I pull the pump out of my pocket and bolus. I am much less self-conscious about this than I would have been injecting in public. Injections always felt to me like a medical procedure, whereas bolusing with the pump feels more like sending my body a text. In an era when most of us are permanently on our phones anyway, fiddling with another electronic device is no big deal.
At lunch time, I test and I’m high: 11.2. I must have had a bit more cake than I realised. No problem, the pump automatically calculates my correction dose, click, click, and I’m done. Then I remember that I’m going swimming later on, so I set a temporary bolus of 60%. My insulin needs vary a lot depending on exercise, stress and so on. On injections, this meant that if I went for a walk I’d have to snack or otherwise I’d have a hypo. Now I can reduce my basal for a few hours then have it revert to normal. My blood sugars are more stable and my Hba1c has come down from 57 to 51 mmol/mol, which is very pleasing.
Before I swim, I test again: 8.8. I undress and unplug the pump, but the cannula, the white plastic needle inserted into my mid-riff, has to stay on. I put on my trunks and stop to look at myself in the mirror. A man passes and looks at the cannula – or perhaps I imagined it? To the casual eye it probably just looks like a plaster, but to me the sense of being an inpatient who has wandered off the hospital ward is never far away. Having a pump means always being attached to something.
I forget about the cannula and muck around in the pool with Sarah and the kids, but then I notice that over an hour has passed. Because the insulin pump provides my basal by dripping in short-acting insulin (Novorapid), I can only remove the pump for up to an hour, otherwise I risk having insufficient insulin and hyperglycemia. While I leave for the changing rooms I can hear the echoes of their laughter from the pool. “Where’s Daddy going?” I hear George ask.
Pocket-sized life support machine
Later that evening, exhausted, I get ready for bed. Undressing, I hold the pump in one hand, while I remove my clothes awkwardly with the other. Initially, I found sleeping with the pump very difficult. To start with I placed the pump next to me in bed, like some bizarre high-tech foetus attached to the umbilical cord of my tubing. But I move so much in the night that I would frequently become tied up in the tubing, lie on the pump, or push it out of bed so that it swung from the mattress in what one of my diabuddies has memorably called “the swinging pendulum of death”. The best option has been to clip it onto my pyjama bottoms. That means I can’t sleep on my front, but I’ve gradually got used to that.
Before I nod off I reflect on the last five months, and it strikes me that the hardest thing has been how it has affected my feelings about my body and diabetes. When I was on injections most of the time I felt, and looked physically the same as everyone else. This allowed me to live in a state of partial denial about my condition: I knew I had it but could pretend I didn’t for much of the time.
But now I am on the pump, it is a constant physical reminder that something in my body is broken. Whenever I undress, there it is, hanging off me like a pocket-sized life support machine (for that is exactly what it is). In effect, it’s pushed my condition, previously skulking in the dark, into the light (something Rebekah Wolkind expresses well here). Ultimately, I think this will help me (and those around me) towards a more accepting and compassionate view of my diabetes. But it’s a slow, and sometimes painful, process of adjustment.
Before I went on the pump, the nurse said to me “You can go back on injections anytime if you don’t like it.” Then she added: “But no one ever does.” I haven’t thrown away my pens just yet, but they are starting to gather dust.
Find out more about Type 1 blood sugar targets for adults with Type 1 diabetes.
Tom Startup is a writer who lives in London and tweets about his condition at @type1_tiger