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November 29, 2007

Why I Am Going on the Insulin Pump

Bakc when I first got diagnosed with diabetes---and this is twenty-five years ago now---I took two injections with a syringe a day, at the same time every day, got up at the same time every day, peed into a plastic tub and tested it at the same time every day, wrote that down, ate the same amount of food at the same times every day, went to bed ... yeah, you get the picture.

Back then, there were no home blood testing kits, so we had to check urine, which could tell you what your blood sugar levels were an hour or two ago, but not right that second. So I wrote down my urine test results (about five a day) and took them to the doctor every three months, who looked at the overall picture of when my blood sugar was high and when low, and adjusted my 24-hour-7-days-a-week schedule to try to even it out more. Sometimes I'd have to take more, or less, insulin for a few months, or take it at a slightly different time.

If my blood sugar went up back then, I just had to wait for it to come back down. If it didn't, eventually I'd have to call the doctor.

Nowadays, this type of treatment is mostly not used anymore, because it's so inflexible, and wears on the body. The goal is to get your treatment to mirror a healthy body's self-regulation as much as possible. So you test your blood sugar throughout the day to see where you are, and you "correct" your blood sugar values by taking insulin if it's too high, or taking sugar if it's too low. There's a science to it: a certain number of units of insulin will manage a certain value of milligrams per deciliter (I think) of sugar in your bloodstream; and a certain amount of sugar will bring your low bloodsugar level (mg/Dl) back up a certain number of points.

There's an art to it, too. If you've exercised, your insulin will be more effective so you'll want to take less. If you're sick, or PMSing, or just tired, or even just stressed out, your insulin might be less effective so you'll have to take more. The kinds of foods you eat affect how much insulin you'll need to take and whether you want to take it all right away; with some complex carbs it's better (for me) to take some insulin before the meal and some after, because it takes the body so long to digest the food.

Point is, you control the whole thing yourself now, not your doctor.

This is now possible because: a) we can test our blood sugar and know where it is right this second, and b) we now have artificial insulins that can work much faster than the more naturally produced insulins I used to have to take. When I was first diagnosed, I took cow insulin. Those allergic to cow took pig insulin. You can probably imagine how much this did NOT mirror a healthy body's self-regulation. It wasn't until my college years that human insulin could be reproduced. A few years later they came out with Humalog, a human analog product that starts working much faster.

So the treatment I'm on now, and have been on for far too long, involves taking a basal insulin, a long-acting type of insulin that releases in my body over the course of 24 hours so that I always have insulin working, and then taking bolus insulin, a short acting type of insulin that responds immediately, so that I can take it right before I eat, or when I've discovered that my blood sugar is too high. The bolus I take with a pen, which is an injection device that looks and works a lot like a pen, only with a syringe cap instead of a nib, and an insulin instead of an ink cartridge. You can carry this around easily and shoot up in front of other people without them noticing half the time.

But the treatment is still vulnerable to human error ... or in my case, human laziness. If you don't FEEL like getting up to go take a blood test or take your shot, then sometimes you don't. Or sometimes you just get it wrong.

The pump takes a lot of that error away. Like the body, the pump's basal insulin output is done with the same sort of short-acting insulin that the bolus output is made with. But the pump gives you a little basal insulin every hour or half hour. You program it to give you the right amounts. Then, when you eat, you type in a bolus and it gives it to you right away.

It's a little hard to understand why this is better without knowing all the ins and outs of diabetic treatments, and I'm not gonna bore you further. Suffice it to say: it's a LOT better because it gives you more control.

The rub? You have to wear a hypodermic tube at all times so that the insulin gets delivered into your body. I could have gotten a pump ten or twelve years ago, but it's taken me this long to get over the psychological block against wearing a disease machine sticking out of my body. I'm over it now, but it's still pretty trippy.

Anyway, I'm set to get a pump before the year is out. We'll see how it works out.


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I'm scaring the wits out of myself by looking at photos of other people's intrathecal baclofen pumps which is what people with what I've got end up with. It's like a giant hockey puck outlined on your belly. I was thinking what would make it cool is to sculpt it to look like this shape but smaller... so the outline would stick out. Why they don't think of these great adaptation of medical implants, I can't imagine!

yeah, the insulin pumps started out as implants, if i remember correctly. someone told me about buttons you press THROUGH your skin. but i might just be imagining the whole thing, the pumps were such an object of disgust to me back then.

why are the intrathecal baclofen pumps (such a cool term!) implants? that seems radical, if you can achieve the same thing with an external pump.

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