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Dr. Bill's Commentaries

PS-Day plus 7   (June 23, 2008)

Last week, I started using an insulin pump (see I'm pumped). And this morning, "PS-Day plus 7" (Pump-Start Day plus 7),  I got the obvious question, from my wife Steph, at the breakfast table: "How do you like it?"

A short question, but I'll give a long answer.

1) It nags me to spend money poking holes in my fingers: "Check blood glucose. It has been 2 hours since your last bolus..." I've clearly spent more time and money poking holes in my fingers than any other week since I was diagnosed. The device's history says I've been doing 9.4 tests/day. No wonder my fingertips are sore...

2) It supplies tons of data, some of which is very helpful (my BG average this past week has been 112; my basal insulin has been 36.64% of my total daily dose [TDD]), and some of which is pseudo-precise (my basal has been about a third of my TDD; I doubt if anyone really cares to know that their basal was 36.64% rather than 37%).

3) There are some software features I'll never use, and some that I can't find. And some I use all the time, that are buried several clicks away. Just like Microsoft Windows.

4) I like the longer tubing (31") much better than the shorter (24"). The extra length makes it easy to stick the pump into my shirt pocket. And safely drive (see below).

5) Everyone knows that there are adjustment problems on how to sleep with a pump, how to shower, etc., but one that I hadn't thought of, but was important to figure out: where to locate the tubing and the pump when using a car's shoulder harness/seat belt combination. Once or twice, I think I had things so poorly arranged so that, had there been an accident, my pump and I surely would have become disconnected from each other. I think I've worked out a solution, and it was much easier with the longer tubing to make sure the shoulder belt wasn't crimping the tubing, and that I and the pump would both continue to function if an accident occurred.

6) After wandering around three computer/cell phone stores, I finally found a clip-on case for the pump that I like: it's got a totally clear soft-plastic window in front, so I can press buttons on the pump right through the case, and it has a clip in back that's not poking me in the ribs when clipped to my belt, as did the original case from the pump company.

7) One thing that hasn't happened to me, but surely happens to most new users sooner or later: Things get so screwed up that you feel despondent, and wonder why you ever made the decision to go onto a pump.

Yes, I've screwed things up a little bit (for example, wasting a whole bunch of supplies when trying to refill the pump with a new insulin cartridge the first time), but to date, most of the issues I've encountered have been related to choosing how much insulin to give for a meal - and what the effect will be on subsequent BG levels - it's clearly different with a pump than with basal Lantus on board. I know that the average user would have been on the phone with their diabetes nurse or diabetes doc a whole bunch of times to sort things out, but so far, so good, on reasoning out what to do without calling for help. (Yes, I did fax a bunch of the data to my endo after a few days on the pump, so he's aware that I did indeed stick with it.)

8) One interesting, and very encouraging finding this past week: no hypoglycemic symptoms. My lowest BG was 77, and that isn't because I deliberately stayed excessively high. It was more because whenever I noticed that I was trending lower (e.g., in the low 80's), I could turn down the delivery of the basal insulin - something that simply can't be done with Lantus or other basal insulin products. This new ability to avoid lows is a large part of the reason that I was finally persuaded to start pumping, and it's an amazing difference from giving shots.

So, in brief, to answer Steph's question ("How do you like it?"), the simple answer is "Very much."

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Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.

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