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Dr. Bill's Commentaries

Half a year on a pump   (December 28, 2008)

As readers may recall, I started using a Cozmo insulin pump last summer, now over half a year ago. It took me a while to make the decision to get a pump, but the obvious question after half-a-year is: "Was it worth it?" I can list some pro's and con's, but the simple answer for me is "yes, it's worth it."

Pro's of pumping:

  • Best ever A1C. I held off on getting my every-3-month A1C after getting one just before starting the pump, knowing that there would be an adjustment period where my blood glucose (BG) would be screwy. (It had been 6.0 just before starting pumping.) I just heard the results of my mid-December A1C: down from 6.0 before pumping to 5.7 now.
  • No more forgotten meal-time boluses. The pump is set to beep and nag me if I don't give boluses sometime within a two-hour window surrounding my usual meal times.
  • Easy to check BG. The Cozmo pump system includes an attached Freestyle meter (cutely called CoZmonitor - yeah, that's a capitaliZed "Z" in the middle of the name), so the meter is always with me. And the pump can be set to beep and nag me if I don't test within a certain number of hours after giving a bolus, which was very helpful when first learning the intricacies of pumping. I've now turned this warning off, but the pump still nags me to check my BG under certain circumstances: for instance, it beeps to remind me to recheck ½ hour after having a low BG.
  • Calculated correction boluses. If I recheck 4 hours after a meal, and the BG is higher than I want, the pump offers the choice of giving a calculated correction bolus. For example, if the BG were 135, and I've preset the pump that I want to be at 85, it will suggest exactly how many units of insulin would be needed to bring it down. Of course, there is some guesswork initially in setting up the parameters, but the concept works.
  • Temporary rates. The idea that I can instantly change the basal rate to something different has proven helpful in one circumstance: if I'm low, I can "dial back" the amount of insulin that will be delivered. And if I'm nearly low, say, 78, that's probably all I need to do - I won't have to eat extra calories to prevent the BG from crashing lower.
  • Alternate basal rate patterns. I could (but haven't) set up a different pattern for weekends. But I did set up an alternate basal rate pattern for days we are out on the sailboat: the increased exercise of scrambling all over the boat when sailing inevitably caused lows, until I started pumping and established an alternate basal rate for boat days.
  • Small enough that it doesn't set off alarms at airport security. The first few times I flew after starting the pump, I wondered if I was lucky or the detectors were broken, but it's routine now: I simply show the screeners that I'm hooked to an insulin pump, and they wave me through the metal detectors. So far, the pump has not set off the security alarms in multiple large and small airports.
  • No meal planning needed. My only restrictions on eating were to completely quit alcohol for the first month while sorting out insulin doses, and I (as always) use low-calorie sugar substitutes and sugar-free soda pop. Note: I still have to count every carb: see below.
  • Easy to give multiple boluses. With the pump, if I'll be eating a prolonged meal (e.g., appetizer first at a restaurant then a long pause before the main course finally arrives), I'll give a bolus to cover the appetizer, and a second bolus later for the main course.

Con's of pumping:

  • It's expensive. Every three days, when I change the pump tubing and the insulin cartridge, and throw away the various wrappers and old supplies, I'm reminded that the costs of pumping are awesome.
  • You must pay scrupulous attention to what you eat. I stated under the pro's that I'm not doing any meal planning, but I do count every carb, and estimate how much insulin I'll need to give to "cover" that amount of carb. I did this with my previous basal-bolus program using an insulin pen, so it's not much different. But it is a hassle to try to eat, share the mealtime conversation, and simultaneously keeping track of how much insulin to be given to cover the carb. BTW, I almost always give my mealtime insulin bolus after eating, rather than giving a dose first.
  • Too many features. That's said somewhat facetiously, as I've picked some of the features the pump can provide, and ignored others. But I sometimes wonder: if I turned on another of the zillions of options that the pump is programmed to be able to provide, would I make life easier, or more difficult?
  • You still can go low. There's nothing magic about pumping that brings BG down to normal and stops there. If you O.D. on insulin, you will go low. Or if you exercise unexpectedly and don't adjust your insulin and eat sufficiently.
  • You have a continuous reminder that you have diabetes. Carrying a device like this means you can't "tune out" your brain for more than a few hours. I now carry not only the pump, but a fingersticker and BG strips everywhere, and if gone from the house for more than a few hours, my entire spare-parts kit.

Was it worth it? For me, yes -- but it was (and still is) a lot of work.

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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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