A decision to pump insulin paved the road back to good health.
January 2008 — Ever been to Wit's End? Not a good place to go on holiday. They have a lousy band playing in the bar area. No umbrellas in your frozen drinks. And the traveling to get there is filled with layovers and delays.
In 1999, I ended up at my Wit's End, after months of adjusting insulin dosages, mind-scrambling hypoglycemic episodes, and two trips to the ER. During an endo appointment, I broke down and cried, hiccupping out: "I'm doing everything that you've told me. Look at all the logs and charts! Why can't I get my A1C down any more? What else can I do?"
My medical team and I had been working diligently to bring my blood sugars down to an acceptable range. Bringing them down meant everything else went up: the number of shots per day, the number of finger sticks, my stress level, and the number of times I frantically shoved glucose tabs into my mouth, hoping I wouldn't pass out. Nothing worked. My diabetes management, already a full-time job, was sending me on a vacation to Wit's End, and I hadn't packed a good book or suntan lotion.
What happened? I left my Wit's End, because I made the difficult decision to change my life by adding an insulin pump. Here is my road map of pros and cons - for those who are at their own Wit's End, perhaps this can help in your own decision making process.
Pros of Insulin Pumping
Freedom: If I don't feel like getting up at the same time every morning, it doesn't matter. If I want to delay lunch until 2pm, I won't crash and burn by noon. If I want to sleep late, I can. Having an insulin pump allows me this freedom. Why?
By having the correct basal rate (the continuous amount of insulin needed to maintain optimum blood glucose in the body) programmed into your pump, you can choose to eat (or not eat), and inputting your bolus rate (the amount given at meal times or to adjust for a higher blood sugar), the insulin pump acts like an artificial pancreas (with a little help from you).
Minor Adjustments: When I was on a multiple shot regimen, and my blood sugar climbed to over 200, what would happen? I would take a single unit of insulin. As you might imagine, sometimes that would be perfect, but often I would find myself treating a low blood sugar later on. With an insulin pump, adjustments become easier to manage. My pump allows me to take 0.1 units if I chose – and it calculates the amount I need to bring my blood sugar into my target range!
Better Overall Control: Not only can an insulin pump help to bring your blood sugars into an acceptable range, but it can actually help control (and even stave off) complications! The Diabetes Control and Complications Trial (DCCT) showed us the positive outcomes of tight control. For women who want to become pregnant, an insulin pump can be instrumental in a successful pregnancy. After I adjusted to being on a pump, I felt better on a daily basis. For me, that was the type of control I needed.
Cons of Insulin Pumping
The Physical Factor: Something is stuck to you 24/7. It's a physical manifestation of the disease. Even when you take off the actual pump, in most cases, you'll still have an insertion set attached. For me, this was a constant reminder that I had a chronic illness and not only was it a physical issue, it was an emotional one, too.
Nine years later, if I don't have the insulin pump on my body, I feel…naked. Like something is missing. Granted, the moments between insertion sets are liberating, but I breathe a sigh of relief when I plug myself back into my pump. It's as if it's become a part of me.
When Things Go Bad: If the pump malfunctions, an insertion set is pulled out, or the insertion site is infected, things can go from good to ER visit in a flash.
The pump holds only fast-acting insulin, so high blood sugars and even DKA (DKA (diabetic ketoacidosis)) can occur much faster than an a basal and bolus insulin injection regimen. I once had a pump malfunction at night, and didn't hear the alarm. I went to bed with a blood sugar of 120 and woke up with a 500. I've also had an insertion site become infected, which was treated by a round of powerful antibiotics, but has left me with a divot as a reminder to always check sites closely.
Someone on an insulin pump must be prepared at all times for the possibility that something can go wrong. I carry extra sets, extra batteries, extra insulin….you get the picture.
Severe Hypoglycemia: While pumping offers better control and can decrease the number of low blood sugars, it also increases the risk of severe hypoglycemic episodes. (Severe often means involving someone else to help the individual, glucagon administration, or ER visits.) Both times I have had glucagon administered; it was after I had begun pumping.
Insulin pump therapy requires vigilance and dedication, and often adjustments to delivery rates over time. This can help with these types of bad low blood sugar experiences.
Time and Money: Insulin pumps and supplies are expensive, and let's face it; we'll never have a "generic insulin pump" that we can buy at our local department store. The cost of research and better technology is passed to the patients, and we bear the cost. Even with health insurance, insulin pumping is much more expensive than traditional multiple shot regimens.
The cost of insulin pump therapy is not only measured in dollars, but in the time involved. If you're not serious about your health, committed to checking blood sugars, and communicating closely with your medical team, pumping is not for you. Some doctors will not prescribe pumps to individuals who don't meet certain criteria, and in many cases, while the patient would benefit from pump therapy, the medical team feels that the patient cannot handle the increased monitoring and adjusting needed.
My ticket out of Wit's End was the decision to begin insulin pump therapy, and I can truly say that pumping changed my life - for the better. It hasn't been easy, and there have been bumps and roadblocks along the way, but I've never looked back. Wit's End doesn't have much of a view.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
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