TEN YEARS WITH MY INSULIN PUMP

by Joanna Stottler

Photo:� portrait showing pump.� Caption:� Joanna Stottler

Retired nurse Joanna Stottler has had type 1, insulin

dependent diabetes for 52 years.� A veteran of both sides of

diabetes care, she has also, for the last 10 years, been

using an insulin pump, instead of a syringe, to supply the

insulin she must have.� Here she shares with us some

observations on the insulin pump.

"My doctor suggested I try the pump (he tried for eight

years!), but at first I didn't like the idea of its

catheter--I didn't want to be connected up to a machine!

Also, I didn't know any other diabetics.� But I finally came

around to his point of view.� So what did it?

I was a nurse in a hospital diabetic unit then, and a

person came in from MiniMed (an insulin pump manufacturer)

to talk to us nurses about the pump.� And at that time I

thought, well, gee, this sounds like a pretty good thing.

But, like I say, it took me eight years to decide that was

what I wanted to do.� My doctor was the one who put the idea

into my head, but I really didn't connect with it until I

met the MiniMed representative through my work.

When I made the decision to try the pump, 10 years ago,

I was taking approximately three to four shots a day, and my

blood sugars were not doing well.� Every time I went to the

doctor, he would change my sliding scale.� I tried-- but it

just seemed like I couldn't figure out how to get my blood

sugars even.� It was just up and down all the time, with

A1c's of 8 or 9.�� And I was still feeling ok, but I just

couldn't get the tight control that would be good for a

diabetic.� That has changed now.

Back when I started, I felt like the pump was some kind

of secret thing.� I tried to find diabetics who were using a

pump, and I couldn't find them.� When I did find some, these

individuals weren't that interested in discussing it with

me, for some reason.� Now, there are a lot of new users, so

it is far easier to find someone to talk to; but I truly

believe that people who use the pump should share their

knowledge, help spread the word.

The pump is a very simple device.� It holds a reservoir

of insulin, and a pump that dispenses a tiny amount of

insulin, every few minutes, according to how you set it.� It

dispenses two ways:� the basal rate and the bolus.� The

basal rate is the basic 24 hours a day "floor;" but it

doesn't have to be the same rate each hour of the day.� You

can change it for different hours of the 24-hour period, at

certain times of the day when you need more or less insulin.

The basal rate means if you don't eat anything at all for 24

hours, with this insulin pump your basal rate will still

give you normal blood sugars.� Now that is the ideal.� And

that will occur.� If I don't eat anything for 24 hours, but

my basal rates are set correctly, I will not run into

trouble.� I can have normal blood sugars for that period.� A

person on multiple injections cannot do this, but a pump

user can.�

I use quick-acting Humalog in my pump.� And, like I

say, there's no back-up insulin to take over if something

happens with the pump.� (NOTE:� Wise pump users keep an

insulin vial and syringe available, in case the pump

malfunctions.)�� But if my pump is working correctly, as it

does for most of the time, and if I don't eat for 24 hours,

my blood sugar will stay normal at my basal rate.� And I

also have multiple basal rates to choose from (my basal rate

doesn't stay the same all the time), as it depends on my

blood sugars and on the Dawn Phenomenon (the early morning

blood sugar rise).

The other insulin dose a pump dispenses is called the

bolus, and it is the specific dose of insulin you give

yourself to cover a specific meal.� Depending on� how many

grams of carbohydrates you eat at each meal, you set your

pump to give yourself a specific bolus of insulin.� My bolus

is 1 unit per 15 carbs.� And then I also include my protein

in that, along with my carbohydrates.� So the number of

carbohydrates I have in the protein, and the number of

carbohydrates I have in the meal, I will count up, and then

give myself a bolus equal to 1/15� the number of

carbohydrate grams consumed, for breakfast and lunch.� And

then for dinner it's 20 carbs for 1 unit.� It doesn't depend

on the number of calories.� It depends on the number of

carbohydrates.

There are a few things on the pump that are really

great.� My pump has a light on it, so if you're in a movie

or something and you want to see what you're bolusing you

can do that.� And there is a feature called a "Square Wave

Bolus," which is what you can bolus in over a period of

time.� If you eat a meal heavy in fats, it takes you longer

to digest, so you use a square wave bolus over a longer

period of time.� You can have the bolus go in over two hours

rather than all at once.� And there is also a temporary

basal rate, which means if you're exercising, or if your

blood sugars are too high, or if you're sick, you can put in

a temporary basal rate, and increase your basal rate over a

certain period of time, too, for certain hours.� That's only

temporary, and then you can bring it back to what your

normal rates are.

I test my blood sugars a minimum of six times a day.

You want to do it a lot, because you need to set your basals

and your boluses right.� I can get by with four, but I

prefer doing it six because it helps me know what I'm doing.

And it helps me be able to regulate my pump correctly.� You

have to do that.�

Remember, the pump is just a mechanical device, and you

are still the one in control behind the pump.� It's not

automatic, controlling the settings.� If you're not going to

do the finger sticks, I would say a minimum of four times a

day, it's real hard to do the pump.� And another thing, you

know I've been sticking my fingers for a long time, and it

doesn't bother me anymore. I know a lot of people who it

really bothers.� But it's just a part of me, like my diet is

part of me.

I get discouraged at times, like every diabetic, and

it's not easy.� The pump takes a while to learn in the first

place.� But you have to realize that it's more like a normal

pancreas� than shots are.� The pump works like a normal

pancreas, more or less.� Now if they could get the blood

sugars somehow connected to the pump, that would be a big

plus.� Someday!

If people think about the pump, and wonder if it might

be right for them,� and they really don't know anything

about it, I think that they need to call the manufacturer

(MiniMed or Disetronic) and get some information.� The best

thing is to meet somebody who uses it, and at least look at

it.� Remember,� I never saw it in the eight years I wanted

to be on it.

I wear my pump on my waist.� I just clip it on.� And

there are different things you can attach it to, but most of

the time nobody can really see it.� It stays on 24 hours a

day and I change it about every two to three days.� I use

the Sof-Set, a small Teflon� catheter.� It's not a needle.

They have different ones.� It goes into the skin at an

angle.� The needle goes in, and you pull the needle out and

the Teflon catheter stays in your skin.�� And then you just

tape it down then and you're set.� You don't even feel it

when it's in there.

The pump costs a lot, but I think a lot of times that

insurance will cover it. But if they don't, sometimes

different companies will support you.� I did read someplace

that the companies are getting more involved in having

payments being made.� The� company will pay for it up-front

and the patient can pay them back or something like that.

I'm not exactly sure what it is.� I know there are a lot of

people who can't afford the pump.�

The pump is not just for type 1 diabetics.� There are

a lot of Type 2's who take a pill every day, and think their

diabetes is under control.� They take one blood sugar test a

day and think that this is fine.� It's terrible, it's just

awful.� I see this, because I belong to a pump support

group.� And that's real important, too, for people to belong

to a pump group.

I've been very happy with the pump.�� Can't imagine

going back to shots again.� Intensive insulin therapy is

probably what the next best thing would be.

You still have to be in very good contact with your

doctor and your educator.� This is really important--to get

those basals right, because the basal is like the foundation

of the house.� If your basals aren't right, you don't have

good control.

For more information, contact the insulin pump

manufacturers:

Disetronic Medical Systems, Inc: 5151 Program Avenue,

St. Paul, MN 55112; telephone:� 1-800-280-7801; fax:� (612)

671-6061; website:� http://www.disetronic-usa.com

Minimed Technologies, Inc.: 12744 San Fernando Road,

Sylmar, CA 91342; telephone:� 1-800-933-3322; website:

http://www.minimed.com