Tuesday, June 20, 2006

Another meme

I haven't been too good at posting on a regular basis. I simply haven't taken the time to do it. Work takes a lot of time - even though I sometimes take a break and spent it on the Internet, as just now ;-) - and in the evenings I hardly turn on the computer because I either have soccer practice/games to attend, want to enjoy the decent summer weather we have at the moment, and/or follow the World Cup games on TV (yes, I am a soccer freak, and I do enjoy watching soccer almost as much as playing it myself, although it is sad that Denmark is not among the participants in the current World Cup). Still, I do manage to spent a few minutes now and then catching up on some of the diabetes related blog that I like to read. One of them (http://lalashilolog.blogspot.com/2006/06/highs-and-lows-of-pumping-newbies.html) inspired me to make this post on the "Highs and lows of pumping".

I am approaching the end of the initial 3-month pump-try-out that I reluctantly agreed upon in March. I was set up on April 6 and my now have 2.5 months of experience and learning with pump therapy. As MDI therapy is still fresh in my memory, I cannot help to compare the two regimes.

Highs of pumping:
  1. A great advantage when I was in Prague for a conference in the beginning of May. Not knowing was to expect from lunch would have been a bit tricky with injections, as I preferred to use Actrapid (Regular) for meals, thus usually would do the injection 15-30 min. before starting to eat. With the pump it was just take a look on that lunch pack you were handed, estimate the amount of insulin needed to cover it and then GO!
  2. Even more flexibility than I had with injections as far as to when and what I eat.
  3. Unexpected temptations (food-wise) can be handled - though when on injections, I would usually carry at least a fast-acting insulin pen with me, there have been time where I did not expect to be out during meal time and therefore did not bring any along, thus needing to moderate my intake of food significantly, or simply say no, because I could not bolus for it.
Lows of pumping:
  1. Adjusting the basals, parameter for the wizard function ect. is a living nightmare! When I started the pump, I did expect it to take some time before these things were settled, but I did not expect it to take as long as it did - it is actually not settled completely yet, though it is far more acceptable now than just a month ago. I know I ought to go through these fasts in order to check how the basals match my need, and I have completed the night-to-lunch fasts, but it has been hard and actually I ought to repeat them as I have changed the basals in order to get closer to my target range than the initial basal would get me. My problem with these fasts are that I am very active every day so I get hungry if I do not eat regularly. If I am fasting while hungry, I can't focus on what I should be doing (work ect.), which is not very effective. My nurse, Alice, understands this, fortunately, but her colleague, who started me up because Alice was on vacation, did not. She actually suggested that I just lay off some of the activity until the basals were set, but I argued against this for several reasons. First, and most importantly, I can't see how you can use resultsobtainedd on a "lazy day" to regulate the basals needed for usual week days where I bike 20-40 km and/or play soccer practicee or game)! Second, I do not have the patience to commute by city busses to get to work. I have had enough of commuting by train and busses the first years of my study, and as we don't have a car, I would rather spent 25-30 min. on my bike in the mornings and afternoons than twice the amount of time in different city busses to get from my home to work and back again.
  2. Pumping is so incompatible with my soccer games! I virtually never had any great troubles with game days when using MDI, but with the pump, I have experienced nothing but trouble controlling BG's. I am usually able to start out pretty good, and a few time I have even managed to be in range just after the game as well, but whether or not I am in range just after the match, I can be sure that the BG will sky rocket afterwards. An example: 6.1 mmol/l (110) just after a game, 17.8 mmol/l (320) with beginning ketones and generally feeling lousy just 2 hours later! I am not comfortable with wearing the pump during games, so I disconnect. I also do that atpracticee, which is 1.5 H, approximately the same as a game without the warm-up, and I have no problems with that. I am not sure if the game issue is related to the amount of time being disconnected, fight hormones, or a combination of factors, but I have never had these problems when on injections. The last couple of games I have therefore defied threcommendationsns from the hospital about not involving any other types of insulin when pumping, and taken a shot of Lantus (dose approximatelequalingng 75 % of my pump basal) in the morning and then a shot of actrapid for the last meal I have before the game. I then run my pump basal very low (10-15 %) until the actrapid is out of my system again, then depending on the blood sugar I will raise the pump basal to 25-50 % of normal waiting for Lantus to also leave. So far this has worked nicely for me, having avoided both hypoglycemia before and during the game as well as hyperglycemia afterwards.
  3. The pump should in theory even out the swing of your BG, but I havdefinitelyly seen a lot more out of range BG's the last 2.5 months. I know some of them are of cause due to the issues mentioned in item 1 in this Lows-of-pumping-paragraph, but still I am certainly not comfortable with the number of BG's below 2.0 mmol/l (36) that I have obtained in this period of time. I even managed to test as low as my meter just saying "LO", meaning a BG below 1.1 mmol/l (20) - I was certainly not feeling well at that time, and fortunately my boyfriend was there to make sure that I got something to treat that nasty low with.
  4. Temptations of delicious and carb-loaded foods can be hard to resist, because bolusing is so easy, not requiring an injection.
This is not a complete list of pro's and con's of pumping for me, but the most important ones for me at the moment. I hope that at least some of the lows will disappear or get less significant by time. I'll let you know what I learn.


justme said...

I am not a big soccer/football fan, though I have enjoyed the few matches I have watched. With your country not participating - who are you supporting??

Heidi said...

That must be Brasil then - now that our Swedish neighbours have been knocked out ;-) I am deeply fascinated by brilliant technique of the Brazilian, and actually the Argentines too. It makes soccer entertaining and exciting to watch, just like when you play yourself, you never know what will happen next.