Thursday, September 14, 2006

To pump or not to pump, that is the question……

…..I am asking myself these days. The post is partly inspired by several conversations that I have had with one of the girls that I share my office at work with over the past 5 months.

When I started on the pump in April, the agreement was that I would give it at least a 3 months try-out, and if I still felt that it wasn’t a kind of diabetes management that suited me, I could go back to MDI and the nurse would keep her mouth shut about the pump for the next year or so (that was her exact saying, although I am not sure if she would be able to keep that promise if I return to MDI ;-)). When I agreed upon that, I had several reasons to finally give in to the pressure of my diabetes nurse for at least giving it a try. First of all she managed to “sell the concept” to Jimmi, who had been on my side regarding pumping until then. Second, I had – and still have – a wish to eliminate the visits of paramedics/my visits to the ER due to severe hypoglycaemic reactions, not only for my own sake but also for Jimmi’s as these episodes are tough on him too. These episodes had probably also affected his attitude towards the offer of a PhD.-position that I got from Denver back in January. I wasn’t sure about whether to go for that offer or not, at least not until I had had the chance to visit the lab in Denver. I hoped that if the promises of the pump (keeping the BG in safe range) would really turn out to be true, I would at least be able to convince Jimmi that we should go to Denver just to take a look at the facilities and the area in general, in order for me to make a fair decision about the job offer. Both still has to happen :-/

Now the initial 3 months are long gone and I am still pumping, but also still debating the advantages and disadvantages of this therapy with myself. Within the initial 3 months I was so close on quitting several times. I felt like I was starting all over again, having to collect experience for the handling of different situation once again, and being frustrated about very low or high BGs. I managed to pull myself together, however, because I was aware of the fact that it would be impossible to give a fair evaluation of the therapy based on less than at least 3 months try-out.

Having tried the pump has changed my conception of it in some areas, but it has also confirmed others. I have no doubt in the fact that an insulin pump is actually the best mimic of a natural pancreas available for the time being. However, I also believe that things can get a lot better. A pump is not optimal in every context of life. Still, it may be the best alternative in others. This is probably also why I am still not convinced about pumping, yet certain that it definitely is the alternative of choice in some situations.

I want to become a scientist. Working as a scientist in the biotech-/biomedical fields means that your working hours are determined by the experiments and other scientific work that you have to do, and that you are likely to go abroad frequently to participate in internal conferences and meetings with collaborators. For a diabetic this offers several challenges in terms of regulation and the need to be flexible. In this regard, no doubt the pump offers most freedom. I got the pump about a month before I was off to a conference in Prague, with limited success D-wise, but as I did not participate in any such conferences while doing MDI, I don’t really have a basis for comparison yet. Regarding the ability to be flexible in order to finish a day’s experiments late in the evening, I have experience with that on MDI, even before Lantus, and that was not easy. Thus, from a “scientific” point of view, I will probably be better of with the pump than with a MDI regimen.

Why am I debating with myself about it then? One of the reasons is leisure time activities. I still find it very annoying to have to wear the pump during soccer. In general, I frequently have moments where I miss not being attached to anything. Although the pump can be disconnected, you still have the infusion site sitting around. Another thing is high readings. Though I do not have that many of them, every time they make me doubt in the function on the pump just as much as in my own actions in the hours before (did I miscalculate the carbs of my last meal, have I done anything different that may cause this, ect.). With injections there are not that many options to consider evaluating a high reading. Of course you can always doubt the absorption and general effect of the insulin, but usually it pins down a wrong assessment of dose size covering your last meal(s). With injections you can visually confirm that the insulin is going into your system by looking at the movement of the plunger move in the pen. With the pump you have no visual of where the insulin is going (I have tried having a leakage somewhere around the place where the tubing enters/connect with the site once, noticing it by an unexplainable high reading and a very wet site patch when I started a correction bolus).

I guess that what it all comes down to me not being totally comfortable with and trusting in the pump yet, despite the fact that I recognise the advantages of it. That is probably why I find it so difficult to evaluate. So far the list of disadvantages with the pump is longer than that of the advantages, but some of the advantages are compelling, so at the moment I guess it is more like a tie that may tip to either side.

Monday, September 04, 2006

More lows

Once again it has been a full week since my last post, and once again due to being busy, not really having time and energy left to sit down at the computer at night.

This last week my soccer team had 3 matches: Monday and Wednesday evening and Sunday afternoon. I played all three matches, only the one on Sunday full time, though.

Monday evening our opponent was the top team of our league, a team that will most likely be promoted to the Denmark’s series (3rd highest national league in women’s soccer in Denmark) by the end of this season. We meet them in the final match of the spring season, loosing that match 2-0, so we were top-motivated to take our revenge – and we did! We won 3-2 after having been behind twice in the match, so it was really a fight. I took part in the warm-up, but only played the second half. Still, the BG stayed in range (at least to my knowledge) as I was 8.0 (144) at the end – much better result than most of the other games I have played while being on the pump :-)

Wednesday’s match was against a lower ranging team, but we still managed to fall behind after only a few minutes play. Despite that we came back strongly and won 4-1! In this match I had a break of 20 minutes or so, and unfortunately had to fight the D a bit more. I started out at 5.1 (92), but during the first part of the first half I didn’t feel that fit, suspecting that the BG might be the culprit. I was replaced 35 minutes into the first half, and when I tested, I had a 3.1 (56) – no wonder my legs felt so heavy! I had reduced the basal to 65 % about an hour before the warm-up (I already run the lowest basal of the day in the hours from 3.30 to 6 PM, so doing a 35 % reduction gave me a basal similar to what I used in the first match – early afternoon – when I wore the Guardian sensor) and had it running like this for 1 h 30 min, but apparently that was not enough this time. I guess the fact that I already had the match of Monday plus all the ordinary exercise of my weekdays in the system may have played a role.

The nights following these two games all meant noctural hypoglycaemia to me. Annoying, but I guess that by time I will finally figure out how to tweak the basals overnight to avoid these lows. The sooner the better as I am not awakened by the lows myself. Jimmi is, or happens to wake up by some other cause, and notice how warm, sweaty and generally unresponsive I am. Thus he has to feed me some glucose tabs until he can wake me up or at least see that I respond to his actions.

The game yesterday was in the afternoon and I had hoped that this would help me avoid noctural hypoglycaemia. I did avoid it during sleep, waking up at 7.1 (128) this morning. Just before going to bed, however, I had a bad low. I was able to treat it myself, although I still wonder how the h… I was able to do that with a reading of “LO” (i.e., a BG below 1.1 (20))! The most scary thing about it was that it sort of came sneaking up on me. I was actually sitting at my computer preparing this post with the plan of posting it before going to bed. I was yarning a bit, but didn’t pay much attention to that as it was almost 10 PM and I had played a hard, full time match of soccer in the afternoon. Jimmi wanted me to check something out on the computer, which I all of a sudden had difficulties doing, and when he looked at me, he told me that he though I was low and I better go test. I was about to anyway, getting prepared for bed, but when I am that low I usually act very slowly. I remember testing at 10 PM, Jimmi standing beside me, immediately putting a piece of banana into my mouth, just to get me started on eating something. He offered me different treats, but I couldn’t really decide upon any of them, so I ended up continuing to eat banana, accompanied by some chocolate and a few crackers. When I finally started to fell a bit normal again, my eyes hit the time display of my old VCR recorder: 10.45! OMG! To me it felt like I had just used 10-15 minutes to eat while logging the result of the day on my BG sheet – I don’t know why the routine of doing something at a certain time of day/context never seems to be put off by the hypoglycaemic mind of mine!

As a side note, we lost Sunday’s game, unfortunately due to a ridiculous mistake by the referee, giving us a 2-1 defeat in stead of the tie that would have been fairer, given the possession of the ball and number of chances to score each team had. There was one happy note about the game for me, however: I played the full match, despite minor troubles with the BG cruising on the low side at the end of the first half/beginning of second half AND was awarded our team’s “Player of the match” title, entitling me to hold our team mascot until the next game :-) I can’t even remember what this hand-doll duck is called, but it is always with us, of course wearing a pink bow tie (because we are the pink army, of course).

Saturday was a bit sad on the other hand. I had to help my younger sister and her boyfriend move from their apartment here in Odense to their new one in Vejle, Jutland ;-( I will miss having her around the city!

That is all for now, folks!