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.


George said...

I think you are doing the right thing. Keep weighing it out and see what you think. I love pumping but as with anything, it is not necessarily for everyone. Good luck in your venture!

Scott K. Johnson said...

Hey Heidi,

Like George said, there is no one thing in the realm of diabetes that works well for everyone.

I think you are being more than fair with your analysis, and giving it a good run. As you noted, there are pros & cons, and each person has to weigh those and see what fits their situation best.

Another alternative to weigh is to switch back and forth - there is no "all or nothing" with it. You would have to carefully balance the transition periods, where your long acting insulin is working its way out of your system.

With your knowledge, I think that would not be a problem at all. Like anything new it would take some time, and some trial and error, but you could surely do it if you wanted to.

Different strokes for different folks!

Heidi said...

Thanks guys!

The whole pump thing was one of the reasons that I found the DOC and started reading blog. I needed to find some more information from people wearing pumps themselves, and not only from the companies producing the pumps or the health professionals.

It is great to read and communicate with other diabetics, who may have had some of the same issues and considerations regarding treatment and daily living with the D.

As you both says, George and Scott, the same treatment is not necessarily the best for all diabetics. This is probably also one of the reasons I am debating the whole pumping-not-pumping issue with myself. Another reason, I guess, is the fact that until just a few years ago there wasn't much of a choice for treatment. Pumping has never been that popular in DK - currently only 0.5 % of Danish diabetics are on pumps - so the common regimen was MDI, and with very few exceptions, MDI using Actrapid (Regular) and Insulatard (NPH). When I switched to Lantus 4 years ago, it wasn't even approved in DK yet. All of a sudden to have to choose between two different kind of treatments is somehow overwhelming, but I am sure I will find a solution to that as well. Time will tell :-)