To pump or not to pump…

For more than seven years since my diagnosis I have been confidently opposed to insulin pumps. I have had my list of grievances ready for anyone who asks too:

  1.  I don’t want to be attached to anything
  2. They are expensive to purchase
  3. They are expensive to maintain
  4. As soon as I purchase one, a better version is bound to be released
  5. They are unsightly

I have spoken with others who think similarly to me and don’t want to be constrained to a device with tubing and sensors. When it came down to it, many of us felt that using pens was less cumbersome. Using insulin pens allowed me to live as anyone else would. I took injections when I needed to but other than that I was just an average guy. This concept of no physical attachment is apparently known in the diabetes community as going “Naked” and you can read about it from another diabetes blogger here. Frankly it sounds like a weird term and surely one to raise eyebrows when discussing it but I understand the sense of freedom associated with the concept. This is one of the major reasons I have been opposed to insulin pumps.

Using pen needles is not without it’s own issues. One of my major problems was taking the time to inject, especially when eating around others.

“Can I grab my supplies and head to a bathroom discreetly?”

“I don’t have enough time or privacy to give myself an injection right now because of (fill in the blank). Can I wait to take my dose of insulin?”

“Would the people I’m eating with be uncomfortable if I pull out my insulin, load a needle, and give myself an injection right here at the table?”

These questions constantly plagued me and back in my dating years added a whole new dimension to establishing a relationship. One of the best things that happened to me occurred after eating with a childhood friend of mine, Scott. He and I have been through a lot together over 20+ years and I don’t remember having much hesitation injecting myself in front of him. Being the oddball that Scott and I both tend to be, he loved it. He made some joking gesture about it and asked me if I ever took an injection into my jugular.

No.

I informed him I have never taken a shot of insulin in my jugular vein and did not plan to . Regardless, anytime I injected from then on he would make a stabbing motion to his neck and say something about “the jugular”. While his complete disregard for treatment guidelines were entertaining, his approach effectively put me at ease knowing he was not uncomfortable when I treated in front of him. Eventually I realized I probably made more of an issue when treating in front of others than they did.

Dexcom

In 2016 I began using the Dexcom Continuous Glucose Monitoring (CGM) G5 sensor. I had been curious about CGM technology and wanted to give it a shot. The glucose readings are updated every 5 minutes but most importantly they show a trend arrow giving direction. Rather than seeing a reading of 85 and being happy, I was now able to see if I was at 85 and rapidly descending, ascending, or stable. Besides this awesome extra information, the unit was able to connect to my phone via Bluetooth so I did not need to carry around any additional items. With the Dexcom app I was also able to share my readings to my wife in real time.

bg-share-glucose-g5-750x500_c

The phone and and sensor on the left is what I had on me and the phone to the right represents what my wife sees on her phone. This came in very handy when I would go on long runs alone.

As with any wearable device I ran into issues getting the unit to stick. Although each application is supposed to last for 7 days and is intended to get wet with showering, exercise, or pools, mine never stayed on. After doing some research I came across a YouTube video and adapted the technique for myself. Once it was perfected I can tell you I was able to keep one sensor in and functional for 3+ weeks regularly but it has risks. I am very careful to clean my skin with both Hibiclens and then alcohol prior to each injection. Over the course of the first year I did develop an infection after leaving one in place far too long so it is not recommended to do this. ( I wanted to see how far I could take it) Another benefit to Dexcom was their amazing customer support. Anytime I had an issue or if a sensor/application did not work properly the company would send another one free of charge. I had multiple calls in to customer support and they always helped diagnose the problem or replace the problematic device. Ultimately my insurance plan changed and I was no longer able to continue using the Dexcom CGM.

Pump

This brings us back to the idea of using a pump or not. (I didn’t forget about the purpose of this post). After much thought and going back and forth I have decided to proceed with my first insulin pump. I have chosen to start with Tandem Diabetes t:slim X2 pump.

dec2016-tandem

I am still opposed to being attached to a “pager” and tubing but I like the idea of not having to carry around insulin pens, screwing on needles, and trying to discretely inject. It is certainly an expensive undertaking especially in today’s insurance market. One benefit to this pump is that it can be updated when new software or features become available so I won’t be stuck necessarily. At this time Tandem does not have FDA approval to suspend basal insulin if the patient has low or trending low glucose values. As soon as the FDA approves this in the next few months, updates will be released and my pump will be able to add this feature. I have again started back on the Dexcom CGM and these two devices will interact and give me the ability to more tightly control my diabetes than I ever have.

 Components have been ordered and I am supposed to meet with a rep and learn how to use everything tomorrow. I will make another post once once I figure out what the heck I am doing.