My Insulin Pump Decision

I read a blog post/article the other day that helped me figure out what I should do about my pump decision.  The author mentioned a few things to take into consideration when deciding between a pump and injections. 

1.     The cost.  Pumps are more expensive and I don’t know how much my insurance will cover (probably only half, like with my Dexcom).

2.    Pumps can have more things go wrong than syringes can.  The battery can die; kinks and air bubbles can prevent insulin delivery; scar tissue build up will prevent insulin absorption; water damage and other malfunctions, etc. 

3.    Pumps don’t work for everyone.  The machine is only as good as its user.  Being on a pump before showed me that I wasn't a very good user.   

4.    Being connected to a pump was something I didn’t like years ago…in fact, I hated it.  The tubing would get caught on things if I wasn’t careful (and I’m clumsy, so that doesn’t help matters), the infusion site sometimes got yanked out prematurely (so annoying!), and I would sometimes drop the pump or it would fall from my hands (I fumble with things a lot).

5.    I want to see how well I do with being “connected” to the Dexcom.  Even though there’s no tubing connecting me to the receiver, I want to see how well I do with changing the transmitter site every week.  Most likely I will do well because it will be showing me patterns in my numbers and I will want to stay on top of them.  I like following numbers on charts and stuff.  Once a week is a whole lot better than every 3 days! 

Therefore, I have decided to not get a pump at this time.  I will be staying on shots.  They are working for me and I see no need to switch.  I just need to choke up on my discipline and I’ll be doing great. 

My Personal Goals

Since my next appointment is on August 28 at 3pm, I figured it would be a good idea to set some goals to meet by then.  I have 33 days from now.

By August 28, I am going to try to get my A1C down into the 10% range.  My A1C in May was 11.1%, so anything in the 10% range would be an improvement.  

My big goal after that is to get my A1C down to 7% by December 31, 2014 (year’s end).  That puts me at a little over 1% per month.  I will accomplish this in several ways:

• Stay on top of correcting high blood sugars and giving accurate food boluses.

• Use the Dexcom (whenever I get it) to track my blood sugar patterns and trajectories. 

• Use my secret weapon – namely, GC Control from Melaleuca – whenever I am able to order it.  
  
  

I think blogging about these goals and my progress will help me stay accountable and diligent.  If you are a diabetic, I hope I can help you in some way.  Likewise, I would appreciate help from you!  Thank you for joining me on my journey!

Carb-counting and Insulin Pump Therapy

Today, I met with an RN at my endo's office to discuss carb-counting and insulin pump therapy.

They also weighed me and I've lost 4 pounds since my appointment 2 weeks ago. I was happy to hear that, even if they thought it wasn't necessary. Anyway.

Apparently I've been miscalculating carbs in fruits and rice & potatoes (meh) so after she gave me a carb-counting sheet, we started discussing insulin pumps. She gave me three brochures on some new insulin pumps that she recommends and showed me some of their demo models. I'm not sure which one I'd choose at this point, but two of them might be compatible with my Dexcom in a few years.

One is called the Tandem t:slim and it's a touch screen with a rechargeable battery.
Another is the Medtronic MiniMed 530G and it has its own blood sugar sensor (like the Dexcom) and is really user friendly.
The third is the OneTouch Ping by Animas, and it's apparently "tubeless," meaning there's no tubing connecting the pump to the infusion site.

I'm going to have to look over the brochures more to see which one might be good for me. I'm still on the fence about it.

Starting on the Journey - Diabetes

I had an appointment with my new endocrinologist (diabetes doctor) and nurse practitioner this morning.  After my in-office blood sugar (169 mg/dl) and vitals were taken (turns out I’m 5’ 11 3/4”!) and the nurse went through the standard medical history questions, Carrie, my nurse practitioner, came in and asked about my diabetes care routine.  She then checked my feet, pulse, and lungs/heartbeat.  

After that, she told me about some new medicines that were on the market that some Type 1 Diabetics use to control their blood sugar and asked if I’d ever been on an insulin pump.  I told her I had, several years ago, and that I preferred being “unhooked” from a pump with tubing, especially since my old endocrinologist had told me that being on a pump with my lack of discipline was dangerous for my health (when Dr. Bussey heard this, he said that was a bunch of malarkey).  

I told her about my desperate need for the Dexcom G4 Platinum Continuous Glucose Monitoring System, and she confirmed that it was a good system with the highest accuracy available.  She looked over my blood sugar numbers from the past few weeks (which they had downloaded from my glucometer), asked me some questions about them, and gave me an informational packet about the Dexcom.  She then left the room to get Dr. Bussey, the endo.  

When they both returned, Dr. Bussey made some suggestions for adjusting my insulin doses.  He said since my numbers were still running high that I should increase my overnight basal insulin by 2 units, adjust my insulin-to-carb ratio (changing it from 1 unit per 12 grams to 1 unit per 9 grams), and changing my correction factor from 60 points over 120 to 50 points over 120.

We then discussed my plans for the future regarding children.  I told him we were thinking not for another year or two down the road, especially since my numbers are so high and our finances aren't quite where they need to be.  Dr. Bussey told me that the best A1c during pregnancy is about 5 (but 6 or 7 was okay) and that the most precise way to maintain that much control for a pregnant Type 1 Diabetic would come from being on an insulin pump – however, it was not required.  I’m still undecided on the matter.  I know I at least want a Dexcom.    

My current A1c is 11% (average blood sugar of 269) – so I balked a little.  A chart on the wall across from me said that an A1c of 7% equates to an average blood sugar of 154.  6% = 126.  The lowest I remember my A1c ever being is about 9 (212 mg/dl)…5, 6, and 7 all seem so hard (nay, impossible) to achieve!  However, he assured me that getting my A1c down that low IS possible and they are going to keep me accountable as I work to get my numbers down, down, down.  They told me they wanted me to come back in 2 weeks to go over carb counting (although they are sure I know what to do) and insulin pump therapy information.  I’ll then come back at the end of August for fasting labs.

Before I left, they had me do some lab work for them (a quick and painless blood draw).  I left feeling encouraged but also a little daunted.  I know I have a lot of work ahead of me, but I hope that having a team of people who are committed to seeing me improve my health will give me the motivation I need to succeed.  Obviously the core determination has to come from my desire to prepare the best I can for the future.  I know that with God’s help, all things are possible – even the things that seem impossible.