Thursday, August 15, 2013

Pumped about pumping 3: Two months on

Gertrude! Gertrude! Gertrude!
How do I love thee? Let me count the ways.

  1. I no longer stress over how many carbs Miss Chief may or may not eat in a particular meal.
  2. I no longer stress if I don't know the amount of carbs in something.
  3. I no longer stress if Miss Chief is at a party and I can't keep tabs on what she's eating or if the table is full of high-carb rubbish.
  4. I no longer have to treat hypos after we've had pasta for dinner, and then have to wake Chief up at 10pm to give an extra needle.
  5. I no longer have to worry about extra needles at afternoon tea if someone is having birthday cake.
  6. I no longer have to try to delay Chief's eating at parties so that we can give her the tea-time needle a bit earlier to cover a massive afternoon snack.
  7. I no longer get the kids settled in bed (a massive effort in itself) only to then realise we have forgotten the bedtime levemir injection.
  8. I no longer stress over what to give Chief to eat if her BGL is a bit high at morning or afternoon tea.
  9. I no longer spend my pre-bedtime or the middle of the night wondering if Chief's BGL is high enough to warrant waking her for an extra needle, or if I should just leave it and try to sort it out at breakfast.
  10. Chief can eat what she wants when she wants (as long as it's healthy and she isn't constantly asking me for more food... but that has nothing to do with diabetes).
  11. Chief no longer has to endure 5 needles a day.
  12. Chief no longer has to choose between missing out on cake or having an extra needle.
Gertrude (and a very stoked Miss Chief) 
on the day she came to live with us.

In short Gertrude, the gorgeous name Miss Chief gave to her pump, has significantly reduced the stress in this D-family.

I would like to point out that pumping isn't for everyone. It does mean being permanently attached to a medical device (albeit a small, temporarily removable one). And it is perfectly possible to get great control and a good lifestyle on MDI (multiple daily injections). It's a very personal choice and one that a family should not be pushed into. I think the way that pumps work and calculate insulin is a great basis for MDI actually and we got our best results once we started working out things such as I:C (insulin to carb) ratio (i.e. how many carbs does 1 unit of insulin cover) and ISF (insulin sensitivity factor) (i.e. how many mmol/ls will 1 unit of insulin lower your BGL by). We worked it all out manually, which was laborious, but there are apps that will do it for you.

I'm sure that over time we would have got great control, and hopefully with minimal stress and lifestyle or diet changes if we had stuck with MDI and developed processes and techniques to support that. However, I have absolutely no regrets about making the move to a pump and I think it's fair to say that Map Man and Miss Chief would both agree.

Many of the concerns that I had prior to pumping turned out to be non-issues. These included:
  • How will she wear the pump, especially with a dress?
  • Will it get in the way when she's playing dress-ups/doing ballet/swimming?
  • How will she sleep with it at night?
  • Will we wake her up at night trying to get to the pump to put in her BGL?
  • Will it be uncomfortable? Will she refuse or hate to wear it?
  • Will cannula changes be really stressful especially as they happen less frequently?
  • Will I forget to change the cannula, given that it only happens once every 3 days?
Well, that last one does almost become an issue when life gets really busy. And whilst we're getting much quicker at doing cannula changes, it is just another thing to have to fit into a busy day. But not every day (hurrah). And would you believe removing the old cannula is way more stressful than inserting a new one? You know how most kids hate having band aids/plasters/elastoplasts removed? Well it's kind of like that. Reminds me of the horrible sticky eye patches they used to slap onto my good eye at the Eye Infirmary when I was a kid, with no thought as to whether it was stuck to my eyelashes or eyebrows. And then they'd just rip it off with no sympathy or concern. I never got to see how many of my lashes and brow hairs were stuck to those patches but I bet it was a few. I hated hated hated those patches. So I try to be really sympathetic about this when removing cannulas. I must be doing okay because the last time Chief declared "I didn't even feel that!" Yay, me!

It doesn't come without its challenges. There have been a couple of kinked cannulas resulting in reduced absorption of insulin and accompanying highs. There have been snacks that we've forgotten to bolus for. We're still tweaking and testing. We are currently experiencing pre-lunch hypos nearly every day so I have to figure out whether she needs less insulin for her morning tea carbs, or whether she needs a reduced basal (background insulin) and if so, when and for how long.

Let me tell you a little story. Yesterday, I was a bad mammy. I had such a rushed day and I was frantically trying to get dinner into the slow cooker before rushing everyone out of the door for a dental appointment. Chief's grandparents are learning how to use the pump and had accidentally given a lunchtime bolus of 0 units of insulin so she'd woken from her nap a little high (12.9) and feeling a bit hungry as a result.

"Mammy, I'm hungry. I'm hungry, Mammy. Can I have this pear? Mammy, can I have this pear?"

Nag, nag, nag, blatent refusal to eat anything else I suggested that might be low carb. So I gave in and weighed the pear. 23g carbs. As I just wanted to get dinner on I figured I'd let her eat the pear whilst I did that then weigh the core and subtract that from the total before putting it into the pump. Anyway, we just about managed to wake up the Happy One and get to our appointment on time and afterwards, on the way to visit the grandparents where they were housesitting, we took Chief for a promised treat. I tested her before she tucked into her chocolate frog and she was 16.7!!! I had completely forgotten to give her insulin for her pear, poor thing. So I popped in the carbs for the chocolate, plus told the pump her extremely high BGL, at which point Gertrude pointed out this was a bit high and maybe I should check Chief's ketones (I always feel like I'm having a finger wagged at me and Gertrude is saying "tut tut tut" when this happens). Less than two hours later, after a bit of running around on the beach followed by a bath, we tested again before dinner and she was 5.7! I was amazed.

No doubt the physical activity helped but back on MDI that would have been a very stressful situation. Firstly, I doubt I would have let her have the pear in the first place. Secondly, we probably would have discussed whether or not she was willing to take an extra needle for the pear. Thirdly, getting a 16.7 at 4.30pm would probably have led us to insist she keep the chocolate frog until after dinner.

I don't know whether pumping will mean better control for us but it certainly is far less stressful and has had a massive impact on all of our lives. For anyone considering it I would highly recommend it. I'll bet all the things holding you back will be irrelevant once you taste the freedom pumping can bring. We LOVE it!

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