Finally, the Pump.
"Absolutely not. I'm not going to mess with that."
For years, whenever a doctor or family member suggested that I go on an insulin pump, this was my response. I had dealt with my type 1 diabetes just fine for years. Decades, in fact. And I'd managed the disease with multiple daily injections.
"Are you crazy? I have my needle right here. I can inject myself whenever I want."
Frankly, I didn't see the benefits. After all, I could give myself as many shots as I needed or wanted. If I checked my blood sugar multiple times throughout the day, what was I missing? Things were fine, I told myself.
"It's expensive, and my insurance probably won't cover it anyway."
But despite all my protests and brush-offs, I finally took the plunge about a year ago. And the insulin pump has changed the way I think about diabetes, the way I handle my illness, and my goals for the future. It has changed my life.
"Well, maybe it's not so bad after all."
For years, I took my diabetes for granted. I didn't bother it, and it didn't bother me. Or so I thought.
In reality, that approach was a luxury granted me by my mother. I was diagnosed at age seven, and she did an exemplary job in managing my illness. She took me on regular walks. She planned my meals. She injected me with insulin and checked my blood sugar.
My mom did what any parent, hopefully, would do with a diabetic child. She guided me, eventually handing over the reins in my middle- and high-school years. I was all set, right? Not exactly.
While I understood that my diabetes was complicated and at times ornery, I never considered it much of a threat. Sure, I had been told about complications. I knew about the long-term cardiovascular risks. But nothing much had gone wrong in the past. Why would it in the future?
In my mid-20s, however, things began to change. My doctor was concerned about my blood pressure and put me on an ACE inhibitor. She scrutinized my cholesterol numbers. This was unfamiliar territory for me.
Looking back, I know exactly what caused the shift. I had been working behind a desk for several years. I had stopped exercising regularly. I had gained a few pounds. And I was too caught up in the day-to-day stresses of my life to see the longer-term issues.
Then everything unraveled.
Maybe that's too dramatic a description, but that's how it felt at the time. Within a year, I received two A1c results above 8. And my ophthalmologist spotted a couple of spots in the back of one of my eyes.
I knew that something had to change. My doctor had urged me for several years to get a pump. I had even made an appointment for a consultation and then backed off. Now, I knew it had to be done. I couldn't go on like I had before.
I was going to get an insulin pump.
"You're not doing that badly."
I made the decision to start pump therapy in the summer of last year. My pump (which I'm not naming here because the folks behind it can buy their own advertising) was actually switched on in late October. The irony is that during my three to four months of preparing for the pump, I got my diabetes under reasonable control. My two pre-pump A1cs were a 7.0 and a 6.8. Not the levels of the super diabetics you read about on certain Internet message boards, but a surprise to the succession of healthcare professionals I talked to.
"It's nice to see you're so motivated."
It depressed me. I got the impression that many people starting pumps went on them too late -- or too early, before they knew what they were doing. No one quite knew what to make of me. Someone barely out of his 20s, interested in taking his control to a higher level -- shouldn't I be out destroying my retinas and kidneys somewhere?
"They what? They turned down the claim?"
Despite having decent insurance coverage, my original request for a pump was denied. Not because of poor health, but because of good health. My A1c numbers mentioned before? Too low. My insurers would cover a pump only if I could show my diabetes was dangerously out of control.
"Thank God that's over with."
I wish I could say I called the insurance company and, with my voice trembling, persuaded them to do the right thing. Instead, my pump company and doctor collaborated to send them additional information (such as the earlier, less rosy A1c results). With little fanfare, the denial was reversed.
The nitty gritty
The reality of starting the pump was harder than I imagined. For all of my motivation and decent blood sugar readings, I had to throw away a lot of what I thought I knew about my disease.
For one thing, I needed to check my blood sugar. Not three or four times a day. More like six to eight. Especially in those early days on my pump, I was never sure exactly what would happen or when.
For another, I realized I had a disease. Diabetes wasn't some friendly condition like athlete's foot or near-sightedness. It was a system-wide, severe illness that wouldn't hesitate to knock me on my rear.
Like I said, it was harder than I imagined.
For those of you unfamiliar with the process of starting a pump, much of the challenge at the beginning is understanding how much insulin should be trickled into the bloodstream hour by hour. Your pump coach -- a diabetes educator specializing in the field -- will work out a rough guess of how much insulin you require over a 24-hour span. But it's only a guess.
My educator had the unenviable task of trying to translate my daily injection regimen and self-reported carb consumption into a program for the pump. And during my first few days on the pump, repeated low blood sugars meant that we dramatically scaled back the amount of insulin I received.
Guess what? I then had high blood sugars all the time. Day by day and week by week, we adjusted the pump's output, closing on on the elusive perfect basal (or background) insulin rate.
I learned that I had been doing one major thing wrong when I took insulin injections. I had been depending on my long-acting insulin to shoulder too much of the weight. That was okay in some regards -- it meant I always had a pool of insulin around to battle high readings -- but it also allowed me to chronically under-count my carb intake.
And in under-counting carbs, I was also able to fudge the actual amount of food that I consumed on a day-to-day basis. Let's just say that I was not, on most days, averaging 45 grams of carbohydrate per meal. Sometimes, sure. But often I was eating 65, even 75 grams of carb at one sitting.
Most of the kinks were worked out by early February, some three months after I began the pump. And my most recent A1c, after about six months of tight control, was a 6.1.
Type 1 diabetics know the disconcerting truth, though. Success is never a single number. It's never a good day, or a proper basal program, or a super-accurate carb count. Success is about all of those things, applied on a consistent basis over time.
I know there is much more to do. My diet can improve. I can exercise more rigorously. And that A1c number can go even lower. But I have faced one of the biggest challenges a diabetic can face -- a complete overhaul of treatment -- and come out happy. I can't recommend pump therapy for everyone. But it's given me new outlook on my disease and a new appreciation of what I can accomplish.
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