I thought I have been doing quite well.
Sure, I've had a few more lows than usual. Sure, stress can do that. And sure, I keep having to remind myself after treating these lows that maybe it's time to slash away at my basal rates so these lows happen less often, but then I forget right up until the next 2.7 is staring me in the face.
Then this happened, and I found myself sitting in my office 2 days ago with an empty pump and a 6-day-old infusion set. That may be the norm for some, but I usually try to keep to a 3- or 4-day site rotation, so 6 is a bit much. Limiting sets to 3 or 4 days usually easy for me, since I've never made it past day 4 with any insulin left in my reservoir.
I think at this point it's safe to say that despite my best (okay, my medium-est) efforts, wedding planning has bested me. Diabetes care has fallen by the wayside. I'm still here, still bolusing for food and chowing back on glucose tablets when I'm low, but being proactive about my self-care is taking a backseat to all of the wedding stuff.
So, step 1 has been Recognizing The Need For Change. I guess step 2 is actually doing it. On that note, I will upload my cgm data to Carelink when I get home tonight. I will. Tonight.
I mean, not right away tonight. We have a meeting with the wedding DJ after work. But after that. Definitely.
I thought I have been doing quite well.
Pump says low.
Melody says shhhh pump, I sleep.
Boyfriend is not home.
Pooch says NO HUMAN WAKE UP YOU ARE BEEPING WAKE UP EMERGENCY OMG OMG OMG.
I want to ask Medtronic what they recommend when pump-users find laaaaarge air bubbles in their tubing.
Bolusing it out (while disconnected, of course!) might work, but it will count all of that insulin as IOB/Active Insulin, which can severely mess with bolus or correction calculations for the next 4 hours.
Re-priming it isn't as simple as it seems. In order to re-prime you have to let the cartridge rewind, which requires removing the reservoir from the pump.
Problems with this:
1) The little plastic nubbins that lock the reservoir into place tend to break off when the reservoir is removed from the pump. I have not found a way to be gentle enough to keep them attached while removing the reservoir.
2) It counts this re-prime as a set change, which will skew data on how frequently set changes occur.
This issue was particularly frustrating on Friday, as my workday started with a LOW RESERVOIR alarm on my pump.
I checked my settings, and - grrrrr - I was a day overdue for a set change. I guess the set had just been comfortable enough that I didn't notice I was on day 3 on Thursday. The LOW RES alarm wasn't a problem though, as it triggers the alarm when I've still got 20 units left in my reservoir, and 20 units is more than enough for basal insulin over my workday plus a lunchtime bolus for food.
The story doesn't end there, though!
Not long after the low res alarm, I visited the bathroom and had a chance to actually look at my infusion set (it was sitting in the top of my thigh). I was quite surprised (and more than a little upset) to notice that my tubing was decorated with tiny spots and differently-coloured flecks. Closer inspection revealed that I actually had some pretty huge air bubbles all along the length of my tubing.
I removed my reservoir (breaking one of the two tiny clips in the process) and restarted the set, which allowed me to re-prime my tubing... but by then I was down a few more units of insulin in my pump. By the end of my workday, sitting there with only 4.4 units left in my pump had me a bit on edge. Grrr!
So...whoa. I guess I knew that it wouldn't be easy, but my first week on a pump was exhausting. Hell, my first *day* on the pump was pretty scary.
I arrived for my pump start at 9am, and the first thing we did was to actually start me on the pump. I was so nervous/excited, my hands were shaking a little :P. My nurse/CDE, Brenda, told me that for the first few set changes she wanted me to put the set somewhere on my abdomen -- somewhere I could see it, and also not someplace where my insulin absorption would change drastically if I exercised (like it might do in my thigh or butt). I noticed almost immediately after inserting the set that it was uncomfortable, and sure enough, it remained uncomfortable over the 3 days that I wore it (but more on my dislike for absomen sites later).
I got to eat breakfast next. Brenda and the nutrition student who was sitting in on a pump start (for credit hours, I think) left me for a bit while I chowed down, then came back about 20 minutes later to jump right back in to the pump training.
We next went theough "the checklist," which was essentially a (very repetitive) list of training items, most of which were things I already felt comfortable doing. We covered things like giving boluses, setting up carb ratios and insulin sensitivity, adjusting basal rates, etc. As far as using the pump goes I actually felt fairly confident, but I did want to spend more time learning how to make changes to basal rates & how to recognize when I need to make changes.
As we went through all of the training items, I did my 2-hour post-breakfast check (a little high), and my training went until around the 3.5-hour mark. After that they sent me home with instructions to check 2 and 4 hours after meals & twice overnight all week, and with a promise that Brenda would be calling me twice per day to discuss my numbers.
I had 2 bad lows on my first day on the pump; one after lunch and another after dinner. Both were scary, for me, as they were 2.2 and 2.4 and came with no symptoms.I honestly think that I was just so excited/tired/hungry/stressed that everything was out of whack. I hope that's what it was, since I never get lows like that with no symptoms...
Things started to calm down over the rest of the week, although I spent a lot of the week running a little on the high side. I was up overnight, multiple times, so I spent a lot of my waking hours taking short naps in between eating & doing post-meal checks. Overall, a pump start is definitely not an experience I'd care to repeat, but having gone through it I can say that I'm happy I put the work into fine-tuning my basal rates and carb ratios.
2 weeks in and I'm still feeling pretty good about being on a pump, so I'd say that's a good sign. There was always a small part of me that worried about the being-attached-to-a-device thing. I wondered whether having a visible sign of my diabetes clipped to my hip would start to weigh down on me and cause last year's burnout and depression to rear their ugly heads. If a pump was truly helping with my diabetes management, I know I could always turn to the wonderful doctors and medical professionals who helped me through it last time around, but quite honestly the while period was horrible and I wouldn't care to repeat it. The actual physical device has only been a minor annoyance when it comes to wearing dresses, but luckily that's it so far!