I Am Now Part Robot

For about 12 years now I’ve been a type 1 diabetic, meaning insulin dependent. Type 1 diabetes requires that you to check your blood sugar throughout the day and take shots to regulate food intake (usually at meals.)

I rarely mention this in my blog because it’s been a part of my life for so long I don’t even consider it noteworthy. Unlike an ambulatory or noticeable handicap I don’t consider type 1 diabetes to be that life altering. With proper care and planning type 1 diabetes is easily manageable, so long as you are disciplined about the food you consume and daily exercise. From traveling to scuba diving to hiking, camping, and skiing – diabetes has never prevented me from doing anything I’ve wanted in life. Oh wait – I suppose it did prevent me from becoming a professional airline pilot, but in retrospect that’s probably a good thing because my alternate life might find me unemployed living out of an efficiency apartment in suburbia. And eating nothing but fast food – thus developing type 2 diabetes.

As benign as it outwardly appears diabetes does constantly factor into your daily life. The most annoying part of type 1 diabetes is the need to constantly test your blood sugar, and also experiencing blood sugar swings. During a normal day, i.e. sitting at the office or puttering around the house it’s rarely an issue: I prick my finger and sample a drop of blood with a meter. Based on the result I take a shot if it’s too high, eat some food if it’s too low, or simply remain aware of my blood sugar level for future activities that day.

However there are times when it’s a pain in the ass to check your blood sugar. When out at a restaurant or bar with friends. Or when doing my favorite “INGS” like flying, hiking, skiing, biking – it requires me to stop what I’m doing and reference my small meter. Granted glucose meters now take less than 20 seconds to process, but it’s still something that requires an interruption. And of course those are the times you NEED to check your blood sugar more often.

For years type 1 diabetics have tested their blood and injected themselves throughout the day this way. However for the past few years many have been using a newer and more effective method of control: The Insulin Pump. Insulin pumps regulate the delivery of insulin more effectively by mimicking the pancreas: they administer a small and constant dosage throughout the day and night. This is far more controlled than ONE daily injection of a “24 hour” insulin, plus additional shots with meals. People who have given up multiple shots for the insulin pump have stabilized their blood sugars and have seen amazing improvements. And with constant delivery the pump is excellent at “holding” your blood sugar levels within a tighter range.

Yet I was never that keen on wearing a pump because I really don’t mind giving myself shots. It’s easy and I’m used to it. That and the co-pay for an insulin pump is north of $1,200. BUT – the advent of the constant glucose meter is something that I find absolutely incredible. When I learned that my insurance would now cover the insulin pump AND the constant glucose monitor I decided it was time to upgrade my gear. For the past month I have been equipped with the Minimed Paradigm insulin pump which operates in tandem with the “Guardian Real Time constant glucose monitoring system.”

The benefit of a constant glucose monitor is to reduce or eliminate major blood sugar swings. Even diabetics who exercise tight control are still subject to blood sugar ups and downs. If you eat without giving yourself sufficient insulin your blood sugar is high. If you’re exerting energy during activity and don’t eat enough food you’re subject to low blood sugar. As mentioned you track these by checking blood sugar, but again when these “finger pricks,” are needed it’s often at the most inopportune moments.

Also correcting high and low blood sugars often result in a “superball” or “pendulum” effect. If your blood sugar is 220, and you correct with a bit too much insulin you risk plummeting to levels too low. Then eating food bounces it back up. Once your blood sugar is “bouncing” it’s often difficult to stabilize it back to a normal range and stop the pendulum effect.

But the constant glucose monitor provides a constant update of what your blood sugar is, and WHERE it’s going. The knowledge of the TREND allows you to take action BEFORE your blood sugars reach high or low levels.

The constant glucose sensor/transmitter attaches to your body and looks like a small seashell. It transmits a signal to your insulin pump every five minutes relaying your blood sugar and rate of change. This rate of change, or “trend” is very beneficial. For example if your blood sugar is 150 and climbing you can correct with a small dose via your insulin pump, rather than a large and potential overcorrection. You are in a sense operating an “external artificial pancreas.” This isn’t automatic though. It still requires you to be aware, alert, and make decisions regarding your food and activity hour by hour. However the resource of this small device as a guide and tool is a significant change in the life of a type 1 diabetic.

Contrary to some beliefs this system doesn’t eliminate blood sugar checks. Since the little “seashell” glucose sensor draws from your interstitial fluid just below your skin while a finger prick checks actual blood (which is more accurate,) you still need to compare and calibrate at least twice daily.

In some ways this system is far more discreet than the routines of my previous 12 years. I’ve never felt embarrassed about giving myself a quick shot. But if I’m on a plane, in a movie, at a concert, in a meeting, or similar environment it’s often inconvenient to squeeze out a drop of blood onto my machine. Now I simply look at my small pager size device for information.

But in some ways it’s NOT so discreet. Although only a small device clipped inside your pocket, you do have a tiny tube connected to a your “infusion” site, which you change every few days. As cool as this gear is, you are constantly tethered to it, and even though the pump and tube can disconnect for showering, swimming, hot tubbing, high action volleyball games, and sex – you still have your small “infusion site” patch on you. Should you find yourself at a nude beach or similar situation where you don’t care to explain a cyborg-like port on your upper buttocks, thigh or abdomen, you can easily remove the infusion patch and transmitter. But the costs of these proprietary pieces means most folks leave them attached for as long as possible. After I adjusted to the fact that this little guy is going to be at my side for a long, long time I realized that everyone, (including me,) has cell phones, iPods, and other miscellaneous toys that already reside on their being all day long. Another gadget in today’s world really isn’t that odd. The only difference between carrying this and another gadget is the small tube.

After reading this a non-diabetic is probably thinking “Holy crap I’m glad I don’t have to deal with such a nightmare.” And I’d probably think the same. But to me this is absolutely the coolest piece of gadgetry I’ve ever owned. I admire the development and technology in the medical field, and I feel very fortunate that I have the resources to obtain this.

The answer to the most FAQ’d? No, it’s not painful. The required two cannulas that sit inside of you are made of extremely tiny flexible plastic. Inserting them is no different than a shot, and once they’re under your skin you don’t even feel them. Good times.

Since my blog is more than sufficiently fragmented between travel, food, Denver, and random musings I probably won’t post further on life with diabetes – but if my regular readers are interested I would be happy to post a follow up.

If you’re curious for more I recommend visiting the blog Sixuntilme.com, written by the very attractive Kerri. Kerri’s excellent writing details life with diabetes, and she also contributes to the online site dlife.com (You guessed it – diabetes life.) Kerri’s blogroll lists a host of other bloggers devoted to the highs and lows of living with diabetes. And I’ll bet now you can guess why that last sentence was a pun.

childrenwithdiabetes.com is an excellent resource for parents, with information on insulin pumps and constant glucose meters. From a design and style standpoint Amy Tenderich of diabetesmine.com suggests we recruit Steve Job’s help in developing the next generation of insulin pumps.

And if you want an example of totally playing up your diabetes for attention watch Brett Michaels “Rock of Love” on VH1.

James Van Dellen Denver

11 thoughts on “I Am Now Part Robot

  1. Hi James. Thanks for linking out to me, and all of your kind words. 🙂

    Are you on the Minimed 722? I’m on a 512 at the moment and am currently mucking through the upgrade process for a 522. Have you used a CGM before? I have a Dexcom but am wicked excited (whoops, there’s that RI upbringing cropping up) to use an integrated machine.

    Excellent blog you have here. I’m looking forward to reading through your archives.

    Thanks again, and enjoy your new gadget!

    — Kerri.

  2. Hi James,
    Ditto. Thanks for the shout-out.

    I am actually on the cool new tubeless pumping system called the OmniPod. Definitely worth checking out.

    All the best,

  3. Hi Kerri – I have the Paradigm 522. I believe the only difference (between the 722) is the size of the insulin reservoir, and I wanted the smallest unit possible. Also being active in general my basal rate is moderate, so I don’t go through the reservoirs that quickly.

    My sister who is type 1 also uses the 512 and I’ve been recanting my new experiences to her.

    As of last month I was completely new to the insulin pump and CGM. I picked up the CGM a few weeks after the pump, so had some time to learn each one separately then together.

    And yeah the availability of the CGM to me was more of a catalyst than the actual pump. But now seeing how the pump holds blood sugars in such a tight range makes me wish I had started on one a few years back.

    I think we’ll see vast improvements with future CGM systems. Currently there are the variances and small lags with the blood sugar reports, and it takes a couple hours for a new sensor to start reporting. I think five years from now we’ll see this generation of sensors as clunky as the first generation of iPods. Better design as Amy mentioned, and cool things like sending the CGM info to a PC app or cell phone (in which a parent could remotely monitor their child throughout the day.)

    But back to the present – other than a couple of bent cannulas I’ve been absolutely thrilled and wouldn’t even consider going back.

    Amy I’ve seen some posts about the Omnipod and people seem to really like them as an alternative to pump/tube. In my opinion (only that) it appears a bit large. (I’m thinking tight clothes here too.) Is it removable at all during the course of it’s life? Just curious – it’s great to have an option for those not wanting the tube. That was just my impression having not seen in person.

    Perhaps I’m fortunate also because I’ve found I can remove my pump for an hour or so (for swimming or active sports) and be temporarily “non-tethered” without any major fluctuations.

    All the best to you both.

  4. Wow. Small world. Claire from Culinary Colorado linked to your site and one of the first posts I read is this one…with a link to (and comment from) Kerri.

    My husband is type 1 and I’m type 2 (and no, I didn’t get it at 29 just from eating fast food…ahem…thanks to genetics and underactive thyroid and a wee bit of inactivity). Anyways, he’s reluctant to get a pump, but agrees that CGMS would be awesome.

    And well, we also enjoy the Denver restaurant scene and travel. And he’s a software engineer. so, hello!

  5. I just won my appeal last week for the CGMS. I have been working on obtaining this little gadget since July and after reading your post I am even more excited to start using this device. I have been Type 1 for 41 years and pumping for 4.5 years, on my second pump/722. I also suffer hypoglycemic unawareness which is huge and I am hoping for the CGMS to bring back my ability to walking 18 holes of golf again without constant fear of bottoming out. Thanks for your great post about switching to the pump and also the CGM.

  6. Hi Rachael – Yeah as I mentioned in my post it’s definitely a change switching to a pump – so I fully understand your husband’s reluctance. I wasn’t interested in using a pump at all until I found out I could obtain the pump AND CGM. I think the long term blood sugar stability is worth it though. But if your husband only used a CGM it certainly would be a tool to help mitigate the ups and downs.

    Karen congrats on the approval. With your Paradigm 722 experience and knowledge I’d guess phasing in the CGM should be a fairly simple.

    I’m working on writing a “tips” post also – basically my user observations (and annoyances too) that I’ve compiled after a month of using the CGM device. Kerri was considering the Minimed Paradigm as well so I’m planning to send it to her.

    As great as the CGM is it’s not a complete liberation from normal blood glucose checks, so I want to be express my feelings accurately and not “oversell” it.

    Thanks both for the comments! I appreciate it and will definitely post a follow up now.

  7. Please do post a follow-up with tips for the CGM. I know it is not the end all, but I really do feel that it will catch a lot of my lows that frustrate me bigtime.

  8. Hi Karen. Sorry for the late response. I was building bookcases in my basement all weekend and took a blog break.

    Alone? I couldn’t answer that. Injecting the infusion site isn’t a big dea, but I’d still probably check with your doctor for advice. One important thing my trainer did was set the basal rate MUCH lower than what my daily Lantus was.

    I took 25 units of Lantus – but my pump is set at 16 units daily (.60 per hour). I’ve upped it a bit, but she said many people set the basal rate equal to their 12 or 24 hour insulin, creating massive lows.

    Just something to consider… Happy New Year – james…

  9. James,

    I have been pumping for 4.5 years, but it is the CGMS that I cannot get into training until 1/8, and now I have decided not to try on my own, but to wait. If you ever have time, please post some of your tips for the CGM.

    Thanks a bunch for responding.

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