I was meandering around the TSA site after writing this banal post on contact lens solution. I checked out their “Diabetes” section under “Hidden Disabilities.” I had seen this page before, but noticed a few updates. The page is now more detailed, and has photos. I suspect this update may have more to do with educating TSA employees rather than diabetic travelers, but in any case its a nice update and a good resource.

I don’t consider it a disability, but I am a type 1 diabetic, which means I usually have a blood sugar meter and insulin within arms reach. A year ago I switched from taking insulin injections to using an insulin pump (the one shown above.) An insulin pump provides a constant dose of insulin over 24 hours, and allows easy and discreet manual doses during meals or as needed. This better mimics the pancreatic functions, or in the case of type 1 diabetics like myself comes one step closer to the holy grail of an “artificial pancreas.” My pump also incorporates a “constant glucose monitor,” – an incredibly cool gadget which relays my blood sugar reading to my pump screen every five minutes, without finger pricks. In the photo you can see my 7pm blood sugar of 75, and the two small ticks below the graph indicate earlier manual doses to correct those small spikes. Yeah I know its not an iPhone, but compared to 15 years ago we’ve come a long way.

Fortunately my insulin pump doesn’t look near as dorky as this one from the TSA site. My pump is much more discreet as it’s carried in my pocket or clips to the inside. But I don’t own beige pleated pants either, which apparently makes pumps look disproportionately large against them.

As for the security experience, I’ve been lucky as of late and haven’t had a bag digging in some time. On the occasions the TSA has done a search and dug up my pile of syringes and insulin they’ve always understood and haven’t make an issue of it. I do carry a folded up note from my doctor in my messenger bag. I’ve never needed it, and its going on about seven years old now. I figure it can’t hurt if I wind up at some foreign land border crossing in future years, or am passing through the metal detector at the Creation Museum where modern science and life extending medicinal gadgets might confound and perplex the employees.

When I started using my pump a year ago I feared the TSA folks would also be baffled and I’d be subject to a time consuming pat down every time. Reason is that insulin pumps are obviously worn on the body. They deliver insulin via a tiny tube which connects to a little port you change out every few days. The “infusion site” as its called looks a bit weird on the skin, but nothing is permanent and its not at all painful. The connection is easy to remove and connect, but since its under your clothing it can be a bit cumbersome and appear odd if doing so in public – akin to someone digging around inside their pants.

When I pass through the xray I usually just keep my pump in my pocket and hope they don’t see it. My success has been about fifty fifty. It doesn’t set off the alarm, and if its inside my pocket they often don’t notice. If its clipped ONTO my pocket, or should I be wearing the above beige pocketless pleated pants, they’ll then inquire, I’ll explain, and they understand. The only slowdown occurred last March in Chicago when a TSA screener spotted my pump and asked me to remove it, (which they should not do,) however another screener sauntered over and corrected her by saying it WAS to remain on. The original TSA rebutted that her grandfather took his pump off at screenings. They went back and forth before realizing I was still standing there and then waved me through, then continued discussing the agent’s grandfather.

Really though it’s not complicated to take on and off – and you have to remove it for showering, swimming, and of course “intimate” situations. But as long as the TSA thinks otherwise I’m just fine with that.

Now – for the Thanksgiving week question: Below are the other two photos from the TSA diabetes page. One shows a blood sugar testing kit with a couple vials of insulin – exactly like the kit I use. The other photo shows a TSA agent meticulously scrutinizing a vial of insulin – in a camera angle I can only assume a CSI fan came up with.

Look closely and study the two vials of insulin on the left. Now, assuming one of these vials is the same one he’s inspecting – Who can tell me what the TSA agent should NOT be doing?

Related posts:

Minimed Constant Glucose Monitor
I Am Now Part Robot
A Touchy TSA Issue

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