This past summer when I visited my endocrinologist (Doctor specializing in endocrinology, generally diabetes), she suggested I take a look at insulin pumping as an alternate therapy to the daily injections I have been on since I was young and first diagnosed with diabetes. She suggested that if I did turn out to be interested to go on an insulin pump, the brand I would probably most like to look at would be the Medtronic brand of insulin pump.

For anyone who doesn't know, an insulin pump is a small device, smaller than a deck of cards, that carries insulin. The pump is connected by a tube to a canula (a canula is sort of like a needle that stays inserted in to your body). The canula's insertion location in your body is changed every few days. Unlike taking a needle to inject insulin twice a day, the insulin pump allows a small dose of insulin to be continuously delivered through out the day.

I followed my Doctor's suggestion and started some research.

As a long time diabetic, I had known about insulin pumps for years. Admittedly, the thought of being continuously connected to a little box had kept me turned off from considering an insulin pump. But as I read the stories of many insulin pump users, and how they raved about how much better insulin pumps were than using needles for injection, I started to warm to the idea. The injection of the canula every few days supposedly didn't hurt as much as taking a needle, and invariably insulin pump users would get better control of their diabetes than they had been able to achieve when injecting insulin by the more traditional needles. As well, with insulin pumps, the food you can eat as a diabetic, and the schedule you have to follow for eating meals, is much more flexible than when you're injecting using needles. I was sold enough to get the official "prescription" from my doctor, and to phone the Medtronic sales rep.

Starting early October, I talked to the sales rep, who is a diabetic and has been on a pump for the last 9 years. It was good to talk to somebody first hand with some real experience. I found out that purchasing a pump also gets a blood glucose monitor that allows me to test the sugar in my blood, and have the reading wirelessly transmitted to the insulin pump, making insulin "correction" injections (or boluses as they are called), easier to calculate as the pump then "knows" what your blood sugar is without you having to manually tell it. I also during this time checked whether our extended medical would cover not only the initial purchase of the pump, but the ongoing supplies, as it generally is more expensive for pump supplies than to simply be buying a few needles for each day. Both my own and Susan's would cover it, so I decided to go ahead.

At the time I put in the order, the company was having a special deal on, that for an extra $200 of my own money, the company would supply basically three extra things (all things that neither provincial medicare nor extended medical cover at this time). Those three things included a notebook computer (believe it or not), a device to upload the pump records (which would include the last few hundred boluses I had given as well as the last few hundred blood sugar readings) to some software that I could generate reports from, and also a thing called a continuous glucose monitor and a half month's supplies for the continuous glucose monitor.

A continuous glucose monitor (CGM) is a device that, like the insulin pump's infusion set, is injected into your body and left inserted for (similar to the insulin pump) three days. During that time, the CGM continuously reads your body's glucose levels, and wirelessly transmits the reading to your pump which stores the values. The invention is genius really, in that it allows the diabetic wearing one to see exactly how their blood sugar is reacting to things like food, exercise, sickness, whatever...

It is brilliant really, no drawbacks other than the fact you've got two things inserted in your body continuously! Oh, and the other drawback being the price... The device itself is quite expensive (if bought regularly), but that's not what would stop the average diabetic from using it. The expense that is too outrageous even though it does help better your health is the ongoing costs, currently that price being in the neighbourhood of $500 per month in supplies!!! As of right now, very few people use CGMs due to the price. As time goes by undoubtedly prices will fall and eventually medicare/extended medical will help cover CGMs, as undoubtedly it is a significant advance in diabetic control.

For now, it is way too expensive to use regularly, but my thought is that maybe once or twice a year I'll do some continuous glucose monitoring for a week or two at a time, so that I can get more data that I can work with my endocrinologist on improving my control. The "special" included the CGM plus two weeks of supplies.

Starting early November after my pump was delivered, I went through about 8 hours of various types of home training. Mid November I went in for a four hour session with the dietitians at St. Paul's diabetic clinic to revisit a technique called advanced carbohydrate counting. I had learned basic carbohydrate counting about 10 years earlier back when I was attending the diabetic clinic in Lion's Gate hospital. On November 17, I finally met with my pump trainer for a half day, and after reviewing a good number of things, I attached the pump. That morning, over a month ago now, was the last time I injected a needle, something I have been doing at least once or twice a day since I was six! That week, I went in every morning to review how my blood sugars had been in the last 24 hours, in the first few days we would adjust something every day, but after a week, things were stabilizing a bit and I have been chatting to her about once a week, and occasionally making minor tuning adjustments. Earlier today (Dec 18) I talked to her and made a couple of small adjustments, and don't plan to talk again to her until sometime early in January (not only am I getting reasonably stable, but she's off on holidays for a few weeks). The first three weeks were admittedly a bit tense, struggling to exactly count carbohydrates in everything I have been eating, but in the last week I would say I have become a little more at ease and have been able to take advantage of some of the benefits that the pump offers to the lifestyle of diabetics on it! For example, yesterday morning in the office, there was a sudden email that there were some doughnuts available in the kitchen, I've now got the flexibility that I was able to confidently go get one I liked and eat it, even though I had had a snack just 30 minutes before. Unlike taking insulin a couple of times a day by needle, where the insulin that you take in large dictates what you can "healthily" eat over the next few (10) hours, the pump has got the flexibility that I could eat a doughnut and bolus for what I was eating. Today when out for a team Christmas lunch, I could comfortably order what I wanted for a main course, then have a cheesecake for desert without causing my blood sugar to go unreasonably high. Then this afternoon at a business meeting where they had some eggnog and cookies available, I could take a glass of eggnog, punch into the pump that I was having 25g of carbs, and simply enjoy. Taking insulin now is so much more subtle than the old alternative of having to take a needle. I can see why it is said that people often gain weight when they start on a pump, the flexibility of what and how much I can eat I have not had since I was younger than six! But truthfully, I have probably more taken advantage of the capability in the last month to simply skip snacks. Enjoying that I don't have to have both an afternoon and a morning snack besides regular meals.

I've been on it for just over a month, and I know I'm not yet 100% tuned, but I know I am liking the lifestyle it is giving me! So far during this "tune-up" time, I've been testing my blood sugar like crazy. In that first week there were a few days where I tested 13 times in one day. The average number of times I've been testing has been quite steadily trending down. I'm now down to probably an average of 8 or 9 tests per day. The small amount of blood that the newer meter takes makes the frequent testing not so bad. Once I'm out of the "tuning" stage, I expect I'll be dropping down to a quite reasonable 4 or 5 times a day.

In case you're still hung up on "Attached to a little box continuously, that's crazy!!!", I have to say it's really not such a big deal. Here is a picture of me and my pump as I generally wear it, and here is a picture of just my pump in order to give you an idea of the size of it. In the month I have been wearing it, I have only had one person say anything about it, and his comment was simply that he hadn't seen anybody wear a pager like that for quite a long time (yes, I admit, it does look like a pager from about 10 years ago).

Sometime in the new year I'll go back for a bit more training on how to use the continuous glucose monitor, and I'll use my half month of supplies soon after that.

So I hope this explains about what is truthfully quite a significant change in my life, and that the next time you see me you won't mistakenly think that I've taken to wearing a 10 year old pager.