A boring one... about diabetes and pumps

I have been struggling, the last two and half years, to get some sort of control over my diabetes.  I have, however, failed miserably.  I hasten to add that it hasn't been through lack of trying:  I have checked my sugar levels 4 to 6 times a day; I  have weighed my carbohydrates and used my calculator to work out carbohydrate portions and corresponding insulin units (different, depending on time of day, whether any exercise is planned, whether alcohol will be consumed); I have adjusted my insulin ratio on analysis of my diabetes diary.  I have read books, searched the Internet and followed up on bits of information my mom has told me about.  All to no avail. I have systematically failed to get my my *HbA1C under 8% in all this time.
  
     * In the blood stream are the red blood cells, which are made of a molecule, haemoglobin. Glucose   sticks  to the haemoglobin to make a 'glycosylated haemoglobin' molecule, called haemoglobin A1C or HbA1C. The more glucose in the blood, the more haemoglobin A1C or HbA1C will be present in the blood.
Red cells live for 8 -12 weeks before they are replaced. By measuring the HbA1C it can tell you how high your blood glucose has been on average over the last 8-12 weeks. A normal non-diabetic HbA1C is 3.5-5.5%.


My diabetic team are happy if I can keep my HbA under 7%, but it has been hanging around between 8.6% and 9.4% for the last long while.  You may not think being a couple of percentage points out should make too much of a difference, but it does.  Research has shown that diabetics who have regular HbA's over 7%, over a long period of time are statistically much more likely to suffer from the consequences of diabetes than those who manage good control.  Consequences like  (... and this is not an exhaustive list!!!)

• Type 1 diabetes reduces the normal life span by an average of five to eight years.
• Heart attacks account for 60% and strokes for 25% of deaths in all diabetics.
• Kidney disease (nephropathy) is a very serious complication of diabetes
• Diabetes reduces or distorts nerve function causing a condition called neuropathy. It particularly affects sensation.
• Diabetes accounts for 12,000 to 24,000 of new cases of blindness annually and is the leading cause of new cases of blindness in adults ages 20 to 74. The most common eye disorder in diabetes is retinopathy. People with diabetes are also at higher risk for developing cataracts and certain types of glaucoma
• Respiratory Infections. People with diabetes face a higher risk for influenza and its complications, including pneumonia
• Women with diabetes face a significantly higher risk for urinary tract infections, which are likely to be more complicated and difficult to treat than in the general population
• Diabetes doubles the risk for depression
• Diabetes changes bone quality and density
• Effect on Estrogen. Diabetes appears to blunt some of the effects of estrogen, which may increase the risk for heart disease. Women with diabetes have a higher risk for early menopause, which, in one study, occurred at an average age of about 41 years.

 And so you can see why after two and a half years of poor control, I have been becoming increasingly stressed and worried.  Anyway!  About 6 months ago the diabetic specialist nurse I was seeing at the time, the lovely Karen Jones picked up on my fear and desperation (the sobbing may have been a clue!), and suggested I may be suitable for an insulin pump.  When she first talked to me about it, I was filled with a mixture of hope and dread.  A butterfly wing flutter of optimism, but beset by a new set of worries - was this the end of the line?  had I exhausted all other options?  If this did not work, was there nothing else for me to try?   And then, when I had worried myself sick with that, I started thinking about the daily practicalities of living with an insulin pump.  I didn't know a lot, but I did know that it was a 24 hours a day 7 days a week thing.  I will be honest, my worries were mostly ones of vanity!  I knew that you needed a pocket or a waistband to wear the pump and was sure it meant I could never wear a slinky dress again!

So that brings you up to date, and now the reason I've been telling you all of this!  On wednesday I had an appointment with a dietician from the pump team.  The aim of the appointment was to provide me with more information and to do a final assessment  to make sure that I was a suitable candidate for insulin pump therapy.  Erin Pringle, the dietician, was very informative, very calming and very kind.  Apparently you can get a holster to put the pump in, which you can then wear wherever you like - so slinky dresses are no problem.  Also the pump that I selected comes with a remote control, so can you dial up your extra food related insulin without having to fiddle around under your clothes, and the remote control is also your blood glucose meter.  You can take it off, for example, to go swimming, but for no longer than an hour at a time.

 A diabetic on more traditional insulin regimes has a long acting insulin that is in their body 24 hours a day, this can either be once daily injection or a twice daily injection to provide your body with a background insulin irrespective of whether or not you eat.  Then you have quicker acting insulins which you use to cover any food and drink you consume. So for me, at the moment, I have 2 long acting (Levemir) injections, when I wake and when I go to bed, and 3 quick acting (humalog) to cover my 3 meals,and then additional injections for snacks.  As you can imagine, I have started to run out of injection sites!

With insulin pump therapy you only have one type of insulin, the quick acting, which the pump drips into your body continually.  This is much closer to what a working pancreas does.  You can program the pump to drip more or less at various times of day when you identify what your body's requirements are. You then give yourself some more when you eat (once you have worked out how much by calculating your carbohydrate consumption, and your insulin ratio).  This clever machine can also be programmed to release the additional insulin in different ways depending on what time of carbohydrate you have eaten.  In theory all of this means that you have the potential for much greater control.  It does require a lot of work on behalf of the pump user, in identifying what your body needs and how it responds to different kinds of food, exercise, alcohol, stress, heat, cold.  Becasue you don't have the long acting insulin in your body 24 hours a day anymore, it leaves you more susceptible to diabetic ketoacidosis (makes you very poorly indeed, hospital visit required), hence the reason you can't have it off for more than an hour.   

The upshot of my appointment is that Erin thinks I do fit the criteria, and I think that it is something I could and would be able to do.  It is going to be a little while yet, but do watch this space....