In case you are not familiar with how an insulin pump works, I thought I’d give you crash course relatively quickly. Basically, in a nutshell, it works as an external pancreas. In a non-diabetic, your pancreas is an organ that releases a hormone called insulin, and your body knows how much insulin is needed to break down every single thing you put into your mouth. For those of us with Type 1 diabetes it’s a little different (Again, Type 2 is very different, and I’ll address that another time.) See, my pancreas is just floating around in my body wasting space. It serves no purpose whatsoever. It stopped working probably about 6 months before my actual diagnosis. No known reason, other than it is heredity. We did not even know that it ran in my family until after my diagnosis, when my mom and I started doing some family history. I do not have a typical all-American family. My mom is an only child, and we found that on her dad’s side (my paternal grandfather), that it was prevalent – his grandmother had it, as did his nephew, and who knows who else. On my dad’s side.. well that’s a whole other story. My dad has a large “family” but none of them are close or speak to one another, really. So that one took some more digging. My grandfather was able to tell me that there were some relatives that had it, but mostly in his generation. I have no idea if any of my first cousins have it. Don’t suppose it’s relevant, but it would be interesting to know whether or not I was the only one destined to carry this gene. C’est la vie.
Ok back to my pump…. I am able to put a reservoir of 300 units of insulin into this device that I wear 24/7 (minus the 20-30 minutes a day I have to remove it for showers.) My dr and I work closely together and meet every three months to compute a bunch of numbers (for the record, numbers are NOT my thing and I did not go into Accounting for very good reasons.) These numbers for the most part are pure D guestimates. So many factors go into what numbers read on my glucose meter (a whole different device). But I digress. So one of the numbers that go into my pump is called a Basal rate. This number changes for different times of the day – I may run higher/lower certain times of the day. The basal rate is the constant that I am given all day long, not counting for any food, etc. It is comparable to what your pancreas would be doing throughout the day, just to maintain a healthy range of blood sugar readings. Now, keep in mind that I may have the perfect regimine of basal rates set up in my pump… but then if I have a stressful day at work, or I come down with a bug, or it’s that time of the month (sorry TMI), or if I am exerting myself more than usual – exercise, etc. Or any number of things that are “out of the norm”.. all of those affect my blood sugars. So in essence, that basal rate can go right out the window, as quickly as you can snap your fingers. It is just a crap shoot basically on getting the right number, and it is constantly a moving target.
The other calculation that we have to put into the pump is called a Bolus (carb ratio). The bolus is what I take to cover anything I eat/drink that may have carbs in it. And if you did not know this, then at least take this tid bit with you .. almost all food has carbs in it. Even fruit, which is good for you … has carbs. Those suckers break down into sugar, in case you didn’t know. Never read the labels? Try it .. you’ll likely be surprised. So every time you see a carb count on something, know that in order for me to eat that, I have to enter how many of those carbs I am planning on putting into my mouth, and also check my blood sugar, and enter THAT number.. and my trusty little friend, aka my insulin pump, will come up with a magical number, based on all of the pre-determined ratios, and it *should* give me enough insulin to cover that food.
Now. That scenario is based on a “best case” example – that I am eating a packaged food that lays it all out neatly right there on the label. When I go to a restaurant, yes, I can look up carb counts on my fancy schmancy iPhone app (thank you to my friend, Suzanne, to pointing out a new App to me this weekend – GoMeals) but again, that is still just a guestimate. And chances are, I have to look up each individal item on my plate to get the carb count for each item, and then add them all together (reference my earlier statement about not being good at numbers. *sigh*) So if I eat out, chances are I don’t add them up correctly and pay for it one way or another aftewards – either by being too low, or more often than not, too high. And between you and me … I normally suck at my carb counts. Exhibit A, my friend Suzanne that I mentioned earlier … her 10 year old daughter was recently diagnosed and so Suzanne is kicking butt at being as on top of this thing as she possibly can. She asked me this weekend how many carbs were in a kolache that her daughter was about to eat. My response, “I don’t know. I probably wouldn’t even bolus for that.” Doh. Wrong answer. We looked it up and there were in fact carbs, and if I was a “good” diabetic, I would have known that and bolused for it. (For the record, my sugars were up a little that day… but it was totally my fault.) Sometimes I just get lazy. There, I admit it. I “know” my body and I know that when I eat something I shouldn’t, and especially if I don’t bolus for it .. I will pay for it later. I really am trying to be better, though. I’ll post one day about the recent changes I’ve made, and my reasons behind the changes.
In case anyone is curious, here are all the “ingredients” to changing my pump site. I do this every 3-4 days (and honestly, I stretch it out longer than I should sometimes, but I’ll fess up to all of that in later posts.) All of these goodies make up my infusion sets, the reservoir, vial of Humalog insulin, IV prep pad, my rockin’ purple insulin pump, my CGM and sensor (more on how those work later, too.)
And here is what my pump looks like when it’s actually inserted in my stomach – don’t worry, the needle isn’t in there. I pull it out and only the cannula actually stays inserted under my skin. See all those dots? Some are red, some are white. Those are scars. From taking shots for over 7,000 days. They don’t really hurt. But they do leave their mark inside and out.
Since I started my story so far back in the stone ages … I thought I’d share the only picture I have of me in the hospital that first week after receiving my label/diagnosis (Potato/Po-tah-toh). I was very involved with my church youth group at the time, and they were my second family. They all came up to the hospital to surprise me that Thursday night – my last night in the hospital. One or two came in, then the rest trickled in till we had the whole gang crammed in that tiny hospital room. Stayed long enough to give me lots of prayers, hugs, and love, before the nurses scooted them all out. 🙂