February 28, 2005

Owie

Well, this set change thing is just as cyberpal Lori (http://brokendump.blogspot.com, why oh why can't I make an HTML link work here?) observes. Some of em are fine and some hurt like the heebie jeebies. So I have a safe, contented tush, but in exchange got the ouchiest set change so far. Maybe a little too high on the tummy, maybe just bad luck. It seems okay now.

Someday the day-to-day events of my life that seem worth recording will have a lot less to do with my ass. I hope.

Jeff, you are so helpful and I will truly continue to ponder the hinder. Err...well, you know what I mean. Thanks so much.

Kathleen, hello, thanks for posting. Yes, nighttime set change, definitely bad. My CDE says I can do a change early in the evening, though, allowing enough time for BG checks before bed. In this case, I had 4.5 hours, which I figured should be time enough to troubleshoot and correct if needed. Of course, if I had to do a replacement set change at 8 p.m., I'd be up kinda late...Right now it's just hard for me mentally to manage it before work, given last week's trouble. I imagine that when I get used to all these processes I'll switch back to the morning.

Finally, a quick plug for a new diabetes blog, www.diabetesmine.com. Let's all say hi to Amy and encourage the posting bliss to perpetuate...

You Want Me to Put That WHERE?

Can a person be faulted for not wanting to stab herself in the butt with an infusion set? I think not. No, no person can be rightfully blamed for resistance to a needle in the ass. The butt is, well, sensitive in multiple ways. (Hmm, does that sentence win me a prize for Most Bizarre Blog Statement Ever? How about Most Obvious? Most Wow-Did-You-Really-Have-to-Write-That?)

So: I am faultless in my earnest wish to spare my derriere. Yet it is this very location that my CDE (Certified Diabetes Educator) has recommended for my next (that is, 1 hour from now) set change. Ack. It’s not unheard of in my very limited pumping experience. Cyberpal Jeff N. is a butt stabber (no offense, Jeff!) who fully endorses the practice. And the idea did come up when I first met with the CDE for training. Came up and was promptly dismissed by me. Very promptly.

The problem unfolds thusly: Being a skinny type, I have a little bit of discomfort with 9-mm infusion sets in the abdomen. But when I use the gentler 6-mm sets, I tend to wind up with a bent cannula (reference the gusher post below, ahem). So the CDE says that bending is more likely with the 6-mm. Hence she thinks the butt + a 9-mm set sounds ideal for me. Plenty of fat there!

There are so many things about this that suck so much that I don’t know where to begin. I am not ready for the butt stab.

Boudoir de Pump

The search continues for a comfortable way to sleep with the pump that (a) protects the tubing from cat attack, (b) does not involve shorts or pants, which I find uncomfortable, and (c) does not make me feel like a fugly matron.

The experiment of the weekend involved sleeveless nighties. The pump can be clipped on the armpit—I put the pump inside, against the body, so that the bumpy clip faces out. Of course, depending on how you sleep, this may be uncomfortable. I like to sleep on my tummy, so it sometimes worked pretty well for me. Results varied depending on the nightie material—if it’s too flimsy or lacks a decently thick seam, the pump creates a gigantic sagging armpit hole and also flops around. Now THAT’S sexy…

Today, on a different note, I’m experimenting with changing the set after 3.5 days rather than 3. I have plenty of insulin in the reservoir and the set feels secure; the main question is whether I’ll experience icky skin irritation from pushing the timeline a bit. It’s not so much that I loathe changing the set (though this is not, as noted below, an enjoyable leisure activity); it’s that I’d like to change the set after work rather than before. Hence the need to push it back a few hours today. Am guessing this will be Not a Big Deal.

February 25, 2005

Practice

This is so obvious that it’s embarrassing, but then again that emotion is a motif of this blog, so what the hell. After the debacle that was Tuesday, cyberpal tippytoes pointed out to me that you can practice pushing those two stupid buttons on the set insertion device. All you have to do is pull down on the spring-loadie thing and, um, push the buttons. It works even though there’s no infusion set in the device.

Well, duh.

Seriously, I never even thought to try this. I had a list of steps and I was afraid to deviate from it because...yeah, because I’m not so good with the physical world! Hee hee. So. This morning is once again a Time for Change. I decide to practice. Almost immediately (impressive, I know) I make the groundbreaking discovery (ahem) that not only can I practice pushing the buttons, I can even put the serter on the spot where I plan to place the new set and practice at the exact angle I’ll need to use for the set change! Wow!!!

Many, many button pushes later, I change the set for real. I am thinking: Push the buttons at the same time. Push the buttons at the same time. I push the buttons...at the same time.

Thanks for the tip, tip.

February 23, 2005

Better

After yesterday’s outpouring of angst (among other things), it seems important to record that the last 18 hours have been better. I am getting good numbers, have heard no unusual noises from Charlotte, and haven’t seen my own blood since yesterday. Woo hoo.

I also think: hmm, that was bad, but I handled it, albeit in my fuddly INFP way. It appears that I can cope. Any day when that sentence holds true is a pretty good one in the twisted universe of diabetes.

February 22, 2005

Change Is Bad, or, I Destroy Many Infusion Sets, with Blood

Have I mentioned lately that I’m not so good with the physical world? Yes? Good. Allow me to illustrate.

Set change this morning before work. I put out the supplies, try to fill the reservoir, rewatch training video, fill the reservoir, try to prepare the infusion set, rewatch training video, prepare the infusion set, ponder my abdomen (pumping gives a new twist to the term “navel-gazing”), swab. I am good to go. It’s a little complex because I want to use a 6-mm set, but the only one I have left has 43-inch tubing, and I need the 23-inch tubing, which is attached only to my 9-mm set. So I must attach the 23-inch tubing to the reservoir, attach the 6-mm set to myself, then swap the one for the other.

If you followed that, you have my empathy, as you must have diabetes.

Infusion set count: Two.

Quick-Sets can be used with a handy spring-loaded insertion device (called a serter in aren’t-we-cool-NOT diabetic lingo) that spares the user the terror of driving that thick creepy needle directly into the body. You plop the set into ther serter, remove the sticky tabs, pull down on the spring-loadie part, and off you go. Only something goes wrong. When I pull down the spring-loadie part, the sticky part of the set gets stuck to the serter. In my attempt to free it without impaling myself on the needle I make the problem worse. Soon the set is stuck to itself as well as the serter. I rip the whole thing apart and start over.

Set count: Three.

The serter has a button on each side. You have to press the buttons simultaneously to get the set to go in properly. If you don’t, the cannula might bend, which would be Very Bad. No insulin for you, clumsy diabetic! As a longtime video game addict, I ought to be very good at this button pushing. Not so. I seem to lock up and do it wrong every time. This time, for example, I feel myself pushing the buttons a millisecond apart. But the set goes in fine, and upon removal of the leftover parts I see that the needle is not bent, a good sign according to my trainer. I pat myself on the head and trot off to therapy (ahem, no wonder).

Two hours after changing the set, you are supposed to check your BG. I do so while sitting opposite my therapist, who has learned quite a lot about diabetes since October. 150, seems reasonable. I trot off to work.

Lunchtime. I am chatting with my friend Vicki, to whom I have proudly showed off my pump. I check the BG—163, hmm, that’s a smidge high, but isn’t it cool how Charlotte will calculate the correction I need—punch in the numbers, and sit back while she delivers my bolus. Ah, pumping. So much easier than injections.

BEEP BEEP BEEP BEEP BEEP BEEP.

Charlotte has never spoken to me this way before. I take a look. (Good thing the pump isn’t in the thigh thing today. Ahem.)

NO DELIVERY

Uh-oh. I remember the unmatched button pushing. But I am prepared. I can change the set right here at work. Vicki makes a graceful exit. I place do-not-disturb sign on office door. Suspend. Disconnect. Pull out cannula. It’s a bit liquidy, eww. And the needle is bent at a 90-degree angle. Ah, clumsy diabetic. Not Charlotte’s fault at all.

Set count: Four.

I put my backup set in the serter, ponder abdomen, swab. I am thinking, push the buttons at the same time. Push the buttons at the same time. I push the buttons, not at the same time. The needle goes in. I start to pull the serter off, but something is wrong. It’s not pulling off the set like it’s supposed to.

Oh. I forgot to remove the sticky tabs, so the set is not attached to me. Moron.

It is impossible to remove the sticky tabs when the set is on top of a needle which is already in my belly. I am a little fuzzy on the next details, but I manage to remove the set—along the way it separates from the needle—and then the needle, upon which a veritable river of blood gushes forth. I do mean a river. And I do mean gushes. Much more blood than ought to ever gush from such a tiny hole.

I and my skirt sop up the blood. (At least I wore dark denim.) This was the only set I had at work. I guess I could switch back to injections for the rest of the day. Bah.

Then again, the cannula isn’t bent. Nor is the needle, though it is now stained a charming scarlet. This is probably Very Bad Behavior, but I reassemble the set, grit my teeth, remember to remove the sticky tabs, ponder abdomen, swab. I am thinking: Push the buttons at the same time. Push the buttons at the same time. I push the buttons, not at the same time…

February 21, 2005

Midterm Report Card

Today’s big news is that I have gone 36 hours without a low. Woo hoo! I had, hmm, something like 6 lows in the 3 days before that, though none under 60. The only thing that I’ve changed, per my clinic, is the basal rate (from 0.30 to 0.25) and the addition of a bedtime snack when I’m below 120. Actually, I had some of those lows even after lowering the basal, so I’m not confident that I’m entirely out of the hypoglycemic woods yet. But it seems like progress.

I haven’t been exercising, though. This was a conscious, if seductively lazy, choice related to the pump start. I didn’t want to throw in yet another variable before the basals were worked out. So one goal for this week is to start wandering the habitrails (Minneapolis skyways) again.

Numbers: fellow diabetes blogger Scott (my attempt to create a link isn't working, bah, but try http://scotts-dblife.blogspot.com) asked how my grades—err, my BG levels—have been since the pump start. Thanks for saying hi, Scott :-) Given the prevalence of lows, my numbers have been, well, low. I’ve been anywhere from 76 to 120 fasting. One of the things about my CDE’s instructions that surprised me is that she isn’t having me check my 2-hour post-meal numbers. Not necessary, she said, because we already know that my carb ratios work. Hmm. As I’m typing this, I’ve realized that I think that’s hooey and I should have been checking those numbers all the time rather than just when I feel low as I’ve been doing. I have a serious neurosis when it comes to finding my own mind when interacting with medical people. Both the CDE and the dietician at my clinic have made subtle references to my being over-intense w/r/t checking too much and obsessing over my numbers, and I think I’ve internalized that a bit. Of course, neither of them are diabetic. Humph.

Anyhow, I’m not sure how good the post-prandials are, but the pre-prandials have been around 90-135. I got a 168 (oh horrors) one night after I overtreated a low. So…if not for the lows, I’d say these are pretty dreamy numbers. I feel very fortunate. (Thanks, Charlotte.) Put that report card on the fridge!

February 19, 2005

Change Is Good

I did it! I changed my set. Details of the physical world not being my strongest area, I am proud. Happily, the videos on the CD that came with my pump were quite helpful. (I found it interesting that Minimed’s online Pump School doesn’t include infusion set videos, while the CD does. Safety precaution maybe?) I’m trying out the 9mm option to see if it’s comfortable; so far, so good. Best of all, that creepy smell seems to be gone, yay yay yay!

Note to self: next time remember to check which way the tubing is pointing before inserting the set…toward the belly button is a somewhat awkward direction! The CDE showed me a sample of a new set—if memory serves, it’s the forthcoming Clio for the Cozmo—that can be rotated so that the tubing can face whatever direction you like even after insertion. That’s an awesome feature, and I hope Minimed will pay attention.

I have also named my pump. She is called Charlotte, mainly for one of my favorite characters in all of children’s literature—the clever, compassionate, bold, creative spider of Charlotte’s Web. Charlotte is a name I wished I’d been given when I was a kid, along with various other girlie names. (I also used to want a nickname, and I liked Lottie for reasons I can no longer fully recall…) I like how it’s feminine yet strong and practical-sounding, very much how I want to imagine my pump. Seems to suit her.

February 18, 2005

Sniff sniff...

I smell insulin.

Bad.

There's no problem with the pump or my infusion site. I'm definitely getting insulin--in fact, a little too much; my CDE is helping me adjust the basal rate downward a bit because I've had some lows. I seem to also need a lower basal at night, weirdly, as I went to bed at 103 and was at 83 with shaking for my 2 AM test. Ate a glucose tab (just one, didn't want to overtreat) and woke at 76. I get hypo symptoms in the 70s quite commonly, so we'll have to fix that.

Anyhow, the insulin is reaching me for sure. Why the smell if the connection is okay? Is this an evil pumping thing no one told me about? Am I doomed to reek of Eau de Novolog for the rest of my pumping days? Ack. Talk about a body image issue.

I HATE the smell of insulin. It is, imho, a foul, medicinal, diseasey smell. I'm sure that no one else could smell it on me, probably, except my sweetie (and even he can't smell it from 1200 miles away). But I can smell it. It's nasty. I wonder if some insulin oozed out of the tubing when I was disconnected for showering, maybe, and then got on the tape or something when I reconnected? Pumpers, help. Tell me this is a fluke, please.

Other than this and the itty bitty low, I had a better night last night: pinned the pump inside a roomier T-shirt so it wasn't squashed up against me every time I moved. Also, by folding down the top of the baby sock and pinning both layers I fixed the flopping problem.

My life right now is very, very practically focused. This isn't my normal mode of being--though it has become more so since I got diabetes--and I find it interesting to consider in an abstract way. Like it or not, this experience does ground a person in the body. I'm more connected to my physical self than I've ever been.

Since I started pumping, I've not taken 7 shots that I would have otherwise needed. Unbelievable.

February 17, 2005

I Become Pumpgirl

You could express it this way: Tonight I ate dinner for the first time in almost 4 months without giving myself a shot.

Or this way: Tonight I went to bed for the first time in almost 4 months without giving myself a shot.

Or this way: I am Pumpgirl. Hear me beep!

It’s happened at last. I’m pumping. I’m a pumper. I pump. (Picture Bill Murray in “What about Bob?” as he braves the waves, bound hand and foot to the mast: “I’m sailing! I SAIL!!!” That’s me.)

It’s surprisingly difficult to put words to the moment, to tell the truth. The reason I’m trying to do so in the middle of the night is that I needed to wake up at 2 a.m. to test—the idea being that it would be good to know if my pump’s basal rate is sending me crashing into nighttime hypoglycemia, which I am pleased to report it is not—and I can’t go back to sleep for the life of me. I’m much too wound up. Everything is new again. Or newish. Still diabetes, of course, but with a twist. Like diet coke with lemon (semi-obscure cultural ref: this is how Marge Simpson describes kissing the Pie Man, who is of course Homer in his superhero costume).

Biggest Fear Unrealized: that I would feel, as articulated in somewhat mortifying detail below, not quite as feminine as I hope to. So far I actually feel—drumroll please—just as I did before. The set and the tubing aren’t gorgeous, it’s true, but they’re also not overwhelming in a visual sense. Nevertheless, I did stop at Global Village to buy myself a girlie (& pump-friendly) outfit on the way home from my pump start appointment. I also did my nails, LOL, which did not turn out well.

Second Biggest Fear Unrealized: that putting in the infusion set would hurt like heck. It actually felt just like a shot, one of the slightly-ouchier-than-average ones. For the technically curious, I’m using the QuickSet, 6 mm, 23 inches—I got a few samples from the CDE based on her thinking that I’m too skinny to be comfortable with the 9 mm. (My current supply from Minimed is 9 mm, which I may exchange, though I’ll probably try one when I change the set.)

Third Biggest Fear Unrealized: that I’d run low at night and not wake up. My sweetie called right on cue and talked to me while I did my test. Yay sweetie! I was at 90. Yay pump!

Biggest Fear Realized: that I wouldn’t be able to sleep. The darn pump-in-the-baby-sock contraption, currently pinned inside my nightshirt, is a bit annoying. The pump stretches out the sock and dangles down and flops around, for one thing. But that can be fixed by putting the pump in something less stretchy, such as the cute pump pockets I’ve seen online. Or I’ll try a nightshirt with a pocket & cut a hole on the inside for the tubing to run through. Actually I’m guessing the sleep problem is more emotional than physical tonight; I’ll just need to experiment with different ways of handling this.

Biggest Fears Untested (well, the rated-PG ones): Will I remember how to change the set? I’ve already gotten fuzzy on the details. Thank goodness there are videos on the online Pump School. How will I do at the business lunch I have to attend (why, oh why) later today? Also, will I retain poise in explaining the pump to coworkers? It’s not going to be visible, generally, but I know it will come up sooner or later. A topic for another post.

Thing I Haven’t Done Yet: picked the name. I need to spend a little more time with the pump first. I feel that the right name will soon become clear.

Rating for First 12 Hours of Pumping: 9.2 out of 10. It rocks. I’m so glad I did it.

February 3, 2005

Arrival!

It’s here! Yay yay yay! Quite a sensation to open the box at last; felt like I was lifting the lid on my future. The pump is quite purply, much darker than the color shown on the Minimed website (well, darker than my monitor indicated, anyway). It’s very pretty, plumlike. I am inundated also with supplies and reading material. The BG meter is back-ordered though, booooo hisssss. Haven’t these people caught on yet that I am Not Patient?

Naturally I’ve been practicing all night—I’m not hooked up yet, of course, and there’s no insulin in the pump, but the functions work. I loved the drama of putting in the battery and watching the pump come to life. A mildly Frankensteinian moment, if you will. Also I was surprised by the appearance of the backlight, which is beautifully eerie. (Am I romanticizing? Uh-huh. But honestly, how often does UPS bring me a truly life-changing present?) The menus are simple and intuitive; so far I’ve learned to do simple boluses and basal settings, check the history, suspend and resume delivery—the easy stuff. The pump makes a very pleasant beeping sound, friendly in tone and not terribly loud.

Figuring out how it works is all well and good, but my preoccupation is—no surprise here—how to wear the gizmo. I tested the Thigh Thing, which is a spandexy band with a pocket to hold the pump. Not bad. Requires a garter belt to hold it up, ooh la la. Currently I have the pump in a sock, safety-pinned to the inside of my pajama top. I experimented with lying down on it; seemed okay. There are several places online where one can order nightshirts and jammies with sewn-in pockets to hold the pump, but for now I’m holding off until I have a more practical understanding of what I want.

Pump name is still pending. But I’ve already started talking to it…

February 2, 2005

Pumper's Remorse?

Okay, I'm not a pumper yet, so I guess I can't have pumper's remorse. Pre-pumper's remorse? I'm terrible at waiting for big changes, very fretful and anxious. What if what if what if. Whatever. Ack.

One of the things I'm nervous about is that I live alone--my boyfriend is waaaay across the country--and I'll be starting the pump without someone here to help me. This has been a difficult aspect of my diabetes management all along--e.g., I worry about going severely low when I'm alone, though it hasn't happened yet. I'm sure the pump start won't be as scary as I imagine, right? It ain't brain surgery. Today it seems daunting, but I learned MDI quickly, and I'll learn this as well.