Tuesday, October 16, 2012

Starting out . . the beginning of the tale

I was diagnosed with Diabetes Mellitis (Type 1 Diabetes) at the age of eight. (March 1971). My memories of that time were that I was always thirsty, but no sooner did I drink a glass of something I had to rush to the bathroom to pee. My teachers thought I was goofing off in class because I always had to go to the bathroom. I was always exhausted and very scrawny. My parents offered me 50 cents if I could weigh 50 by the time I had my 8th birthday in November of 1970. I didn't make it. I also had the mumps the fall of 1970 and I was so scrawny that you couldn't even tell I had them. My brother, Mike, on the other hand, looked like a chipmunk with it's cheeks stuffed full. :-)

I remember being at the Dr.'s office and having them put a hospital band on my wrist and they put me in the hospital. They started my insulin therapy and stabilized my sugars. Other than the diabetes, I was completely healthy, so I enjoyed the stay. I remember some of the negrito (Filipino) children that were being kept in the youth ward and playing with the babies. They kept them in the hospital because if they sent them home with their antibiotics, their parents would sell them on the black market. The ones that had multiple diagnoses requiring antibiotics would get admitted until they were better.

One of the best things that happened to me there was the doctor being very open to people managing their own care. He told my mother that the best thing she could do was to learn to adjust my insulin to what I was doing. Instead of calling the doctor's office to do any changes, she would give me more insulin if I was doing something with high sugar (pizza, birthday party, being sick, etc.) or give me less insulin if my sugars were going low. Because of this, I have always been able to have a normal childhood and teenage years. Now, that is how people are taught to treat their diabetes, only now they call it a sliding scale or a basal and bolus.

Testing my sugars was nothing like they do it now. Prior to the personal testers, there were these lovely sticks and paper tapes that you would pee on. They wouldn't give you your glucose level, but would let you know when your glucose was high enough that it was spilling over into your urine. While that let us know when my sugar was high, it didn't give an accurate account of what the lows and medium levels were doing. Prior to that, I had a nifty diabetic chemistry set that my dad put together. I would have to pee in a cup, put five drops of urine and ten drops of water into a test tube and then drop a little fizzy pill in it. You'd watch it bubble up and cross your fingers the whole time that it turned a dark blue color, which told you your sugars were ok. If it turned bright orange, your sugars were way high and you had to be careful. My dad made this awesome wooden frame and painted it white that held my four or five test tubes so they were in a nice stable place and kept safe. I could put the test tubes in upside down after I rinsed them out and let them drip dry.  Now you poke your finger, put a drop of blood on a stick and stick it in a monitor to get a fairly accurate measure of your blood glucose. Before that, the only accurate testing was done at a lab.

Injections - What fun! NOT! Who wants to shove a sharp object into their skin? The needles were a little longer and definitely not as thin as they are now. Needles are measured by gauge, and the current ones are mostly a 30 gauge. I can remember the earlier ones being a 26 at the smallest and maybe even larger. I remember them trying to teach me to give myself shots. They gave me an orange to practice sticking a syringe into, but seriously . . how is an orange like your leg or skin? Finally, one brave nurse came in and had me give a shot with water in it in her arm. They wouldn't release me from the hospital until I gave one to myself. I remember a lot of tears and finally it was done with a little help. Thank goodness for improvements. My mother finally found something called a Busher Automatic. It was a little metal contraption that held the syringe. You would insert the syringe into an adaptor and lock it into the busher, then pull it up until it cocked into place and then placed the foot of it on your leg or stomach. When you were able to get up enough nerve, you pushed the button and it let it slam into your leg. It was a lot easier than pushing it in yourself. Now that I've done it for more than 40 years, I can't figure out what the fuss was about. I remember the first several years, while we lived in the Philippines, the syringes were glass and had to be sterilized. Luckily, nowadays, the syringes are disposable. In fact, recently, I've started using insulin pens where there is 1000 units in a large pen shaped object and you twist on a new needle each time you want to use it. When you're done, you put the cap back on, twist of the needle, throw it away and then recap the pen. It was a lot handier than the old syringes and vials.

Insulin - The first insulin I was on was a bovine insulin. Then they improved control by moving to porcine insulin. Both of these types of insulin were obtained by pharmaceutical companies extracting the insulin from the organs of slaughtered animals, as they no longer needed the insulin hormone. Many people had problems with these types of insulins, as they would have allergies to animal products. I was really lucky and did pretty good on them. The only side effect I had from them was that it broke down the tissue under the skin, so my outer thighs (where I took my injections) had dents in them with no fat layer or tissue, just muscle covered by skin. In the late 70's, someone finally figured out how to do a human type insulin (no . . . not taken from human organs but lab created) that drastically improved the control of diabetics everywhere. They also realized that diabetics did better with insulin coverage that acted all throughout the day, similar to how your pancreas continually feeds bits of insulin into your system to keep you healthy. About 4 years ago, I started using Lantus insulin, which was a 24 hour insulin that provided a basal (baseline) coverage of low amounts of insulin that took care of your minimal insulin needs. When I ate, or if my sugar went high due to stress or illness, I used a bolus (sliding scale) of a fast acting insulin to address the immediate concern, which is basically what your pancreas does.
Ta daaaaa  . . .

Finally! I gave in and said YES to the pump. My endocrinologist gave me the booklet and contact information for the Medtronic people and told me to contact them to get set up with a pump. They were very quick to respond. I called them on Tuesday, 9/25 and had my training class and got hooked up on Friday, 10/12/2012.

The first two nights were a little dicey while I figured it all out and tried to keep my glucose levels above 50. In the past, I've always estimated my meals at their fullest and then caught up on my sugar later, which has gotten me into some trouble with dropping sugar. The nice thing about the pump is that I can estimate the food on the low side and then if I eat more, I can just do a small bolus to cover that and it doesn't mean an extra shot. Problem solved!

The insulin pump clips onto my belt, in my pocket, on my blouse neckline, etc. It has a reservoir that I insert the insulin into and then insert the reservoir into the pump. The thin tubing that I attach to the reservoir has a catheter with a needle on the end of it. After I prime the tubing, I load the catheter/needle into an adaptor and set it against my skin. When I squeeze the buttons, the whole catheter/needle injects into my tummy area and then I pull the needle out, leaving the catheter behind. I let the pump know that it's inserted and it puts a couple of miniscule drops in to clear the catheter. All set!

I was surprised at how much an insulin pump can do for you. I have the purple mini-med, which is great. It's about the size of a pager. It came with a Bayer Contour usb glucose monitor, which plugs straight into your computer and wirelessly connects with the pump. When I first set it up, I told it what I wanted my low glucose readings before and after meals to be and what my highest glucose reading before and after meals should be. I also programmed it to give me a unit for every 15 grams of carbs that I eat and a unit for every 30 that my glucose is over my high. When it's time to eat . . .
  • I test my glucose
  • the monitor sends the results to the pump
  • I accept the results into the pump 
  • I tell the pump how many carbs I am going to eat
  • the pump decides how much insulin to give me depending on how high or low my sugar is, how many carbs I'm going to eat and how much insulin is still working in my system
  • I confirm the amount of insulin
  • the pump dispenses the insulin (very slowly)
So far my biggest challenges are:
  •   How to hold my pump when I use the restroom and have to drop my pants. The first time I did this I nearly ripped it out of my tummy because the tubing isn't long enough to go all the way to my knees (lol)
  • Keeping my cats from playing with the tubing when it's exposed from under my shirt, or laying on the bed while I'm getting dressed
  • Where to put it when I sleep (I hate pajamas)
  • How to get another Bayer monitor so I can have one in my purse and one in my room
  • Remembering when to change out the tubing (every three days)
The tubing, catheter and reservoir are supposed to be changed out every three days. To make it easier on myself, I am going 3.5 days. This way, I've been able to set two alarms on my phone. Every Monday morning at 7am and every Thursday evening at 8pm an alarm goes off on my phone to tell me to change my tubing. Hopefully, this pattern will be easy for me to remember and I'll keep it straight.

More later!