Friday, 27 April 2012

HA1C test

I am sure everyone here has mixed feelings when looking to their HA1C tests that get done regularly.  I just got back from having my blood taken for my test.  I am always of two feelings when getting this done.  On the one hand, it is a good view of how good my control has been over the past few months, and given the time I have had recently I think that I will see an improvement in my results.  On the other hand, there is always that dread that I am going to get a higher reading than before, and get a "talking to" from my doctor.  :(

While I am hoping to get into the low-7% range (somewhere that I haven't been a very long time), I know that it would be much better for my health to get down to a level of under 6%.  (For those of you don't have the conversions available to you at hand....a 7% reading would equate to an average glucose level of approx. 8.6 mmol/L or 154 mg/DL, and 6% would be 7.0 and 126, respectively.)  I had been well on my way to achieving the latter goal since my last test, however six weeks of turmoil at home has told me I will be lucky to get to the low 7% values. 

I do not know how things work where all of you live, but for my government to continue subsidizing my insulin pump, I have to show improvement from where I was when I started out on the pump, and continually work towards getting my blood sugars under control with respect to this test.  As everyone knows it is easier said than done. 

So, for everyone waiting to get their HA1C results, and feeling anxious about it, just letting you know that you aren't alone!  :)

Friday, 20 April 2012

Pimp My Pump!

Before I start this, I want to dispel any thoughts you have here that in this post I am doing any advertising.  I am not making any money by promoting the following companies or sites in this post.  The only place I make a few cents, is if you click on any of the advertisements on this page.

When you look at an insulin pump, you don't really see much.  It is a little rectangular box that you carry around with you all day.  Sure, it has a colourful button, or two, but that is about it.  Why don't you have fun with it.  No matter what insulin pump your choose, or currently wear, there are a wealth of opportunities for you to choose from for making your insulin pump as "you" as possible.

First off, with the pump itself, there are a variety of options available for both protecting it and expressing yourself.  You can go to and choose an adhesive "skin" for your pump, that wraps around your pump and covers all the plain, boring parts of your pump (starting at US$15, these are priced really well, in my opinion).  Whether you are looking to support your favorite sports team, declare yourself a princess, or get your Popeye on, you will find a multitude of designs ready for you.  You can even design and upload your own pictures.  Some pump manufacturers even have their own skins, which are made of more sturdy rubber that does more protecting of your pump, and have them in available in a number of bright, flashy colours (Animas has eight to choose from).  Accu-check has skins in six colours which also allow you to attach a belt clip directly to the skin to attach to your clothing.

After you have covered your pump with a skin, you need to be able to carry your pump around with you.  Sure, you could simply carry it around in your pocket, but who wants to be so boring?!  Not when you can go to Angelbear and pick or design your own pump case (this looks to be a good site for finding case, or insulin pumps harnesses, or even clothing for your young child wearing an insulin pump).  Pumpwear also has a wealth of cases and clothing to choose from.  This site has a lot of good products for kids and adults.  Not only can you choose from a variety of cases, but for those of you want to hide your pump from view, men can get boxers with pockets, or women can get bras with a pocket for your pump.  Of course there is always Ebay to go to and find cases, as well.  A recent inquiry on the site brought up case with Thomas the Tank Engine, Justin Bieber, and a zebra pattern.  :)

Of course your Insulin pump manufacturer will also sell cases that you can wear in a variety of ways.  So far I have gotten by with only two cases to carry my pump with me.  One is a leather case that attaches to my belt, and another is simply a black fabric case that velcros around my waist.  However, seeing all these sites, makes me want something else.  Decisions, decisions!! :)

Whatever you do, have fun with it!  Take a look at these sites or find others on your own that will bring our your own personal style.

Friday, 13 April 2012

Changes to your Basal rate

One of the neat things about having an insulin pump is the fact that you can customize your pump to give you a basal rate of insulin to more closely match what your body would actually do.  I am not referring to bolus insulin levels when you are eating, but basal levels to sustain a healthy blood sugar level.  Your body does not act the same way all the time, if it did, a lot of things would be much easier, including the management of your diabetes.  When you wake up in the morning, your body may require a certain amount of insulin to keep your blood sugars under control, however, as the day goes on and your activity levels change, your body has a different level of insulin required to sustain your blood sugars.  Then in your evening hours, body requirements can change again, and one more time during the night when you are asleep. 

Under traditional syringe based therapy, you will be giving yourself one or two "long-acting" insulin injections a day that are meant to give you a steady stream of insulin over the course of 24 hours.  These rates cannot be changed or adjusted much (if at all) based on how that type of insulin works.  However, with the insulin pump, you can set multiple rates to cover the 24 hours in a day.  These rates will give you the fast-acting insulin that is in your insulin pump, but (virtually) continuously over the course of the day.  Myself, I use four different rates during a 24 hour period. 

The fine tuning of these rates are often done with regular visits to your diabetes nurse educator or endocrinologist.  Ensuring you have your insulin rates correctly calibrated for your food intake (i.e. your bolus rates) is important for your overall blood sugar levels (ultimately your HA1C tests), however, in relation to your entire day, your basal rates affect you the whole day, not simply for periods of eating (as your bolus rates do).  These rates are important to have done and done right.  Not only can the proper calibration of these rates ensure your blood sugars do not stay high, they will also protect you from going into hypoglycemia.  Basically what I am saying is, "Don't mess around them, unless you know what you are doing."

Thursday, 5 April 2012

Disadvantages to insulin pumps

I am very strong advocate of using an insulin pump, for type I diabetics, although, I am not blind to the disadvantages that are inherent in them.  I will briefly discuss each of the disadvantages I can think of.  After all, when you are deciding if the pump is right for you, you want to be able to see both sides of the story.

1. Expense: Right off the bat, this can be a prohibitive factor for some people.  An insulin pump can run you $5,000 and more, and that is just for the pump.  Insulin pump supplies (for things like cannulas, tubing, and reservoirs) can cost in the area of $3,000, annually.  These costs are in addition to those that you will still have to pay for your other diabetic care regimes, such as blood glucose testing strips.  Many countries realize the cost that diabetes is going to have on the public funds in the near future in terms of health care for diabetes not managed as well as it should be.  For this reason, many places are funding the purchase of insulin pumps, allowing people (who meet certain requirements) to either pay nothing or a minimal portion of these costs.  Some insurance companies are also starting to come around and pay for the pumps, as well, in countries where the costs are not picked up by the government. 

2. Diabetic ketoacidosis: A shortage of insulin being supplied to the body forcing your body to switch to burning fatty acids and producing ketones (in high doses, ketones are poisonous).   Obviously this is also an issue under regular syringe therapy, as well, if you leave your diabetes unchecked and unmanaged.  The same thing can happen with an insulin pump if you leave your diabetes unchecked and unmanaged.  The risks of this occurring with your insulin pump relates to the fact that your insulin pump simply supplies you with fast acting insulin, so if you have no insulin delivery for a number of continuous hours, and let your blood sugar raise to dangerously high levels, you are at risk of ketoacidosis.  Reasons that your insulin pump may stop delivering insulin for hours on end include:
- your battery dying
- a kink or puncture in your tubing
- run out of insulin in your reservoir
- some sort of technical malfunction (these are mini computers, and something could happen)
Your insulin pump will have alarms for most of these items, and it is incumbent upon you to adhere to these alarms and pay attention to them.

3. Scar tissue build-up: I discussed this previously in that you must make sure you rotate the insertion points for your cannula.  This is a bit of plastic inserted under your skin, and your body will develop scarring around the site as it is inserted to your skin for up to three days at a time.  You must make sure you rotate your insertion point to avoid a build up of this scar tissue, which will hinder insulin absorption. This is true, however, for regular syringe therapy, as well.

4. Allergic to adhesive: some people will be allergic to the adhesive used by some suppliers.  This is generally not a huge issue as you can choose from other suppliers in most cases, and most pumps will offer a trial period of their pump at first and if you notice that you are allergic to the adhesive and cannot find another type of adhesive, you can return the pump and use another.

5. To be careful when involved in rough sports: Depending on the sport, or other activity you are involved in, you may have issues with the tubing or wearing of your pump, in that the cannula could get pulled out or get tangled up in your activity.  There are ways to ensure your pump and tubing are out of the way of "dangerous areas" or a host of other solutions you can either discuss with your diabetes educator or pump supplier.

6. Weight gain: this is the issue that I suffered from the most when I started on my pump.  In the months preceding my insulin pump adoption, I lost a large amount of weight, despite eating really anything I wanted to.  If you are reading this blog, you know a few things about diabetes and know that isn't right.  My blood glucose control was not good and my HA1C test proved that.  When I got on the pump, my blood glucose levels came under tremendously better control, allowing my body to properly process the food I was eating.  When I kept my same eating habits, my body held onto what I was eating, because of my better control.  I therefore gained a lot of weight.  However, I am now less likely to have future diabetic related health problems in the future.  Now I just have to worry about losing the weight again in a healthy fashion!

While it is true there are a few disadvantages to pump usage, overall, I still am very pleased with how relatively seamlessly the pump became an integrated part of my life.  I am lucky to live in a province in Canada where the pump purchase was paid for by the province and the supplies are subsidized.  Expense is really the biggest inhibitor of insulin pump adoption, in my mind.  Having that obstacle removed has added years to my life and improved my quality of life dramatically, of that I am certain.