You have been forewarned!
As I was looking at the paraphernalia that is regularly attached to my abdomen, I thought many of you may not know what it it’s like to use an insulin pump and/or a continuous glucose monitor (CGM).
Well, it’s not pretty, especially on a 54-year old’s belly. So, in the spirit of sharing, here’s what it looks like on me (the only PhotoShopping I did was to add the text and arrows):
[Side note: Quite often, I have bruises from all the various insertions, but lucky for you, when I took this photo, my tummy was pretty clear].
Realistically, it’s not a lot of equipment – just 3 pieces:
- The insulin pump
- The infusion set
- The CGM transmitter and sensor
First, let’s talk about the pump. This is truly my lifeline. Most T1Ds inject insulin into their bodies several times a day with a syringe. I used to do that, but I have been lucky enough to wear an insulin pump for the last 10 years or so. (As a reminder, an insulin pump is an external, battery-powered device that delivers insulin into my body at a programmed rate. The infusion set is a reservoir and tubing, which, when connected to the pump, delivers insulin from my pump to my body).
I always have the insulin pump on and the infusion set inserted into my body. I’ve kept it on during surgeries, I sleep with it, I keep it on when I’m flying, I wear it when I’m exercising…The only time I don’t wear it is when I am showering or swimming (and then it is only off for minutes at a time).
The pump is “programmed” for my specific needs. (And I purposefully put that in quotes because it is not an exact science by any stretch of the imagination). Essentially, my insulin pump works this way: I get a tiny but steady stream of insulin all the time (the basal rate) and when I eat, I give myself additional insulin (a bolus) to compensate for what I ate (so that my blood glucose doesn’t get too high). Now, I used to have to do those calculations in my head when I was giving myself shots, but the pump has a featured called the Bolus Wizard which helps me with that.
Sounds simple enough, but you also have to take into consideration things like exercise, glycemic rates, the fat content in your food, stress, whether the stars are aligned (you think I jest) and so much more. And sometimes (many times, actually), what worked yesterday doesn’t work today. But that’s the life of a diabetic.
Theoretically, this combination of basal rate and bolusing mimics how your pancreas works (if you’re lucky enough to have a working pancreas). For people like me, this little machine and my brain are doing the work for my pancreas. Like I said earlier, it is truly the lifeline that I cling to.
I change the infusion set every 3-4 days. I usually rotate from one side of my abdomen to the other each time I change it. It takes me about 3-4 minutes to remove the old equipment, rewind the pump, fill the reservoir, insert the infusion set and prime the pump. Once that is done, we’re off and running again.
Occasionally, when I remove an infusion set, I’ll have a bleed out. Those can be quite embarrassing (I had it happen in a restaurant once), but you just handle it.
Lest you think this is a lot of trouble (and it can be), I wouldn’t go back to giving myself six shots a day for anything.
Now on to the Continuos Glucose Monitor, or CGM, which measures my glucose levels in real-time, twenty four hours a day. A tiny electrode (the glucose sensor) is inserted under my skin to measure glucose levels in tissue fluid. It is connected to a transmitter that sends the information wirelessly to my pump. The pump can then detect and notify me if my glucose is going too low or two high (thresholds that I have set in my insulin pump).
And notify me it does! Which is a good thing, but sometimes (especially when it is going off in the middle of the night), it can be overwhelming. (Just today I was yelling at my pump because the low glucose alarm kept going off, and I was eating, and it was taking longer than I would have liked for my glucose levels to rise). And yes, I can adjust my thresholds and other things to make those alarms occur less often (but that kind of defeats the purpose, imho).
I change my CGM every 6 days (which is the life of the sensor). It takes me about 5 minutes to do this, mostly because it’s a little trickier than the pump and infusion set, and I haven’t been doing this as long. I still mess it up from time to time, and when I end up wasting a sensor, I just think “ka-ching, ka-ching.”
Note that I do not have to wear the CGM all the time, but I am finding it quite useful these days in helping me try to keep my blood sugars in better control. We shall see how I am doing when I visit my endocrinologist in a couple of weeks.
So, there you have it. There are a lot of other details and nuances about using a pump and CGM, and this was in no way meant to be scientific or comprehensive. But it thought it might give you a glimpse into what I – and so many other T1Ds – do every day of our lives.