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Re: [IP] post it and don't worry
On 20 Jul 00, at 16:42, Jim S. wrote:
> I always have a problem when people generally talk about "how much more
> flexible the pump has made their life"....
And some of us get our buttons pushed when people talk about how easy
things were for them "pre-pump" because our memories of that time include
THE SCHEDULE (iron clad, no variation for anything...) and THE DIET
(even when doing the pre-carb counting things there was always the
balancing act between "is it worth a couple of shots to eat this" and the
need to eat properly, and the fear of not eating enough to cover the peak of
the long term insulin which would hit sometime in the next 1 to 6 hours) along
with bruises from the multiple shots, hypertropy in our arms, legs and
stomachs and all the other things that we had to put up with. I remember
my doctor and I trying all kinds of things, including me getting up at 3:00
a.m. to take a shot of regular insulin in order to get my morning bg below
200... and the problem of having to take the shots based on what you
thought you might be doing six to twelve hours in the future. And then
something would change and you were in trouble because your shot schedule
didn't allow anything unpredictable to happen... I remember having to leave
a family in the emergency room at the hospital just after the doctor had
told a woman that her only remaining family member, her brother, probably
wouldn't live through the next hour because I should have been finishing up
my evening meal instead of sitting with the family at the hospital. I had to
leave to find something to eat in the hospital cafeteria - and they have
strict rules about bringing food into the er waiting room too...
> And the problem is mine. My experience did not include such "major
> Having to eat went away for me in the early to mid 80s (pre pump)
> Unexpected treat - take insulin - means isn't an issue for me
> Don't like carrying so much pre pump? - I carry more post pump
For some of us the reality is different - just goes to show how every person
is unique. I was on a tight control protocol for years (normally 6 shots a
day, plus extras if needed) where I used regular syringes, Novolin Pen and
a MediJector for injections. I had the various methods in order to be able
to have some convenience when I needed it.
I carry about the same amount of junk around with me, except that nothing
weighs as much as the MediJector did (that thing was heavy!) and people
don't grab my pump out of my pocket the way they did the Novolin Pen.
That caused some interesting times - like when an accountant sitting next to
me at a meeting just reached over and grabbed the Novolin Pen from my
shirt pocket, unscrewed the cap and sat there with his mouth open looking at
it. He thought it was one of those expensive ink pens...
> I think if people learned as many things related to DM management as they are
> "required to" for pumping MDI wouldn't be so "inadequate"... Spending so much
> or fighting insurance makes it uncomfortable to say this "isn't for me" after
> the fact...
I learned enough that I was keeping my doctor, his nursing staff and the
local CDE up to date on what was going on. I was doing a version of carb
counting before we called it carb counting... and yet I found MDI to be
woefully inadequate, primarily because no one could ever figure out how to
make the long term insulin (NPH, Lente, Ultralente) work in a repeatable
and reliable manner.
I do agree that it probably would be a good idea for people to try intensive
therapy first - and learn the carb counting and meal bolus concepts before
going on the pump. That way the basic ratios can be predetermined fairly
closely and the switch to pumping just helps gain repeatability and
predictability... but not like the old two bg crashes every other day that I
used to have on MDI. You may know the kind - you drop your long term
insulin by one unit and your bg is over 300, you raise it by one unit and it's
> Ever know anyone who expected the pump to "fix" their diabetes and it
> didn't? I have... Luckily there was awareness of a "professional
> in-training" to make the needed calls. Survival was in question.....
I've met several disappointed people like this. Some of it was the result of
bad training by the "medical professionals" who led patients to believe this
was the cure. Other cases were people who had trouble with intensive MDI
being put on the pump (not a good idea in my opinion) and then balking at
learning more - when what they really wanted to do was forget it all. It's
just part of human nature - there are some people who jumped on bg
monitoring in the same way back in the early 80's and then became
disenchanted with the whole idea. There are people who quickly climbed on
the pumping bandwagon and then fell off or jumped off once they found
out what it was like.
> Think about the intensity of feelings if there are pump or site problems.
> Panic, inconvenient, or "oh well"?????
All of the above, plus a bit of anger, disillusionment and depression thrown
in. All of these are normal in MDI too - or at least they were in my life.
Usually when the insulin shot didn't work, or I discovered that I'd just
ruined my last white shirt because my shot that I took before breakfast
(stomach, usually) was still leaking blood an hour later when I got dressed
before church. I used to have a bunch of shirts that we never could quite
get the blood stain out of. My wife is a nurse and we tried all the things
that worked on her uniforms, but it always left the blood stain visible on my
The key issue is that the pump isn't perfect - it's just another tool in the
inventory of available technology that can help manage diabetes. The
problem is that appropriate application of the technology sometimes
requires a lot of effort from the medical team as well as the target patient.
We'd all like the magic pill, shot or even machine that would allow us to
lead "normal lives" and we are constantly promised that it's just around the
corner via transplants, closed loop systems or drug therapy. The problem is
that reality doesn't match the promise and we are left trying to get
whatever treatment protocol is best for us set in place, often while fighting
the enemy insurance company or ignorant medical professionals...
Any of the intensive therapies require motivation, intelligence, problem
solving skills, record keeping skills, data analysis, predictive statistics and
even a strong sense of identity (so we won't get caught up in a numbers
game), along with a good support system and adequate resources ($$$) to
be viable. Using a pump is easier for some, harder for others - and the
problem is that it isn't easy to determine which it will be for a particular
person until they've experienced it for a while and have also had the
opportunity to compare it to intensive MDI.
Comparing use of an insulin pump to the old 2-shot a day NPH regime just
doesn't work, primarily because the old routine wasn't designed to result in
your A1c value being close to normal - it was designed to keep you
moderately asymptomatic. That means not spilling sugar or ketones in the
urine tests, avoiding too many insulin reactions (hypoglycemic episodes) and
generally feeling halfway functional most of the time.
Have I slapped anybody's wrist too hard this time? I hope not, but if you
are trying to make people feel bad for advocating pump therapy then I will
The bottom line is that pump therapy is the best option for many of us and
the worst option for some people. It's hard to tell which group some people
fall into until they've had a chance to experience the options. I have a
friend who is in graduate school now who doesn't see any real reason to
keep his bg under control much beyond the two shots and one or two bg
tests a day. His doctor is in agreement since he feels that the complications
are unavoidable anyway so why bother... This person is not a candidate for
a pump, but I don't look forward to the day when his vision gets even worse
or other complications start showing up... but that's his decision and I
probably won't even say "we told you so" when things start deteriorating
further... it's really his choice.
I'm concerned that people don't have enough information and practical
experience to make an informed decision. They rely to much on anectotal
evidence and medical hype or misinformation instead of real data... or they
are just suffering from information overload and cannot handle the deluge
Everybody is different, and every person deserves a chance to try to keep
their bg as close to normal as possible. They should also understand the
cost involved in making that effort and the long term cost of not making
Rev. Randall Winchester
WD4HVA (email @ redacted)
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