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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
> differences".
>     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 
start slapping...

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 
of data...

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 
that effort...

Rev. Randall Winchester
WD4HVA (email @ redacted)
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