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[IP] Re: Pump Questions


My apologies at being a little slow at getting back to you - I'm one of
these people who is going full tilt all the time. I hope that you see this
note before your visit to your endocrinologlist.

I'm sorry to hear that your particular group coverage plan from SUN LIFE
won't cover a pump since both the pump ($4895 (Canadian dollars, at least))
and the pump supplies ( quick-release infusion sets ($13.75 replaced every 3
or so days), syringes ($3.30 - I use it 2 times for a total of 6 days)) are
expensive. Perhaps it would be worthwhile talking to your employer and
seeing if they would consider arranging for some sort of an add-on to the
group coverage for people with diabetes. They should appreciate that:

1. The cost of a pump and supplies is less than the cost of paying for the
treatment of the complications which often develop in people with diabetes.

2. The statistics are out that improved control of blood sugar levels is
associated with fewer complications.

3. Use of a tools such as an insulin pump (together with frequent use of  a
blood glucose meter) should allow for better control (I doubt if there are
any scientific studies which make such a strong claim - The problem here is
that it would be difficult to get a large number of people with diabetes who
would be compliant enough to control things as well without a pump as one
can much more easily do with a pump).

Here are my answers to your questions:

> Is it great? Is life a little easier?

Yes and yes!

> 1/ What is the best thing about pump therapy?

The single best thing is to not be held hostage by an unpredictable long
acting insulin which was taken perhaps 30 hours ago. With the pump and a
short acting insulin such as Humalog, it is easier to keep your blood sugars
at normal levels. For most people, 90% of the effectiveness of the Humalog
is gone after two hours. (I seem to have to be careful when exercising
within 3 hours after a meal time bolus).

I have always had troubles with the long acting insulins (whch. of course
are used as the "basal" insulin for non-pump users). For the first 12 years
during which I had diabetes, I used NPH insulin as the long acting insulin
with a dose of it upon arising. It could fell me at almost any time in the
day - from mid-afternoon to the next day. The action seemed to be very
unpredicatable.  There were many times when I'd wake up in hospitals after
an aborted attempt at cycling home from school or work (and I certainly was
careful to eat consistently  (this was in the scary days before blood
glucose testing strips were available). There were also times in my early
twenties when I would go low overnight and not wake until 8:00 P.M. the next
night. After twelve years of this, I switched to Lente insulin. This insulin
was a much less violent than the NPH, and, what with blood glucose testing
strips (the greatest of all inventions for someone such as myself), I only
was carted off by ambulance a couple of times. After a year or so of Lente,
I then tried UltraLente which I used for the next 16 or so years until I got
the pump. It seemed to be fairly flat for me. I could almost always catch a
low and do something about it before the level went so low that my body
would not obey orders any more. Still the problem was that the blood sugars
were all over the place - from the low 1's to the high 20's - and I would
not  feel well when they were swinging all over the place. The problem with
the UltraLente, perhaps, was that it was more consistent than my body's
blood sugar reaction to changing internal and external conditions. I'd try
to anticipate, but gee, even Environment Canada doesn't do a very good job
in guessing the weather.

> 2/ What is the worse thing about pump therapy?

I get a little irritated at the costs associated with the use. I find them
unjustifiably high. It makes me feel as if I am a "lunch ticket" for the
producers of this equipment (I feel even more strongly about the costs of
those stupid little glucose test strips). I wish that there was more
competition for my medical dollars...

> 3/ How long have you been on the pump now?

Since Dec 21 1997, ie., for 77 days.

> 4/ Was it difficult to get on to and get your basal rates set?

No and No.

In Ottawa we are very fortunate that  the pump instructor for MiniMed is a
nurse who has had diabetes for 30 years. She uses a MiniMed pump for herself
and hence is an invaluable resource. She instructed me in its use and
followed me closely for a number of weeks (daily phone calls at first). I
was extremely fortunate to have access to such an instructor, and as well to
an endocrinologist who very much wanted me to use a pump.

Concerning the basal rate setting - My doctor made a first educated guess
based on my weight and the amount of insulin I had been taking. The guess
was .7-.8 units/hour which she then, for safety's sake, replaced with a
first trial of .6 units/hour. This actually turned out to be too much (ie.,
my blood sugar levels were dropping during long periods without
food/insulin), and I am currently taking a basal rate of .5 units/hour (with
.6 units/hour taken between 4:00 and 7:00 A.M.). It only took a week or so
to feel that everything was ok.

> 5/ Do you have kids and do you work?

No I don't have any kids - well, at least not of my own.

Yes I work full time (and some). In addition, I do some math tutoring on the
side (So sometimes I feel as if I have a big family of kids! I enjoy them
very much!).

If you have any more questions, always feel invited to write (or even phone
- virtually any time - I never go to bed before 1:00 A.M. and I would prefer
the phone to an alarm in the morning!). I'll try to check my email a few
times before your March 10 doctor's appointment just in case you have any
more questions.

     .-~O       .-~O
    _ \`,_     _ \`,_    ..... Celia McInnis, Work: (613) 991-7302
   (*)' (*)   (*)' (*)                               Home: (613) 523-9327

Insulin-Pumpers website   http://www.bizsystems.com/Diabetes/