I have been diabetic since I was six years old. In April of 1999, I finally made the decision to go on an insulin pump. By that point I was up to six shots a day, still with terrible swings in blood sugars. I thought it was a last resort - but I ended up loving it. As other members of the Insulin Pumpers list say, "You couldn't even pry it out of my cold dead hands." . I am an open person and love to talk about it, so feel free to ask me anything, anytime. I created this site because despite of my open nature, some people are a little shy when it comes to asking certain questions.

What is it?

An insulin pump is used to deliver a continuous stream of insulin just under the skin. The other alternate therapy is taking multiple daily injections (MDI). Prior to starting on the pump, I took anywhere from 4-7 insulin shots a day.

Insulin, in layman's terms, is the key that allows glucose to be converted into energy for cells. Without insulin, I would die.

Where does it.. GO? How it is attached to you?

An infusion set is used to attach the insulin pump to my body. The infusion set is inserted with a LONG needle (scarier than it looks), but the needle is then removed. A small teflon (plastic) cannula remains in place, under the skin. Surprisingly the infusion set rarely hurts unless you hit a nerve or something (which I've only experienced twice). I've even taken a direct hit in kickboxing on the site and felt no pain. The infusion set has a connector which attaches to the tube leading to the pump. Thus, the pump can be disconnected at the site for showers, swimming, changing clothes, etc. I wear it close to 24 hours/day, removing it basically just for showers. I change the infusion set every 3-4 days.

The infusion set I use (there are four other types)

My favorite place to put it is just below my beltline on my back side. I also periodically wear it on my stomach/abdomen. If you ever want to see the site, just ask! If it's not in a viewable location, the next time it IS in a viewable location, I will show it to you.

So it is basically a portable pancreas, right?

Far from it actually - the pumper has to be the brain for the pump. It is NOT a closed loop system. You have to monitor a number of variables and tell the pump what to do! More on that later...

What do the beeps mean?

Most of the time when I "beep," it is because I am telling the pump to administer an additional amount of insulin to cover something I am eating or to correct a high blood sugar level. The second most common reason is that I have temporarily suspended the pump or reduced it's basal (drip) rate. I do this when I feel that my blood sugar might be dropping or if I know that I may have "overguessed" a meal bolus. There are a few other reasons for beeps - various error conditions and such. When I "beep" and immediately leave the room, you can guess that it is an error (such as it is out of insulin, is unable to deliver insulin, low on batteries, etc.). Nine times out of ten though, I am just giving an extra dose, called a bolus.

So, how does it work?

The human body produces insulin twenty-four hours a day, even if you are not eating. Most people think that insulin's only purpose is to convert food into usable energy. But actually, even if you never eat, you still need insulin to survive. The pump is programmed to mimic this constant stream of insulin the pancreas produces. To verify that you have set the basal rates correctly, you fast. If your basal rates are set correctly, you should be able to maintain a steady blood sugar all day/night if you do not eat or exercise. Everybody is different when it comes to basal rates. I have mine running on a .5 unit/hour drip rate for most of the day. From noon until 3 pm, it is at .4/hr, from 3-5pm, .3/hr, and from 5-8:30 pm .4/hr. It is fairly difficult to get these set correctly and they often change. Mine change when it gets cold, if I have not been working out as much, if my allergies are acting up, if I have an infection... you have to constantly be looking for patterns for change.

Now once you have the basal rates set, you could go forver keeping a "normal" blood sugar... but then there is that small matter of food. Most problems with blood sugar come with incorrect guesses at matching food to insulin needs. Whenever I eat, I need to administer an extra dose of insulin called a bolus. To determine the amount of insulin to give, there is a fuzzy equation that varies from person to person. One of the biggest hurdles in figuring out how to handle my diabetes was learning that with the human body, 2+2 is rarely equal to 4! There are too many factors to make a precise equation. Instead you make an educated guess, and correct your blood sugar after a few hours in necessary. In general you only consider the amount of carbohydrate in a food. As an example, let me toss out a few meals/snacks I eat:

• Breakfast: 2 Crunchy Peanut Butter granola bars - has 29 g of carbohydrate and 2 g of fiber, so 29-2=27g is the total carbohydrate in the meal. Because there is not a large amount of fat or protein, I know that all I really have to consider is the carbohydrate. So my breakfast ratio is appromiately 1:16, so I give 1.7 units.
• Lunch: 2 soft tacos with cheddar cheese, ground beef, sour cream, etc. The two flour tortillas have about 19 g /piece (I guess at these amounts often, and you also inadvertently memorize a lot of them - but I also have a carbohydrate counting book to help when I am completely at a loss). Now, there is a *LOT* of fat and some protein in this meal. What this means is two-fold: the digestion will be slower and I am liable (from experience) to have higher blood sugar levels because of the fat. My lunch ratio is approximately 1:12, so the tortillas need 3.2 units. Now I also add 2 in hopes of combatting the high fat meal. So I'll give 5.2. Also, because the digestion is slower, I tell the pump not to give me 5.2 units right NOW, but rather me half of it now (about 2.6) and another 2.6 units over the next hour and a half.

Other things need to be taken into consideration when doing boluses for food - like if I expect to be exercising in the next 1-2 hours, then I will need less. (Exercise for me is like a catalyst to insulin). There are tons of other little variables. Because of the "guess" factor, you should test a few hours after eating to check to see if you guessed right. If you didn't, you either eat more to correct a low blood sugar or give more insulin to correct a high.

So what's a day in the life of a pumper like?

Wake up. Test blood sugar. If "good" and in range, go for a run/walk. Suspend insulin during walk to avoid blood sugar dropping. When finish, bolus 2 units to counteract my body's response to early morning exercise before eating. My body, the liver to be specific, dumps glucose with early morning exercise.

Disconnect. Shower. Pray that those two units weren't too much. Reconnect. Check infusion site. Is it red? tender? Not too bad... Eat breakfast. Count the grams of carbohydrate in breakfast: 2 slices toast * 17 grams per slice - 3 grams of fiber per slice + 12 grams in Peanut Butter. Think about fat and protein in peanut butter. How much will this slow the absorption of that toast down? Hmmm... Decide to go with a 2.0 unit initial bolus, with an additional 1.5 units spread over 1.5 hours to cover the delayed absorption.

Get dressed, gather belongings... miss the bus. Damn - have to walk a mile to the next stop. Hmm... have had a recent bolus, better suspend the pump. Finish walk. Decide to leave it suspended for another 15 minutes or so, will test when I get to the office. Test at the office - 65 - damn, really need to get that bus on time. Eat 15 g of carbohydrate to bring me back to normal.

Work, work, work... time for lunch. Test. 220 - damn, what did I miss? Oh... forgot to bolus for the sugar in my morning coffee! Bolus 1.0 unit and wait another hour before eating. Eat lunch, just salad because I want to go to the gym later. If I want to avoid getting low in an afternoon workout then I can't have any major boluses in the four-five hours prior. Work, work, work. Test two hours after eating to make sure I bolused the meal right. Right on target. Four o'clock - cut my basal to 50% in anticipation of later workout.

5 o'clock - eat a powerbar, 25 g of carbohydrate. Hmmm... do I need any insulin? Decide to give .2 (normal without exercise would require 1.5 units for me). Suspend pump. Start aerobics class. Halfway point - stop and check. 180 - a little higher than needed, give another .2 and re-suspend.

Go home. Couple hours later, test. I'm "good." Make dinner. Calculate carbohydrates, protein, fat... most a high carb meal - bolus what I think is necessary. Work for a few more hours. Hot cocoa - another bolus. Bedtime - better check before bed - 157 - how long has it been since my last bolus? More than two hours? Not really... decide not to correct it - should continue dropping - go to bed.

What a day!

What a day indeed - but it is a part of life. Kind of like remembering to brush your teeth at night - it becomes very routine. The major thing is that it allows you complete freedom in mealtimes, exercise times, allows you to sleep in, dance the night away... sigh. It is SO MUCH BETTER THAN SHOTS. FREEDOM. A non pumping diabetic lives life by the clock - having to eat at certain times, planning for exercise as long as 24 hours in advance... it's impossible - especially in a college/grad student's life! Having a pump is like being NORMAL AGAIN. I would rather die than go back to shots. It is a lot to remember, and a lot of math. But I know tons of children that are on insulin pumps, and if they can do it, anyone can.

What would be your number one reason for getting one?

Do I HAVE to pick only one??? Laughing... this thing is the greatest invention for diabetics yet. My primary reason for loving it would probably be because it makes exercise so much easier. It takes a lot of work to figure out a "plan" for exercise... but the fact that I can start an intense workout at 140 and finish from 100 seems nothing short of a miracle from God... and the pump is what makes it all possible!

What about sex/showering/going to the beach?

The newest type of infusion sets can be disconnected right at the site. I usually disconnect for showers, exercise, and when I am laying out. If I am doing something non-athletic, then I bolus two hours worth of insulin before disconnecting. After two hours, I reconnect and bolus the next two hours, etc. This works best for beach days. For short periods of time, I don't worry about what I missed.

For intimate moments, most people disconnect - it IS exercise ya know ;) Some people leave it in... it varies. The only problem people on the IP list (mail list of almost 2000 pumpers) mention is remembering to reconnect afterwards!

What do you do with it when you are sleeping?

Honestly I toss it in the bed with me and hope it doesn't fall out of bed in the middle of the night! You have like four feet of tubing so I can turn any which way and not have a problem. The tape is pretty strong where the set is attached to. When I first got the pump, I'd forget that I had it when I got up to go to the bathroom in the middle of the night. I'd get halfway there and hear this thump thump thump bumping along behind me! Yes, you can drag it behind you and it doesn't even hurt. Ah... the wonders of modern medicine.

Now drawer handles are another story! I am lazy about tucking my tubing in and every once in a while, it gets hooked on something. I've never pulled it out, but that can hurt a little!

How much did it cost?

$5500

What happens if it stops working?

So several times since I have gotten the pump, it has stopped working in the middle of the night. Both times were due to a 'bad' set. That means the tube that is under the skin either got blocked or the tissue around the site got "tired" of absorbing insulin (happens after about 3 days). The last incident was by far the worst. I woke up, and knew I was high. I was thirsty as all and VERY nauseous. I tested my blood sugar and the meter displayed HI meaning that it could not read it! I checked my urine for ketones and only had a trace. If you are dehydrated, have high blood sugars AND have ketones it means your body is in a state of ketoacidosis. This is a toxic state where the body is burning fat for energy because it has no insulin to "unlock" the energy (sugar)in your blood stream. Diabetic ketoacidosis (DKA) can be fatal. Nausea is a key symptom of DKA - so I was scared. I gave a shot of 12 units (1/2 the amount I usually take in a day), and removed the pump. I laid down for a bit to see if the insulin would work... About an hour and a half later, I had dropped to 400 (normal is 80-90). I gave 5 more units and laid back down. I started to feel somewhat better but decided that I was so dehydrated that I needed to go to the health center anyways. I decided to shower, hoping it would make me feel better. Big mistake.... halfway through I got so dizzy that I clutched the shower curtain, spun around and whacked my head HARD on the tile wall. I did a quick rinse and got out and laid on the floor, willing myself to not throw up. I dry heaved twice, eek! At this point, I thought I was in serious trouble. I got up to get dressed before I called for help since I have a male roommate ;) Slowly I started to feel better and it all turned out okay. What did I do wrong? I brought down the blood sugar too quickly, putting myself at risk of all sorts of problems like cerebral edema. Believe me - I've never felt that bad from a high (I estimate that I was around 700-800), and next time I'll just go to the ER!!! (Dinesh, THIS is what I was talking about last friday!).

Can you get stock quotes on that thing?

Sorry, Jason, had to include it :) I will say that he was intoxicated when he asked! Most people when they see the pump think it is a pager or some other cell phone type device, so I do get strange questions.

Other fun questions:

Where did you get the cool pager chain? Is that an antenna? (depending on my mood, I've been known to say, "YES! By attaching the antenna to your body, it's like having a giant 5'7" antenna - you get GREAT reception!") When did you have the surgery to have it implanted? Can you put other things in it besides insulin? ("Yes, on bad days I put a little herion in there to give me that extra kick").