A bit of a catch up...

I've been really busy recently, and time just seems to have evaporated recently.

Christmas thundered into site and disappeared in a carbohydrate based cloud of smoke as usual, but this year was a fair bit easier than previously.  The pump made a huge difference and certainly evened things out, although I did see a '14' reading at one point.  This christmas I made a point of ripping off the nutritional info labels from anything that was going to take a few days to eat, only to find that they'd ended up in the bin along with the mountain of other festive related rubbish!  Sometime best intentions don't quite work out!  Anyway, overall I'd say that it was a successful festive season from a blood sugar point of view, as well as the general fun that was had.

Bad Insulin
I think I've had a bad vail of insulin recently.  Some unexpected and pretty much unexplainable high readings suggested something was amiss and I did the usual changing of infusion sets, but high readings remained.  In the end I binned the vial, started a new one and normal service was resumed.  Another lesson learnt!

More airports.
Airport security are improving their hit rate!  Think it's been 6 trips through the security since the last time I mentioned this and out of those 6 I've had one random search, so another explosives swab for the pump.  Travelling with the pump real has been a breeze and the airports all seem to know what they are and are sensitive to them.  No issues yet, but I'm hitting the sky again next week, but this time through London City Airport whose security is really, really tight.  I'm expecting it to be found this time!

I'm still very, very happy with the pump and still wouldn't be without it :o)

A Good Week

I suspected that this had been a good 7 days and a look at my target graph on the meter confirmed this.

Remember, my target range is set from 5 to 7 mmol/l, so the meter / pump combo are working to achieve an average of 6 mmol/l.  Pretty ambitious compared to what I could achieve with the old pen Basal / Bosal combination.  The pie chart is showing the following:

19% above 7
58% between 5 & 4
23% below 4
0% less than 4

Looking into the figures further, I've worked out my average reading for the last 7 days was 5.95 mmol/l.  I'm well chuffed with that :o)

Pump 3 - Airports 1

It's been a hectic couple of weeks in and out of work.

First the work bit.  Lots of O/T and 'unsociable hours', meaning less than ideal food.  On the whole it was fine, with BGs at a good level, except for one Sunday morning where I hit 21!  Now, I blame this on a) starting at 02:30am and b) there being a shed load of crap food around.  Some correction bolusing saw me return to normal levels pretty quickly.

I've also been out and about quite a bit, including more flying .  The general out & about aspect meant unpredictable food intakes, but my carb counting was pretty much spot on, with no dramas.  This is good :o)

The flying bit proved to continue to be interesting, well, the security checks have been anyway.  As I've said before, the airport scanners don't set the pump off.  Each time I've negotiated security, I've been clutching my hospital letter which sates I'm a pump user, etc.  Now of the last 4 times I've been through the security process, I've only once been challenged.  the other 3 times, they've completely failed to spot the pump.  I do find this slightly alarming in today's 'terrorist sensitive' society, but hey, I got through quicker, so all's good for me!

Last week also saw my 6 monthly check up at the hospital, and the first HBA1c blood test. I was expecting a bit of a rise as it's only couple of months since going on the pump and a bit of fluctuation was to be expected.  My last HBA1c before going on the pump was 49, or 6.6 in 'old money'.  This test was exactly the same!  I was pretty pleased with that, especially as I'm so new to this pump business.  My target range that we've set on the meter is 5 - 7 mmol/l.  This basically means I'm aiming for 6 (or 48 for those younger than me!), something I think I'd never achieve on the old Basal/Bolus pen regime.  I'm pretty sure that I'm be there come the next test.

Bubbles, yes, I've been struggling with them, but I think I've nearly got it sussed.  Key to this is getting the insulin out of the fridge well before drawing it up into the pump cartridge. For some reason, it's a lot less susceptible to 'bubbling' at room temperature.  I'm sure there's some fantastically complicated scientific reason for this, but it's lost on me.  Having the insulin at room temperature and slowly transferring it to the cartridge seems to do the trick.

Finally, it would seem the season of festive engorgement is rapidly approaching.  It's always a bit of a testing time for us diabetics, for instance, an average mince pie is around 40g of carbs per pie and a modest slice of Christmas cake about 50g.  Oh, and that tiny slice of Christmas pudding?  That'll be about 60g.  Best I stock up on insulin supplies!

Bubbles, have I got it sussed?

The routine had become, very carefully fill up a cartridge, taking extra care to ensure that there are no bubbles in it whatsoever, then put in pump and, discover (after a day) loads of bubbles or one big bubble.  Where the hell were they coming from?  I made sure there weren’t any when I changed cartridge!

Then it struck me.  There must be a zillion teeny weeny microscopic bubbles that I can’t see, so a different approach might be needed.  Therefore I pre filled a new cartridge yesterday and left it in the fridge.  There were no bubbles in it at all.  Today I went to change cartridge and there they were.  Bubbles.  This gave me the opportunity to expel them before loading into the pump.  The insulin in the cartridge certainly looks clearer, time will tell if the bubbles have been banished.

More mucking about with used infusion sets now. Just how strong is that tube?  Very, that’s how strong.  Today I ‘tested’ one by hanging 20lbs (9 kg) from one.  

It stretched a bit, but didn’t break!  Most impressive.

Airport

No, not the old dodgy film or the old dodgy song, but real life airports.

This week saw my first flights since going on the pump.  Some questions were answered through my experience.

Some basics first.

1) leave the attached & running

2) take your letter from your GP or hospital ‘just in case’ you need it.

3) be prepared to stop the pump and remove the battery, just incase someone insists that it goes through the X-Ray machine

So, does the pump set off the the metal detector?

It would appear not!

At security on my way out, the vigilant chap at the metal detector thing spotted the tubing coming from my pocket.  I told him what it was and removed it from my pocket.  What happened next was something of a surprise.  He instantly kind of became my best mate!  I was almost treated like royalty and he engaged in smalltalk.  That’s the first time that’s ever happened at airport security, and I’ve flown a fair bit!  I showed him the letter from my hospital explaining the pump, he had a quick read of that, asked me my postcode and with a cheery ‘bye’ I was into the departure lounge.

On my return flight, things were very different.  They didn’t spot the tube and I was not challenged in any way!!!!!

I’ll admit I was a bit apprehensive before I left, expecting something akin to the Spanish Inquisition, but it all turned out to be a massive anti-climax!

It's stronger than you might think....

So, how tough is the pump setup?

Pretty darned tough!

The pump itself is standing up to day to day wear and tear just fine, including being bashed against the odd door frame.  There are no marks on it at all and it seems pretty water (well sweat) resistant and copes with much bouncing around playing Badminton and when out on a bike.

I'd suspected that the infusion set (the tube from pump to cannula) would be a bit fragile, so I set about trying to break one when I changed a set.  I can tell you now, that despite looking thin & fragile, it's anything but fragile.  I tried to pull the tube out of the end that screws onto the pump end, but although it stretched a bit, it would not come back,  Trying to snap the tube didn't work either, it just stretched a bit.

Two tubes in one

Next I cut it in half, which demonstrated how tough it was as it required a fair bit more effort than I was expecting.  After cutting, I then cut a slit down the tube (somewhat tricky with such a thin tube), which revealed another tube within.

So, the verdict - you win' gonna be snapping or pulling the infusion tube out of anything.  It's plenty strong enough to get caught on something without issue and the pump itself will quite happily swing around, dangling on the end of the tube.  The weakest point if the cannula itself that can get pulled out, but that's not such a bad thing!

Lessons to be learnt

In my last post I mentioned that my levels had been a bit high, which I found massively frustrating.  My target range is set pretty aggressively at 5 - 7 mmol/l, giving a target average of 6.  Something I wouldn't have dreamed of whilst injecting, I'd have been hypo'ing too much to consider aiming for that.  Anyway, I was running a bit high and everything I checked seemed good.  Bubbles were purged, cannulas were changed, but still I remained a bit high.  I only 'fixed' this when I changed the entire infusion set, cartridge and insulin.  I suspect that the cause was that the insulin had started to 'go off'  I've had this before with a pen, so I guess I should have known better.  As soon as I was on the new cartridge and insulin from a new vial, levels were right back where I wanted them, seeing readings around and just under 6.  This, although frustrating, was a pretty good learning experience.  I'll know for next time!

I've also experienced my first mechanical malfunction, as my wife rolled over in bed, caught the infusion tube and it lifted the cannula just enough for it to come out.  I definitely felt it come out and the cannula poking at my skin was somewhat irritating.  So was this happening in the small hours of the morning!

Had another hypo in the last week.  It was around 2am and I was 3.8, so not that low, but still technically a hypo.  Treatment for a hypo used to be fast acting glucose (I use Gluco Tabs) followed by something longer acting (cereal, bread, etc.), which isn't really ideal, but we all have to work with the hand we are dealt.  Treating a hypo on the pump is much better.  Take a test, see what level you are and then the meter suggests how much fast acting glucose to have.  Gluco Tabs are 4g of carb each, so as the meter suggested 12g of carbs, that was 3 Gluco Tabs.  A test 10 minutes later read 4.9 and that was it. Job done and back to sleep.

My pump has been beeping and vibrating at me this morning.  It's running low, currently with only 11u of insulin, so it's time to fill up a new cartridge and change infusion sets.  This whole process was a bit daunting at first, but it's pretty simple and doesn't take that long to do.  The longest bit is probably purging the bubbles, speaking of which, they still have a habit of appearing from nowhere!