Friday, 30 September 2011

Team Pump Wins

For those of you following my journey towards a decision I don't think you'll be too surprised by my request today.  For those of you hoping I'd stay in the light on #teammdi, I apologise as I have been drawn to the dark-side.

As mentioned last time, I saw my Endo and he was supportive of whatever decision I wanted to take. Thanks to the thoughts and input of the DOC my lingering doubts have been lessened.  I wouldn't say removed; more that I'm coming to ask if it's really that important.

So what are the driving factors for change for me:
  • Convenience. The ability to be able to bolus in tiny amounts and easily must be my number one driver.  Taking today as an example; I'd been floating around 7.8mmol/l (142mg/dl) all morning.  At this point I always find a single unit too much of a correction and a half-unit by itself injcted has no effect at all.  Tomorrow I'll be going to a sporting event where fish 'n' chips are the traditional pre-match cuisine. Normally I'd skip as, for me, injecting on the street has never been something I'm comfortable with - blood testing, yes, injecting, no.  I know that's my hang-up but this is my decision after-all. A pump would give me the chance to bolus-and-go which would appear to be much simpler.
  • Number of injections.  Recent improvements in my control have brought along an increase in injections.  Previously I'll admit to being very lax and injecting at main mealtimes and the basal at night but since I actually started testing effectively I'm finding most food comes with a stab in the stomach.  And a few weeks ago my basal stabs doubled from once day to twice. Now after 32 years you'd think I was used to injecting but I'm afraid I'm still not that keen. A shock, I know, but there it is.  The idea of one 'shot' every three days has a much greater appeal even if I know that that one hit might sting a little more than before.
  • Funding and approval is available.  The way I'm seeing it is that I've thought about it long enough and the only way to see if it works for me is to give it a go.  As it stands currently I'm getting support from my Endo and DSN so why turn it down now? I might have another 12 months of umming and ahhing to decide that maybe I should give it a go, only to find out that cut-backs mean it's no longer available to me.
  • Tech is gooooooooood. I'm a tech boy and like my gadgets.  New meters excite me so having new tech to play with is always good.  My current Accu-Chek Aviva Expert is a fantastic meter and whilst losing the bolus calculations, having a pump to do that for me is good.  And it also means I can shrink BG meter again back to the Aviva Nano which is also good. Yes, I know I will need much more kit now but being able to slim down one piece compensates a little.
  • Choice of pump and CGM.  Well, technically no, not a choice. My clinic only supply the Minimed Paradigm Veo.  This is good for me as out of all current generation pumps available this is the one that floats my boat.  Permanent CGM is not being offered initially as the clinic like to loan out a wireless Minilink transmitter for 6 day sessions rather than fund it individually. However the loans can be pretty frequent as not many people do it.  Going forward I may start a campaign for the CGM so having a pump that is compatible from the start makes that easier. And.... tech changes, in the four or so years I'm gonna be connected to the Veo, CGM functionality may develop so having the capability now gives a little bit of future-proofing. Ever hopeful anyway. I'll end this little bit with apologies to those unable to get one if they do want one.  Funding (either NHS, private or health insurance) is always a primary driver and I know I'm fortunate to be able to have the choice.
  • I can go back.  This is a big one.  If it works great, if it doesn't I won't have lost much in the meantime.  Carpe diem and all that bollox!
The negatives still exist (always there, tubing, tech failure etc) but I'm finding that with D it's not always the positives that have to be compared but the negatives.  It's a crap 'condition' so we've got to make the best of it we can and for me, at the moment, the pump is the best option available.

What happens next?
  1. Whilst I was there today an email was sent confirming my desire and for the NHS Trust to proceed with the purchase.
  2. I need to read. Pumping Insulin - thanks for the many, many recommendations, is on it's way to me thanks to the wonders of Internet shopping - so I need to get into that and do some serious cramming.  The way I see it is that if I can hit the ground running, me and P (yet to give it a name, although Adam appeals to me for some reason) will get on much better from the start.
  3. On the 18th and 21st October I have some 1-2-1 training sessions with the DSN to go through the workings of the pump and ask any practical questions. I expect then we'll go through the detail on infusion sets etc.  As a side-note I'll be sticking with Novorapid (Novolog) as my insulin of choice as it works and we've not fallen out yet.  30 years of Novo can't be wrong.
  4. In early November P (or Adam) gets presented to me and I leave 6 times daily injections behind for a lifetime of wires and tiny adjustments - well, for ten years anyway when the 'cure' arrives. It has to be ten years as it's been that far away since I was diagnosed.
So that's where I am and how I got here.

As always, thoughts, comments, arguments and mild abuse welcomed.

Next update expected either after training or once pump arrives.

Wednesday, 14 September 2011

One Step Closer...

.... to having to make a decision.

As I've said before I'm moving along the conveyer belt towards a pump but am still not sure whether to run towards the light or just bail and stick with what I have.

Last week's review at the hospital was another productive hour of my recent drive to 'sort things out'.  It was the first time I'd met him and after an initial nervousness on both parts we got down to some fairly heavy discussions.

Short-term we agreed to try a split of my basal (Levemir) with 2/3 of the units around 10pm and 1/3 at around 10am.  For me this is a fairly significant change as my night-time dose tended to be at bedtime rather than a set time.  Obviously on a 24 hour dose this has less of an effect than if staggering it to twice a day.  Today is the first day of the new regime so alarms have been set for 10am (not needed as remembered and dosed) and 10pm.  So far, so good but we'll see in a week's time how it's working.  I can see the logic for the extra dose and agree in principle but the obvious issue here is the extra daily stab.  Now after about 35,000 injections an extra one a day shouldn't make too much difference - yes, it was rough calculations but BLOOMIN' HECK - how many????  But it does, it's another little inconvenience to add to everything else we have to manage.

I was aware the Dr was largely pump-favouring and we had a fairly lengthy discussion on whether better A1cs was because of the pump or as a consequence of the control and monitoring needed.  The end agreement was that yes, with my continued monitoring and CHO counting, lower average glucose results could be achieved there was no guarantee of how big those savings would be.  However, on the flipside, the ability to adjust in much, much smaller doses was a benefit neither of us argued about.

I asked about funding and was assured that with my current obsessive testing, longevity of being a D and desire to improve this wouldn't be a problem.  He also said he'd need to speak to my DSN to confirm that she believed it was right for me but I've already primed her with my desire to progress the process.  And here I apologise for it being relatively easy to everyone who is fighting for one for themselves or their offspring.

I'm back with the DSN in a couple of weeks and I will be asking if I can borrow one for a few days just to have it stuck on but not giving any doses.  That way I'll be able to see if one of the key negatives - always being there - is that important anyway.

Whilst the conveyor keeps moving towards a pump there's still a huge part of me resisting.  My previous blog gave a pretty long list of the pluses and minuses but now it's down to a few key minuses:
Always there - currently I'm Dave who happens to have diabetes that he treats with a small pen (now two pens) in his pocket. The future could be Dave the Diabetic with something always there to remind him and everyone else.
Nightime - I go to sleep currently after injecting and now that my basal is doing it's job. I've not woken up and needed to test for a pretty long time. Pump means I have to have confidence that the thing stuck on me is working correctly 24/7 and the only way to know this is to test. 
Daytime - as above. I bolus when eating and know that it's delivered because after an airshot the plunger on my pen goes down. Pump needs me to have certainty that when I hit that electronic button it delivers a requested.

The pluses are well known and are a huge draw but I need to get my head around it first.  My wife, as always, is very supportive and agrees that a trial might be the best option next.

As plenty have said I wouldn't lose anything by giving it a go for at least a few months to see whether it was right for me or not.  

I apologise lots if any of the above is repetitive of what I've said before but that's where I (still) am.

Next update will be after my next DSN appointment.

Finally as a little PS is a picture of a competition prize I won this week.  I tend to enter online competitions if it's easy, of something I like and from a company I trust not to flog my details to the viagramongers of the interweb.  I'm still waiting for at least one big telly or weekend in Vegas.  However, I did get an email saying I'd won a behind the scenes tour of the Thorntons chocolate factory!  Unfortunately work commitments meant I was unable to accept but asked if I could have a runners-up prize instead of an 'I Love Chocolate' hamper.  For those taking out their carb counters that's 910g of carbohydrate or 91 lines / exchanges.  Pass the Novorapid I may be here some time :)

Thank you to Thorntons and they will be gratefully consumed by me, my family and colleagues.

Please read, comment and RT.  All feedback gratefully received