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


Thanks,
Dave

4 comments:

  1. Great post Dave. Will be interested in seeing how you get on with split Lev. The potential inconvenience of another fixed-point injection in the day is not lost on me. As for pumping, you and I share a lot of the same thoughts. I've not heard of many total mechanical failures, dodgy sites/sets yes... But I am not quite so concerned about having to check up on it every night. Basal testing in the early days will be a drag, but the carrot of the benefits still dangles in front of me.

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  2. Thanks for the comments Mike. My opinion appears to sway daily but the big threat of 'complications' seems to be dragging me towards the P more and more. I think you go first and then I'll follow ;-)

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  3. Dave, I like the humble honesty you share. Aside from the *DOC* that is a invaluable resource 24/7 have you thought about calling a couple of the pump companies.

    Perhaps if you had any specific concerns you could discuss directly with a rep? Just a thought!

    Also the *Pumping Insulin* book by John Walsh is excellent. 12 Quid for a thoroughly informative read. Contains section for MDI'ers looking towards pumping.

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  4. Thank you Mike. The DOC have been fantastic for me over the last six months and it's through reading others stories and questions that I feel I can just put down what I'm thinking without being judged - well, I might be being judged but thankfully no-one has told me directly yet.

    Whilst I'd be tempted to speak to reps I'm alwsys cautiously against those with a biased view and while their input would be useful I'm certain that it would also be more strongly weighted towards the pros than the cons.

    The book has been recommended a few times now and as I seem to be moving closer it would make sense to purchase I think.

    Thank you for the feedback, it's really appreciated.

    Dave

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