Friday, 11 November 2011

P-Day Approaches

So I'm nearly there.  A relatively short journey towards pumpliness remains after a near lifetime of daily stabbing. At  the age of three I (or more accurately my tormented mother) started injecting once a day, through time this doubled to twice and then a strict four to the current 'multiple' number depending on food and required correction boluses.

After a chasing phone call to my DSN a couple of weeks ago the pump arrived at the clinic last Friday and I'm booked in for Monday the 14th to go live with attachment, insulin and everything that goes with it.

So what are my thoughts as I approach so a significant shift in my treatment?  I'll be honest; the predominant word is 'fear'.  I'm scared that after a virtual lifetime of daily injections and a long-acting background dose that just kept me ticking along until I ate and bolused, I'll now be reliant on a little bit of tech to keep my background BGs at a respectable level.  I love tech, and all the stuff that goes with it.  A cupboard of redundant meters and phones prove this beyond reasonable doubt.  But, and this is where my semi-irrational fear sits with me - tech can go wrong.  If my phone stops working, I curse Apple, spend a few hours reloading and then love it all over again.  If my pump fails I'll find out a few hours later when DKA kicks in for the first time in a couple of decades.  Now, for all you regular pumpers, I know this kit is reliable and safety checks are there to ensure it works properly.  But at go-live minus three days my fears are taking over a little.  I think I explained it best to my fellow new-pumper Mike when I said I want my pump NOW but not yet, all at the same time.  The benefits are going to be huge, as mentioned in most previous posts, but as I've not got it yet I'm tempering my enthusiasm slightly.

Anyway, negatives aside I am excited. For the observant amongst you Monday is also significant for other reasons. It's officially been recognised as World Diabetes Day. I love the irony of me starting a totally new regime on a day when diabetes around the world will highlighted as the important disease/illness/killer/condition/nuisance that it is for so many people.  What better way to celebrate for me than to start my first 24 hour period where I don't need to inject since I was an incredibly thirsty and tired three year old boy with a bad hair style and questionable fashion sense.  Wow!  Although I can't say the years in between have improved my styling much.

So how have I prepared?

  1. Well firstly I wore a pump for a week with it attached to my skin but without the cannula inserted. That seemed to go well and the permanence of it is less of a worry than it was back in August when I first weighed up the goods and the bads. 
  2. Next step was, on the recommendation of many, to buy and read John Walsh's Pumping Insulin book.  So far its given a good background but I'm sure that in the coming days and weeks I'll learn more and more as I keep going back hoping it can answer my "what do I do now?" questions.  
  3. My prescription for Novorapid in vials went into my excellent Doctor's surgery this week and I picked up my mini-bottles today. Once again memories came flooding back of times when drawing up insulin was needed before I got onto the 'pen' regime to make vials sooooo last century. 
  4. I've calculated with difficulty my TDD (Total Daily Dose).  I've had real trouble here as one day never matches the next and my food intake can't be classified as consistent. To try and find a good starting point I've averaged the last two months and just gone with that value. Thanks to my Aviva Expert I'm fairly comfortable that my current correction values and ratios are fairly accurate but I'm sure they'll get changed in the next few weeks too just to confuse me even more.
  5. Talked lots with my fantastically supportive wife about what's coming up and, as always, been given the answers I need to believe I'm doing the right thing. And as she said "Try it, if it doesn't work, at least you've given it a go."
So what happens next?  Monday afternoon at 2pm I meet with my team at the clinic and go, go, go.  I believe I'm fairly well researched and knowledgable but I'm sure my D will come and bite my ass at some point just to prove that the 'so many vucking fariables' can't all be accounted for.

My final mention today goes to the people that have given me support and confidence in my decision over the last few months. Firstly a big thanks in general to the DOC and in particular the Twitter 'family'. My continued surprise in the warm regards and good advice is a wonderful thing to experience.  Having 
previously hated standing in the school playground when teams were picked at football (that's Association Football or 'soccer' with a correctly shaped, spherical, ball) I hate to name people individually so I'll say thank you to all and especially the UK (and Spain) section who seem to 'get' me the most.
However, I will make an exception for two:
Mike previously mentioned has been on a very similar, reluctant, journey to me making the switch from Team MDI to Team Pump. For every question I've had Mike has seemed to have similar and whilst we couldn't always answer them, knowing that someone else was having the same thoughts made everything seem a little more 'normal'. 
And Emma you can consider your work is complete. The Duck has provided some very honest feedback from the dark side that answered most of my concerns but was also honest enough to discuss the drawbacks even when I was a reluctant MDIer who was convinced that tight MDI control was as good as, if not better than, pumping

So this is one chapter of my diabetic life over with a new exciting one only a couple of days away.  Not sure what's going to happen but I'm going to have fun finding out.

Sorry I've rambled a bit again on this one but I felt I needed to defrag my mind fully before the next step.

Hope everyone has a great WDD and stay safe and healthy.



  1. A very thoughtful and honest post Dave. I'll always think of you as my pumping 'partner in crime' there have been so many similarities as we have moved toward this point. Of course I'm a whole week ahead if you now, so I know *everything*!

    From this side of the 'great divide' I can only say this... A lot of what you know about how your body responds to MDI doses will no longer apply. Your sensitivities and ratios will be very different next week. I kid you not, I am making 0.25u corrections and seeing a significant effect. Expect a major reduction in TDD proposed by your DSN, and just go with it. They will most likely suggest new I:c and correction ratios based on a 50:50 basal bolus split and other rules of thumb. These never worked for me on MDI, and while Ive got a load of tweaking still to do, the initial week has been within tolerable limits. I am observing and tweaking little by little, and the changes take effect straight away. Mostly basal tweaks so far, but I've already had some Lantus-beating nights.

    Watch those first few cannulas. Make sure you have a few different types and lengths to try. Any discomfort after the first hour and make sure you are testing lots to spot any delivery errors.

    One last point. My wife commented yesterday how much cheerier I was. It seemed as if a decent pump-start has lifted a veil of grumpiness that I didn't even realise was casting a cloud.

    Best of luck for Monday. I'm sure you will take to it like a duck to water.

  2. Thanks partner. The blog has been useful over the last few months and has been a bit of a chance to brain-dump - I'm hoping that after P-Day I can find some more interesting and less self-focused posts.

    It makes me smile how close we've been over the last few months and to arrive at the same destination within a week is a huge coincidence.

    I believe the initial weeks will have a huge focus on tweaking. Hopefully stability is nearly achieved before the Christmas challenge arrives.

    I look forward to the bright, sunny Dave arriving in two days :-D

    Would that be like a purple duck?

    Many thanks as always for your honest and helpful feedback.

  3. Many thanks for the kind mention, Dave. My work is not yet complete, though - I think I owe you all the help I can give during the transition after all the pro-pump rants I subjected you to!

    Best of luck with the switch :)

  4. No problem. If it's as good as you promise, you deserve a big thank you.

    I'm now attached but not overly confident yet. Everything is still 'new' to me. I'm a lot nervous about tonight though.

    be prepared for the question overload!