Pump Reflection

In 2018, I wore an insulin pump and a continuous glucose monitoring (CGM) device for 5 days. I filled the vial with saline instead of insulin and simulated life on a pump. This entailed keeping it on 24/7, pricking my finger, counting my carbohydrates to calculate insulin doses and calibrating the CGM I wore. Although I don’t have Type 1 Diabetes, I was grateful for the opportunity to relate as much as possible to patients on insulin pumps.

 

Initial experience

Inserting all the necessary gadgets made me nervous, especially when the monstrosity to insert the CGM was heading towards my belly. With the calm help of my colleague, a paediatric diabetes specialist nurse, it ended up being far less traumatising than I had imagined. The first few moments having everything attached saw me postured like an alert meerkat, but I soon realised that I could bend and move as usual without any discomfort. In fact, after a while, I hardly noticed my new appendages.

 

CGM

I loved wearing the CGM. Well, not actually wearing it, but being able to view the data it provided in real time. I found myself completely obsessed by the trends it showed so that I could learn how different activities/foods affected my sugar levels.

 

Counting carbohydrates

Because I am a dietitian, I felt confident counting the carbohydrates in my meals, snacks and drinks. I did, however, find it far easier to do so when I was at home – in my own space; with my own scales and unlimited time to think and calculate (I chose not to estimate). My analytical nature kept me distracted when doing this in public because I double checked myself a few times after calculating.

 

Exercise

I was eager to see what exercising would be like while wearing a pump. I went to a gym class on Friday and out for a run on Monday. Before my HIIT session at the gym, the pump alarmed saying that my blood glucose was 3.8mmol/L. If I had Diabetes, this would classify as a ‘hypo’ and I would need to treat it with quick acting carbohydrates and recheck my blood glucose after 10 – 15 minutes to make sure I was back in target range and ready to safely exercise. My gym class was just about to start so this was incredibly inconvenient timing. I had only put the pump on a few hours before this and began to feel paranoid that we had used insulin instead of saline. I knew it was probably fine and likely to be the CGM needing recalibration, but felt too self-conscious to whip out my glucometer in front of everybody to prick my finger and double-check (confession#1). I didn’t feel embarrassed, but I was unwilling to draw attention to myself. I was completely preoccupied and remained distracted for the first ten minutes of the class after which I saw my blood glucose rise on the CGM graph on the pump (the type of exercise I did raised my glucose level). Positioning the pump appropriately for exercise took some time, but I eventually found a spot that kept it secure when I jumped and out of the way when doing abdominal exercises. I did move it around a bit during the class and didn’t feel any shame in doing that – even though others could see. When I went for a jog, I clipped the pump on to my crop top and it behaved itself there without bothering me.

 

Stress

I had pasta for lunch on Friday and the CGM graph showed a beautiful curve where the blood glucose peaked and came back down again after a couple of hours. Later that afternoon, I went to the GP for an appointment I was nervous about. As shown in the picture below, the stress of the visit gave me a blood glucose curve almost identical to the one the pasta had caused!

 

A weekend away

I drove out one evening to spend the weekend with an old school friend. She is squeamish and felt uncomfortable seeing or speaking about the pump. I kept it tucked away most of the time. We saw a few friends over the course of the weekend and even though most of them saw the pump or saw me pricking my finger, no fuss was made about it and everything was accepted quickly without the interrogation I was expecting.

 

Eating out

On Saturday evening, a few of us went out for a meal. I’d love to play the diligent healthcare professional here, but I’m afraid I let my desire to avoid inconvenience get the better of me. I did not wish to take a bag out and so I took a blood glucose reading before leaving the house and left the glucometer at home (confession#2). I used that reading an hour later to put into the pump with the carbs I was about to eat and gave the ‘insulin’ the pump advised. #verynaughty #NOTadvised #Don’ttellyourchildrenIdidthis. I only got away with this because I do not actually have Diabetes and so don’t live with the fear of going hypo or running high. This is one thing preventing me from fully understanding what life is like depending on the insulin from a pump.

A night out

We went out dancing on Saturday night and because I’d had a glass of wine with dinner, I decided not to drink any more alcohol. I assume that this is the choice I would have made if I had Diabetes and there was no point wearing the pump if I was not going to make every effort to relate to those living with the condition. The club environment completely killed any enthusiasm I had for telling people about the pump. Any simple question felt like an invasion of my privacy and if I were in a similar situation as a teenager, I definitely would be looking for ways to blend in and avoid any unwanted attention. It was helpful having a friend there who knew what was going on. I was surprised by how self-conscious I felt on the dance floor and I did not enjoy having a bumpy pump on me. I cannot imagine how annoyed I would have been if I were to have a hypo and be forced to prick my finger, have some sweets, wait around and then prick again to make sure I was in the safe zone. Where would I do this in a crowded club on a freezing cold evening? Not fun. This night helped me understand how easy it is to feel frustrated and even rebellious when living with Diabetes.

 

The infamous Pizza

Pizza has a very low glycaemic index and so eating it was my chance to try using a combo bolus. This gives a percentage of the calculated insulin bolus immediately and the rest over the next few hours. We had friends coming over and put out crisps with dips on the table. The pizzas were coming out of the oven every 20 minutes or so and we would be munching away during the afternoon. I did my carb counting in reverse by giving myself a generous 200g limit to the carbs I would consume and estimating the amount of crisps and pizza that this would amount to. I put on a combo bolus that would give me 15% of the insulin immediately for the crisps and 85% over the 4 hours that followed for the pizza. I have no way of evaluating whether this worked or not because my body was using its own insulin, but it was a worthwhile activity none the less. I kept my eye on the CGM graph for glucose trends during the afternoon.

 

Sleep

This is the part I enjoyed least. I love my sleep and a pump alarming in the early hours of the morning because my glucose level was low made me grumpy. I had to get up, prick my finger, recalibrate the CGM (because it wasn’t low) and attempt to get back to sleep. During the first 2 nights, I woke up each time I rolled over the pump and (confession#3) was so frustrated by this on night 2 that I took the jolly thing off at 2am. Once again, #verynaughty, #NOTadvised and #Don’ttellyourchildrenIdidthis. I am pleased to report that this did not happen again and I adapted enough to sleep through the night regardless of the pump’s whereabouts in my bed. If I wore an insulin pump long term, I’d probably invest in a pump bag to house it while I sleep.

 

Concluding remarks

I knew I would download my pump data at the end of the 5 days which would allow the Diabetes team to see when (and if) I tested my blood sugar, whether or not I counted my carbs and worst of all, exactly how much I ate! This played in the back of my mind more than I am bold enough to admit. Everything I did (or didn’t do) would be seen by someone and probably pointed out. Although it felt like an invasion of my privacy, knowing that a team of experts were holding me accountable helped keep me on track with daily management. That being said, I did manage to gain some insight into the temptations to ‘cheat’ that pump wearers might face in an understandable attempt to reduce the burden of care. I appreciate that I cannot fully understand what it is like to live with Diabetes, but wearing an insulin pump in different situations was an invaluable eye-opener for me.

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