A Day Without the Damn Insulin Pump

Last night I was woken up about a dozen times by alarms from my insulin pump. People now think of me as a dialysis patient and often forget that, besides the foot of tubing, the tape, the gauze, the transfer set, and the peritoneal dialysis belt, I also wear an insulin pump with another foot of its own tubing under my clothes. Last night the insulin pump was keeping me awake.

The pump first alarmed that the battery was low, so I changed the battery. Subsequent alarms either noted that the battery was low or that the pump wasn't primed. I primed and I primed and I wiggled the battery. Weary with all this fussing, I finally called the 24/7 tech support line. After much more fussing, the rep said she would send out a new pump that should arrive some time tomorrow. But that means I'm without a pump and back to taking shots for almost 48 hours.

The insulin pump I have is about the size of a cell phone. A little beefier.

Every three days at the latest--and often much more frequently--I must remove the insertion needle, refill the insulin cartridge, prime the machine, select a new insertion site, and place the new needle in one of my thighs or in what space there is on my abdomen (what isn't taken up with the dialysis exit-site bandaging and tubing).

One of the most frustrating things about the insulin pump is its failure rate. The mechanism that delivers the needle into my body doesn't cock properly or it hesitates in its delivery. This happens about one in three times. Then I have to start all over because this needle will not be correctly positioned to deliver the insulin. Sometimes I think the delivery is fine, and then a few hours later, I check my blood sugar, and it's sky high because no insulin has been entering my system.

Then there's the challenge of putting on and removing clothes--something that most people give very little thought to. But I must be very careful not to brush the clothes against the insertion site and risk pulling out the needle. So when I take down my underwear, for example, I have to pull the elastic around the top of the thigh a few inches away from my body, rather than just let it slide down my thigh and risk pulling out the needle.

When the insulin pump is working, it works great. I can dial in the grams of carbohydrates I'm consuming and enter my blood sugar, and the machine calculates the recommended amount of insulin. Also, through the pump's basal function, it delivers a steady, low-level stream of insulin around the clock, in much the same way a pancreas does. Even if you're not eating, you still need a small amount of insulin in your system. Then when you eat carbs, your pancreas releases a bolus of insulin to cover the meal. The insulin pump works in a similar way, only I must dial in the insulin that is then carried from the cartridge inside the pump, down the length of the tubing to the insertion site and into my body. The pump parses out the insulin in .05-unit increments, whereas the smallest measurement on an insulin syringe is .5 units.

One of the most frustrating things about the insulin pump is its failure rate. The mechanism that delivers the needle into my body often doesn't cock properly or it hesitates in its delivery. This happens about one in three times. Then I have to start all over because this needle will not be correctly positioned to deliver the insulin. Sometimes I think the delivery is fine, and then a few hours later, I check my blood sugar, and it's sky high because no insulin has been entering my system.

Then there's the challenge of putting on and removing clothes--something that most people give very little thought to. But I must be very careful not to brush the clothes against the insertion site and risk pulling out the needle. So when I take down my underwear, for example, I have to pull the elastic at the top of the thigh a few inches away from my body, rather than just let it slide down my thigh and risk pulling out the needle.

And then, since I place my pump inside a baby sock and tuck it into my underwear, rather than clip it on the outside of my clothes, I have to remember to also hold the insulin pump under my arm as I'm pulling my clothes off. Otherwise, if the pump drops, the needle will pull out, since the tubing is not long enough for the pump to drop to the floor and remain intact.

So, at least for the next day and a half, I'm free of the pump. I can take off and put on my clothes as easily and unthinkingly as the next person. I can go to thebathroom without performing a juggling feat.

Of course, I am back to taking shots, which have their own challenges. I no longer have a long-lasting insulin, which functions like the basal rate does on the insulin pump, providing a steady flow throughout the day. The insulin pump only uses the short-acting insulin, since it parcels it out in 20 micro injections per hour. That means that my blood sugars will not be as well controlled as they usually are with the pump. But it is nice to be just a little less encumbered, a little more free, if only for a short while.