Tuesday, 25 May 2010

Loopholes and pitfalls!

There are many benefits to life on the insulin pump. I could reel off five or six reasons without even putting effort in! There are no injections, decent levels are much easier to achieve, it calculates the dose you need to take for each meal, it calculates the correction dose you need, you can 'inject' in public without being stared at like you are stood buck naked in the middle of town! The list goes on.

However, much in the way that injections have their pitfalls, there are also 'lessons' you have to learn about the pump, which can take you by surprise when they happen to you and which you really need to be aware of!

When you are on the injection basal bolus system you usually take 4 or 5 injections a day, encompassing one or two slow acting injections which release insulin over 24 hours and fast acting insulin injections before each main meal. This means you should always have some insulin in your system.

Diabetic Ketoacidosis (DKA) occurs when there is too little or no insulin in the blood, which means in turn that no glucose can enter the muscles. If this is continued for a while, in the space of a few hours a diabetic can become what is called ketotic, meaning that the body begins to break down muscle for energy and produces acidic ketones as a result.

DKA is perhaps one of the most immediately threatening complications for diabetics, due to the fact that if it is not treated in time can lead to coma and even death.

If diabetics take their insulin there should not normally be a risk of DKA, because even 'some' insulin in the blood should stop the likelihood of DKA developing.

However, when you are on a pump, you don't receive any long acting insulin, as the pump releases fast acting over 24 hours rather than in fits and spurts, as with injections. This should mean that you also have a constant supply of insulin.

But as I found out this weekend, that's not always the case!

On Sunday I was due for a site change. No big deal, I'm a pretty dab hand at this now. I prepared a new site and used the Quicksert inserter to get the new one fixed. After about 3 hours I was started to feel a bit weird. High weird. If you're diabetic, you will know exactly what I mean. Tired, grotty, thirsty. The usual suspects.

I tested my sugars and they were a pretty whopping 23.4mmol. Not a nice number to see screaming back at you from your glucose meter.

So I took a correction dose and pondered what I had done wrong. Or what life had thrown in the mix today. Perhaps that is a better expression, seeing as I refuse to accept that I'm doing something wrong, seeing as 'wrong' would suggest it's my fault.

Diabetes is nobodies fault.

Anyway, I tested again an hour later and I was 24.9mmol! Brilliant, not only have I not come down, I've actually gone up - despite a 5 unit correction dose!

I decided to test my ketones as I was starting to feel a little queasy and completely wiped. Two very good indicators I may have had ketones.

So I whipped out my ketone tester and did a test.

0.4 ketones.

OK, so 0.4 isn't really much to write home about, but considering I never run higher than 0.1 with my usual readings at 0.0, I had enough justification to pull my pump set and try again.

As I pulled it out, I noticed a very tiny 'kink' in the subcutaneous needle. This meant that I wasn't receiving the insulin I was programming in, because the damn tubing was blocked at the needle end! The end I can't see! I have no idea how it happened or if it has happened before, but it was enough to remind me how close to 'trouble' every diabetic is.

Within 4 hours of not having insulin in my system my ketones had begun to creep up, my high was well and truly having a party without my permission and I was feeling quite frankly, crap!

I remedied the problem without too much hassle, by simply connecting a new set and dosing a whole load of insulin. But the ketones still freak me out, even when it is resolved and the numbers were never that high to begin with!

Before I went on the pump, I never had ketones and I've had them twice since being on the pump. I won't go in to the other time, but it was something to do with fiddling with the site during my sleep and unclicking the tubing from the cannula!

I guess it is one of the drawbacks and something I just need to be aware of. And I guess maybe it's the reason a pump isn't offered to some people until they are truly ready to monitor it closely. Because even those few hours without insulin could cause someone to get themselves into a fair bit of bother if they hadn't realised there was something wrong with the set, and changed it asap.

I guess it is something 'bad' about the pump. I never thought I would say that, and I would never want anyone to decide against it based on something they read, but I was always going to be honest about my experiences, and this something to know!

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