I’m probably dating myself a bit, with the above title. Pitfall! was an excellent, 8-bit video game that was released in the early 80’s and that my father used to let me play on his Commodore 64. Yes, you read that right! A Commodore 64! If you have no idea what that is, Google it and prepare to be awed at the current state of technology, when compared to what we had available three decades ago. Games that gave you a finite number of lives and if you died, you started ALL the way at the beginning. None of this “save point” bullshit! But I digress…
Enough reminiscing about how I used to spend my weekends as a child. The pitfalls I’m referring to in the title relate to the use of an insulin pump. Just to be clear, I LOVE my insulin pump. Besides the fact that it makes insulin delivery a breeze at mealtimes, my current pump maintains pretty tight control of my blood sugars when properly used in conjunction with a CGM or Continuous Glucose Monitoring system. But innovations and technology are only as good as the user allows them to be. And user error is always a possibility.
In six months, I will have rounded the corner on seven years of insulin pump therapy. Being as obsessive as I am, I used to be in the habit of testing my blood via finger pokes almost a dozen times a day; something not everyone can afford to do, for various reasons. The use of an insulin pump with CGM has allowed me to have some freedom from the glucometer, at least as it relates to how often I used to test. A couple of months ago, I managed to achieve the best A1C reading that I’ve had in decades, a direct result of tighter control through the micro-bolusing provided through the SmartGuard technology and CGM.
As good and wonderful as all of it has been, and as often as I like to quip that I’ve become a cyborg (since I have both biological and mechanical/electronic parts sustaining me), there are definite pitfalls to the use of an insulin pump. Hence the title. I know that I tend to harp on Diabetes a fair bit. But it’s for good reason, since, well… Diabetes sucks! I often like to speculate about how life would have turned out for me, had I not been diagnosed with type-1 Diabetes. But the reality is that I have it, it’s here and I deal with it. And I think a big part of who I am has come from how I’ve had to fight against Diabetes. I remember reading a quote somewhere that said, “Diabetes is the leading cause of bravery, determination, resilience, maturity, empathy, strength and compassion.”
While it’s true that I’ve learned to be as strong as I am due in part to my condition, the pitfalls are quite measurable and user error can occur unintentionally. I recently wrote a post about how the pump had been waking me every couple of hours throughout the night. There’s nothing quite like being woken up because your levels are “too good” and the pump wants constant blood sugar readings to understand why nothing’s changing. But I worked with the pump manufacturer and managed to stem that issue. But now, I have a different problem keeping me up at night… My gut!
A few nights ago, my wife and I decided to get an early night’s sleep. This tends to happen at least once a week, where we crash very shortly after we put our kids to bed in an attempt to stem the increase of overall fatigue throughout the week. That night was just such an instance, and we ended up in bed prior to the 10 o’clock hour. At roughly 10:30, I was awoken by the sensation of my pump vibrating. It’s annoying as hell but I prefer to be woken by it, than having it escalate to the audible alarm that ends up waking my wife as well. I rolled over and took the pump out, thinking it was going to request a BG reading again.
Instead, the display told me that insulin flow was block and to consider changing my infusion set. I had barely been asleep for an hour and still had well over a hundred units in my reservoir, so there was no way in hell that I was changing out my set. I wiggled the cannula on my gut slightly, then start the arduous process of getting the pump back to functioning order. You see, if the pump thinks that insulin flow is blocked, it’ll do three things:
- Sets off a “blocked flow” alarm. This starts as a vibration, followed by an audible alarm that gets louder, the longer you ignore it. This is important, as non-delivery of insulin can lead to high blood sugars and a whole host of problems;
- Turns off Auto Mode. This is where I start to get pissed off. There should be some way for Auto Mode to continue working for the few minutes it takes me to correct the “blockage”; and
- Turns off SmartGuard. This is linked to Auto Mode and uses CGM sensor data at five-minute intervals in order to control overall blood sugar levels.
It doesn’t look/sound like a lot when you read the words, but getting all that shit started back up, takes between two to five minutes, which is more than enough time to wake me up to a state akin to poking a grizzly bear’s ass with a bar-wire wrapped baseball bat. So just imagine if that happens a few times, throughout the night? See my problem? A few nights ago, I was woken up this way at least three or four times. Bearing in mind that my blood sugar levels remained ideal, the insulin WAS being delivered. It took until the last time for me to realize that it was my gut, pressing against the cannula that was the issue.
It turned out that every time I turned over in my sleep, the pump would encounter resistance in delivery due to laying on my front. Teaching yourself not to move in your sleep is difficult, if not altogether impossible. The placement of the infusion set is critical, as well. I’ll admit that I have a bit of a “Buddha belly,” so the angle the cannula sits at, can mean the difference between a comfortable night’s sleep or having the pump lose its freakin’ mind every few hours.
As you can see, there are definitely pitfalls to the pump, despite the noticeable and measurable benefits that it provides. As smart as the machine is, it can’t recognize and adjust if I’m physically doing something that interferes with its proper function. On a separate note, it may be a helpful reminder that with the summer season I need to work on trimming my “Dad bod!” ☯