Getting Used to an Insulin Pump

Posts tagged ‘Accu Chek Spirit Combo’

The … Diabetic

The ... Diabetic

The … Diabetic

I received an e-mail the other day relating to playing volleyball with an insulin pump and thought that the questions and my answers may be relevant, not only to volleyball but to a lot of other sports and activities.

I asked the nice young lady if she’d mind me using it for a blog post and she said that was okay as long as I used her pen name which is The … Diabetic, She writes her own blog (click on that link to get to it). I’ve also changed her e-mail address for the one she requested so feel free to contact her if anything on her pages floats your boat.

Date: Tue, 5 Feb 2013 14:43:08 -0800
From: the_3dots_diabetic@yahoo.com
Subject: Insulin Pumps and Volleyball
To: NottsType1@hotmail.co.uk

Hi Dan,

I came across your blog when doing some research on insulin pumps and playing volleyball. I’m quite interested in getting an insulin pump, but am only at the start of my investigations. I have an appointment with a Pump Doctor at my local clinic in a few weeks time, so I’m trying to do some homework beforehand and be prepared at the appointment!

I’m quite a keen volleyball player. I train 2 hours on 3 nights each week, I help coach juniors for 1 hour on one of these nights (before training), and play matches on a Saturday. Depending on the match schedule, I sometimes play on a fourth night in the week too.  I guess my main worry is how well infusion sets stay in place when jumping, blocking, hitting and diving, as well as how easy it is to avoid a pump getting damaged whilst throwing myself around court.  Would you be able to give me a bit of insight? Do you disconnect your pump? Have you had problems with air getting into sets or sets coming dislodged? From your blog, I gather you’re using a Roche Spirit Combo – has it been a positive experience? Where do you put it when on court? Finally, did you have to ask permission from the referees commision to play with a pump at matches?

Apologies about the million questions, there aren’t many testimonies out there of people playing volleyball with their pumps, and providing details on how they manage, so any extra insights would be much welcomed.

Kind regards,
The … Diabetic

My Response:

From: Type 1 Diabetic <nottstype1@hotmail.co.uk>
To: The … Diabetic <the_3dots_diabetic@yahoo.com>
Sent: Wednesday, 6 February 2013, 16:34
Subject: RE: Insulin Pumps and Volleyball

Alright The … Diabetic,

I’ve actually quit volleyball temporarily for a number of reason’s, none of which, I’m sure you’ll be pleased to hear, are to do with the pump!

So to answer your questions as best as I can:

1. My infusion set always stayed in fine while playing, I chose the Accu-Chek TenderLink when I started off pump therapy but have changed to the FlexLink, both of these have a flexible cannula but the TenderLink goes in at an angle which I thought would protect it better from bumps while playing, however I am on the thin side (about five foot eight (1.72m) and 10 and a half stone (65kilos)) and I found after a bit of use my stomach looked like a pincushion. The FlexLink ones are, in my opinion, if anything a little hardier and come with the added bonus of the Link Assist Insertion Device which works like a kind of staple gun to get it in to you (honestly, better than it sounds!!!). If you have a preference for which side you dive on it might be worth considering that when placing infusion sets but with the amount you play your probably better just to stick it in and see how it goes. Certainly reaching up for blocks and the force of hits seemed to have no effect on the set staying put!

2. I have a neoprene pouch with a loop to feed the velcro elastic strap that came with it through, not sexy but worked for me, however you sound like you play pretty intensely so it might be worth you looking at the hard case along with sports belts here. I wore my pump on my back turned so it ran vertically up my spine, more or less, so there was little chance of me falling on it, kept it on the whole time and didn’t have any problems with bits falling off or coming loose.

3. Keep it plugged in pretty much all the time, only time it comes off is when I shower or swim.

4. Never had problems with air getting in, they are pretty well sealed units, although when I got it I was warned that I should keep checking the tightness of where the pump connects to the cannula and I now do that pretty much as standard without even thinking about it.

5. The Accu-Chek Combo has been brilliant for me, although I suspect that there are probably better pumps out there already, I’ve had it nearly two years now after all. This site is pretty good for the latest info, but as above it’s probably worth checking what accessories you can get when trying to make a decision, it might also be influenced by your healthcare team but frankly I have a lot of friends on various pumps and no one has been disappointed!

6. Never even thought to ask the referees, although I did check with my coach as well as my Diabetes consultant, whether they thought I needed to consider taking any action other than what I had already decided (e.g. wearing it strapped on and on my back while playing) and they both said it should be fine.

If there is anything else I can help you with, Volleyball related or otherwise please drop me a line, I’m always happy to help.

By the way is it okay if I use your e-mail and my response in a blog post? I suspect this information would be useful to a lot of people!

Cheers

Dan

Web-Monkey
Nottingham Type 1 Diabetes Group
I’m Gonna Stick You!!!

Hope you all find that useful!

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Ooh, Pointy!

When I was at the clinic the other week for my annual pump check up I asked if I could try a different infusion set, because my stomach looks a little like it has a bad case of acne from the places where the needles have been. My pump is an Accu-Chek Spirit Combo and I’ve used the TenderLink infusion set since I got it because I thought having the bit that sticks in to me at an angle rather than at 90 degrees would be better for e.g. when I was playing volleyball and such like.

Anyhoo, I was given the only one they happened to have a few of laying around which was the Ultraflex, this one has a needle which goes straight in to you but is much shorter and (I think!?!?!) thinner than the TenderLink. Anyway I got four of them and so I used them over the previous couple of weeks, then last night I went back to the old standard.

I have put a picture of both below, the old one on the left and the new one on the right and I just wanted to say that the old one now feels like trying to stick Cleopatra’s Needle in to myself. Sadly I have about three or four boxes of the TenderLinks left and I don’t believe in needlessly sucking money out of the good old NHS so I’ll use them up first but when I next give those nice people at Roche Diagnostics a call I’ll be changing my standard order to the FlexLink infusion sets!

Accu-Chek FlexLink Infusion Set

Accu-Chek FlexLink Infusion Set

Accu-Chek TenderLink Infusion Set

Accu-Chek TenderLink Infusion Set

In the words of the Cat: “what is it?”

Insulin and Carbohydrate

What Happens to Carbohydrate with Insulin

Okay, I’ve had enough of what I’m meant to be doing at the moment and anywhere to get a drink or something to eat has shut so I thought I’d start on my A-Z of Diabetes, or at least trying to give a bit of background on what it is and what all the things I talk about mean so…

Type 1 Diabetes, also called Diabetes Mellitus is an autoimmune disease, that is it is a problem with your immune system, in my case I believe I got a virus of some sort when I was about 22 months old, my white blood cells killed off the virus but then didn’t know where to stop and decided that my beta cells in my pancreas were also BAD so they started destroying these as well!

Beta cells have a few roles but the most important of these (to a Type 1 Diabetic at least) is that they pump out insulin and (sort of) glucagon. Both of these hormones have an effect on carbohydrates, insulin turns carbohydrates in your blood stream in to energy which your body can then use to power itself, glucagon turns stored energy, e.g. fats, etc. in to energy if you don’t have enough carbohydrate in your blood stream when you need it.

Obviously you need energy to power pretty much anything you do, if you do not have enough then parts of your body can start malfuctioning! This is called “low blood sugar” or a “Hypo”. I have experienced a whole gamut of different types of hypo and personally find they tend to be different dependent on what I’m doing at the time, for instance if I am exercising, not necessarily full on cardio-vascular body pummeling, can be as low impact as walking (or more likely these days pushing a pushchair!) then I will tend to have a muscular hypo, that is some muscle group in my body, possibly all of them, won’t have enough energy and therefore I’ll get wobbly legs or arms or possibly collapse on the floor or else not be able to get out of a chair.

Worse for a number of reasons are hypos that occur when I am thinking hard, e.g. writing a document at work or doing a brain intensive DIY task, in these cases the organ in my body using the most energy is my brain and so when I run out of energy my brain ceases to function properly. The reason this is particularly bad is because my brain, being short of energy, is often unable to realise that it is short of energy and so I miss the signs I would normally pick up and just get lower and lower until (on occasion but not so much these days) I become unconscious, it can also cause bad moods, arguing (more than normal) and a general change in personality. If it is one of these ones the best thing to do is just to tell me it’s a good idea if I do a blood test, I might well argue but if I do too much you can just leave me until I collapse and then call an ambulance 🙂

So, because I am unable to produce my own insulin I need to somehow get insulin inside my body, over the years this has been by syringe and needle, plastic syringe, pen injector and most recently an insulin pump (hooray), all of these devices do pretty much the same thing but to different degrees of control, syringes were okay but you simply sucked up as much insulin as was required by eye and injected it, insulin pens were a bit better as you wound up the dose and it would give you the same dose, standardised, each time you wound it up on the pen so you knew you were getting exactly 10 units if that is what you selected. I’ll come to the pump in a minute!

Of course to control the level of insulin you are giving yourself you also need to find out how much carbohydrate is in your body, originally when I (in fact my Mum and Dad) had to do this you had to catch some urine in a test tube and add some water and a pill which would then change colour to give an indication of how “sugary” I was, e.g. whether I needed to exercise to try and bring my blood sugar down or if I needed to eat something, they were pretty much the only options available back in 1976. Then they bought out dextrostix, which were plastic sticks with a reactive piece of chemistry on the end which, again, changed colour when you wee’d on it, somewhat simpler and less prone to accidents or mistakes in the process. Nowadays I have a blood test monitor, this involves pricking my finger with a lancet to draw some blood, this blood then goes on to a strip, not a world away from the Diastix I used to use but plugged in to a machine which then gives a reading as to your blood sugar, this has a number of advantages!

The old Diastix used to have a number of colours for the different readings, I believe that “blue” meant your blood sugar was between 0 and 9 millimoles per litre (mmol/l the standard unit of measurement until fairly recently) green was between 9 and 12 (or something like that, it was a long time ago!) and then a range up to brown which was frankly much too sugary! Bearing in mind that a normal blood sugar is meant to be between 4 and 8 it obviously didn’t give a lot of fine control over your blood sugar. Also it meant whenever you wanted to test your blood sugar you needed to be able to pee…and find somewhere to pee! Finally because it takes a while for your body to process carbohydrate and eject it the tests were always about an hour or two behind where your body was currently at.

Blood tests are more or less instant, you still have to carry kit about with you but no longer need to find somewhere private to test and the results are to 0.1 mmol/l, in this way my average blood sugar results have come down from somewhere between 9 or 12 to about 7 these days which is obviously desirable and in fact makes me feel much better about myself.

So these days I need to do blood tests to check my blood sugar, guess the amount of carbohydrate in food I am eating and adjust my insulin accordingly (a bit more about insulin types another day).

The pump is a fantastic device, it is programmed with the amount of insulin I need to deal with 10 grams of carbohydrate (CHO) and the amount I need to bring my blood sugar down by 1mmol/l (0.3 units I think) and when my blood test monitor tells the pump what I am eating (which I program in to it) and what my blood sugar is it decides how much insulin to give me for the food and to adjust my blood sugar to the right level and then pumps it in to me! Technology is fantastic.

That’s it for now, gotta go. I’ll continue this another day, feel free to ask questions if you want more info about anything I’m talking about and remember these are my views and opinions and probably wrong on a number of counts!

Holiday Time, Sort Of!

An Umbrella

Not that Kind of Holiday Sadly 😦

After today the updates may be a bit intermittent for the next couple of weeks as I am not at work for a bit. However I’ll do my best to keep updating every now and again until normal service is resumed.

My blood tests yesterday afternoon did not finish as I expected staying pretty much where they started for the rest of the tests, even going up a bit towards 6pm. I believe the reason for this is because once again I’m not entirely well, I have a sore throat, a cough and am apparently snoring like a herd of Aberdeen Angus (sorry Dee)! What with this and my annual leave I’m going to leave the fasting blood tests until after I’m back at work again.

I also badly misjudged the amount of mashed potato I had served myself at dinner time last night and ended up with a blood sugar around 18mmol/l which just goes to show that you’re much better to check if you’re not sure, which I wasn’t!

My time off work is going to be spent doing a variety of things including trips to Dorset and Cornwall, another (final) birthday party for the Little ‘Un and a host of DIY tasks at home so it should be a good test of my pump management skills.

The party should be good as all three of my brothers are making it, even the one who lives in Brazil, so it’s a nice way to celebrate my son’s first birthday, even if it is nearly a month after his actual birthday. There will be cake and chocolate and all manner of interesting foods.

Talking of tasty food I don’t think I’ve mentioned it before but Deanne is from Australia and with it being ANZAC day we should be having ANZAC biscuits on Monday (the 25th of April) so I need to figure out how much carbohydrate they have in them, not such an onerous task really 😉

Volleyball tonight should be okay, I’m feeling a little more confident about how to not have hypos and not get too high while playing now but I shouldn’t get too complacent because that is always when things go wrong.

I’ve also got the Nottingham Type 1 Diabetes Group website fixed and have updated that, including details of the talk I will be doing on the 7th of June on how I went about getting hold of my insulin pump and then how I’ve been dealing with adjusting to having it so be sure to check that out and keep the date clear in your diary.

So for the time being I’ll sign off and until I’m next on-line I’ll bid you farewell and have a nice bank holiday.

Pump – Day 3

My Pump

My Pump

Well, things are continuing in much the same vein, the pump is continuing to pump and I am continuing to be pumped in to.

Last nights BM was 6.7 and then this morning I was 5.6 so I’m feeling pretty happy about overnight but still may need to adjust when I do my fasting blood tests overnight.

Had another high and a “nearly” low but at completely different times to yesterday. was 13.9 before lunch but forgot to do a test mid morning, was 15.0 and needed a bolus at two hours after lunch, weird ’cause I had the same lunch as yesterday when I was fine, then two hours after that I was 4.4.

I think the pump may have adjusted by -0.7 at this point but it didn’t make it very obvious. Have a horrible suspicion I might be low at dinner time but I’ll let you know tomorrow…

Pump-Monkey – Day 2

Waterstones in Nottingham

Where I Went at Lunchtime

Well I’ve been plugged in more than 24 hours now and it seems to be going okay, although I have a sudden, seemingly terrible, case of man-flu which I think is sending my blood sugar up a bit, as well as having had one particularly nasty high (15.9) at 9am, pretty sure I get the dawn phenomena but still need to wait a couple of days before I can start doing fasting blood tests as there will still be some basal insulin hanging around in me from B.T.P. (Before The Pump).

Total Hypo’s so far = 3

Total High’s so far = 2

The hypo’s are winning at the moment! Feel relatively confident that I’ll be able to sort it out but as I say I’m going to wait at least a couple of days before I attempt any kind of extra pump acrobatics.

As far as how I’m actually feeling betwen the highs and lows I am actually more relaxed about the whole thing than I thought I would be. I was expecting a feeling of constant nerves initially but it actually seems a lot more natural than I thought it would having a cannula stuck in my tummy and a tube coming out of me.

Bed was fine last night, wore a pair of shorts with pockets in and chucked the pump in the pocket, it survived fine and so did I! Not sure how long it’ll be before I feel brave enough to just let it dangle free when I sleep…I’ll let you all know.

The hypo today may possibly have been caused by my lunchtime jaunt to Waterstones, I have a suspicion that exercise shows itself a bit more obviously on a pump, might start playing with my exercise settings when popping out at lunch times?

I’ll jump on-line at some point this evening and get the pictures uploaded that Deanne took last night so you can see what the pump and the cannula actually look like on me. It is not, as my lovely wife suggested, just an excuse for me to show off my six pack 😛

Web-Monkey’s Pump – Day 1

My New Pump

My Pump, On Me

Well, I’m now plugged in, it’s a bit like being in the Matrix only with less slow motion and more insulin.

The consultation with the nice lady from Roche Diagnostics and the Diabetes nurse took about three and a bit hours during which time they helped me set the pump up in order that it delivers “about the right amount” of insulin, of course these things aren’t an exact science because everybody is different so we’ll have to see how it changes as time passes.

I’ve started off on half a unit an hour, still using Humalog, that works out to about 0.025 units every three minutes (it gives a dose every three minutes in case you were wondering!). Compared to the rather clunky half unit that was the least I could inject at a time with my pen it feels like a whole different world of Diabetes control.

Have only had one slight…erm…hiccough so far, Deanne dropped me off at the hospital and went off with the little ‘un to playgroup, when I finished she couldn’t pick me up ’cause he was having a sleep so I decided to walk back from Dundee house at City hospital to home, near where Edwards lane meets Mansfield Road, got home, decided to have some lunch and my blood test was 2.4 mmol/l. Oops! However it’s a good lesson that I still need not to be a complete donkey when managing my diabetes!!!

Apart from that I finally made it in to work at about 2pm and everything seems to be going very nicely so far.

More to come as I work out what’s happening.

Oh yes, one last thing…I think I might have to shave my belly :-S

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