About That Pump

Those of you on Facebook have been inundated with my posts about Type 1 Diabetes (T1D) for the past week as November is Diabetes Awareness Month.  All of this is an attempt to dispel some of the myths and give a little insight into how our lives are affected  by this challenging chronic disease (effected?  I have no clue.)

I've been on an insulin pump since March 2011. I fought it for a long time.  I've noticed that diabetics are often resistant to changing the way we treat our disease.  I couldn't be happier with this change.  I can't imagine my life without a pump, which I think means the next time a new technology comes along, I'll be resistant to that one too.

For the uninitiated, I thought I'd share some of the details about what goes into using a pump.  First of all you need one of two things:  Lotsa money or a premium drug plan.  I'm extremely lucky my hubby has an incredible extended medical plan that gives me 100% coverage on my pump and supplies, right down to the AA lithium batteries that need replacing about once a month.

My Animas Pump costs just under $7000 and is warrantied for three years.  I have to change the infusion site (where it goes into my body using an "inset") every three days and the insulin is stored in a removable cartridge (which also has to be changed) inside the pump. A month's worth of insets and cartridges is about $525. Then there's the insulin which is actually relatively inexpensive at around $35 a month.

Friday I changed my pump site so I took some photos.  Here's what I do every three days:

First I get all the stuff together.  From left to right:  Vial of fast acting insulin, the cartridge...what's that you say?  Am I going to put that big gross needle into me?  No no, that big gross needle is how I get the insulin from the vial into the cartridge.  To the right of the cartridge is the pump.  The screen tells me that it's "rewinding" at the moment.  It's rewinding the plunger so I can put a filled cartridge into the pump.  I didn't say "full cartridge" because you don't fill it up totally.  After some trial and error you figure out how much insulin you need for three days and put that amount in the cartridge.  The round blue plastic item at the bottom is the inset.  It's a spring loaded device that helps get the cannula (the tiny flexible tube the delivers the insulin into me) under my skin.

Here's a picture of the cannula I just removed.  That clear little stem in front of my index finger is what stays under my skin. The tubing carries the the insulin from the pump to the cannula which is very flexible and so small I can't even feel it. 

Meanwhile back at pump set up, the next step is to attach the tube from the inset to the cartridge.  Then, as in the photo I put the cartridge into the pump.  Once it's in the pump, I'll screw that little black rubber thing over the end of the cartridge.  It holds it in the pump and helps make the pump waterproof.  (Yup, I can go swimming wearing my pump - though not scuba diving.)

Now I need to "prime" the pump.  I hold down a button that makes the insulin go through the tubing and I stop pressing when I see insulin come out of the tube that covers the needle in the middle of the inset.  Sorry you can't really see it in the photo.  See that white tab on the inset?  That's part of the paper covering the sticky fabric that will hold the inset in place on my body at the infusion site.  I'll remove the paper before the next step.

I usually move to the bathroom now as I find it easier to look in the mirror and find the best site on my stomach or upper bottock.  Sometimes I use an upper thigh, but I don't need the mirror for that.

I've pulled back the "spring" on the inset and it's ready to go.  Friday I used a spot on my stomach about two inches from my navel.  I hold the open part against my skin, making sure the tubing is pointed towards my waistband as I'll be clipping the pump to my belt. I squeeze both sides of the inset (you can see the spot where I press on this side under my thumb).  This pushes the needle and cannula into the infusion site with great force.  Next I push the back of the inset with my index finger, just to make sure the sticky part is tight against my skin.

In the top half of this picture you see a clear bandaid type thing and the envelope it came in saying "Bioclusive".  You can put this over the infusion site to keep everything from accidentally coming off your body if you've got it in a spot that is vulnerable to wear or if your tubing gets caught on something like a doorknob or a bicycle handle (been there done that).   If you've had an IV on your hand in the hospital, it's similar to what they use.

The other envelope says "skin tack wipe".  It's a little swab with super sticky stuff on it that you can rub on your body at the infusion site.  It helps things stick better.  I use one or the other, or sometimes neither depending on the spot.  I tend to get a heat rash from the Bioclusive and woe is to you if you get the sticky tack wipe on your fingers.

And here's what it looks like. Ignore that little bit of blood at 2:00.  Can't ignore it?  Ok...Sometimes you forget to do things.  See above where I said "I'll remove the paper before the next step."  Well I lied.  I did not take the paper off the sticky part.  The needle went in, but when I pulled the inset away from my body, everything came back with it because the fabric wasn't stuck to me.  A dumb mistake but sometimes you get distracted, c'est la vie.

Normally you wouldn't put two sites so close together, but it wasn't really a "site" because it was just a quick injection with a micro thin needle.

Here's the needle that went into me.  It looks a bit scary but really it's not. I've used the pump for about 4 1/2 years, changing it every three days. That adds up to...a whole lot of times I've done this.  And then there are the extra times when in comes off accidentally or I change it because my blood sugars are wonky and I suspect the cannula did not go in properly or the sticky has come loose.  So out of the hundreds of times I've done this, I've only felt the needle maybe four times and it only hurt for a millisecond.

When the pump trainer came to the house to show me how to use the pump I was pretty overwhelmed.  Not so much by the pump itself, but more by the amount of waste created by the process.  Luckily the with a little bit of work, the majority of the supplies are recyclable.

 As you can see, the cartridge needle is removable, you can cut that blue thing that helps deliver the insulin to the cannula off the end of the tubing.  Pliers make it easy to remove the needle from the inset.

Then it all goes into the Sharps container, which goes to the pharmacy once it's full. 

 All of this goes into the recycling and the cannula goes into the garbage.  Oops, took the picture before I cut that blue thing off the tubing.  Anyone know what that's called?
 
So there you have it folks.  In the next few days I'm going to do another post about how the pump, my glucometer and I achieve perfect control of my blood-sugars.  (Inside joke for the other T1D's and their families)