In The Name Of Research!

I did proclaim my love of the Animas pump after my brief trial but in the interest of fairness and information I have decided to go on a similar saline trial with the Minimed 522 pump. After this trial I will be able to report on the pluses and minuses of each pump and really make an informed decision about which device will help me best control my blood sugars. Next Wednesday I'm also meeting with a rep from Deltec, the makers of the Cozmo pump. The Cozmo pump has been getting some good publicity on the internets and I wanted to check them out as well. Unfortunately, Deltec has a policy of not allowing saline trials so I'll have to really check that pump out during the sales pitch.

I'd love to hear the experience of some pump users out there!

Stress & Blood Sugar

Over the weekend I had some external stress that wreaked havoc on my blood sugar. Since my diagnosis it has been very rare the I've had a bs reading of over 200. When you have a sister whose a holistic medicine doctor, exercise and nutrition guru you tend to become really good at counting carbs. So this weekend when I had 2 readings in the upper 100s and 2 readings above 200 I knew something must be up. I assumed by carb:insulin ratio couldn't have changed 10 units overnight and I wasn't eating any exotic foods, therefore I attributed the highs to some external stress. I don't want to go too much into my personal life but a canceled vacation can really affect a guy!

I've been reading alot about how stress can affect diabetes and trying to determine if stress can "cause" diabetes. While most of the literature I've read indicates stress can't cause type 1 diabetes but it can be the factor that makes the symptoms prevalent. In the period leading up to my diagnosis I had taken the GMAT twice, applied to 4 MBA programs, and had a major restructuring at work. It has become apparent that the combination of those factors led to the final shut down of the beta cells in my pancreas. While I no doubt had some sort of auto-immune issue that caused my body to attack the beta cells it was the external stress that brought on the final knock out punch. Although there is research that says stress has no effect on the onset of diabetes, I'm of the mindset that the extreme mental stress I put myself under for about a year was the equivalent of Michael Spynx making Mike Tyson wait about 45 minutes for their fight back in the early 90s - it riled him up and well 90 seconds later Tyson looked like the baddest man on the planet, so the stress made my t-cells attack my beta cells that much more violently.

This past weekend as my personal life was causing alot of emotional anguish my blood sugar was alot harder to control. To combat this I played some extra golf and then ran harder than normal on Tuesday. Previously my best half hour distance was 3.5 miles. Yesterday I shattered that by running 3.56 miles in 30 minutes; all the golf, time spent outside and hard run helped me put my blood sugar in check and reinforced my belief that through sweat and hard work diabetes is alot more manageable.

Getting Used to the Pump

Two things occurred in the past 24 hours that have completely convinced me to go on the pump. Last night I was battling some lows - my Dad's 66th birthday was last week and last night I was able to have a slice of cake with him. To account for the pizza my family had for dinner I took 6 units of novolog and added 4 units for the cake. I started to get a headache about an hour later but my bs was a manageable 157. A few hours later I had dropped all the way down to 55 and needed a full glass of orange juice and 3 glucose tabs to return to normal levels. I realized that if my pump was filled with saline and not insulin I simply could have reduced my basal rate for a 1/2 hour to account for my mistake with the bolus injection - way easier than eating a ton of food to counter the combination of lantus and novolog.

The other thing that sold me on the pump was my time at the driving range today. As I previously stated one of my biggest fears was being comfortable with the pump during athletic activity. After 4 orthopedic surgeries I decided to hang up the cleats and turn to lower contact sports for my athletic endeavors. One of my passions is golf and it is really important to me that diabetes interferes as little as possible with the game. Today was my first time swinging a club while trying out the pump and I was thrilled with the results. In 90 degree weather, sweating like Patrick Ewing in the 4th quarter the canula stayed in the entire time. I'll attribute the problems with the infusion site I had during my run to my ignorance/ inexperience in setting up the site. In the future I plan to use IV Prep, I need to do some more research on which infusion set to use, some people have recommended the Unomedical Comfort Set. So I think I'll give that a try when I get my real pump, I plan to tell Danielle first thing Tuesday morning to file the paperwork so I can get the Animas 2020.

The Search for a Pump - Part 2

My experiment with the Animas 2020 has continued and I've been pretty pleased with the results. Alot of my fears about how I'd react to the pump have really been alleviated. After the first cannula fell out I had some issues getting a new one in. The first time I tried to put a new cannula in I forgot to remove the plastic needle guard; the second time I removed the plastic needle guard but forgot to remove the paper on the adhesive tape! It is really disconcerting when you stab yourself with a needle to realize you just ruined that infusion set because you're too dense to remember all the steps - now I see why it takes 2 office visits until they let you use one of these things!

The other big challenge was getting into my bathroom, the Animas rep only had the 46" infusion sets for me so I'm dealing with twice as much cord as I'd like. Each time I went into my bathroom last night the tubing got stuck on my door handle. Beyond that I really didn't have too many complaints. I was able to sleep perfectly well, the tube never got wrapped around my body and when the tube was resting across my stomach I hardly felt it.

Today at the gym I decided to remove the tube and pump since I was doing squats and bench. The doctor's say you can leave the pump out for about an hour and 1/2 at a time so I thought my hour workout would be fine. Although I'm only using saline at this point I'm trying to make my trial as realistic as possible. The cannula stayed in during this workout so I was a happy man!

Each time I'm supposed to give myself a bolus I do it with my novolog pen and with the saline in my pump. I really can see how the pump will improve my quality of life and allow me to have an unexpected snack. For example, when I was headed to Grand Central today to catch a train to my parents for the long weekend I was dying to get a hot pretzel with some cheese for the hour long ride. However, I didn't really feel like exposing my stomach to the world to stab myself in front of small children. If I had insulin instead of saline in my pump I could have gotten that pretzel, hit a few buttons and kept my bs around 100 - this trial is really convincing me the pump is the way to go.

The search for a pump - part 1

I've been on multiple injections since my diagnosis and each endo I've spoken with thinks it would be a great move for me to go on the pump. I'm constantly fighting lows after I work out and basically need to make sure that my blood sugar is around 250 if I'm going to run and 200 if I'm going to lift. A 30 minute run drops my blood sugar about 170 points and a hard lift drops my bs about 120 points. Since I'm determined to have this disease affect my daily activity as little as possible I've done a ton of research on pumps. The big advantage is that they offer more flexibility in how you receive insulin. A lantus shot (long acting insulin) will be in your system for 24 hours and the more you work out the better the insulin will work. A pump uses short acting insulin which will leave my system in 3 to 4 hours. Also the pump allows me to slow down the insulin delivery so that less insulin is in my system prior to my exercise helping to avoid a massive carb load before the gym.

What I've learned - they all pretty much do the same thing but the level of customer service and style of pump is vastly different. However, for someone who studies efficency, profitability and business improvements for a living my research has been extremly frustrating. I can't believe the lack of technology in the pumps and have to completly agree with Amy Tenderich and her letter to Steve Jobs. For example, the omnipod (only wireless pump) is a fantastic idea but why not make software for a palm pilot to drive the device rather than create your own PDA - just another thing for diabetics to carry around. The minimed paradigm has both a remote and constant glucose monitor but neither really adds value to the pump. The remote only gives you the ability to add a bolus shot or suspend the pump - if the pump spoke back to the remote and allowed for actual programming it would add real value. So I left my diabetic educator's office more frustrated at the lack of technology than excited about the possibilities.

That evening as I gave myself a bolus for dinner I thought it would be really nice just to hit a couple buttons rather than lift my shirt and prick myself. I got over my frustrations with the lack of technology and contacted Medtronic (Minimed), Insulet (Omnipod) and Animas (2020). Medtronic and Animas both wanted to meet me privatley while Insulet simply offered to e-mail me the forms to see if my insurance would pay for their device. That simple difference took the omnipod out of the running (plus I'm not sold on their design). I spoke with both the Minimed and Animas reps at length on the phone and set up meetings for the following day. By the time I got home from work that evening I received 2 e-mails from other Animas employees, one who is a marthon runner and the other is on the board with DESA. Danielle, the rep from Animas knew I was concerned with athletics and my pump so she wanted to get me as much information as possible.

The meetings with each rep were fairly similar but I felt like Animas really wanted to help me live a full life with diabetes where Medtronic just wanted my business. When I asked the rep from Medtronic why she would choose the Paradigm 522 over Animas she stated "we've been around the longest, are the biggest and have sold the most so we must be the best." The Animas rep answered that question with "We're always trying to improve and Johnson & Johnsons acquisition will only help us, over 90% of the employees at Animas have diabetes and Mr. Universe wears our product, plus if you purchase an Animas pump you become part of our family." With the e-mails I had received the previous night and the hour long conversation I had with the marathoner I truly believed her. By the next morning she got back to me and offered a loaner so I could try out a pump - one of my main concerns was wearing the thing at work and at work outs.

So today I have my loaner Animas 2020 pump in - I love the interface and its actually alot more comfortable than I thought it would be. Unfortunetley the infusion site (Inset by Unomedical) fell out when I was doing speed intervals on the treadmill. I'm going to talk to the marathoner and see if there is a way around this besides surgical tape. While I see the benefits of the pump I'm not 100% sold that the infusion sites will be durable enough for work outs - I wish the pump could screw into something in my skin that was just replaced once a year, but for now I'm going to have to find tape that's strong enough!