To pump or not to pump? Things to consider....

Any milestone in this life with T1D, whether it is the first test or injection or just the first time you try something new and you calculate your diabetes to perfection, is a feat to behold. In this age one of the biggest management changes that can be made is to choose whether or not you start pumping or stay on MDI.

As with all big decisions there are positive and negative aspects that need to be considered. But with every decision there is always a balance between the 2 and hopefully with sound judgement the right decision is made.

I have spoken in part of my decision about pumping and even the decision to have my 2 year old daughter on a pump but I suppose I haven't gone through the consideration process.

First to consider is what stage are you at -

• Are you a long standing or well experienced T1D and you have been giving so many injections over the years that your tired of the routine, the feeling of being a pin cushion, the inflexibility and to a degree the blindness that can come with MDI?
• Are you a long standing or well experienced T1D with control and a view to maintain the control and avoid complications well into the future?
• Are you new to T1D and looking for a management method that will be as like to normal function?
• Are you a parent trying to work out what is going to suit your little one the best to ensure that they can minimise the risk of complications?

For me some 8 years ago I was 16 years in to my journey. I was living on 5 injections a day and calculating my food intake by exchanges. I was a slave to feeding my insulin rather than have my insulin to what my body requires. I was tired of the needles, I was tired of managing my intake by knowing what I had to have hours before hand so that I could have my insulin 30 minutes prior to eating.

All of the above stages have elements to them that will have a dramatic effect on what decision will be made.

As with all methods of controlling T1D pumping can in fact be a method that can be stable and also have quick change if not paid attention to. By using short acting insulin only, you can have something go wrong and  it can change your BSL in minutes. This is not to say that on MDI with a long acting insulin this won't happen and to tell you the truth the worst hypo's that I have had is when I was on MDI with a long acting insulin. I suppose that with the short acting insulin you can make changes and have them applied within minutes and hours rather than days.

If you have gotten to this point and you think pumping, which is the most advanced method of T1D management, is something that should be considered (which I completely agree with) then you need to take the following into account -

• What type of pumps are there? Well in our market there are 3 on the market that can be prescribed. All of which do the same basic job however, and this is where you need to do the research and understand about the support and company behind them. A pump is only as good as the support that goes along with them. Do not expect that each of the companies are the same. Do your homework.
• What functions do you and your health team think are important? Is it small dosage ability for your basal rates, is it the ability to connect a CGM to the pump to help with a little bit of automation and reassurance through out the day or is it a combination of all the little things that make up the pump.
• How do you work with your Team? Do you wait until your 3 monthly appointment before you review your BSL's and rates or do you expect the information to be available to you and your team no matter the day or even where you are in the world. For me this is a big thing, I download my pump and that data is available for my team to review whether I am there with them or I am in the other side if the world. This allows me the speak to my team and tweak my settings to ensure a maintainable range is kept.
• Is it more about the aesthetics? Can you read the screen, can you navigate through the screens in an easy manner and would it be in user friendly terminology?
• Does your endocrinologist have a vested interest in understanding how your pump can work for you to ensure your life immediately and in the future will be better. Even though I was on a Medtronic pump for nearly 8 years prior to my daughter being diagnosed and knowing that I wanted her on a pump I still asked her medical team for their professional opinion on what they thought was best. Of course I could have argued with them if they didn't agree me as to the best but that wasn't to happen.
• Is it a concern that you will have a device attached to you 24 hours a day, 7 days a week? Well this is an interesting question as there are many like situations. My wife is not a T1D however she has a device that I would say is attached to her 24x7 and is rarely more than a meter away from her. The difference is that I think she can live with out her phone compared to me not living with out my pump. It is a change to have a device attached however the pro's quickly outweigh the con's and within days you live like it isn't there. My daughter, since seeing me with mine her whole life never second guessed her pump and to her now it is normal.
• Can you teach old dogs new tricks? It's never too late to make a change and if you have gotten through 10's of years on MDI and have little to no complications then pumping could be a management style to get you through the next 10's of years minimising the possibility through hard work of complications.
• The pump is not a cure! This was one of the first things my endo told me. It is a management tool that if abused can be dangerousness but used in the purpose of why it was made, have awareness of your body and have the drive to always want the best for yourself and the pump will be a shimmer of normality back in your life.

For me and my daughter the pump has been a welcome addition to life. It has put flexibility and control back in our hands. It was the best decision I could have ever made in my years so far as a T1D. I understand that people could be adverse to the change but if there is an incling that any one point above has made you think then at least ask the question and investigate. Do not be afraid to make a change for the good.

The day it all began - Diaversary

Today I have mixed and strange feelings, I wonder to myself whether or not I need to be happy, excited or angry and confused. Today is the eve of what many call their "Diaversary". This is the first time in 24 years, and it is because I am a lot more thoughtful since my daughters diagnosis, that I have been able to sit back and recognise the day that it happened some 23 years and 364 days ago.

Is it something you celebrate? Is it something like a birthday? Or is a time to reflect on what has been done and what will be done?

For me I think it is the later, reflect on achievements made through the years, celebrate that life still comes first and that T1 has not caused major problems. Celebrate on the advancements in management and the ability I have had to change to make my life better.

Before 1921 there was no management, there was no insulin to keep us alive. Now that may seem like a long time ago however I then put it in perspective with the people around me. My grandmother was roughly born around the same time that insulin was found. My grandmother is still alive now and to me I would say that modern management of T1D has been available for only 2 generations. I don't know about you but that doesn't seem like a long time to me at all.

Then to think of the advancements from glass syringes to disposable syringes, no blood test equipment to machines that take 5 seconds to give you an accurate reading, urine base ketone tests to once again blood machines to calculate ketones and probably the biggest change is the modern day insulin pumps and CGM sensors. I saw a photo a photo the other day of the first insulin pump and it resembled a ghost busters back pack. To think we have moved from that to a small pager device that has the ability to mimic the natural body's insulin production. This I am thankful for. Not only for me but most for my daughter. If I can maintain tight control then maybe just maybe she can also learn to keep any complications at bay.

Now that we have looked behind us now it is time to get excited of what could be in front. If in 93 years we can go from death to having the ability to manage this disease with a little pager then what is coming at us in the near future. With the rapid advancement of technology I would have to say that the next breakthrough in management is only around the corner. Whether it is a full blown artificial pancreas that is able to determine the BSL and then give either insulin or glucagon to keep it in range or if there are elements of automated predictability then anything is welcome. Anything that will help maintain levels to keep the other hidden complications at bay is always going to be welcome at my door.

So in reflection of this post tomorrow is my "Diaversary" and I will celebrate who I am and what I have become with T1D on my side and look toward tomorrow for things that will make the next 24 years as successful as the last.

Personal training begins

A few months ago I wrote an entry on trying to loose weight and how when eating the right portions and exercising  alone was difficult and scary in the point that the unexpected lows and the management of insulin levels as your body needs less was and is difficult. You never want the low to hit in the middle of the night that is for sure.

As this is the case I decided that this time I will try a different tactic and use a personal trainer. It was also timely that I saw online that there was a personal trainer who was looking to make the next step and become a personal trainer that is qualified to train people with critical diseases or problems such as T1. To me I didn't even know this existed so I thought it should be interesting to see what they know and what they could do differently.

On MDI I lost 30 odd Kilograms at one point and in doing so I had some of the worst hypo's I have ever had. One day would be fine the next would be the body saying your now loosing weight so you don't need so much insulin. To which case I would adjust what I was having but where I would try and preempt it I would run high and just feel terrible. It was great to loose weight but it was a scary time.

Now on a pump with a CGM sensor it is very interesting to see the impact of what I am going to put myself through.

I get to the gym on my first session dreading what was to come and I get the information that we are going to want to work out to bun fat and not glucose. I had never really thought of this before, and probably it was just naive  of me, but to do this it meant we would work on the large mussel groups with heavy weights with high repetition. As I like to think that the people who are the specialists in their profession know what is best I did the work out.

The weight section of the work out consisted of dead lifts, squats, squat jumps and bench press. The cardio section, even though it was a very small fast bursts, was done on a rope pull machine. Like short sprints it was 2 minutes of fast paced repetition.

By the end of the sprints it was then onto the treadmill for a cool down walk to ensure my heart rate lowered. I can safely say that by this stage I felt like vomiting from the lactic acid flowing through my limbs and it felt like my legs were jelly.  It was a hell of a work out.

Now the interesting part. Usually when I do a cardio workout my BSL will rise and the 2 or so hours later it will drop dramatically. Through out my workout and because I was wearing my Medtronic CGM I was able to monitor what was happening and anytime through the hour. I was shocked to see that through out the hour my BSL remained roughly the same. I had no rise and even more importantly I had no major drop even hours after. I was amazed and I felt great.

I have continued to work out and wear my CGM and I have had consistent results. Heavy weights with high repetition saw stable BSL. There had been a number sessions since where we incorporated sprints on the bike along with the rope pull machine in the one session. As this was multiple cardio elements I did notice on my CGM hours after the workouts the drops in BSL occurred.

Moving forward there is a fine line between burning fat instead of glucose but if nothing else I have another element to use in the war with T1D and how I can just manage what I can to get the results I need.