While I am on the subject ...

I guess I should mention what the insulin pump actually does for a person with diabetes for those not in the know.  My pal, Jen, asked me about it on the phone tonight and I realized that in all of my postings I never mentioned what pumping is all about.

What is insulin anyway?
In order to accurately describe pumping, it is necessary to understand the basics of how insulin works in the body of a person without type 1 diabetes.  For all of us without diabetes, our pancreas regulates our blood sugars by releasing two different hormones, glucagon and insulin.  When going about your daily tasks, the pancreas lets out small doses of insulin constantly.  It keeps the blood sugar range from going too high by increasing the insulin to turn food into energy.  It keeps the blood sugar from dropping too much by releasing glucagon (this stimulates the release of glycogen from the liver), ultimately raising the blood sugar.  The pancreas is a well oiled machine that keeps our blood sugar in really tight control.  Even before we take a bite of food at a meal, our pancreas has already started delivering higher levels of insulin to balance with the food we take in. 

Insulin is necessary to take every bit of food we consume and turn it into energy.  But people who have type 1 diabetes no longer make enough insulin to turn food into energy.  Without insulin the blood sugar rises to high levels and the body compensates by making you drink lots of water to dilute the level of sugar.  When this happens no sugar enters the cells of the body and therefore it cannot be used as fuel.  In response the body thinks it is starving because it has no sugar available for use in the cells.  So it starts burning fat stores for fuel. The body literally starts eating itself.   All of this makes a person with developing diabetes very sick.  Without treatment this person would die in a very short amount of time (weeks, not months).

Injections ... for now
My daughter has been on insulin injections since she was diagnosed at the age of four.  She doesn't just have one or two shots per day, she has more like four, and when she's sick you can easily double that number.  I don't say this to complain or to make you feel sad, I tell you this so you'll understand what we currently are doing to keep her blood sugar in good control.  For type 1 you cannot take a pill to treat diabetes.  You can't just watch your diet and eveything will be oaky.  You must take insulin or you will die ... soon. 

Pumping!!!
The pump makes things so much easier.  First of all, instead of getting poked with a needle four times per day, you only get a needle poke every other day.  The insulin is delivered through tubing that connects to the body, called an infusion set.  The other end of the infusion set connects to the pump, which is a small electronic device (the size of a pager or cell phone) that contains a reservoir with insulin.   The computer inside the pump helps deliver small little bits of insulin throughout the day, very similarly to the way the pancreas does.  So with the new pump, my daughter will get a  super small dose (we are talking tenths of units here, folks) every three minutes.  This function aims at keeping her blood sugars steady throughout the day.  Because this is a machine and not an actual human organ, it doesn't work anywhere near as well as the pancreas, but it is much better than shots.  In addition to the little bits of insulin delivered during the day (called basal dose), the pump also delivers a bolus dose. 

A bolus dose is a dose of insulin that is delivered when the blood sugar is too high or at a meal (or snack) time based upon the amount of carbohydrates eaten.  So right now if Samantha wants a couple of pieces of candy for a snack, she either has to take a pass and miss out on the Easter candy (because the insulin needed to cover that amount of food would be too small to administer via syringe) or she would have to eat a little more than a couple of pieces so that she could receive a bolus dose by shot.  But once she starts on the pump she can have those two pieces of candy, enter them in the pump and the pump will deliver the right amount of insulin to cover those consumed carbs.  When dinner time comes around we count up every gram of carbohydrate eaten and we input it into the pump.  Based upon a bunch of calculations and definitions (I won't bore you with them) previously set up in the pump's computer, the pump recommends a meal bolus dose.  We can accept the recommended dose or we can modify it.  Similarly, when the blood sugar rises out of target range the pump recommends a correction bolus dose to bring it back into the preset range.  Once the dose is accepted it is "pumped" out of the reservoir through the tubing and into the body.

The benefits of pumping over injections are many.  First of all, there is a reduced risk of low blood sugars (which happen regularly with injections).  Second, it keeps the blood sugars from fluctuating so much and if everything is set up correctly, it can lead to much better blood sugar control.  Good blood sugar control reduces the risk for complications (blindness, heart disease, amputation, kidney failure, etc.).  Anything that does that and allows my daughter more freedom with food and fewer needles, makes me a very happy mom!