Monday, 27 February 2012

Pump Mortuus Est.

Pump meus mortuus est. My insulin pump is dead.

And, it's out of warranty.

I upgraded from my Minimed 512 to the Medtronic Paradigm REAL-Time with Continuous Glucose Monitor (CGM) in February 2007. The CGM tests my blood sugar every 5 minutes and sends it, via radio frequency, to be displayed on my pump. If I get too low or too high, an alarm goes off. This feature is the only reason I upgraded. The CGM helped me sleep a little bit better after suffering the first hyperglycemic seizure of my adult life. Although I had a few seizures as a kid and teenager, this one was somehow much scarier. Much more real. This seizure was different because it gave lie to the sense of security I had developed after a few years of stability under the pump, and also because this time I could see the horror of a seizure clearly reflected in the face of my girlfriend at the time, who watched it happen.

Since that time, the pump has been by my side (get it?!), and I have used the CGM feature nearly continuously (get it? continuously? get it?!). CGM changed the entire way I viewed my blood sugar. For years I would try to get a picture of what my body was doing using finger-stick testing only. Now, I could see what it was doing. Now, my blood sugar was not just 'high' or 'low' or 'just right'; it had rates of change, too. Sometimes the arc of my blood sugars was steep, sometimes it crept up slowly. I had gone from a 1-dimensional world of blood sugars (i.e., I only observed my blood sugar at a certain point) to a 2-dimensional world (I observed my blood sugar as a continuous series of points in time). I loved it.

And, I hated it. Those alarms for highs and lows are as annoying as they are helpful, especially when your blood sugar is not really as high or as low as the CGM thinks it is. There's nothing quite like being needlessly woken up every hour by a frantic little vibrating machine attached to your leg to put you in a sour mood. And you're trapped: There's no easy way to correct the CGM when it's mis-calibrated, and disabling the alarm altogether would defeat the purpose of the CGM. (What if you really did get low later in the night?) Still, the CGM saved me more than a couple of times, and I'll swear by it---warts and all---for the rest of my days.

Beyond that, Minimed did not seem to care very much about usability. The interface was annoying to get through; in an iPhone world, the pager look and feel fall very short of the standard we've come to expect when interfacing with machines. I get where Minimed is coming from: they're making a product to keep me alive and don't have time to worry about bells and whistles. On the other hand, this is a product like any other, and I'm a customer. Right now, Minimed has a monopoly in the US on CGM-enabled pumps, so they can afford to ignore issues about usability. But, if they don't start producing a product diabetics like to use, some company or another certainly will. I let my pump go out of warranty hoping that it would last long enough for the Animas Vibe, approved in the EU, to hit the North American markets. Unfortunately, the coveted Vibe is a long way from being available, so it looks like I'll be getting the newest version of the yesterday's pump.

In the mean time, I'm revisiting injections, and what a trip it's been. When I first started using a pump, it was because I was taking 4 types of insulin (NPH, Ultralente, Regular, and Humalog) at least 6 times a day (including a daily injection at 3:00 a.m. to address morning highs). It was the Frankenstein monster of diabetes management. The basal routine of the pump simplified that in a wonderful way. Since I started the pump, however, better long-acting insulins with no peaks, such as Lantus, came out. So, I've been using Lantus and Humalog injections for the last week or so, and my blood sugars are not much different than they were with the pump. I'm most aware of the difference between using a pump and using injections---and this came as a surprise to me---when I am taking my pants and underwear off.

That's right.

I had no idea, but I have developed a habit of pulling my pants and underwear away from my body at the same time that I pull them down, because if I didn't (if I just slid them down my legs like everyone else), then they would rip the pump right out of my thigh. I didn't notice I did this until I caught myself trying to avoid ripping out of my leg something that wasn't even there.

My pump is dead. But I feel it there. I feel it vibrating in my pocket, trying to tell me something important. I reach for it when I am about to eat a snack. I have phantom pump syndrome. But it's not there. It's dead.


  1. Ben, this is amazing. I loved reading this. I love the flashes of humor.

    1. Thanks, Devin! I'm glad you liked the humor. I didn't want to over-do it, so that's why I only added flashes of it.

      By the way, for making the first comment on my blog, you win your very own case of ItGoesThroughMe (TM) used syringes! Check your mailbox!

  2. hah i also like the humor "frankenstein mode" happens to me alot and waking up alot to piss but i dont use a pump i use navolog and lantus the habit off pulling you pants down ha me to but man sometimes shots in the ass hurt im running aroung like dam that hurt haha.

    1. Dude. It's crazy to me that I can take a shot in exactly the same place, and sometimes I don't feel it at all, while other times it hurts like hell! Hang in there!