Two months ago, I went from years on MDI to my very first experience with an insulin pump...the omnipod to be specific. It was a long time coming, and if you're wondering how or why I made the jump have a read through the post below:
Want the complete low - down on my experience with the omnipod so far?! Then carry on reading and bear with me while I spill all my thoughts on paper...well, screen I mean.
THE TRANSITION PERIOD
First thing's first, the transition period. This was the part I was most anxious about, and I'd heard from different people that they all started their pumps in different ways. I'd been told to do everything as normal until I go in for my pump training, but it's very easy to start comparing and discussing what others have been told. Here's what I learnt :
Your pump nurse know's what she is doing.
I learnt from my experience that there are different ways to prepare for a pump, and different ways to begin the "transition". Different nurses follow different methods, and they do it all the time, in a way they find comfortable. It's easy to say now, but there really is no reason to compare methods. For me, I was told to do everything as normal until I go in for my appointment. When I was there, I got my pump training - it was basically a very brief "how-to" on my new pump. My nurse, Sue, ran through all the settings and buttons that I need to know. She set up my basal rates, my I:C ratios and taught me how to adjust my settings according to what happens in the following weeks.
It's a lot to get your head around, so looking back, it feels like a blur. With a pump in her hand, Sue suddenly asked "Right, where do you want it?"
Oh gosh. It suddenly felt very real. Before I knew it , I had a working pump on and I was good to go. Because I had taken my basal shot that morning, she turned the basal setting off, and taught me how to turn them on in a days time to allow my current basal (Tresiba) to run its course out of my body. It seemed easy enough, although I made sure I was fully prepared for some rough days ahead. I left the hospital with everything I needed to start life as a pumper. It felt surreal. I was very conscious of the pod she placed on my belly, but it was surprisingly lightweight, and I found myself forgetting about it quickly already.
Long story short, here's how my first couple of days went :
"wow...this hasn't been too bad."
Here's how my third day went:
Change is never easy. No matter what you're doing, there is bound to be a shift in blood sugar control. Whether it be, changing from one insulin to another, one ratio to another, a warm season to a colder one, and going from manual injections to a pump is no different. The first day's were fine, I still had my basal rates turned off to give my Tresiba time to phase out, and it was pretty strange getting used to eating without manually injecting! But i'll get to that later. The third day, I turned on my basal rates and braced myself. Boy should I have braced harder. That was a long day of persistent hypos, corrections and more hypos. I was a mess! I called Sue in a complete panic, exhausted and defeated, but I was assured this would soon settle as it was probably my Tresiba insulin still phasing it's way out. And it was, the days after then got better and I quickly got myself to a good place with my settings.
Okay, so remember when I said it was strange to not manually inject before a meal?! Yeah let's talk about that now.
It was by far, the most emotional, exciting, overwhelming feeling out of the whole transition. 16 years is a very long time to be manually injecting EVERY TIME you eat anything. It becomes something you do on autopilot. At least, it did for me. My first couple of days on the pump felt so surreal. So surreal, that I made it a point to highlight this every time I ate. I'm surprised my fiancé didn't ever throw me out.
"Hey look! I'm eating my dinner and I didn't have to actually inject! Look! Look at me!"
Yeah, there was a lot of that for a while, but he let me bask in my glory until it got old. (Will it ever get old? I don't think so.) Anyway, I felt so free for the first time in a very long time. Bolusing for meals just felt SO....easy that I had to make a conscious effort so that I wouldn't accidentally reach for my pens.
BUT. I want to keep this realistic for you. It isn't all sunshine and rainbows. It's a huge step. It's a huge change and it's a lot to get used to. For me personally, it was an emotional and overwhelming time. I had overcome A LOT, to get to this point where I was fully embracing an insulin pump. No matter how long it takes you, no matter how much you want a pump, or how long it's been, or how ready you are, the notion that you are now ALWAYS connected to your "pancreas" can be somewhat daunting and something to bear in mind during the transition.
For me, this happened the first time I ran myself a bubbly bath since starting the Omnipod.
I suddenly realised,
"Oh. Can I do this? Should I do this? Oh my god, this tiny pod is keeping me alive and it needs to be stuck to me at all times".
That realisation can spiral very quickly into daunting thoughts and an overwhelming sense of "forever". With pens, I used to inject and go. They go back in your bag until you need them again. With a pump, aside from changing, and a quick possible "naked shower" (I have not done this yet), the pump is essentially made to be attached to you at all times. It's like an artificial pancreas, except where real ones (the one's that aren't lazy and decide to quit altogether) are hidden away inside your body, this one is on the outside. With pods, they are tubeless, meaning it definitely brings a new meaning to the phrase "stuck together". I found myself in a panic, googling all sorts and trying to rationalise my thoughts in my head. Here's what I decided:
Even though it hadn't been that long I loved my pump so much by then, that having my pancreas "stuck" to me everyday seemed like something I could get used to.
You CAN have a bubbly bath. It can be submerged in water, and as long as it's not scalding hot the insulin will be fine. (Beware of jacuzzi's though, I've heard these can be trouble....oh and maybe watch how long the long baths are....maybe keep them within a 40 minute window."
Forever doesn't seem that daunting if you slow down, and take it day by day.
Anyway, my naked meltdown lasted about 5 minutes, and since then I've never looked back.
I've been on the Omnipod for just over two months now, and there are so many things I love about it. I've tried not to write this blog post through rose tinted glasses, (is that the right expression?) although it's pretty hard because it's too early in the relationship for me to have truly found all the faults. I'm still pining over how awesome it is. None the less, I'd still say this is a pretty balanced and honest overview.
Pod Change Day
Pod changes come and go every 3 days, and at first I thought it was quite a complicated laborious task. It involves vials of insulin, syringes, beeps and lots of priming, however two months down the line, I now find that I'm doing them so quickly that I have to retrace my steps and make sure I didn't miss anything out. It's quick and easy, and to be honest pretty painless! Beats injections everyday for sure!
Bolusing for meals has become the easiest thing in the world! (Minus the constant "umm-ing" and "ahhh-ing" over the carb counts but what's new?!) Using the PDM - personal diabetes manager (I've called mine Joey...because like Tribbiani, we are always up for food, especially bacon and pizza, he's my loyal companion in life and we don't share food because pre-bolusing for exact amounts is no joke!) I can basically bolus for food in under a minute. There's no pulling out insulin pens and needles at a restaurant table, there's no urgent search for a bathroom because you can't inject your belly under your dress in public without flashing some strangers.
In fact, that brings me onto another thing I love. This summer, I wore a summer dress to brunch with some friends in London. It was the first time in years that I didn't have to leave the table to inject for my meal because I chose to wear a dress for a meal out. (I could only inject my fast acting in my belly towards the end of MDI...which isn't the easiest to access in certain outfits!) It was such a special day for me...for once I didn't feel the need to plan my outfit around where I was going to eat and where I would need to inject. I felt free! I didn't need to leave the table. For once, I felt like the other girl's at the table....except for the fact I was discreetly bolusing for my meal. But even that can be done so quickly, (and on what looks just like a mobile phone to the untrained eye) that it rarely took up any of my time or attention. Quick, easy and discreet. I spent the whole afternoon with the girls, chatting, eating, and then after more chatting, more eating!
That actually brings me onto something very important that I believe is instrumental for a happy life.
Snacking. (Or eating, like, all afternoon.)
This is something I NEVER allowed myself to do before. No snacks. Ever. Unless they were carb free, like cucumber. Snore. On MDI, I just couldn't seem to avoid all the repercussions that an afternoon snack would bring.
With the insulin on board feature the pump brings, you can see exactly how much insulin you still have in action, so calculations can be made accordingly. Did I mention it does all the maths stuff automatically too?! No more awkward finger waggle as if to say "DON'T TALK TO ME" while I'm trying to add, subtract and what not at the table so I can bolus for my meal. Once you input all your settings and ratio's, the PDM has everything it needs built in to do all the calculations for you.
So basically, all the magic maths it does along with the insulin on board feature has now made it super easy (and without the mayhem that I used to have to deal with on MDI) to enjoy a piece of fruit whenever I want! (Okay fine, biscuit with my tea like what even is the difference anyway?) Being able to snack finally, is something I'd describe as AWESOME.
You know what else is awesome?
The ability to extend your bolus.
I actually have only used the feature once so far, but I can tell we are going to be the best of friends. If you are here as a type one diabetic then you'll know know this very well, but if you are here as the owner of a perfect pancreas then you should know something about pizza. For people like me, PIZZA IS THE DEVIL.
It's carb heavy, they take ages to kick in, and when they finally do there is no holding them back. It puts another meaning into the whole rollercoaster thing we like to complain about.
With the Omnipod, I can bolus a percentage up front, and have the rest essentially drip through over a certain number of hours, meaning it gives food the time to kick in, and then attacks the stubborn carb climb later. This is absolute perfection, and although it might take a while to figure out at first, the feature means I am well equipped for any future battles that I may have with pizza, that friday night chinese takeaway...basically the foods that can be a nuisance but taste way worth it.
Thank goodness for cool science tech.
Whoever realised we needed the extended bolus feature definitely had their priorities straight in life.
THE "MEH" THINGS
I've named this next section - the "meh" things, because I'm not ready to see negatives yet. These are simply some of the things I've noticed that don't necessarily get advertised in all the positive day to day pump posts. Because, believe it or not, diabetes is not a simple thing and there are always inconveniences. I don't think it would cause so much angst if it were simple...I think it's why me and Betty don't often get along. (Did I tell you I call my diabetes Betty? I'm not sure if she's ever been introduced. Betty meet reader. Reader meet Betty. Hi Hi.)
Anyway, with the pleasantries out the way I'll tell you about the few "annoyances" that I've found.
There is A LOT more to carry in terms of supplies and back ups. When I was on MDI, I only every carried my pens with me, perhaps with a back up cartridge. On the Omnipod, there are a few more things to lug around. It is recommended that you always carry a back up pod with you. Back up pods means you need to carry the insulin vial. Should you lose the vial or the PDM, you need a back up insulin pen for emergencies. This means you need the back up cartridge and needles. It's a lot, and when you add the hypo treats, it can take some getting used to...and it might definitely need a bigger bag. Up until now, (thanks Co-vid) I've not really strayed too far from home so I've only every needed to carry the extra pod...so I can't complain...yet.
Carrying spares are important because although not often, pump leaks and fails DO happen. It is not a myth.
It's not one of those things that "only happens to other people".
Saying this, in two months, I've only ever had one official pump leak. There was blood. Obvious insulin smell. I caught the leak early and changed the pod in no time at all. I've had two that were "dubious" but less because of a leak and more due to stubborn sugars. When in doubt, change the pod...before thing's get nasty!
You have to be a little more vigilant. With pens, you know exactly how much insulin you're injecting and you know you have your basal insulin on board because you take it daily in a shot (or two) and then it's done. It's almost certain that you'll never have zero insulin in your body. With the Omnipod, like all pumps, if there is a fail or a leak, a high blood sugar can rise very quickly. Your basal insulin won't be delivered properly, and DKA can set in within a number of hours. Knowing this higher risk, I find myself checking on my site and blood sugars a lot more than before.
I have, since starting, had one pump fail. There is no way you'd miss one of these. When a pod fails, you definitely cannot sleep through the alarm sound that goes off to alert you. It's a super high pitched scream.
The kind that will wake you from the deepest of sleeps at 7am, making you scramble for your PDM to deactivate it before you go bezerk with the noise.
It'll probably wake up the neighbours dog too.
Oh! Here's another thing. The adhesive from the pod's can make my skin itch sometimes. I think it is worth noting that, yes, I was THAT kind of kid when I was younger. Tights made me itch. Wooly jumpers would itch. Feather pillows made my nose itch. Fabric wash made my skin itch. So it is no surprise to me, that pods would inevitably start to itch too, albeit only usually towards the last day. It's pretty bearable, and alternating sites helps, so it's not so much of an issue right now. Plus, I don't think that first itch after a pod removal would be half as satisfying otherwise!
It's important to remember that it's only been two months since starting the Omnipod, and I think there is still a lot of groundwork me and Joey need to cover, before truly being settled with one another. Saying that, there are results that are plain to see already.
The ability to set my basal rates according to my hourly and daily needs has been a major game changer. I can set a different basal rate for the weekends, and in doing so, my weekends for the first time in years, have been much more stable in comparison. I have more control over my blood sugars and what's controlling them. I finally sleep the night's through!
More sleep = More energy = A happier me!
Its a butterfly effect that seems to have been triggered by switching to the pump. Except the pump is a way bigger butterfly.
After two months, I lowered my Hba1c from 6.5 to 6.3. It's not a huge change, but I'm not measuring the success by focusing on the number...instead I'm going by how I feel. I've managed to essentially keep my number stable, but with less mental strain, less angst, less corrections and less constant thoughts of diabetes.
It's felt easier, and that to me, is the true success.
But don't get me wrong. The pump has not been the sole saving grace in all of this. It's important to note that great control is achievable both on MDI, or on a pump...it's really an individual, personal choice. The pump just feels, like it is perfectly tailored to me for now. And I love it for that. But I'll share some insight with you all....the pump is not my hero. ME and pump Joey are a superhero DUO. It takes work from both ends....and it's not easy. Along with all the fancy settings that the Omnipod brings, I work hard every day to make sure I'm taking steps that help me gain the best control. (Joey doesn't get all the credit!)
I'll let you in on a few of my secrets (one's that work for me):
I pre-bolus EVERY time I eat. This used to be something rare for me...looking back I'm kicking myself because it's mostly very easy. Once you get into the habit, it becomes part of your daily routine. I bolus an average of about 15 minutes before eating. Pre-bolusing seems to be the KEY stable blood sugars.
I avoid snacking late in the evening. Those pesky carbs WILL catch up to you...and if you think about it...a night in range, is a lot of hours altogether. If you crack the night sugars, then the challenge is half defeated.
I correct highs as soon as I catch them. Not only do they feel horrible, but making sure I don't spend too long above my target range is important to me. Sometimes this means being extra vigilant, or a few extra corrections a day...but to me its worth it.
Last but not least, I rarely ever overcorrect a hypo. I know I know, it is the HARDEST THING EVER. When all you want to do is eat the entire contents of the fridge, it's hard to have the restraint. I avoid having any extra treats at home, and most of the time I'm good at sticking to 3 or 4 Jelly babies to correct a hypo. Sometimes, for those more drastic lows, the hunger crave can just take over. So when this happens, well...I let it happen. I eat whatever I can get my hands on. But, I do it all with a mental calculator so I know exactly how many of those "extra" carbs I'm inevitably inhaling. I bolus for these as soon as my blood sugars show signs of rising. Neat trick right? Sometimes when ya gotta raid the fridge, you need to just "do " first and "fix" later!
POD TIPS FOR YOUR EYES ONLY
Although I'm not quite a pod connoisseur yet, I have already got some tips under my belt. I'm sure I'm not saying that right...but you get what I mean.
One, avoid aggressively ripping pods off! I've learnt the hard way that this just makes the prolonged adhesive use worse on the skin. I use the Trio Elite Adhesive Remover spray and a couple of sprays that pod will be coming off like it wasn't glued on to begin with!
Two, if bolusing is painful or the site hurts, change it. My pods tend to be comfortable and never really bothers me, but the one pod that hurt, I ignored. A day later, it was leaking and bleeding all over the place. Take the signs. Listen. It's better to be safe than sorry!
Three, avoid oily moisturisers on or around the site, especially before changing a pod. We want those buggers to grip and stay where they have been applied.
Four, decorating them brings out the artist in you, that you never knew existed! There's something special that can be said for making the devices really feel like "you". I love to paint mine in seasonal colours and co-ordinate them with my outfits too! Making diabetes "pretty" makes it that bit less of a pain in the ass!
Five, protect those pesky insulin vials! They are SO FRAGILE. One slip of the hand and you have liquid gold all over the floor. I bought some vial protectors from vialsafe.com/shop and now I'm a lot less nervous when handling those glass bottles.
You've now reached the end of my massive ramble about the Omnipod!
I know it was long, but congrats on getting this far. Whether your thinking of making the step yourself to go from MDI to a pump, or if your simply just curious on how it all works...I hope there has been something insightful in all of these words of mine! If you have any questions, do not hesitate to ask...or follow me on my instagram page @t1diabetica for daily updates on life with Joey.