I started using an insulin pump this week. This doesn’t exactly make me an early adopter, but multiple daily injections have worked fine for me for many years. What prompted this change was the prospect of looping: linking the input (insulin) and the output (glucose levels) with a computer, to which you outsource some of the thinking and management.
I’m not yet looping yet, as I’m awaiting the parts for a more mainstream glucose monitoring system, and the hardware to link that with my pump. Meanwhile, here are thoughts on using the Omnipod system.
A brief primer: Omnipod involves two main components
- A ‘pod’, which sits on the skin feeding insulin into your body via a cannula, and lasts for 3 days;
- A ‘PDM’ (personal diabetes manager), which is like a smartphone but a shit one that only talks to your pump, and has the usual poor quality interface that you can expect from a medical device.
- Injecting insulin isn’t difficult, but it is easier to press a few buttons on the PDM to get a dose, especially in the context of a busy family life that often involves two small children climbing on me :P I used to take shots of insulin on the doorstep before going in at the end of a work day, as that’s easier than trying to inject once inside.
- It is very cool that I can reduce my basal insulin level (the background dose, if you will) if my sugars are dropping.
- Insulin delivery is much more efficient, partly as the sites are slightly different and have less scarring, and partly as the delivery is slower so the insulin has time to disperse better. I legit need less insulin.
- You can do an ‘extended bolus’ where delivery is extra slow. This is awesome when indulging, for example, in a curry (which usually leads to spiked sugars after 4-5 hours).
- Changing the pod is easy. (But why don’t they slip an alcohol wipe in with replacement pods?)
- I don’t have to replenish all my supplies (needles etc.) every evening.
All the stuff
As someone with type 1 diabetes, I am always vexed by just how much stuff I have to wear/carry with me to be safe. I’m wearing 3 different things at the moment: current pod, my Freestyle Libre (a wearable device that relays glucose levels via Bluetooth) and the Blucon (hardware linking the Libre with my phone).
With the introduction of an insulin pump, I assumed I’d have less to carry with me: add one PDM, subtract a bunch of stuff, right? Wrong.
Besides the wearables listed above, I need to carry (and not lose)
- Sugar tablets
- Phone (I monitor blood sugar levels with this, via a Blucon device on top of a Freestyle Libre).
- Backup glucose monitoring supplies in case the phone/Blucon/Libre fail: test strips, lancets, pricker device
- Backup insulin delivery supplies: insulin, insulin pen, needles
- Spare pod
Just before writing this post, I collected most of the above and put them in a bag, as I keep losing track of items. Look:
Omnipod introduces a lot of intrusive beeps and bloops, with no way to disable these (even though it has a vibration mode). I literally disabled insulin delivery (after a large bolus) during an important meeting this week to avoid low reservoir alarms. I googled this and got so many results from other folks in similar situations, for example:
I was never the type of person who could remember to change my pod at the same time every 3 days, and it isn’t always possible if you have a pod failure/bad site that needs to be changed in the middle of a day, so I constantly had to put up with that pod change beeping and hated it.
I try to swim regularly. Before my first swim wearing the pod, my concerns were
- Will it come off?
- What do I do with my basal rate of insulin?
It did not come off! As to insulin rates, trial and error panned out. For the first swim I reduced the basal insulin to 40% of normal, but in future I’ll reduce it further.
The pump records ‘Insulin On Board’ (how much insulin is currently active), which I guess replaces my keeping track of “how long since I last injected?” I don’t think it simplifies my “what action do I take in the middle of the night?” questions, but it is different data.
I’m still getting a feel for how much insulin to put into a pod before applying it; you can’t replenish it once it’s on, so it’s good to get this right.
I’m still confused about the economics, in part because I am not a native to the Canadian health ecosystem (e.g. despite my many prescriptions, I hadn’t realised PharmaCare exists until recently). I don’t miss a great deal of things about the UK, but the NHS is up there for sure.