Friday, 18 January 2013

The insulin pump

This blog first appeared on the Diabetes UK website on 18th January 2013

As I mentioned in one of my previous blogs, I'm taking part in a clinical trial.  It's called the REPOSE (Relative Effectiveness of Pumps over MDI and Structured Education) trial and is basically design to determine whether or not insulin pump therapy is more effective at treating adults with T1 diabetes.  The trial splits particpants into two groups, half are randomised to receive an insulin pump and half continue with their daily injection regime.  Everyone then attends a DAFNE course.  You can read more about the trial on the National Institute for Health Research website.

I've been randomised to the pump half of the group and yesterday I spent the afternoon learning how to load operate, fill and attach the pump.  It's currently filled with saline so it gives us chance to get used to wearing the device and having the cannula attached without actually using it to medicate.  It's a Medtronic Paradigm Veo pump which you can find out more about on the Medtronic website

My DAFNE course starts at the end of January and I'll switch over to insulin the night before it starts.  We'll then go through the DAFNE course getting support for the first week before we're left to fly solo.

I wrote in my own blog  before I'd had my hospital visit about how I felt about making the change.  I'm going to discuss my first impressions of having the pump and the "induction" process here.

Firstly there's a LOT to take in.  To get the pump operational, you need to fill a new reservoir, tell the pump to rewind itself (similar to retracting the plunger on a pen), attach the infusion set (i.e. tubing) to the pump and insert the cannula into your stomach.  Of course it's one of those things that will become second nature pretty quickly, but I imagine the first time I try it by myself will take a while.

Secondly, as I alluded to above, there's a lot of stuff needed to make all this work.  The picture below shows you the contents of the goody bag I brough home from the hospital

As you can see, there's a lot more consumables required for a pump than for a pen!

Inserting the cannula was a bit daunting.  As I think I mentioned before, I'm not actually very good with needles and I had a slight flash of wooziness as I was doing it but thankfully that passed.  It's never good to be the one who passes out during the induction!!  I remember having the same feeling the first time I used an insulin pen and now I don't think twice about that.  I think removing the cannula for the first time is probably my last real challenge but as they stay in for 2-3 days at a time, I've not got that far yet!

I don't really notice the pump during the day which surprised me.  I thought I'd be a lot more conscious of the device (currently clipped onto my belt) and the cannula than I actually am.  There's a bout 2 feet of tubing which can be a bit tricky to conceal but it's nothing major.  It was a bit of a broken night's sleep last night but that was to be expected.  I'm going to try running with it tonight and I'm ordering a pouch I can wear to keep it a bit more concealed so I'm less likely to knock it.

Whilst the overall induction process took a lot out of me, I woke up feeling positive about the change.  I've definitely got a steep learning curve ahead of me, but I see it as something to embrace rather than be afraid of.  I'll write a follow up after DAFNE when I've been using the pump to actually control my diabetes and I'll be able to give an appraisal on how well the first week or so has gone.

Tuesday, 15 January 2013

Standing on the edge

"Come to the edge, he said. They said: We are afraid. Come to the edge, he said. They came. He pushed them and they flew." - Guillaume Apollinaire (1880-1918)

Today is a strange day for me.  It's the last full 24 hours that I'll be medicating my diabetes with multiple daily injections (MDI) for the foreseeable future.  Tomorrow afternoon I'll be switching to an insulin pump as part of a two year clinical study aimed at determining what is more effective at treating people with Type 1 diabetes.

I won't go into too much of the detail about the study here.  I'll be writing a blog for Diabetes UK about that later this week (and I'll post it here as well) so if you're curious, you can read that (or drop me a line on Twitter @Broomowl).

This blog is more focused on that greatest of intangible things - feelings.

I genuinely don't know how I feel about it to be honest.  Overall I'm pretty positive about it I think.  As I understand it, the pump will allow me greater control over my condition and allow me to alter my medication much more proactively around things like diet and exercise.  There's also some altruistic benefit I guess as it will help determine whether or not an insulin pump is truly beneficial for people with diabetes.  This should mean that, in the future, people being newly diagnosed with the condition will receive the best treatment possible.

If you've read a few of my blogs before, you're probably familiar with the concern I have that at some point, my daughter will also develop diabetes.  I think the odds are roughly around 1 in 7 so I suppose I'm partly doing this for her as well as me.

The other side of the coin is the fear and the doubt that accompany any lifestyle change.  For the most part, I control my condition pretty well.  I don't struggle to understand what to do or how to comprehend the science behind it all.  I struggle with self discipline.  I'll have some chocolate because I'm feeling a bit down, or I'll forget/not bother to test my blood as often as I should.  It's lazy and there's no excuse for it - I'm my own worst enemy.

But when all that's said and done, with the correct discipline, I can manage my condition pretty perfectly, which is something to be proud of.  But it's taken me a number of years to get to that level and from tomorrow I'll have to start from scratch.

Thinking about it rationally, the principles aren't going to change overnight and the science will remain the same.  I'll just have to learn a new way to practice it.  I don't think it can be quite as terrifying as it was nearly 12 years ago.  I'm also going to be part of a group of people all in the same boat, so I know I'm not alone.

My only other concern is how it will affect the day to day stuff I take for granted at the moment.  I haven't figured out how I'm going to sleep with the pump attached to me yet (though I suspect "not very well" would be a good answer for the first few nights).  I also don't want it to stop me playing games with my daughter because that's obviously a hugely important part of my life.

I think that overall this will be a good change for me once the learning period is over.  There's a chance I might take to this blog a little more frequently to 'think out loud' about it but as a mechanism for ordering my thoughts a little, the blog really helps.  I'm also lucky that I've got a group of close friends that I know I can rely on to help me when I need it.

Thanks for taking the time to read this.


Tuesday, 1 January 2013

2013 - Resolutions and more

Happy New Year!  I hope you're all recovering from whatever you got up to last night.

The first few days in January are usually a time for people to think about what wholesale changes they'd like to make, and then persevere with them as much as possible.  I wrote last year about how I'd been in a similar boat myself a number of times and all my good intentions had fallen by the wayside by late January.

There's traditionally talk of making major lifestyle changes which is usually difficult to achieve.  Not through lack of desire per se, but through the difficulty in overhauling your day to day life and sustaining those changes.  I'm as skeptical as the next man when people say that's what they're going to do, but this year, that's exactly what I'll be attempting.

At the end of this month, I'll be starting a two year clinical study to see if insulin pumps help people manage diabetes better than multiple daily injections (MDI).  This will effectively mean a brand new type of medication, a brand new way of looking after myself and a lot of other changes that affect my day-to-day life.

I wrote in the the very first post on this blog how I do my best not to let being diabetic define my entire life, it's merely a part of who I am as a person.  Whilst that remains the case, a complete change in a medical regime I've been used to for over 10 years will take some getting used to I suspect.

With that at the back of my mind, I've only made 7 resolutions this year but I'm hoping to keep them all (as opposed to the 8/10 from 2012)

1.  Run the Sheffield Half Marathon and the Great Yorkshire Run

As regular readers will know, the Sheffield Half is my nemesis and I'm determined to conquer it this year.  The Great Yorkshire Run eluded me last year as I'd pushed myself a little too much and wasn't able to compete when the day came.

2.  Raise £500 for charity

After raising £1,500 last year, I'm taking an admittedly more modest approach this year (but then again I'm not running the London Marathon this year either).  I'd like to be able to do more for charities that are important to me, but at the moment, I'm not sure how to do that other than run around and ask people to sponsor me for it.  Hopefully I'll meet my target this year

3.  See 12 gigs

This is the same as last year - I just like to be able to have a night out once a month so I'm hoping there'll be some great live shows to see this year

4.  Read 11 books

Slightly more ambitious than last year's 10 - I ought to read more and having got some excellent books for Christmas, I'm confident I'll make this one.

5.  Do a photo-a-day project

This is something I've wanted to do for a long time and I've never motivated myself to do it.  I enjoy taking pictures and I'm probably quite reasonable at it.  I'd like to become a lot more accomplished over the next 12 months and I think this will be a good way to do that.  I'll be posting the results on a separate blog if you want to keep track of them

6.  Keep my weight below 190lbs all year

There's a technicality that means I've got to get my weight back under 190 first (having lost 32lbs last year, a few have crept back on over Christmas).  This one in itself is fairly ambitious as I've never maintained a weigh I'm happy with for more than about 6 months.  I think the fact that I'll be in the clinical trial will help motivate me here.

7.  Run 450 miles

That doesn't sound like too much - less than 10 miles a week shouldn't be that hard when you think about it.  But I'm conscious I could end up injured again and I want a target that is attainable without having to put my body on the line in order to meet it.   I'll be trying for 2/3 runs a week and supplementing that with sessions on the exercise bike at home.

So there you have it.  That's my goals for the year in a few short paragraphs.  It may not sound like too much (and I feel a little like I've copped out), but I think I have to be mindful of what else will be happening this year.

Once again, I hope you all have a wonderful 2013 and that you manage to keep any resolutions you've made.