Revisiting REPOSE

This blog first appeared on the Diabetes UK blog site on 30th April 2013

It's been nearly three months since I started using my insulin pump as part of the REPOSE trial I'm taking part in, and I thought it was about time I did a bit of an update on how things are going.

I think the first thing to say is that whilst it's only been three months, it feels like a lifetime - and in a good way too.  You might recall that I was somewhat apprehensive about making the switch to a pump, a natural reaction to changing the way I've looked after myself for the last 10 years.  I'm happy to say that, at the moment, those fears were misplaced.

That's not to say that the transition was an overnight success, or that I've not had a few wobbles, but overall I feel like I've had a real, noticeable improvement in how I've felt which can't be a bad thing.

It's hard to say what exactly the cause of that is.  It would be easy to attribute it to the pump because that's the most obvious change, but there are a lot of other smaller changes I've made since I've been on the study which have probably had an effect.

Obviously I've attended a DAFNE course which, as I mentioned in a previous blog was an incredible experience and allowed me the time and opportunity to learn about some of the key things I'd either never been told, or had long since forgotten.  It was also really good to meet other people with type 1 and share some experiences.

I've also been recording my blood glucose levels, carbohydrate portions and insulin doses in a daily diary - something I've not done since I was diagnosed nearly 12 years ago.  I think that must be having some kind of effect as it lets me see the patterns over a few days rather than relying on memory which I've always done in the past.   A knock-on effect of that is that I'm testing my blood glucose more frequently than I ever have - from the dark days of a couple times a week a few years ago to at least five times a day now.  I take my testing kit with me everywhere now and that's certainly something I've never done before.

Having the pump gives me the ability to control my basal insulin more effectively and working through that process has been a real eye opener.  I wasn't previously aware of the "dawn phenomenon" (where your blood sugar can rise as you wake up) and going through periods of carb-free eating to understand what my basal levels should be showed me just how differently my body reacts to insulin at different times of the day.  Discovering I need to double my basal doses throughout most of the morning, just to stay level was a bit of a shock!

Whilst I do feel very comfortable with the pump (sometimes I genuinely forget I'm wearing it and panic that I've left the house without my insulin), I think it's worth looking at a couple of the 'negative' aspects of it as well.

Being wired up to something 24/7 is a constant reminder that you have type 1 diabetes (I joked recently that I'm effectively battery operated these days).  Whilst it's not something that particularly bothers me most of the time, it does make it a little harder to forget on the occasions that you'd like to.

On a daily injection regimen, there was always a small chance that you might inject somewhere that might mean the insulin didn't work as effectively as it should, but it was unlikely that would happen for every injection in a given day.  With the pump, as you place the cannula for three days a time, if you hit an ineffective injection site, all your insulin goes through there for a few days (unless of course, you notice, and change the cannula).  You also run the risk of the cannula not being inserted properly but that's possibly a story for another time.

The overall aim of the REPOSE study is to determine whether insulin pump therapy is more effective at treating people with type 1 diabetes.  Whilst I think it's a quite early to make any definitive statement, I know that so far I feel like it's had a positive effect on me so far and hopefully that will continue into the future.