5000 Days with diabetes

Today marks a milestone for me.  It’s my 5000^th day with diabetes.  It’s nothing special in itself I suppose – I’m coming up on 14 years since my diagnosis, and many people have lived with this thing for a lot long than I have.  But 5000 days… that’s worth considering.

Generally, looking back on life, we often find it hard to believe how naïve we were about a lot of stuff – laughing at our younger selves for not knowing things that seem so obvious to us now.  My relationship with diabetes is no different.

I remember my diagnosis.  It was the start of my graduate year at university, and I’d been flicking through a magazine when I happened upon a side-bar that was talking about some symptoms of Type 1 diabetes.  Reading through it, I was mentally crossing them off… tired all the time, drinking a lot (of water!), needing the toilet all the time… This had been happening to me for over a week.  I could never drink enough water to quench that thirst, no amount of Mars bars would give me energy to stop feeling lethargic (...seriously).  I couldn’t see the notes on the board from the front row of lectures.

So I went to see the campus GP and told her I’d read a magazine and I thought I had diabetes.  To be fair, I’d have been sceptical in her position – I suspect it’s the equivalent of Dr Google these days.  But  I had a blood test and got a call the next day…

“You’ve got diabetes.  I need you to go to the diabetes centre at the hospital…”

“Er…” *looking at lecture schedule* “I could go Wednesday afternoon?”

“I need you to go NOW.  Right now!”

And that changed my life.  There’d been a kid in my class at primary school who had diabetes.  He was insanely resilient – you never really saw much indication of it at all – he just got on with doing what other 8 year olds do.  We all knew he had to have a needle (and this was the 80s so it was proper needles) but that was it.

Now I was sat in a room in a hospital with my parents who’d just bombed up it the motorway, with a nurse (Vicky Clancey) who was telling me I had to inject myself every day (along with a lot of other information).  I think I asked if I could just have a pill or something not utterly terrifying but to no avail.  I came home with a mountain of papers, booklets and more medical supplies than you can shake a stick at and I got on with it.

Over the next decade or so I had a complicated relationship with diabetes.  I worked hard some of the time, and saw the benefits of it on that half yearly report we’re all so familiar with now.  Other times I gave up entirely.  I took insulin when I was supposed to, but testing became a thing of the past – used only to justify eating when I was low (both blood sugar and emotionally).  And I spent time in between those extremes, giving my health the minimum attention it needed.

I think all that changed about four years ago.  The chance to take part in a clinical trial looking at insulin pumps and education courses (here’s link to an article discussing the results) was a huge turning point in my life with diabetes.  It finally allowed me to fill in the huge gaps in my knowledge, gave me the opportunity to meet people in the same boat as me and let me see that there was a world of other people that I could talk to.  I spoke at the Diabetes UK Professional Conference earlier this year about how DAFNE changed my life, and I don’t think I could ever possibly state how much that is true (you can read/watch more about my relationship with DAFNE on the Diabetes UK Taking Control site).

So I look back at myself now, after 5000 days of counting carbs, injections, finger­-prick tests (sometimes!), set changes and I can’t help but laugh.  I wrote on the very first post on this blog (which started as a London Marathon training blog) that “Whilst I’ve been diabetic for the last 10 years, I’ve…never let it define who I am”.  I don’t think that could be any further from the truth now – at least in some sense.

I used to be a terrified young adult who’d never really accepted this… thing… he’d been given.  Someone who was scared to ask for help, didn’t want to hear about complications because I was too young - that stuff will never happen to me right?  Someone who felt so low he gave up looking after himself for almost two years without a thought to the consequences.

Now, it’s different.  Diabetes is absolutely a huge part of my life – it has to be.  I feel part of a community that I can ask for help whenever I need to, and I’ve made some truly amazing friends as a result of this condition.  It’s still not always easy by any means, but it finally feels like that millstone around my neck has turned into something a lot more manageable and, dare I say it, more positive than I’d ever expected.

I don’t think you can live with a chronic illness without experiencing highs and lows (…sorry) but I think it’s about how we emerge from them that really matters.  We all carry battle scars as a result of diabetes (physically and mentally), but we’re still here, we’re still fighting and we’re still living, not just surviving.

How I felt back in October 2002 is completely alien compared with my outlook on diabetes today.  You go through a lot over 5000 days and how you use that life experience is so important.  I’ve gone from being a naïve 21 year old to a 35 year old who understands so much more than I thought possible (or at least I think I do...). 

I’ll be almost 50 by the time I reach 10,000 days with diabetes.  There’s going to be a lot more to learn, but I finally think I’m up to the challenge.

Taking education to the masses

I’d had my eye on the Education session on Day 1 with equal excitement and trepidation.  The education campaign is one I feel personally connected to.  I felt like the DAFNE course I did has made a huge difference to how I manage my own diabetes, and so hearing a number of professional views on the subject was something I was looking forward to.

Equally, I’d been asked to give a short view of my experiences of education to the assembled professionals, so I was a little nervous about how that was going to go.

If you’ve not had a look at the Diabetes UK Taking Control campaign yet, I’d urge you to start there.  The campaign launched towards the end of last year, and is aimed at making sure everyone is given the chance to learn about their diabetes.  I think we’re at a point now where the evidence for education is no longer in question, we’re now looking at how best to get that education out to as many people.

The session was split down into five talks:

•           Taking Control campaign – Bridget Turner
•           Making the case for diabetes education – Charles Gostling, Helen Hopkinson, Alison White
•           Getting people there – Vivien Coates, Anne Scott
•           Adding options to the education menu – Sarah Newall, Rebecca Owen, Kingshuk Pal
•           Addressing specific local barriers – Tahseen Chowdhury, Seonaid Morrison

Bridget set the scene, explaining why Diabetes UK are championing education and how using an adapted House of Care can be used as a model to deliver education to more people.

Bridget Turner (Director of Policy and Care Improvement at Diabetes UK),
discussing the adapted House of Care model for education

I gave my own (short) view on my personal experience of DAFNE, and why I think education is important.  I won’t dwell on my own personal views too much here, but I generally believe that education helps people become more active in their own healthcare and that in turn helps them achieve better outcomes.  I’ll save that for a separate post outside of the conference.

The stage was set for the other examples from the rest of the speakers.  Charles Gostling started off talking about how they deliver education to people in South London.  He made a great reference to the latest National Diabetes Audit (NDA) data, saying that without clear data, we don’t know where we do things well.  I think that’s a point that can’t be stressed enough.  Without getting side-tracked into a debate on NDA submissions, I think it’s really important to understand your starting position and data is the way you do that.

We know diabetes education referrals are generally low, the take up rates even lower.  Two key messages Charles got across were simple (but important ones).  Firstly, find out why people don’t take up the offer of education.  Secondly, share local success stories.  If someone is doing something well, make sure it’s publicised across your local area so others can learn from it.

Helen Hopkinson then moved onto how the education offering was redesigned, talking through the journey they went on to get to DAFNE (‘because it’s evidence based and we know it works’).  She made a great point that redesigning your education offering can be cost free but when looking at how to do that, you need to engage all your stakeholders.

Why choose DAFNE?

That second aspect sounds so fundamental, that it almost beggars belief that you’d have to say it at all.  It’s a pretty short-sighted approach to try and design something one group of people, that’s paid for by another, provided by a third and ‘marketed’ by a fourth without including them all in the process.  You wouldn’t expect it for iPhones, so why should diabetes education be any different?  It was eye opening in its simplicity.

“Getting People There” looked at reasons why people with diabetes choose not to attend courses (“I learned from other sources”, “more important things to do”, “don’t see the point”).  Some of these struck a chord with me.  I started out with the view that I didn’t need education, but now I’m a big advocate for it.  I think we need to do more to sell the benefits of people who could be persuaded to go if they knew what they’d get from it.  Others need a different model of support – as with everything related to diabetes, one size doesn’t fit all.

As we moved to the discussion on “Adding options to the education menu”, we saw some interesting and innovative ways Lambeth were engaging with different groups within their area.  As with the other parts of the session, there’s some blindingly obvious bits in there too.  If you’ve got an education offering, tell people about it.  Spread the word as much as you can, use community centres, library groups, church meetings – anyone you can – to widen the circle of people who know you have something for them.

One of the most interesting things that came up was the concept of taster sessions.  These are short (90 mins) sessions that act as an introduction to the larger scale education courses on offer.  They’re typically targeted at groups or populations that are historically harder to reach (the example they gave was the Sri Lankan community in Lambeth), or those where Did Not Attend (DNA) rates are higher.   With all the taster sessions, people were ‘followed’ to see how many attended a full course later.  That stood at about 10% for the first year, but it’s hoped to be higher for 2016.

The last bit I’d like to talk about was HeLP Diabetes – an online learning option for people with Type 2 diabetes.  I think it’s important to cover as a lot of people want more online support and if we return to this ground breaking idea of providing what people want, this ticks the boxes.

Around 50% of visitors to the HeLP Diabetes site come outside ‘regular’ working hours, when it’d obviously harder to provide traditional education like DESMOND.  Interestingly, despite some of the upsides to the online delivery (24/7 access, anonymity etc), it still faced some of the more traditional barriers, such as spreading the word about its availability.

I’m a huge advocate of education because I’ve got a deeply personal experience about how it transformed my ability to be in control of my diabetes.  I think the case for things like DAFNE is huge (given its evidence base), and I think that by selling the benefits of the education, we can convince those who have the time, but no inclination, to attend a course and hopefully go on a similar journey to the one I went one.

That said, it’s naïve to think there’s only one way to persist, and if we want to give the benefits of education to as many people as possible, we need to consider how best we offer that education to meet the needs of the many.  “Education is about interaction with others, whether that’s other people with diabetes, healthcare professionals, of your friends and family” – I think many of us who’ve been on a course, or have used social media to help us with our diabetes would agree with that.

The last word should go to Seonaid Morrison from Argyll & Bute on the West Coast of Scotland.  She gave an incredible talk (without slides after a technical problem), on how she crosses a huge geographical area to try and bring education to as many people as possible…

“When you provide education to people, you see the change in them. That's what gets me up and out of bed in a morning”.

Libre Intentions

This will be quick - I've got to get a munchkin ready for a party in 30 minutes...

My first Freestyle Libre arrived in the post on Friday.  It's currently sat in its partially opened boxes on my sofa.  I'll probably take the plunge this evening - but right now, I'm filled with a sense of apprehension.

Not just because of the intimidating packaging (and thanks to those of you who've reassured me), but more because I'm not sure why I've got one.

There's no doubt it's popular among the online community - I've seen plenty of tweets and blogs about the virtues of it's quasi-CGM ability, and I've met a few people in real life who are incredibly complimentary about it too.

But I know my control is actually pretty good overall.  And I know I have the moderately addictive personality that could mean I can't just use two sensors and revert to conventional testing.  I've held off for so long because I want to make sure I'm going to use if for the right reasons for me.

Regardless of all the basal testing I've done, I know that at some point between 10 and 11am, my BG takes a dip.  Not always a huge one, but something strange happens around then and I'm hoping I can start to visualise what that is.

I also do a lot of exercise, and whilst I've worked hard to be able to manage my diabetes and run as much as I do, I've got a genuine curiosity about what happens to my BG whilst I exercise.  Again, the Libre should help me out there.

Lastly, I'll have some evenings where I eat late, and things don't behave in the way the usually do.  Last night was a prime example, where, despite meticulous carb counting and appropriate insulin delivery, I woke up around 16.5.  Not much cop is it?  Hopefully I can understand how that happens, so I can learn what to do about it in the future.

What I don't want to do is become someone who chases flat lines on a graph with temporary basal rates and huge doses of insulin.  I know from DAFNE that a more patient and informed approach is more likely to give better results and understanding in the longer term.

As you may know, I got to listen in on a few sessions at the Association of Children's Diabetes Clinicians conference on Friday, and two talks there really captured my attention.

Firstly, Dr Peter Adolfsson talk about how, in his native Sweden, patients (particularly paediatric patients) are introduced to continuous glucose monitoring before they start pump therapy.  Indeed it turns out, not all patients want or need pump therapy once they've understood how the glucose reacts to different situations.  This gave me hope I was making the right decision with a Libre.

The second talk was from Prof. Kath Barnard, who spoke brilliantly (and candidly) about the lack of psychosocial support for people using diabetes technology like CGM, and how many that self fund, do so and ignore a lot of the information they receive (e.g. cancelling/ignoring alarms from devices).  This made me feel more cautious with the Libre.

Am I getting myself into something I fully understand that will give me the information I want, without changing my existing attitude and approach to managing diabetes?  In short, I don't know.  But there's probably only one way to find out...

Diabetes Week

This blog was first posted on the Diabetes UK blog site as part of Diabetes Week

It's already well documented that living with diabetes can be a frustrating and challenging experience.  I remember thinking when I was diagnosed with Type 1 in 2001 that it was so fundamentally life changing that I wasn't sure I'd ever be able to cope with it.

One of my first thoughts was of a boy who went to my primary school who had diabetes as that was probably my only exposure to someone who lived with the condition.  I remembered that had carried a vial of insulin and a large hypodermic needle around with him all the time.  That memory convinced me I was doomed, that I'd never be able to manage.

Being here 12 years later to write this blog isn't a tribute to my own incredible ability to overcome the impossible, but a real testament to the power of research into treating diabetes and improving the lives of millions of people.

Recently I became involved in a clinical trial called REPOSE (or The Relative Effectiveness of Pumps over MDI and Structured Education for Type-1 diabetes).  The aim of the study is to determine whether an insulin pump provides additional benefit to people with Type 1 diabetes versus Multiple Daily Injections.   All participants, regardless of the treatment type they are assigned, also complete a DAFNE course to ensure that structured education is provided.

Whilst a recent report showed that the UK is lagging behind the rest of Europe and the US in terms of insulin pump usage in treating Type 1 diabetes, there have been no trials in adults that compare how well patient fare between MDI and pump therapy when combined with structured education.  It's important that research like this is carried out to be able to

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.

Exercise

This blog first appeared on the Diabetes UK blog site on March 26th 2013

Like many people, I have a love/hate relationship with exercise.  And like many people, I suspect I'm not the only one who finds the hardest part of it is actually getting up off the sofa in the first place.

My particular weapon of choice when it comes to exercising is running.  I remember thinking when I got diagnosed that it was the end of my dream of running the London marathon.  I couldn't see how I could manage something as complex as diabetes whilst doing something as gruelling as a marathon.

Thankfully my specialist care team at the time helped me see that diabetes doesn't have to be a barrier to things if you don't let it.  Whilst I'm sure he might already be one of the most famous diabetics, Sir Steve Redgrave is someone that probably personifies that attitude more than anyone else.

Training for a marathon is a pretty tough business as you can imagine and adapting that regime to take into account diabetes makes it that little bit more complex.  I started by working out a plan for how often I could expect to run.  I suffer from a few other, less glamourous, conditions (mild asthama and shin splints) that hampered me a bit but it gave me a place to start.

After that, I was back speaking to my specialist care team and trying to understand what effect my training plan would have on me.  This was back before I'd been on a DAFNE course so a lot of the information felt brand new (despite how long I'd been diabetic).

The upshot of it all involved running with one pocket full of jelly babies and the other with my blood glucose tester packed in a little plastic zip-lock bag so I could monitor how I was responding to the exertion.  Happily I found I could do about 10 miles before I needed an energy boost and that 4 jelly babies would get me about 4 miles.  That made running on the day a lot simpler!

I learned a few important lessons from that training which I think can apply to any kind of exercise you're thinking about:

• Always have fast acting carbs with you.  I learned that one pretty quickly after having to abandon a run when I went unexpectedly low
• Speak to your care team before you try something new, be it a marathon or any kind of physical activity. The hour I spent with a dietician made a world of difference
• Monitor your BG.  I found that even having pretty good control before I started training, my routine mean things changed (e.g. my sensitivity to insulin at certain times) and monitoring is the only way to understand that
• Don't be afraid to adjust your doses.  While I was on my two insulin regime, I'd never appreciated I could adjust my basal insulin (nor did I know by how much).  If you're doing lengthy exercise, this could help
• Do some research - websites like Runsweet are packed with information and tips for all kinds of exercise
• Make the most of the opportunity.  I was incredibly well supported and raised £1500 when I ran the London marathon.  If you're taking on any kind of challenge, then encouraging people to sponsor you can provide extra motivation for you whilst raising money for good causes.

I think the most important tip is to find something that works for you.  I know that running isn't for everyone but I genuinely believe that  20 minutes of something a couple of times a week not only makes you feel better but can have a significant impact on your quality of life as a diabetic.  I finished the year on an exercise bike in front of the TV as I couldn't run comfortably and that was just as good as dong miles on the pavements.

I'm happy to report that I completed the marathon last April in a respectable, if not earth shattering 5 hours 30 minutes (about 30 mins slower than I would have liked).  My plans for this year are a little more modest, but do include some unfinished business with the Sheffield Half Marathon in May (an injury training for that race in 2008 set me back a lot) as well as four 10km races.

As always, I'm raising money for DiabetesUK and The Children's Hospital Charity in Sheffield (specifically to raise funds for a summer camp for children with diabetes).  I'm aiming to raise £500 this year and if you'd like to contribute, you can do so by visiting my fundraising page (note all money is split 50/50 between the two charities)

DAFNE

This blog first appeared on the Diabetes UK blog site on 6th February 2013



As part of the REPOSE trial I talked about last month, I recently attended a DAFNE course.  I'll be honest and say that a couple of weeks beforehand I was still pretty skeptical about attending.  Not so much because I didn't think I'd get any benefit from it, but more that I'd never been given any information about what DAFNE was beyond "it'll help with your carb counting" and couldn't understand how it was a five day course.

That said, after I'd had the pump on for a few days, I was really eager to get started and by the time the course started I honestly couldn't wait.   I didn't feel too apprehensive at the start, as I'd already met half the people on the course when we'd had our pump induction, and I knew that everyone there was in the same position as I was.

I thought the DAFNE course (Dose Adjusted For Normal Eating) itself was very well structured.  We followed a daily timetable with 4-5 sessions per day, building on regular daily topics such as insulin dose adjustment and carb counting/nutrition as well as discussing other topics such as alcohol and exercise.

For the afternoon session on the second day, we were invited to bring along a family member to give them the opportunity to see what the course entails, and to speak openly about their experiences of living with someone with diabetes.  I think that helped a lot as it allowed us to reflect on what those we love have to deal with, which I would guess is a point of view we don't often stop to consider.  I think that afternoon worked really well and having everyone participate in the exercises was great.

What I found surprising (and a tad embarrassing) was the amount of the history/biology about diabetes that I either didn't know or that I'd forgotten.  While I suppose it's all a matter of personal preference, I enjoyed the sessions that touched on that information as I felt like it provided a great base for all the other topics we were discussing.

There were, of course, some more difficult sessions, and the one we spent discussing the long term complications of diabetes could have been uncomfortable to talk about.   We spent the time in two teams, playing a game of which complications could be specifically diabetes related, how they were caused and what could be done to prevent them.  It lightened the mood and allowed us to learn at the same time.

I think as a group we all agreed that being in a safe, open and honest environment with people all in the same situation was one of the best things about the week.  As I may have mentioned previously, I've not actually met anyone with Type 1 diabetes before and so to be able to share experiences, tips and frustrations with a group was such a positive thing.  I was also relieved to find out I'm not the only one who sometimes forgets to change needles and lancets as often as I should!


As part of the course (and over the next two years as part of the trial) we are all recording our BG readings, carbohydrate portions and insulin doses on a daily basis.  We began and ended each day with a review of the numbers.  I think that really helped to build a great spirit in the group and allowed us to share advice with each other.  It was pretty nerve wracking presenting your numbers back to the group for the first time, but by Friday, it was an experience we'd all got into and were going to miss quite a lot.

Being in that environment gave everyone a lot of confidence to speak up and discuss their own situations without feeling judged or under pressure.  That similar feeling when sharing BG levels (some not always the numbers you'd hope for) was valuable in discussing our progress.

It would be remiss of me to talk about the course, the environment and the structure that allowed us all to benefit so much from the week without a mention for our DAFNE Educators.  We were lucky to have three Educators supporting our course all week, two diabetes specialist nurses and a dietician.  Their enthusiasm and encouragement kept us going for the week and I personally think they did so much to help foster the environment that allowed the course to work so well.  Thank you Carolin, Val and Val.

After a full week using the pump with insulin I'm starting to get accustomed to it and DAFNE has put me in an excellent position to feel confident using it and adjusting my doses where necessary.  On a personal level, one of the hardest things I've had to do is learn to curb my desire to try and fix everything at once and adopt a more patient and measured approach to fine tuning my regime.  I'm not quite there yet, but having the confidence and knowledge to be able to make changes should hopefully mean I'll have all my BG levels within target very soon.

As a final word, I'd encourage anyone to follow this link to the DAFNE User Action Group’s e-petition and sign it to lobby for a centrally funded diabetes education programme.  Studies have shown that not only does education help diabetics manage their condition with better glycaemic control and fewer hypos, but that the education will effectively pay for itself within five years.  Please take the time to follow the link and encourage as many others as you can to do the same.

Whilst I may have been skeptical before I started, I'd nopw say I'm a huge DAFNE advocate!  I'd be keen to hear on your own experiences of diabetes education courses, DAFNE or others.

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.