So many shots, three different types of insulin. Mixing, measuring,
after so many years I began to feel like I was working in Dr. Evil's lab. Then things changed.
Flo had many hypoglycemic--low sugar--episodes in the first grade.
She was fairly unaware of the condition until it was too late for her to correct it herself. She simply keeled over in the
classroom. Her classmates had previously been educated by me about how to correct the situation and they did an excellent
job of it.The teacher was accommodating but too freaked out to provide much assistance herself. Children are very courageous
and the six-year-old classmates very matter of factly fixed the problem. But it was happening too much.
Flo's physician suggested that an insulin pump might be a better choice
for Flo because it only uses one type of insulin.With it I wouldn't have to worry about when the medicine I
gave six hours ago is going to have its peak and whether or not Flo is going to feel like eating when it does. The major cause
of hypoglycemia is too much insulin in the body and not enough food. Flo is at best a picky eater and I've learned that children
cannot be force fed.
The doctor recommended an Animas insulin pump because it delivered
as small a dose as 1/10th of a unit. We began our pump education with the diabetes educator in the doctor's office.
We learned that all carbohydrates would have to be accounted for and
insulin would be matched to the amount of carbohydrates. This is called a bolus ratio. For Flo, every 15 carbohydrates eaten
would require a 1 unit insulin bolus.
A basal rate was also prescribed. This is the amount of insulin the
body requires when not eating. This amount pumps for 24 hours at three minute intervals. Her prescribed basal rate was .30
units per hour, just a little under a third of a unit. The insurance company approved the change and the pump was ordered.
A short time later the pump arrived with a big sign in the box that
said do not attach pump without a doctor's supervision! An appointment was scheduled with an Animas trainer to instruct
us how to use this new device.
Basically, the insulin pump is a small computer about the size of a
deck of cards. It is menu driven and many different basal rates can be programmed into it. Often one's basal needs fluctuate
during the course of a day. At this time both Bart and Flo are prepubescent and require more basal insulin in the hours just
before dawn. The pump does a thousand self checks a minute for the purposes of safety to ensure that all is working properly.
We had to set insulin limits in the pump so that Flo would not give herself an accidental overdose. If the pump senses a problem
it simply stops delivery altogether and sounds an alarm. This is also a safety issue that prevents a malfunction from giving
an accidental overdose.
It runs off four tiny 357 batteries which last about six weeks.
The insulin is delivered through a port in the skin similar to that
of an IV port. The pump catheter simply attaches to the port. For swimming, bathing, and contact sports the pump may be disconnected
for the duration and the port sealed until it is time to reconnect. The port must be changed to a different site on the body
every three days. The body's defense mechanisms will try to "reject" the inserted catheter after this amount of time
and the insulin will not be absorbed properly. Popular sites for placement are on the stomach, upper thighs, or hips.
The Animas Corporation claims that its pump is waterproof. I suppose
I won't worry if some water is inadvertently spilled on it. However, I am not going to send my kids into a swimming pool or
bathtub wearing the pump. I believe that is asking for trouble.
Some people might not like the idea of being "attached" to something
all the time. Flo has done very well with the pump and this idea has not bothered her or prevented her from living her life
like any other child her age. The episodes of hypoglycemia still occur occasionally but not nearly as often as before.
Bart was doing pretty well on the three types of insulin shot regimen. He had fewer hypoglycemia
episodes and was pretty well controlled. The difference is, he could always be counted on to eat when necessary, even on command.
At first he really didn't want a pump but after spending two weeks last summer(2003) at the Tennessee Camp for Diabetic Children
he came home and announced that he too wanted a pump. There were 90 campers there and 48 of them had pumps. We began the process
again for him and now have two Animas insulin pumps.
Both children now have A1cs(three month blood sugar
average) in the mid 6 range. 6 is considered normal.
