Pump it up

A new chapter began this morning in the book of Curesam. Chapter 2 will be called Pumps.

Our diabetic nurse Anne Ince came to visit us to go over Samuel’s options if he wants to go down the pump route. I thought it would be a good idea to document this part of our diabetes journey, so if you or your child is thinking of travelling along the same route, you can share our experiences. And if you have already got a pump and are ahead of us on the curve, please fell free to comment and share your experiences too.

By way of background, since Samuel’s diagnosis on July 7th, we have been using the basil-bolus method of management and have achieved good control over his BM’s. I understand both are a prerequisite for getting a pump in the UK. Our consultant said that with both these in place, current NICE guidelines suggest that any child in the UK should be given a pump, should they want one. However, the final decision always rests with the Primary Healthcare Trust (PCT). As our consultant is a fan of pumps in general, she was happy to put us forward for one, which she did when we saw her on 8th September. We got the phonecall from Anne just over a fortnight later to say that we had been approved for a pump. Wow!

I had read on the internet that many people had struggled to get a pump, and had to fight tooth and nail. I imagine that people’s experiences must vary a lot from consultant to consultant and from PCT to PCT. So far however, ours has been first class. From diagnosis to this weeks first look at pumps is less than three months.

We had a choice of three different pumps from Roche, Medtronics & Animas.

All are pretty similar in size. The Roche Accu-check Spirit comes with a remote that has a built in meter. The Meditronics has a remote but requires a separate meter (so three items in total!!) and the Animas doesn’t have a remote, but does have a cool colour screen.

We assessed all three in the main for the slightly different ways in which they approach inserting the cannula. For Samuel, this is the most traumatic part of it. He seems very comfortable with the thought of wearing one all the time. But has struggled until quite recently with needle anxiety (although it’s getting better) and so was focused on how the cannula was inserted and removed. He is also a keen swimmer, doing an hour every monday night, so wanted the cannula to be small and without wires hanging when the pump is removed.

Inserting the cannula is done using the Infusion Set. Anne demonstrated these using a soft toy with a belly specially designed to mimic human skin. I know that sounds vague – if she brings it back again, I will take a picture. Anyway, it worked well for us to try out the different Infusion sets for each pump. Once inserted, it will not be changed for about 72 hours, so needs to be well situated.

Basically, they all approach insertion in roughly the same way, but the Infusion sets they have produced are very different. The cannula is inserted by a needle that penetrates the skin and is then instanly removed, leaving the small (usually plastic) cannula behind. Each device holds the cannula and patch about 3-4 cm above the skin and is spring loaded. Having primed the spring, a press of a button releases it to quickly drop to the skin and insert the cannula.

There’s quite a few video’s on Youtube that show the different options. This one shows the Medtronic infusion set. This official video shows the Roche Accu-check system.

It comes with a couple of different infusion sets. One of which was our preferred choice, the Accu-check Link Assist device. The others, especially the one from Medtronics, didn’t seem as robust or well engineered. And with regular use, we wanted something that would be simple and reliable.

When we take delivery, I will post a video so you can see.

And that was it. Having made our choice, the next stage is to try it out. But not with insulin. Samuel is booked in for three days from Monday 18th October, to have a go with living with the device, but it only pumping a small amount of saline. If we are happy after that, the next stage is to move onto the insulin.

Anne gave us a brief indication of what would be involved then. And it sounds like a lot. Because an insulin pump delivers a regular and small amount of insulin every few minutes, he no longer has an injection every night of slow acting insulin (Levemir in our case). We have to calculate the doses Sam’s body needs by “calibrating” the levels in the first few days. We didn’t go into too much detail on that. You’ve gotta walk before you run. And it did sound like a lot was involved!! So more on that later.

In the meantime, Samuel seems very excited at the prospect. I’m not sure whether it is because he likes gadgets and it is just something new and different (like father, like son!!!). Perhaps, the thought of not having to use needles anymore. He has also mentioned that the thought of being able to snack more easily appeals.

We shall see.