Friday, September 10, 2010

A Bump in the Road

   I was originally going to write today about my own personal (albeit brief) experience with the pump, and I still will, but a strange thing happened on the way to the blog.

   First off, Jonathan is loving the pump (aside from set changes).  He loves the fact that he can have a meal and not see a needle.  And although the novelty will surely wear off at some point, he thinks his new pump is the bomb.  He's so far, knock on wood, been really good about not playing with it as well as reminding any of it's users to lock the keypad before putting it away.  Sleeping with it has not seemed to be an issue so far with one previously unforeseen problem.

   When Jonathan's numbers are high, we are pretty much assured a wet pull-up, and sometimes a "breech of containment".  This happened Wednesday night (wee hours of Thursday morning).  It's happened before and was not a shock at the time.  We did have to deal with a wet pump case, but it washed nicely in the sink and was dry by morning*.

   We changed the set yesterday, just before dinner, and with a few tears and a couple yells, it was over rather quickly**.  We all ate, I went to a JDRF meeting, Bobbie stayed home and watched carefully as his numbers dipped as low as 4.2 (76), but come back up on their own to be about 8 (144) in a straight line through the night.  I was ecstatic, what great numbers, thank you pump.  We tested him at 7am for breakfast and got a 4.1, but it was just as he was about to eat and the pump would reduce.  When I lifted hi pajama top to get the pump for the bolus, I saw the previous site we removed last night (it's a little hard to tell from the puctures, but it looks like he's going to give birth to a golf ball).

   Luckily, we already had a doctors appointment for Alexandra this morning so the doctor saw them both at the same time.  Definitely infected - pain, swollen, slight fever - antibiotics.

   Jonathan was quite upset this morning when he had to sit at the table and eat breakfast, in hindsight the night belt was probably putting pressure on it (dumb daddy), but he insisted on going to school and I allowed it since I was already planning on being there every couple hours again today to finish off the first week of pump.

   Hopefully the antibiotics kick in quick and this passes.

   A couple of things that came to mind as I was writing this post:

* - If it wasn't the urine, I have to wonder if it was the belt itself over the old site all night.  The body side of the belt is the soft loop side of "velcro", so now I can't help but wonder of some loose fibers worked their way in as the belt rubbed against him last night.

** - I didn't dress the wound from the site (I did wipe it with an alcohol wipe and put pollysporin on it).  This was his third set that had been inserted and the previous two only left a mosquito-bite like mark that faded after a couple of days.  This was however the first one that had insulin going through it.  I doubt that could he the issue (it better not be).  Regardless, I think I will be having to invest in some button bandages just to be on the safe side.

   I was psyching myself up the whole time for a kinked cannula, set pulled out, even the dreaded A33 (aka "a word I don't ever want to use in this blog" code), but this came straight out of left field.

   Despite the discomfort and the freaky looking bump, Jonathan still says he wants to keep his pump and not go back to shots.  Barring issue, his next set change is Sunday evening and he coincidentally has a follow up appointment for this issue Monday morning at 9am, so, God forbid, the next former site pulls this s#!t, he already has an in with the Doc.

Tuesday, September 7, 2010

HEY! Diabetes!..... Seh 'ello to my l'il friend

   I've been waiting over two months to use that post title - ever since we chose Jonathan's new weapon.  And, what a little pistol it is.

   It was strange.  I got up this morning and there was nothing.  I was expecting myself to run out of the bedroom, rushing to get ready, only to be at the hospital two hours early, but it was a calm and orderly start (amazing considering it was Alexandra's first day of grade 2).  It wasn't until we were about half way there that it really hit me, that today is THE day, P-day.

  Rewind: Last night, as I tucked Jonathan into bed and told him that he had one more needle and then it was all pump, his face lit up to the point that I was speechless (of course with 2 night-time corrections, D made a liar out of me, but Jr doesn't know that).  I was overwhelmed with emotions because I could see in his eyes how much he wanted this and despite his awesome cooperation over the past year, he really hated the shots more than he let on.  I think that is what kind of made this morning a little anti-climatic, a big chunk of the drama happened last night as he wore his pump for the first afternoon and night.

   This morning we flipped the switch.  All his long-acting basil was out of his system and he was officially pumping.  As we reviewed what needed to be done to re-tune his ratios, basil, and sensitivity, I quickly realized that this was more like starting over than I had originally thought.

   The doctor's orders were the same as his current MDI orders.  I felt a little uncomfortable about this and we nudged the carb side of the ratio up a bit.  Even though his "target" was 6-10mmol/L (108-180), corrections only occurred at/outside of 4&13 (72-234).  With his new target of 8.0 (144) (they said a single number target for now makes it easier to tune in basils) we will effectively be correcting at >8 instead of >12.9 and from some of the lunch numbers I've seen over the year, that 5 mmol margin has saved his bacon a few times.

  Lo and behold... Lunch - 3.0 (54).  Yikes!!!  He was over 18 (324) just before we put the pump on a little over 2 hours earlier, AND had 15g snack that wasn't bolused.  Basil must be out of whack.  His lunch was 45g of carbs which typically earns him a bolus of 3.0u, with a reduction of 1.0u for the low... Pump result = 1.7u.  Sounds good to me.  He ate his lunch, was at 6.5, we pumped 1.7u into him and 2 hours later... 4.6 (83).  That's not right.  He's low and still has 2 hours of active insulin in his system.  OK 15g snack.  45 minutes later = 5.9 (106).... Hmmmmm... 18g snack.  45 minutes later 8.7 (157).  Nice!  Home at 5:14 = 10.7 (193), decent.  Dinner, 9.8 (176), booyah!

   Now, I have previously learned my lesson that posting good numbers online will lead to only one thing... crazy numbers.  But I have already resigned myself to the fact that the next few days and weeks will be as squirrely as the weeks following Dx.  One thing on our side is, we're reasonably sure the honeymoon is over.

   So.  For all you out there that want to say I told you so... Don't bother.  I know you were right.  To one gentleman in particular, whom I had the pleasure of meeting this past June in Toronto at the JDRF Canada AGM, while I can't say that your insight and experience were the sole reason we have taken this direction, you did give my head enough of a shake to realize that it was at the very least worth giving a fair shot.

   To everyone that has provided stories of experience and they're support and kindness, thank you!  So far, no regrets.  I feel that we have done exactly the right thing, at exactly the right time, for all the right reasons; the most compelling of which:

Jonathan: Upgraded!

Monday, September 6, 2010

Goodbye, Farewell, and Amen

   Just under an hour ago, we said goodbye to one of our constant companions - Lantus.  Jonathan received what is planned to be his last ever injection of the stingy stuff (still have a couple vials in case of pump issues but that's not part of the intended plan).

   He's not sorry to see it go either.  He's hated the stuff since day one and I can't say I blame him.  I had to do a little research to figure out why, but I learned that it has the same pH as tomato juice... I hate tomato juice!  As much as I'm glad to see it go though, it unnerves me a bit.  This little bugger was one of the reasons I liked MDI.  It was all about insulin on board.

   Jonathan typically got his Lantus at 6:00pm, but since his pump start is in the morning we've been dialing it back the last 5 days to land him at 8:00am.  He had his last dose, that's his syringe there, and the leftover Lantus that will be going in the garbage.

   Barring a correction for a high tonight, Jonathan will be saying farewell to to his pen after just three more shots (lunch, dinner, and breakfast tomorrow just before we head off to the hospital).

   He is excited about the pump.  Not too crazy about set insertions, but he's only had two and I think that will get better with a little time.  Jonathan is really looking forward to this change and the end of MDI.  Amen!