John and Jonathan

   Jonathan and I had the opportunity to do something pretty cool recently - we met John Chick of the NFL's Indianapolis Colts.  John is a defensive end who, with the CFL's Saskatchewan Roughriders,won the 2009 Grey Cup championship and was named the CFL's Most Outstanding Defensive Player for that same year.  It takes a lot of hard work and dedication to become a professional athlete, but it's all the sweeter when Type 1 Diabetes doesn't stop you.

  John was diagnosed at the age of 14 while already playing football in eighth grade.  In an instant it seemed to most like that was the end of his dreams of becoming a professional football player - not to John though.  Managing his diabetes with multiple daily injections, he continued playing and received a scholarship to Utah State University.

   In his freshman year his blood sugar dipped too low while driving after a practice and he rear-ended a stopped car at about 70km/hr (~45mph) totaling both vehicles in the incident; fortunately there were no serious injuries.  He considered this a huge eye-opener and decided that MDI was not reliable enough and it was time to switch to the pump.  Although the linked video might be considered somewhat misleading in how "automatically" the pump maintains blood sugar, he did find it to be a huge improvement over shots.

   John wears his pump all the time, even when playing, and in six years on it has never broken one despite the physicality of his profession.  He spoke to us in a very matter-of-fact way about how Type 1 has been a part of his life, but never a defining or limiting factor.  He talked about the importance of being positive and believing in ones self, but also how important it is to stay on top of this disease and make sure that it doesn't get an upper hand.

   He also emphasized that just as important as it is to not let Diabetes limit you, don't limit yourself, don't settle.  Yes he is a CFL champion and an NFL player, but being on the team - being on the practice roster - isn't enough, he wants to be the best.  As a 28 year old husband, father of four children under the age of 5, and one of the top athletes in his sport, he knows that there is still more to do and he has no doubts about doing it, diabetic or otherwise.

Pause the audio player and press play below:

   I don't think Jonathan really took in a lot of the detail of what John talked about, but sitting there and watching him stare up at this 6'4", 260ish pound guy I'm pretty sure he got the hint that diabetes doesn't mean the end of a journey, you just have to bring it along with you and bend it's will to your own.

He's too smart for my own good

   Jonathan's a bright kid (and he better be if he wants to make good on his plans to become a doctor), this was no news to me.  Starting the pump just before he turned 5 I figured we wait a good four to five years before we would start teaching him how to use his pump.  Well... little man had a different plan apparently.  I guess seeing something done three or more times a day, seven days a week, for three months, he was bound to catch on to a thing or two.

   A few weeks back, Jonathan began insisting he could lock his pump himself - and promptly demonstrated the swift button presses to do it.  At first I was a little concerned that he would push any buttons, but knowing how obsessed he is about having his pump locked I thought this would be OK should an occasion arise where he was without us and noticed his pump unlocked.  Content to have him maneuver his tech to a safe place, I let it go for a while.

   Monday night, much to my horror, he unlocked the pump.  "Hmmmmm..." I thought, "this isn't good".  So we had a little talk about who unlocks and who doesn't.  He happily agreed.

   Last night, when it was time for his shower, I was disconnecting him and he proudly told me that he knew how to suspend his pump.  I paused for a moment and then decided I should know if he really could.  I handed him his unlocked pump and S#!T  Click click click - beep.  UH OH!

  While I'm impressed that he picked this up and does it without even seeming to have to think about it, I'm totally horrified that he could suspend it and go hours without insulin... or even worse yet... the unthinkable.... give himself up to 5 units without a single carb to balance it (5 is his current max bolus setting and I don't think he'll be changing that without an insane amount of bad luck).

   And so my dilemma...  Do I start teaching my five year old son how to use his pump properly or put the fear of God into him that if he so much unsnaps the case a holy hell-fire will rain down upon him?  I figure the latter will result in some sort of emotional scaring that will take reams of therapy to correct before he can ever look at the pump again, but the former just doesn't seem right for us at this time either.

   So with some serious thinking and a nice chat with a great friend (who is also a nurse, CDE, and is pretty much the go to gal in the clinic at the hospital) I think I'm going to go somewhere down the middle: there will be Jonathan jobs and Mommy-Daddy-Nurse-Grandma jobs.  Jonathan can keep his hands clean before testing, Jonathan can test and Jonathan can unlock and lock with Mommy or Daddy present.  Mommy-Daddy-Nurse-Grandma are the only ones who can push other buttons, and most importantly - Jonathan NEVER activates insulin (by the way, I know he knows how because he talks grandma through it step-by-step).

   Even giving him a little responsibility with the pump specifically is terrifying.  He could test all day long for all I care (as long as he is at least testing), but to push pump buttons.... I think this is what handing over car keys someday might feel like.  So hopefully, for my sanity, at least a few years of pump drivers ed and then we'll see where we go from there.

Upgrade!

   Oh!  And speaking of cool......


    The watch kinda took a backseat today, at least in the "new" and "cool" arena.  I know I kinda left that little cliffhanger at the end of the previous post...  I did that on purpose, because I knew something.  I pretty much knew it when we started Jonathan on the pump but it wasn't a sure thing until the middle of last week, and even then we didn't have it in out hot little hands.


   Well, now it's here.  Fresh through the Health Canada approval process and a brief stint with the Assisted Devices Program, Jonathan is one of the first people to get Medtronic's Veo.  Built upon the same platform as the Paradigm, it does all that his current pump can... and more.

   Where to start...  There are many subtle differences, like bolus in 0.025u increments up to 1, then 0.05 after that instead of 0.1 and basil in 0.025u/hr instead of 0.05.  Reworked set change menu for less button pushing.  On-board event capture to record BG, insulin, meal, exercise and other as opposed to getting into CareLink to enter it into the log book.  IOB is now on the status screen.  And there's probably a few other little goodies in there I have yet to come across.

   One of the things that helped us pick Jonathan's Weapon of Choice was the built in CGM system.  Despite the sensors being financially prohibitive for us to use them all the time, we can and likely will used them from time to time for any number of reasons...  Here's the biggie and the top new thing for Veo - Low Glucose Suspend (LGS).  It does what it says... When BGs meet specified criteria, insulin delivery will be automatically suspended for a period of time.

   We knew Medtronic's Pathway Program was there to move him up as new technology becomes available, and because we are within our 90-day trial period, we get a full ride to new.  Even if something bigger and better comes along in the next 5 years we can still choose to upgrade with a cost dependent on where we are in the cycle.

   There are two main things I want for Jonathan when it comes to Diabetes: 1) First and foremost, a cure.  2) Until a cure, the best possible management of his diabetes.  LGS is a step, and one side of a coin in an artificial pancreas.  The dicier side is the high glucose correction / automatic bolus.  Those two things, coupled with a dual hormone delivery system (glucagon) are the basis of a self contained support system and along with the integrated cannula / sensor would be no more intrusive than the current infusion set.

   My patience is really a hypocrisy.  As much as I want to get better and better management tools, I really want a cure.  I want a cure for Jonathan, I want a cure for all the kids that have recently been diagnosed, I want a cure for everyone with some years under their belt.  I want a cure for all the people that have been waiting decades.  I want a cure for the ones that are going to be diagnosed.  I want the CDEs, and the pharma reps, and everyone making a living off of diabetes to find their living somewhere else... and I want it NOW!!  But in the mean time, I want a safe and happy and healthy Jonathan who can grow and learn and reach his potential, and then go beyond it.

   To that end, next week, after the nurses at the clinic are trained on the Veo, Jonathan will have the latest and greatest available to him.  :)

Reluctantly I did it, and very glad I didn't miss out

   I meant to get to this about a week or so ago, but as you know things got a little hairy (speaking of a little hairy; and yes, infusion sets double as miniature waxing strips).

   When we first met with the Animas rep, she insisted that we were going to each wear a set to see what it was like.  Quite frankly, she kinda rubbed me the wrong way about the whole thing.  Even when we had the reps out to the house, she was still harping on it.  I can honestly say that her pestering me about it didn't influence my decision though.

   Once we got the pump and I started playing around with and getting things set up, I became a little curious.  After a couple of weeks of seeing it sitting in my office, a little thought started to fester in the back of my head.  For some strange reason I though I might actually want to wear it myself during the training (I must have been having one hell of a masochistic moment).

   As the day of reckoning drew closer, I became more and more nervous.  I have had a life-long issue with needles.  More of a mental thing than a physical thing.  I know they hurt a little, but are bearable however, the thought of a foreign object being inserted into my body through the skin gives me the heebee-geebees.  There were a few times where I though I could wear the pump but forgo the set itself.  In the end though something told me I needed to do this.

   At the clinic that morning we reviewed some things and went over the  pump and how to use it.  A couple hours into the training we got to the practical hands-on stuff.  I rewound the pump, filled a vial, primed the line... and then....  All eyes were on me, or rather my big white belly, and my shaking hands holding a site and an inserter.  I put them together, cocked it back, paused for a moment as I tried to see through the blur to the area I had wiped with the alcohol swab, and then I did it.  With a click and a pinch, it was over.  It was a lot like a mosquito bite.  On one hand I felt a little silly for all the anxiety I had let myself experience, but on the other I was glad it was behind me (at least for a few days until set change).

   It was kinda neat actually.  Outside of the diabetes aspect of all this, I like gadgets and new things so it was cool.  A few people even said to me "I didn't know you had diabetes", to which I replied "I don't, I'm the test monkey."  By the end of the first 24 hours I was kinda used to it (except the sleeping part).  I started to forget it was there until I had to deal with it for whatever reason, be it a meal, trip to the washroom, knocking it with the seat belt buckle...  And then Nicole asked me what I felt was a pretty profound question "So how does it feel to be connected to your son's life line??" All of a sudden it hit me.  This wasn't just another pen or syringe, this was going to become part of him, this was going to be a 24 hour a day lifeline.

   I knew that switching to the pump meant no more long-acting insulin on board, and I knew that it was a life-sustaining device for him. I understood the mechanics and logic, but the moment I was asked that question it became so much more, more real than before and for my few days it became a little bit of a symbol of diabetes and a life with managing it.

   I said from day one that I would switch pancreas' with Jonathan if I knew his immune system would just get him again, and as sacrilegious as this sounds: I kinda felt, for a moment, like I did.  For a couple days it was me instead of him - well, more like me and him instead of him alone.  As much as we do to manage his diabetes now, this is truly his burden - one he will carry for the foreseeable future.

   After a few days I didn't want to give it up.  In fact, I started thing about taking saline shots at meals with him.  I didn't do that though, and probably a good thing too because I would have likely been spending more time with men in white coats.

  Although it was brief, I'm really glad I didn't miss out on the opportunity to do this and share a little piece of Jonathan's journey.  Things are back to "normal" now.  Jonathan is the only one getting poked and prodded.  Even as I write this, I wish I could go back to two weeks ago.  There's a lot about the experience that I still have a really hard time describing, but I would definitely recommend to any parent, or anyone for that matter that has someone close to their heart living with D, to share in this brief experience with them.  It's definitely worth the poke.

Down, but not out

   We're baaaaaccccckkk!

   Well, what can I say? It was a s#!^^$ 5 days, but things are lookin' up.  Like the mainstream pop phenomenon the Willie was, our pumplessness was short lived.  Of course Jonathan had stellar numbers on the shots today, but we will get there with the pump too, and beyond.  As always, thanks to all for your kindness and support!

   I asked Jonathan if he wanted to go keep the shots and he looked at me like I had two heads - which was the second funniest thing this evening right after the kids did a duet of Flo Rida's Low in the car on the way home from school.

Irony

   I remember a time when I was dead set against putting my son on an insulin pump. It seemed as if there were too many risks to make it worthwhile. I eventually came to realize that people tend to share bad news more than talk about the status quo and when things are non-events and the potential issues were far and few between. It took almost a year and a lot of researching and soul searching, but I finally got to a place where I was comfortable with pumping and really looking forward to it.



   This morning, Jonathan's doctor asked us to take him off the pump for a week or two until the infection clears up. I haven't seen Jonathan since this, but Bobbie says he seemed ok with going back on shots. Me on the other hand, I'm not happy about this at all! After a taste of not having to drive a needle into him multiple times a day, having a more relaxed schedule (in terms of meal times), and being able to correct those slightly off numbers, I don't want to go back and feel that it's horribly unfair for him to have to go back to MDI. I made him a couple of shirts for his birthday tomorrow that I think I will put away until he's back on the pump since they include a lot of pumping related things.


Ducking Fiabetes!

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.

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!

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!

Training Day

   Finally after months of stalling, a brief crisis of decision and weeks of waiting, it is finally September 2nd - training day.

   The closer we got, the more excited I've been.  Knowing that this day started the final countdown to the next chapter in Jonathan's journey.  In five short days, Jonathan will be a pumper; but for the time being it will be me as we have some hands on time with no risk.

   One of the things I was not looking forward to was inserting the infusion set....... into myself!  I'm a wuss, so I opted for the 6mm quick-sert infusion set despite the fact that Jonathan is sporting a 13mm silhouette.  I managed to load the quick-serter despite the fact that my hands were shaking and I was losing my capacity for rational thought.  Worse yet, aside from my wife and mother, there were three women standing around watching me.  The longer I looked at the the needle in the cannula, the longer the needle seemed to get.  I couldn't delay any longer as I would surely chicken out soon.  I put the insertion device to my well padded tummy and I pressed the two white buttons...

   I'll admit it, I've had mosquito bites that hurt more than that.

   Although there is a lot to it, the pump is remarkably easy to use.  I actually had it all programmed weeks ago and had a good idea of what to do with it, but it was definitely worthwhile to spend the three and a half hours going through it with the pros.  My mother also came along because she doesn't want to give up her nights with the grand-kids.  As well, the site manager for the Latchkey joined us as they are allowed to use Jonathan's pump (they aren't part of school board) and in the near future he will not have the nurse at Latchkey as they can do everything he needs now.

   I will be spending the next week with the school and Latchkey staffs to oversee and assist in the transition into his new class, new schedule, and, God help me, the supplied lunches on his off days.  We did learn yesterday who Jonathan's teacher is and thankfully she was with the school and aware of Jonathan's condition the past year.  I'll be sitting down with her tomorrow to revisit the information I presented at the beginning of the last school year as well as introduce her to Jr's new tech.  Within the next week or so, a proper diabetes educator will go in to have a more detailed session with teacher and staff.

   Tuesday, September 7th, at about 09:30, Jonathan will go live with his pump, loaded with insulin, and begin making MDI a distant memory.

Big Brown Box

   It's here.  I have 5 weeks.  I have 5 weeks to learn everything I can about this pump and what it can do.  I have 5 weeks to prepare...  That's exactly 5 weeks longer than I had to prepare for Jonathan's diagnosis, so were ahead of the game in that way.  I do however have two thick books to read... aye carumba.  On the bright side in 5 weeks I won't do what I did tonight 73/17=4.3.... hmmm add 4g or random something, or lose .3 units (and in hindsight, I probably should have given him 1/2 a mini-box of smarties....

   Ok... off to school... have a gooD night.

It's on it's way....

   We got the call last night.  The nice lady from Medtronics Canada called to let us know that Jonathan's shiny new pump was being shipped.  Odds are it's half way to Memphis by now.  I still find it silly that to get from Toronto to Windsor (400Km / 240mi) that it goes to Memphis first... silly FedEx...

   It's weird.  I was so reluctant to go pump just months ago, and now I find myself waking up in the middle of the night like it's Christmas eve.  Jonathan is excited too.  I don't think he fully understands all of the implications here, but he seems to be clear on one thing trade 12 needles for 1.  By the time he goes on the pump, he will have had well over 1500 shots, probably closer to 1600 or 1700.  Fast forward to September 2011... 122 infusion sets (maybe a few extra, nothing's perfect).  And when I need to give him 2.7 units of insulin, I can, I don't have to add extra food to get to 3.0 or short him 0.2.

   I'll admit it. I am scared about having to put the words kink and cannula is the same phrase.  I'm concerned about DKA and giving up long acting insulin, but on the other hand, he usually doesn't go more than 6 hours between tests (that's lunch to dinner) and we can add one in there!

   I'm not looking forward to the first couple of insertions and the first time we hit a vein.  But I am looking forward to taking him to Sunday brunch and not caring that the next meal may be a couple hours away.  I'm looking forward to letting hip sleep on Saturday morning instead of rushing him to the breakfast table because I know he has to eat lunch by 11:30 so we can get his sister to gymnastics.

   I'm not going to jinx it by publishing the reason there haven't been many D posts recently... but I'm sure we'll be talking a lot about Mi-me (maybe Jonathan can come up with a better one) in the coming weeks.

Weapon of Choice

    What can I say?  I called it wrong.  A week ago I was ready to jump all over one pump system and run with it.

    By the advice of our CDEs and my own conscience, we invited two of the three reps to spend some time with us and review their particular products.  As it turned out, the number I had for the Accu-Check rep had two digits reversed.  I looked on-line at the Spirit and was not at all impressed after seeing what Animas and Medtronic had to offer.  No disrespect to Roche, but it just seems to be a very out dated system and not user friendly (which was the number one complaint I found on user groups).  And with that it came down to one decision: Ping or Paradigm.  What made the final decision so tough for us is that both systems are so great.  They both fulfill the basic functions of an insulin pump.  They are both popular and have established track records.  And... they both have advantages over the other.

    After meeting with the two reps and doing hours of internet and soul searching, we finally picked our new weapon in Jonathan's fight: Medtronic Paradigm 522

    So, why did I change my tune?  Why did I go for the pump that he can't wear swimming?  Why did I go for the pump that I'm going to have to dig for to bolus in the middle of the night?  Why did I opt out of the pretty colour screen?  Why did I walk away from all the neat things that Ping can do?  In a word... Perspective.  I guess you could say I had a paradigm shift.

    I gave up waterproof.  Medtronic used to promote their pumps as waterproof.  The 511 and 512 models developed stress cracks over time, many of which were not easily visible and went un-noticed.  Some of the pumps took on water and shut down.  Even Animas pump casings have been known to crack.  Animas has reinforced some areas of their pump that were prone to cracking, but is it a 100% guarantee that water will never get in? No.  The guarantee is, that if water does affect them the company will replace it.  Also, while wearing the pump, you may be able to lounge in the pool, or lake (God forbid your $7000 pump fall off in the lake!), or maybe even do laps.... Jonathan likes to do cannon-balls, one after another....  I just don't think that's great for any pump - besides, with the way he goes, we'd probably have to suspend basil anyway.

    I gave up remote.  The Ping remote does two big jobs that the Contour Link doesn't: 1) Has the Calorie King (after a year though we know Jonathan's diet inside and out and what we can't get off a package we probably have to weigh on his dietary scale anyway.  2) It controls the pump, the same way the key pad on the pump does.  The only time that the remote control bolus would come in really handy is in the middle of the night which at present we bolus on average about once a week (some weeks more, some weeks none).  Another reason I gave up the remote is you only get one, and only one can be linked to the pump, which means to use it when we're not with him is to give it to him (at $250 each to replace), while the Medtronic can accept BGs from multiple remotes, we get three to start, and if we need another it's only $60.

    I gave up smaller increments.  This was a tough one for me to gauge and I really needed the clinic's help in determining this capability's importance to Jonathan.  Does he really need 0.05 increments for bolus and 0.025 increments for basil?  Animas' increments are half of Medtronic's.  The wonderful ladies at the clinic went to great lengths throughout this process to ensure they did not sway our decision, and their answer to this question was no exception: "We have children over the age of 3 on the Medtronic insulin pump -- and have not had a problem up to now needing to have the .025 unit shifts in basal.  Our little ones under 3 have chosen Animas for this feature."  A respectably impartial statement if I do say so myself, as well as in line with at least one very experienced family.

    What did I get in return?  Well, I got three linkable meters to replace the meters currently at home, school, and latchkey (hmmmm 3 for 3... that was a nice coincidence).  Also, I got CGM capable.  We had initially dismissed the CGM because we can't get it covered and the sensors are $50 for 3 days (although we know some stretch that to 6).  While the transmitter is OMG expensive ($700), we can get a loaner from the clinic from time to time when we need to get a better look inside Jonathan to help straighten things out, and Medtronic also has deals occasionally where you can get a pack of 8 sensors and a transmitter for $500 and they will send you the sensors as you need them.

    Beyond the meters and ability to CGM on and off at will (I would full time if it was covered or we win the $50 million in tonight's lotto), we got a few bonuses that didn't really factor in to the decision but did sweeten the deal.  1) Medtronic has (at least here) an automated supply service... I fill out a standing order form (that I can change when necessary) and they ship us product every three months (which is also the frequency of the government coverage checks).  I also ordered an extra months supply right up front because I want to always be at least 3 weeks ahead.  2) As much as this shouldn't be about the money, the supplies were more cost competitive.  One other bonus that factored in was that of COT (Continuation of Therapy).  The government only shells out for a replacement pump after 5 years.... manufacturers warranties are 4 years (go figure)... Animas offered a $500 extended warranty program... Medtronic supplies a "loaner" if there is a failure in the 5th year to carry Jonathan through.

    The other thing I should touch upon is the software.  Both pumps are capable of downloading their memories onto a computer (Animas even supports Mac - but we don't have one).  The huge difference for us and the team though is that Animas' system generates a PDF file of numbers and basic graphs where as Medtronic's is a web based system that allows for a far more analytical review of the data as well as access by anyone you want to give it to.  Animas is "getting new software" eventually; "it's on it's way".

    Both pumps showed very well and both reps were very knowledgeable about their products and were wonderful to talk with, but in the end the Paradigm just ended up being a better fit.

Pump arrival: First week of August.

Tons of reading and button pushing and going to on-line "Pump School": Rest of August.

Official training and start of saline trials: September 2nd.

PUMP START: September 7th 2010 (Day 374 ADx)