Insulin Pump Demystified

Thursday, March 30, 2006

Losin' my Meter...

It's a familiar scream in my house. "Fred, I can't find it! Anywhere!!!"

"Where did you test last?" my husband asks me.

"I don't remember. If I remembered, I could find it!" I answer.

"Okay, calm down. It's got to be here. I'll find it."

"I've looked everywhere, it's gone! I need to test...I think I'm getting low."

"Yeah...think you forgot to look in your purse. Here it is."

"Oh, okay," I mumble, temporarily humbled. "Thanks."

And so it goes--a variation on this incident occurs at least three times a week around here. I'm not sure what it is. I really don't think I'm consiously trying to lose my meter. I just test on the run a lot. For example, I could have tested last in my office, where I'm working, when I here a kid wake up over the baby monitor. Off I go, leaving the meter near my keyboard. Or I might have it next to me on the couch when I'm trying to stay up to watch E.R., but when I inevtabaly fall asleep and wake back up around 2am, I won't remember to look for my meter on the floor by the couch. I'll expect it to be in the upstairs bathroom, where I try and keep it most of the time. But since it's 2am, I'll feel a strong urgency to find it...won't be able to, will wake up Fred...and the scene above takes place.

I'm writing about all of this because I am very, very, very curious about the new "Omnipod" insulin delivery device. Have you seen it? Just the idea of wearing a "pod" rather than a "pump" lures me into thinking that progress has been made. And it seems like it has...the pod has no tubing. It's pretty small. No cartridges to deal with. You just stick it on and replace it with a new pod every couple of days. How cool is that?! Less stuff to shlep around.

Only, you program in your boluses and basals with a device that includes a blood sugar meter that comes separately...a device that you hold, a device that you must have to deliver insulin through the pod, a device that you--well, I--could lose.

So I'm thinking that the pod probably would not create much progress for me, after all. :)


Tuesday, March 28, 2006

Updates on the scale

It's been over a week now that I've been "blogging," so I want to write about where I'm at with my weight loss goals. Siiiiiigh. No progress this week. In fact, I'm up a pound. This is the week before my period, which always means a couple of pounds in water weight gain...but still. I think that if I want to get these last 15 pounds off, I need to watch everything that I'm eating more closely, even during "this week."

For some time, I've been struggling with setting my basal rates correctly in the ten days or so before my period. I become extremely insulin-resistant (any women readers out there go through this?) due to changing hormome levels. I end up increasing my basals during this time...but the challenge is how much to increase, when. If I increase too much too quickly, my blood sugars can crash. Starting out slow, though, usually results in a couple of higher-than-normal days. I tend to settle somewhere in between...unfortunately, even record-keeping doesn't help me to master this dilemma because each month is truly different in terms of when the insulin-resistance hits.

So my basals are set at what feels the right place now, but the weight is just there. I'm hoping that now that spring is officially here, getting out for more walks--combined with watching my food intake more carefully--will help me get closer to my goal.

Yesterday it was about 55 degrees here and I put my kids in their double stroller and walked up a really big hill. My neighborhood--Manayunk--is the hilliest in looks a lot like San Francisco, or Pittsburgh even. I made it up the hill pretty quickly, even with pushing the stroller. And that felt good. That was a new feeling. That made me remember that even if the scale isn't showing it right now, I am getting into decent shape. Just got to keep moving up those hills...

On June 7th, I turn 35. It's kind of just hit me that this is a signficiant birthday. I won't be in my "early 30s" anymore. Maybe living with diabetes is making me think a bit harder this year about mortality, in general. I want 10 pounds off by my birthday, that's a new goal. I want to keep living this next year with daily awareness of how my emotional/spiritual/intellectual/and physical health interact. I'm feeling happier now than I ever have in my life...and I want to honor that feeling in my body, as well as in my spirit and mind.

In peace,

Saturday, March 25, 2006

Today I received my copies of the latest "Diabetes Self-Management" magazine, which includes an article that I wrote last fall about pregnancy and diabetes. It was exciting to see the article in print. I wrote it after June was born...feeling more determined than ever that there need to be more resources out there for women with diabetes who are planning pregnancies. Having a non-eventful pregnancy and giving birth to a healthy child is absolutely possible for us--but doing so takes a huge amount of knowledge, hard work and support.

One anecdote that I didn't include in the article is about my switching endocrinologists after finding out that I was pregnant again. Immediately after finding out I was pregnant, I put a call into my endo. I wanted to check in with him, get help adjusting my basal rates and move my appointment up (it was schedule for 7 weeks from then). I phoned his office and his receptionist took a message with all of that information, and I waited for his call. I was pretty eager to get in touch with him because the first trimester is so critical in terms of blood sugar control; birth defects in the fetus can occur if sugars are too high. So I waited...a couple of days went by and no return call. I was going to call back again the next afternoon, when I got home from seeing my high-risk ob/gyn.

At that appointment, my Dr., Nancy Roberts, suggested that this time around, I see an endo who works at the same hospital as my ob/gyn team. For George's birth, I wanted to stick with my endo--whom I had been seeing for five years at the time--even though he was affiliated with a different hospital from my ob/gyn team...whcih did result in a lack of communication between them. So, I agreed with Dr. Roberts to see an endo at Lankanau hospital where she practices and long story short, Dr. Roberts made a phone call and I left her office, took the elevator down a floor, and went to see a new endo, Dr. Claresa Levetan.

Dr. Levetan, it turns out, is a leading diabetes researcher and also a fantastic clinician. I was in tears by the time I met her, so stressed about my sugars being out of target range. She was extremely resassuring, connected me to a continous glucose sensor which I wore for the next three days, so we could collect as much data as possible about what was going on with my sugars. Within the week, she helped me set basal and bolus rates that helped me reach my blood sugar goals throughout the rest of that trimester and she was a tremendous help throughout my pregnancy.

I wanted to get back in touch with my former endo and let him know what was going on...after all, I had been seeing him for 7 years by this time and was grateful for his help in getting me started with the pump. I decided to write him a note and explained my decision about wanting an endo and high-risk ob/gyn team at the same hospital; I explained that I had called his office to let him know about my pregnancy, but obviously the message hadn't gotten through. I thanked him for all of his help and promised to get in touch after the birth.

A few days later, I came home to a phone message from that endo. He wished me well and said that he had gotten the phone message and hadn't gotten a chance to call me back. I was stung to hear that. No time to call me back? A patient who is pregnant and needs help adjusting her basal rates?

I am so deeply thankful for Dr. Roberts' call, for my trust in her, for meeting Dr. Levetan and for all of the miraculous things that fell into place that allowed me to give birth to a healthy baby. But this incident is a reminder to me that people with diabetes--pregnant or not--need to be advocates for themselves...and need to remember that our doctors don't always make the best judgements. This was a painful way for me to learn this lesson, but now I am more empowered about seeking ou what I need from my doctors to help me be as healthy as possible.

In peace,

Thursday, March 23, 2006

Yoga Benefits

This morning I stretched for the first time in probably a good month. I haven't been able to find a way back into a regular yoga routine since somewhere in the middle of my pregnancy with June, and I've started feeling its absence in my body. I began doing yoga in 1997 and found myself totally taken with the way practicing the asanas helped me to clear my mind, tone my body and learn how to "just be" in the moment. Managing my stress through yoga practice also yielded benefits for my blood sugar control. Especially after starting pump therapy, I was able to measure just how much a stress-induced adrenaline rush could make my blood sugar soar. Daily yoga helped me to internalize a sense of calm...a calm that I could easily lose on a daily basis...but still know that I had tools to find a way back to it. my mind, I've been wanting to carve out a space--somewhere in my life--to get back to yoga. But there is just so much to do--personally and professionally--during my small windows of free time that I just haven't made it happen. But this morning, the house was quiet...June was having her morning nap and George and I were reading books. "Let's stretch together," I said to him.

At age three, he is definitely into the "mimicking" phase and jumped right up and stood next to me. I stood in mountain pose and he imitated me. I reached my arms up high and he did the same. I did a forward bend down to the floor and George followed. We were both laughing as we stretched up and down, side to side. At least I knew I was breathing! After about 10 minutes, he lost interest and went back to his books, while I continued practicing asanas for another five minutes. Soon, June woke up and the moment was over. It was certainly not a perfect kind of practice, but I loved stretching with George and the feeling of tension releasing throughout my body as I stretched. I remembered how important it is to really be in my body, to notice when I am stressed or tense. For me, carrying unreleased tension can undercut my best efforts at blood sugar control. And breathing and stretching through moments of high anxiety can help to counter the effect of stress hormones on my blood sugar.

Probably nothing has been as helpful as my yoga practice in preparing me for parenthood. Spending as much time as I do with two young kids is truly an exercise in being in the moment. When I can stop my mind from racing and running, I can appreciate the blessings of our simple, mundane moments...the richness of the every day.

When things settle down even more in my life, I hope to get back to an ongoing pilates practice, too. A couple of years ago, I was fortunate to meet Colin Reynolds, who also has Type 1 diabetes and wears a pump, and is an amazing pilates instructor. Colin is an inspiration--he is in such fantastic shape and is using pilates to help people with diabetes. Colin gave me simple routine to do at home, which helped me to get back into shape after George. I had a few lessons with him last December and have managed to squeeze in some pilates time here and there since.

Today taught me that waiting for the perfect time just means...waiting. Meanwhile, for the sake of my health--emotional, physical, and spiritual--I'll keep stretching away with my 3-year-old. If I can give my children a way to calm themselves through yoga poractice, that will be a huge benefit, too.

If you live in the Philadelphia area and want to know more about Colin and his awesome work, check out

In peace,

Tuesday, March 21, 2006

Experimenting with Symlin

For the past two months, I've been using Symlin in addition to insulin to help manage my blood sugars. For those of you who haven't heard about Symlin yet, check out It's basically another hormone that works with insulin to keep blood sugars from peaking too high. It is the first medication that is being prescribed for people with Type 1 to work with insulin...since insulin was first bottled and prescribed.I'm thankful for the opportunity to try it--and that something else has come out on the market to help people with Type 1. So far, it is helping me to lower my post-dinner blood sugars and keep my sugars more even throughout the evening. The only problem for me right now is that symlin is only supposed to be taken if you are eating at least 30 grams of carbs (or you can risk low blood sugar) at a meal. Since I've been on my weight loss campaign, I'm not eating that much carb at breakfast (a non-fat yogurt) or lunch (usually salad, cheese and a few crackers). I'm more into grazing right now and that is working well for me...I usually grab a piece of fruit between breakfast and lunch and again between lunch and dinner.The one thing that is also a drag for me about taking symlin is returning to syringes--yuck! After seven years on the pump, I'd forgotten how inconvenient they are. I don't mind the actual drawing up the needle and sticking it in...I just so much prefer the convenience of insulin delivery by pushing a few buttons.On Saturday night, my husband and I went out to dinner for his birthday and as I was throwing things into my purse, I thought, "I really don't want to pack up a needle & bottle of symlin." I mean, I don't need it in the smae way that I need insulin...or obviously it would be packed! It just brought up memories for me of leaving the table on a date to go take a shot before dinner. Pulling out my pump and pressing a few buttons has spoiled me.I've heard about some people with Type 1 who LOVE symlin and are actually wearing TWO pumps: one with insulin and the other with symlin. I'm not there yet, but we'll see..If you're taking symlin, please leave a comment about how it's working out for you.In peace, Gabrielle

Saturday, March 18, 2006

Daily Ritual

Since June was born six months ago, I have added a new ritual to my morning routine: stepping on the scale. For years, I had scale-phobia and dreaded that part of my doctor appointments more than anything else. It's been an ongoing challenge for me to balance optimal blood sugar management with achieving my "ideal" weight; before I started pump therapy, I was at my thinnest that I've been in my adult life, but my daily blood sugars were out of the healthy range. When I started pump therapy seven years ago, I gained a good twelve pounds in the first couple of months...but my blood sugar control was the best it had been since being diagnosed. Part of that weight gain showed that my body was healthier--processing sugar rather than spilling it out in my urine. But a lot of the weight gain--which I openly admit--came from my now being able to indulge in desserts, chips and other high-fat foods that I used to avoid...because now I could just blus enough insulin to cover the carbs & fat and still come out with a blood sugar in the healthy range.
I caught on quickly that that way of thinking and eating was not healthy for me or anyone. Still, I struggled with getting the extra weight off. Over the next couple of years, I gained significant weight with each of my pregnancies. Now that I am on the other side of that, and have decided not to have any more children, I have set a new goal to try and maintain optimal blood sugar control AND reach a more ideal weight. Thankfully, I've taken off all of the weight from my pregnancy...but still have 15 pounds to go to my goal.
Standing on the scale each morning forces me to acknowledge where I am in terms of reaching that goal. This has been a helpful tool. Yet, I also don't wantthis ritual to determine my mood for the day. I don't want to punish myself if I'm up a pound or two or reward myself if I've lost half a pound. I want to take in the information, use it to help me, but not allow myself to get caught up in my weight equating my self-worth.
Growing up with diabetes since age ten, I have battled the feeling that the numbers on my blood sugar meter defined me. I would look and the number and label it either "good" or "bad"...and there was no separation between the number and me. If the blood sugar was good, I was good; if it was bad, I was bad. It has taken me a long time to recognize my blood sugar as either "high" or "low", rather than good or bad. Part of accepting that is acknowledging that as hard as I work at blood sugar control, there are factors...sickness, stress, my menstrual cycle...that can undercut whatever steps towards control that I take.
As I work out my relationship with the scale, I'm trying to bring that awareness to my process of losing weight. Today I lost one pound. And I did step away from the scale with a lighter step...

Friday, March 17, 2006

Starting my blog

Finally! I have been wanting to start this blog for some time. My baby, June Elizabeth, is 6 months old and between caring for her and my older son, George (3 and 1/2), and taking care of my diabetes--not to mention writing, working part-time and occassionally cleaning my house--it just hasn't happened until now. But here we go...
Some of you know me as the author of "Insulin Pump Therapy Demystified" (Marlowe & Co, 2002), in which I shared my experiences--and those of nearly 100 other pump users--in becoming adjusted to life with the pump. The insulin pump truly changed my life, allowing me to step into the driver's seat in terms of my diabetes control and I wanted to write the kind of book that might have helped me when I was confronting my doubts and fears about trying a pump. Writing and publishing my book has been one of the most rewarding experiences in my life, especially when I connect with people for whom my book was helpful in their decision to choose pump therapy.
Since 2002, I've continued writing about diabetes in various publications including "Diabetes Self-Management", "Diabetes Health" , "Yoga Journal" and others. But lately I've been amazed by how the world of blogging is connecting people with diabetes in a completely new way. Just exploring all of the blogs about diabetes makes me feel less isolated and more in community with others who are dealing with the same daily challeneges as me.
And so now...I am adding my voice to the diabetes blog world. What you'll find here are postings about my current challenges to achieve the most optimal control I can: balancing self-care with care of my young children; attempting to lose weight and get back into pre-pregnancy shape; lowering my a1c; attending to my emotional and spiritual health as I pay attention to my physical health; and hopefully keep my sense of humor along the way.
I look forward to your responses to my postings!
And for more information on "Insulin Pump Therapy Demystified", check out my web site