...wait a minute... do I know the carb count on jam? Does jelly have fewer carbs than jam? What should I put the jam/jelly on? Bread? Bread has carbs. Should the bread be wheat?!
In a fraction of a second, my diabetic/fun song pun was ruined.
So it goes with the infamous insulin pump, a $5,000.00 toy. When I was finally persuaded by my husband and doctor to take the leap from shots to an insulin pump, I had a lot to learn. In theory, the pros definitely outweighed the cons, but it was hard to pull the proverbial trigger (in this case, needle). In my eyes, once I went pump, I'd never go back. In a more dramatic flair, it seemed like the disease was winning.
A Quick Lesson on Insulin Shots vs. Insulin Pump
I took an insulin shot with each meal. First, I would check my blood sugar by sticking a finger and putting the blood on a testing strip. A glucometer read the amount of sugar in my blood. Then, I would consult the sliding scale chart, provided by my doctor, and determine how much insulin I would draw from an insulin bottle and put into a syringe. I would disinfect the injection area with a wipe and then take the shot. That was for the first type of insulin, known as fast-acting, which would "cover" consumed food and drinks. The second insulin was a long lasting, non-peaking type. It would be taken in the morning and/or night.
An insulin pump is a pager-size piece of equipment that is attached to my body via an infusion set. The pump's reservoir has to be filled and the insertion site has to be changed about every 3-4 days. Longer than that and my skin becomes irritated (changing it more frequently makes ME irritated. I digress....). The infusion set is similar to an IV; it is inserted with a long needle, the needle is removed and (BAM!) the infusion set stays in place. Repeat every 3-4 days. Insulin is located in the reservoir, which is located inside of the pump. Insulin is delivered through a clear, narrow tube and it goes from the pump to the infusion set. A positive point is that my pump only uses one type of insulin.
So, I'm connected to this cool, pink pump that looks like a pager on my waistband (PAGING DR. HEITERT!). Now what?! This lil miraculous machine continuously delivers insulin to my body. When I eat, I check my blood sugar with the glucometer-same as before-and enter my blood sugar number into the pump. Since the pump has been set up with the help of a diabetic educator, the pump uses it's lil pump brain and calculates how much insulin it should give to achieve my ideal blood sugar level (95). Next, I enter the amount of carbs I ate or drank and it uses my predetermined insulin/carb ratio (1:15, 1 unit for each 15 grams of carbohydrates) to cover the consumed yummies. NOTE: The first time I did this and hit ACT to open the insulin delivery flood gates, I expected this enormous wave of a feeling, like a huge WHOOOOOOOSH. Didn't happen.
On With My Story
The more Type 1 diabetics I talk to, I realize a lot of them are like me... A. Don't tell me that diabetes is going to control my life, B. I can do everything a non-diabetic can do, C. All of the above.
Enter set pump. The idea of the pump is to have tighter blood sugar control. Instead of increments of whole units, the pump gives insulin in much smaller segments, .25, so the pump's dosages are much more precise. Also, it allows flexibility for physical activity. An insulin pump does all of the above because I can give myself insulin (bolus) as needed and I can change the amount of insulin the pump gives me 24/7 (basal rate).
The idea of the pump was that it could help me achieve one of my fitness goals, which was to run a marathon. After I got my pump, I ran often. Lots and lots o' miles. I ran with a group while establishing a pump routine. I controlled my blood sugar by setting the basal rate down one hour before I started the run. Then, I set my pump to deliver no insulin or I would remove my pump during the run. I was instructed to not have my pump off for more than 90 minutes. I always carried emergency supplies with me, such as sport beans, various running carb products and I checked my blood sugar often.
I set a goal to run a marathon at a local park's event, called Flatlanders. This is an ultramarathon event, sponsored by the St. Louis Ultrarunners Group. In this event, runners run as many miles as possible in 6 or 12 hours on a 1.8 mile course. I committed to running 26.2 in this controlled environment because my husband could be there with all of my diabetic and running supplies. This would allow me to frequently check my blood sugar and make sure I was being responsible and healthy. My husband always supported my running goals and he knew how much I wanted to reach the marathon status. I was physically able; my heart and lungs were ready. It just depended on my blood sugar's mood that day.
Which brings me to the next part of this story. 26.2 miles is serious business and I found a marathon training plan and followed the mileage requirement each week, including a Sunday long run with my running buddies.
Each run routine included: adjust basal rate, check blood sugar, remove pump, run, check blood sugar, run, check blood sugar, bolus. Throw in the occasional energy food as needed.
The weekly long runs and smaller runs around my neighborhood went well. Not only was I beaming because I was making my marathon dreams happen, but I was doing it well; I was healthy AND happy. Not to mention, I loved having my kids involved and talking to them about exercise, goal setting and nutrition. I want them to treat physical activity as part of their daily routine, just as important as brushing their teeth.
Finally, September 6, 2009 arrived. My husband, kids and I went to the Flatlanders event and set up a camp: blanket on the ground, chair, food, water, diabetic supplies, etc. I felt confident because I was prepared. All of the runs leading up to that point were successful.
Until that day. I started feeling dizzy around mile 8. My blood sugar was low, despite the fact that I did everything the same that morning as previous morning runs. Exactly. Believe me, I am a creature of habit. I treated my low blood sugar and got back in the game. I continued to have issues and kept stopping each 1.8 mile loop to check my blood sugar and eat. I made it through, but it wasn't pretty. At one point, I was eating Oreo cookies while running (how did I not throw up?!). Thank goodness for the potatoes dipped in salt. They calmed the sweet feeling in my stomach, provided carbs to keep running and gave me some salt for the hot weather. With the help of some friends, I reached my goal. I finished 26.6 miles, .4 over, thank you, which technically made me an ULTRAmarathoner. ;)
Remember my lil mutiple choice above describing how I don't want to be defined by diabetes? It's true. I was extremely happy, despite the circumstances, of the Flatlanders results. One of my running friend's daughters summed it up best when she said this about me: I think that girl ate more calories today than she burned in her marathon. Ha! True, but I got 'er done.
I can't help but wonder...how would I have performed if I didn't have the frequent low blood sugar issues (like every other running day)? Why did I have such a problem THAT DAY? All I know is, I'm determined to find out.
Maybe my marathon days aren't over!!!