Pumping Fun

Today was the third day since I put the pump in live, and I'm happy to say that the insertion site lasted until this morning with no trouble. I was afraid it would start to come loose, but I think my liberal use of the IV prep and my conscious dabbing of sweat away from the site during my workout paid off. My daughter wanted to see what it looked like when I pulled the set out this morning before I showered. A set change, by the way, gives a welcome though brief respite from having anything foreign in you - the suggestion is that you remove the set, then shower, so that the old site, and any new site, are all nice and clean. So the best time for me to change is in the morning.

Anyway, I pulled the set out and showed her where the canula entered the skin, but as soon as the canula pulled all the way out, gigantic drops of blood started to come out of the hole. Not spurts, thank goodness, but very large drops. I quickly moved my hand to catch the leak and got some tissue to help apply pressure and cause a clot. By the time I reached the tissue box, I had a handful of blood, but I only lost one drop to the floor - just missing the carpet by a centimeter. The pressure stopped the bleeding almost immediately, fortunately, and even after my shower it was still ok. I'm afraid I will get a nasty bruise there by tonight, but that all depends on whether there was any accompanying internal bleeding. I must have nicked a blood vessel, but it couldn't have been a big one.

After the kids got on the bus, I put in the new set. It went in just fine, and I chose a place only a very small distance away from the last site. Next time I will switch back over to the right side; for now, I wanted to stick with the left. It went in fine, with no trouble, though on my lunchtime bolus, I could swear I felt the insulin go in (which Lisa said would be normal). We'll see if it was a phantom sensation or real the next time I bolus.

As for numbers, things are pretty good. I was 89 at dinner last night, and 110 two hours later. At midnight I was 115 and 116 at 3am. I had 150 at breakfast time, so I took a single correction unit. At 9am I was 120, and at lunch I was 83 (I had donuts this morning at work, which is rare for me, but if someone brings them in, I'm rarely able to resist them; it was nice to be able to bolus for the treats without pulling out the syringes).

I need to remind myself to head for the pharmacy to pick up my strips - I'm quickly running out. I also need to buy a sharps container. I've been throwing them in the garbage, which I know is bad, though I am not too concerned about it. There are only two sharps that I have to deal with any more. One is a largish needle used to draw insulin out of the bottle, and which never enters the body. The other is the insertion needle, which does enter the body and would then be a biohazard. That's the one I want to dispose of properlythe most. They have the containers at the pharmacy, I just need to remember to pick one up.

Things are still going well. My set has been in place since Monday morning, and I'll be changing it tomorrow, assuming my insulin supply holds out that long (I have about 45 units remaining right now, that should be enough). That's a perfect three-day rotation, which is what I'd like to shoot for, considering the cost of the sets and cartridges.

I left Lisa two voice mails yesterday to keep her up to date, and I called her again today at lunch time and spoke with her live. She seemed pleased with my numbers and said that she wouldn't recommend any changed at this point. The two times I've been higher than desirable were easily explained.

On Monday night I had pizza, which always screws up my numbers. I did a normal bolus and said that the next time I have pizza, I will do a combo bolus, spreading the second half of the bolus out over two hours. The second time was yesterday's lunch, which I ate at Uno's, and I am notorious for underestimating sit-down restaurant meal carb counts. I always get it right at Wendy's, or Burger King, or McD's, because they all publish nutritional info and their portions are well-controlled and standard. Places like Chilis and Friendly's and 99 and Unos don't publish and are inconsistent even if they did. It is always a guessing game. I guessed a hamburger with onion petals would be 75 carbs - but based on my BG readings, it is a lot more.

So, last night after lunch, I had these BG readings: 290 at 2pm, 237 at 4pm, 220 at 6pm and 73 at 8pm. I ate dinner at 6pm and overestimated my carbs for that meal, apparently. We had pork roast and broccoli, which is very low carb, and I threw in two pieces of wheat bread. I guessed 50 carbs for the whole thing, but 35 to 40 was probably closer to the truth.

Anyway, last night after I worked out, I went to buy a 2-liter bottle of Diet Coke and bought a chocolate chip cookie that I couldn't resist. I had a 147 BG and did a slight compensation bolus and bolused 4.5 units for the cookie (it was really good). At 3am I was 133, at 7am, 94, and at 9am I was 90. I was 107 at lunch. Today has been a perfect day - just now, I was 122. Beautiful.

I'm going to my parent's house for dinner tonight. My sister is home from California, which is a cause for celebration, though the reason she is here is far from joyous - a high school friend of hers killed herself, and she came for the funeral. Since she was a Jew, the funeral and burial had to be done quickly (I think it is within 24 hours, am I right?) so it has been a whirlwind few days for her, and we're all very sensitive to what she's going through right now. I'm not sure what we're having, but knowing my parents it will be Bove's pasta (mostaccioli or lasagna) and if so, I'll try a combo bolus tonight.

Finally, I think I may have *finally* gotten somewhere with Dell - I've been trying to get them to ship me a second label so I can recycle my old computer, and it has been quite a struggle to get this little slip of paper... but today I bitched and moaned enough on the phone that I think I finally got someone who knew what to do. I'll know if I get a new label in the mail within a few days.

Well, everything is going fine so far. It was a busy day yesterday, somewhat unusual in that we did not eat dinner until 8pm. But no really high highs and no really low lows, so that's good. My site is pretty good, my workout last night didn't force a set change. So, here it is by the numbers.

At 11am, just a few minutes after putting the pump in, I had a BG of 192. I did not correct. At 1pm, I ate lunch; 53g of carb, BG of 143. I bolused 6.6 for the carbs and .8 for the BG. At 3pm, my BG was 74.

At 8pm, I ate dinner, pizza. Carb count was estimated at 150, BG at 135. I bolused 15 plus .5 for the BG. At 10pm, my BG was 151. I did not correct. At midnight, my BG was 158, no correction. At 3am, my BG was 195, no correction.

I decided that I should not correct any BG readings below 250, because I wanted to see what would happen. This morning, my carb count was 35, BG of 212. I bolused 2.9 for carbs, 3.0 for correction. At 9am this morning, I had a BG of 60, and I ate 15g of carbs to compensate with no insulin bolus. I have to call Lisa to let her know all these numbers, but I wrote her number down on a piece of paper that I left at home. I was going to call first thing this morning, but since I don't know her number, I have to call into the clinic, and I had to wait until they opened. They've been open for a while, but I have to work, too, you know....

So my readings were all pretty good. I figure as time goes on, I will correct for those highs, so a 212 at breakfast will be rare - if I'd corrected the midnight 158, I probably only would have been about 150 at breakfast. Sleeping was fine - I might like the set on my left side better for sleeping. I'm wearing jeans today, because all of my shorts were in the wash, and so I'm getting to try the set out with jeans and a belt, and the site I chose is fine for the shorts and the jeans - I was concerned the jeans might rde higher, but they don't. I do tuck in my t-shirts when I wear jeans, though, and tucking in the tubing with the shirt was a little odd. No biggie, though.

OK, we're now live -- I'm on the pump with real insulin, and so far so good ... though there has been no difference between now and the past few days, since I've done nothing different so far. I came in with a BG reading of 228 this morning, which is high but not unexpected since I only had half of my dose of Lantus on Sunday morning. By this morning, that half dose was nearly worn out.

I went in to work for a little while, just enough time to go through emails, then high-tailed it over to the doctor's office for the appointment. The two people who I'd been with two weeks ago were there, Kim and Dave. Kim, she herself admitted, was a little overwhelmed and emotional. She'd had a BG reading of over 300 that morning - though I don't like seeing readings like that, I never get emotional about them. She was ready to admit defeat, I think, and had Lisa let her, she probably would have. But Lisa talked her through some things, and within an hour, things seemed ok and Kim had had a BG reading of just over 200. That's what you have to do, in my opinion - just take things one slow step at a time, and never let things get you down too much. This disease can beat the crap out of you, physically and emotionally, but only if you let it. Some things you can't seem to control, and so I try to take full ownership of those things that I can. When I have a high BG reading, and I have no explanation, I just deal with it. And that's it.

Anyway, I changed my set pretty quickly (actually, I took my set out last night, since it was hanging by a thread), so I got to watch the other two put theirs in. I noticed that I made a mistake that made going in hurt a bit more than it should have - I forgot to pinch my skin into a paunch for needle insertion, and just jabbed it in. It really didn't hurt too much, but I did have to push harder than I should have. Dave had a bit of trouble with his auto-inserter, which I don't use, and I got to see the Minimed pump in action a little bit. Dave brought his wife, and she had a lot of questions. I saw Dave roll his eyes at them a couple of times - but I'm sure being there made her feel better.

Kim put her new set it under the waitsband of her pants, which is interesting, and I may have to try that - I've been putting mine in over the waistband. I'm still wearing shorts a lot, so when I go to jeans for fall and winter, we'll see which way I like better. I moved my set to the left side, having put it on the right twice. I also reported to Lisa that I ended up clipping almost all of the hair off my belly, as it just wasn't worth it to worry about it.

She assigned me a basal rate of 1.2 units per hour, and we'll work from there. I got a vial of insulin from her, so I should be set for about five set changes, but I also got a new precription for vials which I'm going to take to the pharmacy at lunchtime. I also got a new script for strips, going from 100 for a month to 300 for a month. For the first 30 days or so, they essentially want 10 tests a day, like this: one at each meal and one two hours after each meal, for six. Then a reading at 9pm, one at 12am, and one at 3pm... actually, that's just nine - maybe they figure on at least an average of one more per day to check after boluses and the like. Any way, I don't plan on doing nine or ten tests a day for long, though Kim noted that she already does 10 to 12 a day. Wow.

I didn't bring my meter into the appointment with me, but I did do a BG when I got back to my car, and I was at 192. Again, high, but I think perfectly understandable. I am about to head out to go to the store to fill these scripts, and to get something to eat. I'll be reporting back in a bit to say what my readings were.

So far, the saline trial has been a success. I've showered with it in twice with no ill effects, for example. I worked out tonight, and the edges of the set are starting to come loose. The sweat did that. I only have to keep it in for one more night - and if worse comes to worst, I can pull it tomorrow.

I only took 22 units of Lantus tonight, as a get my body ready to be weaned off that stuff and onto the pump. Good timing, too, as I only have about three or four days of Lantus left. Tomorrow morning I will take another 21, and then that's it.

The trip was fun - not too exciting, but a good getaway, and time well-spent with good people. I'll fill in details later, I'm pretty tired right now. Friday night we went out to dinner and I had had a dessert - one of the largest concoctions I have ever seen for one person: a brownie, topped with chocolate ice cream. Then layers of chocolate mousse alternating with layers of whipped cream; all topped with chocolate shavings and hot fudge. It was called Chocolate Perversion. It was perverted, but oh so yummy.

The pump is in and running. The class went fine - I thought it might take less than three hours, but it took lamost exactly that. There were four of us in there - one person, Kim, I've seen several other times. She's about my age, maybe five years younger. Another is an employee of the hospital and already on a pump, and who just got an Animas 1200. The fourth was a nurse from Endocrinology learning about pumping to help patients.

Everything went fine, the pump is delivering saline right now in place of insulin. I have had to change me set, though, already. The site I selected for the set had too damn much hair, and by tonight, the adhesive was no longer sticking to my skin, except for a small circle of it, barely holding in the canula. They said at the class I'd have to trim my hair on my stomach back - not shave, just trim. Well, I said screw that and took the clippers and tonight, before I put in the new set, practically shaved my stomack clean. Not completely - I used a 1/4" guard on the clippers so it is very short, but not to the skin. I don't care one way or the other. When I put in the new set, I also moved it down and back so that it is closer to where I wear the pump and closer to my beltline. Before I had it further up and toward the front, and I could tell almost immediately that that was not going to work. I know I can unclip from the tubing, but I planned to go swimming tomorrow! The set is not exactly a neon sign, but it is not exactly inconspicuous either, So hopefully, where it is now will be easier to hide or conceal when I get on a bathing suit.

Again, I don't care, but I don't want stares or awkward questions. Some of the people I'll be with tomorrow know I'm on the pump now, so for them it will be no big deal, but others I don't speak to socially and they have no idea.

Anyway, I got the old set out and the new one in with no trouble. The first big test in my mind will be sleeping tonight. I'm not a tosser in bed, so I'm not too concerned there, but I do wonder where I'm going to stick the pump. The tube is only 23 inches, and while that's good when the pump and the site are two inches away from each other, it can make it harder to get it out of the way. I've already found that 23 inches isn't far when you need to drop trou. I'll have to remember to unclip the pump from my belt when I get undressed The next big challenge will be showering in the morning, then all the activities tomorrow (like a hike and a boat ride down Ausable Chasm), then keeping the set in for three days. I plan to change it next Monday morning when I put it in for real.

I won't be logging anything tomorrow, since I'll be on the road - so TTFN!

I got a call on Tuesday from Ann at Animas, but I'm so bad about listening to voice mail that I didn't get the message until today. I called her on her cell phone - it sounded like she was driving, probably heading up here for our appointment. She asked if I'd had a chance to watch the DVD that came with the pump, and I had to say that I never did watch it. I'd thought about it a couple of times, but never got around to it - I was too excited to watch THX! She said that was OK, and I noted that I had been wearing and playing with the pump for several days, which she said was good. I think I'm pretty comfortable with its interface at this point - the thing that is the biggest mystery to me is how the sets go in and attach and all that. The DVD probably showed that, but too late now.

I was going to work out tonight to see how the set stays with me all sweaty and moving around, but I've pretty much decided that since I'm driving for our outing tomorrow that I will be staying home and going to bed early, maybe at 10, maybe at 11 - depends on whether I decide to watch ER tonight or not. I won't be around on Friday to work out, but I will be swimming in the hotel pool and hot tub on Friday night (at least that's the plan), so I'll be able to test how water proof the seal is. I don't think I'll wear the pump swimming, though. Not much point to that. I wanted a waterproof pump to protect me from accidents, not so I could swim with the thing on.

Karen called me yesterday afternoon and asked how the pump was - I had no idea what she meant. Turns out she thought my appointment was yesterday, not today. Later, as we were watching the Dr. Phil show (I told you we'd have to watch that, didn't I!?), my mother called and asked how the pump was. I again had no idea what she was talking about (having forgotten by that time about Karen's misunderstanding), and then realized Karen must have told her what she thought was happening. I had to tell her, too, that the appointment was today. It was like the real-life version of that game Telephone!

I burned a new CD today to have in my car for the outing trip tomorrow. It has some of my most recent favorite songs on it, though it was too short for a full CD so I had to go to Napster to download a few more to flesh it out. My favorites on the CD are One Thing by Finger 11 and Broken by Seether and Amy Lee.

I took a break from the pump yesterday, knowing that I would not be able to do so very soon. When I got home from work, I took it off and left it on top of the TV and left it there the rest of the day. I didn't take it to the gym and I didn't take it to bed. This is the freedom and I will miss; but yet, the freedom to not have my insulin with me is one of the things that I've found vexing over all these years. The problems have abounded. When I was on syringes, I would leave the wallet in different places and not remember where. Having to mix Regular and NPH, and having the two bottles run out at different rates. On the pen, having the much smaller cartridges run out a lot faster than the old bottles. Taking the pen with me without its case, but forgetting a pen needle. Being "somewhere" and deciding to have an early lunch or dinner, yet not having the insulin with me; or worse, leaving it behind somewhere. These things all come with the freedom to not have your insulin with you.

With the pump, the freedom to be without the insulin is gone, and hence so are the hassles. I do take some solace in knowing that I can disconnect from the pump for some length of time, like during a shower, sex, or a workout, though the infusion set will always be in there. But these are short, discrete times, and the goal of reconnecting must always be there, or else things start to go bad. As my diabetes educator says, with Lantus, there is always insulin there, working for you. With the pump, if you disconnect, there is nothing.

I'm looking forward to seeing Lost tonight (or at least taping it, since I suspect Karen will want to watch the Dr. Phil Special). I wonder what would happen to me if that were to happen - if I got stranded on an island with no hope for speedy recovery. How long would it take before I died without a fresh supply of insulin? Even with needles, I would carry, at the very most, a 20 or 30 day supply. Eating what's available on an island, my insulin needs would be pretty low, but the need for basal insulin would be the same, and without that, bad things start to happen. I've figured I could probably last 30 or 60 days, but when it all runs out, DKA would be hard on my heels. I guess I need to not get stranded on a desert island!

Oh, I bought THX 1138 last night, and can't wait to watch it. I've always loved the film, and am excited to see it in its newly updated glory.

Two more days until I'm hooked in. My appointment is on Thursday at 1pm. I debated with myself this morning about leaving the pump at home the rests of the week, considering what happened yesterday, but I decided to bring it to work with me - in for a penny, in for a pound, eh? I have placed a note on the label on the back with my last name and phone number. I should find out if anyone I know has an engraving tool, so I can put something a little more indelible on the thing.

Aside from the pump, today's a busy day. I set up a few sign-up sheets for the boys for their popcorn sales - their first big duty as new Tiger Cub Scouts is to try to sell popcorn. We'll buy some from each of them, of course, and I think I'll buy an extra tin of the candied popcorn from each. A lot of people around work are big popcorn eaters - I smell it popping almost every afternoon, so hopefully they will get some good sales from my work. Brittany always does pretty well selling Girl Scout cookies in the winter, but I think the Girl Scouts have a lock on that market, and the Boy Scouts' popcorn is an also-ran.

This afternoon, Karen already has meat marinading for dinner, because after I get home from work it will be a tight night. Brittany has ballet, and the boys and I are going to go to Costco to stock up on a few things. I might buy THX 1138 while I'm there. What's $15 when you're spending $200 on other stuff? I'd buy the Star Wars trilogy on DVD, too, but I'm going to wait on that one. I might get it for my birthday from someone :)

On Friday, as I've mentioned, my department is going on our outing to Lake Placid. We'll make a few stops along the way, to eat and do some sight seeing, before heading to the hotel. It will be a nice quiet night alone - though on the last outing, a bunch of us went out for drinks in the evening. I'm not sure what kind of night life Lake Placid has, especially compared to Montreal, but if anyone else is game, I'll go out. I'll be on the pump, but only with saline. I made sure that I was not going to be away in the first weeks after I go live. No sense in taking any risks.

I don't mean the new show on ABC (which I do plan to watch, or at least tape, by the way) - I mean I lost my pump. I cannot remember the last time I had such a feeling of dread. I got home from soccer practice and reached by to adjust the pump on my belt, and felt the belt clip there ... but nothing inside the clip. Empty clip. Pump gone. Pump missing.

OK, don't panic, I thought. It must have fallen out in the car - but in the car is nothing, not even between the seats. OK, now I can panic. This little, teeny $5000 piece of medical equipment that I have not even hooked up to myself yet is gone. Fortunately, I noticed almost as soon as I got back from soccer, and I had come straight to the soccer field from work.

I'd noted earlier in the day that the belt clip, which swivels, swivels 360 degrees, and I found the clip with the opening upside down. It must have slipped out as I was sitting to watch the boys practice. With daylight quickly waning, I rushed back to the athletic fields and hurried to where I was sitting - nothing. My daughter had also been at practice, though at a different field, and the boys and I walked over to her field to meet my wife. So I tried to walk the same path, thinking that it was just plain gone - or that someone must have picked it up and hopefully had held onto it to turn into the school or the police the next day.

Scanning the ground, the deep green, long grass, the dread was creeping up - until I spotted it. It looked so small there on the ground. But it was fine, luckily not trampled upon by any of the departing soccer players or parents. I picked it off, wiped off the fine mist of dew, and headed home. How could this happen? The case had to have been upside down, so it slipped out, and falling on the grass, I did not hear it hit the ground. How would I prevent this in the future?

Of course, then I realized that as of Thursday, it will not just be clipped to my belt, but it will also be attached to my skin. Best case, it would end up just hanging there - worst case, it will rip out the canula, and I'll just have to reinsert. So that set my mind at ease a bit. I got home and my wife was just as relieved as I. She's not as keen on the pumping idea as I am, but even so, she's not one to throw five grand out the window either.

I'm not going to ever be the kind of blogger who dumps a dozen links into a message. I'm not that interested. I have added a few links to my sidebar, though, and I'll post them here, too, to show when I did it (if anyone ever cares to kn0w).

The first is to Animas. I've found myself Googling Animas a half dozen times over the past week, so it made sense to put a link somewhere convenient. The address is http://www.animascorp.com. I kept forgetting to put the "corp" part and kept ending up at a quilting site. I know how it goes. Worse, the Animas site has a banner page that you need to click to go by, so my sidebar link goes directly to the page past that. Ah, I love it.

I was wondering if my pump oculd talk to my Palm via the IR port - I haven't found out yet if there is a hack out there (and I'm not really willing to shell out $160 for Animas's software to find out if it will), and in the course of doing so, I found a site at http://www.insulin-pumpers.com. For now, I'm going to put a link to that site on my sidebar, and I'll read it further as time goes on and decide if it is worth keeping. I also spotted a few blogs out there that were chronicling the same thing I am. I want to go back and read more of this one: http://www.kweaver.org/blog/ She started up on her pump just about a year ago, so it might give me an interesting perspective.

Not much else went on this weekend, though it was as busy as ever. After my 500 reading on Saturday night, I was back down to 117 the next morning, so I countered the high pretty well. But at 2am, just before I went to bed, I felt low, so I did a reading, and it was 62. I ate a piece of toast without any insulin to counter the carbs. That seemed to help, and the 117 was the result. Last night, we went to my in-laws for dinner, and had spaghetti - one of my favorite meals. I tend to overindulge with spaghetti, and last night was no excpetion. I figured on three servings of pasta, plus bread, and estimated 120 grams of carb. I think that was low, but once you commit ... I also ended up having some cookies for dessert, and I added insulin after I ate them. But I must have killed it all with the extra pasta, because I had a 325 reading last night at midnight, and that was after my cardio work-out. I was back down to 160 this morning, so I countered that high pretty well, too.

I don't think the pump will help with these highs, since most of the time they are the result of my miscalculation of carb counts, or my addition of carbs after I've taken insulin to counter what I planned on eating. Pasta is the worst for that, since it is so easy to just have one more scoop.

So this is really my last week before I get rid of the Lantus for good. Next Monday, I will be on the pump live. This Thursday I will be getting my second class, which will include going on the pump with saline. The kids are prety pumped (pardon the pun) for me to start - they're asking all kinds of questions, like where does the medicine go, where will the tube come out, how big is it, where will it stick into me ... they'll have a good enough look at it soon enough, so I've tended to tell them to just wait a few more days and they'll see it all. In the mean time, I have shown them the tubing and the screen on the pump, just so that they'll know what's going on. Brittany will be learning about the human body later this term in Science class, and I expect she'll be doing a research paper on something. I have wondered if she'll choose to do one on diabetes.

Yesterday was awfully cold here, but they say the rest of the week is supposed to be dry and warmer. I hope so - I'm not ready to be wearing pants yet. My shorts were calling out to me today, but I had to pass on them. We nearly got frost last night for God's sake.

I don't mean that figuratively, I mean it literally - we went to a fireworks show today. It was great. Each year, for the past four years, the merchants of a huge commercial area known as Taf Corners Park have put on a fireworks show in mid-September. It started in 2000 and had some special significance a year later. One of the "businesses" in the Park is the INS, and we tried to sit on the INS's lawn that year, but go booted off by an over-zealous security guard. This year we planted our behinds at PetSmart (or is it PetsMart?) and watched. The kids liked it, and I loved it.

The relevence to this blog? Well, we had snacks at the fireworks, including crackers and cheese and Swoops. Swoops are these yummy little Pringle-chip shaped bits of chocolate, and I had far too many of them. Though I thought I'd properly compensated in terms of insulin, I had a 500 glucose reading tonight. 500! I've had highs, but that it really high. I might have miscalculated at dinner, too, but it seems more likely the problem was the snacks. Then again, I bet it was both... for dinner, we had left-overs, and though it should not have been too hard to calculate the carbs therein, I always worry that I underestimate. My readings, aside from this 500, were OK today. A little high at breakfast, but just in range at lunch and dinner.

I played with my pump a bit more today. I took out a cartridge and infusion set and just examined them - they're expensive little things, so I didn't want to ruin them. The cartidge goes in the pump pretty easily. I did not try the infusion set - I'll wait until someone shows me how to insert it. I plan to do it by hand, and not use an inserter device. The pump has a setting to remind you to test glucose some time after a bolus. I set it for two hours, especially since I'll be doing that on a regular basis the first few weeks. I don't think the plan is that I test more than four times a day once I'm into a routine, but it is that I will test up to 10 times a day at first, to get good baseline readings. That is a lot of testing.

I went to the "pump management" class today - it was mostly informational, with a call for any needed prescriptions. The first few weeks are going to be hell on my fingers, with all the BG readings Lisa is going to be asking for. I do four a day now, one before each meal and one at midnight (or bedtime, whichever is earlier). I don't have all my notes here, but several I already do, but in addition to these four, she wants one two hours after a mealtime bolus, and one at 3am, at least for a few days. Yikes - I'll have to see if the pump can set an alarm (I think it can) to wake me to test at 3am. If not, I'll have to set the alarm, and then change it to my normal wake-up time, which would be a royal PITA.

She also talked about a time when I will skip some meals, so that they can see if the basal rate is correct. For example, I'll skip a breakfast and take normal readings, seeing if my levels spike or dip unexpectedly. With the variable of a meal and a bolus, it is hard to tell if any dips or spikes are caused by something other than a bad basal rate. That will be a fun few days!

She also said that she normally has people stop exercising during the first few days, but since I do it every day, almost without fail (usually at least 25 out of every 30 days), she's going to keep me on that plan. She said that disconnecting from the pump during exercise is an option, and we can talk about it - the 90 minutes or so I'd be off isn't that big of a deal, and it might be hard to use some of the machines with it on. I could do cardio with it on and remove it for weight training ... we'll see.

Tonight I'm off to the big company conference party, and I plan to eat like a pig and get smashing drunk. I'm having my wife drive me to the hotel and I'll take a taxi home. I know if I had my car there I'd be tempted to drive, and I plan to be too wasted for that. Cheers!

OK, all of the appointments are set now. Tomorrow, from 9 to noon, I have my first one with Lisa (I keep calling her a nurse, but she's a diabetes educator ... I know how important titles can be!). It will be on pump management, what to do with highs and lows and the like. I guess I'll be needing to get a new prescription for insulin soon, hopefully tomorrow, as I'll need it in big vials now instead of the pen-size vials I'm using now.

Then on 23rd, I go in for an appointment at 1 (I'll need to ask for how long that one will be), and I and another patient will be meeting with the Animas rep. Lisa said in a phone message that the rep (whose name I forget) will probably want me to power up the pump before this appointment and play with buttons and stuff. I've already been wearing it, and I guess I'll put a battery in tonight. I didn't want to power it up lest an alarm go off that I wouldn't know how to cancel, but I guess I can put it in suspend mode. At this appointment, we'll go over the features of the pump and learn more about it hands-on. I'll go on saline at that point. The next day I'll be heading out for my department outing, so I'll wear it with saline for that and see how it stands up to "real life."

The last appointment, four days later on the 27th, is when I will go on the pump officially with real live insulin. I'll be able to put my pen needle case away, and package up the pen needles and pen insulin cartridges in the fridge for an emergency stock. Then I'll be a full-on pumper. It will be nice - today at lunch, I ate with three co-workers and I could see the women squirm when I shot up with insulin. They squirmed when I took my glucose reading, too, and that won't be going away, but if I can be more discrete with those readings, and then bolus with a few button presses, it will make it so much more nice. If only I could find a better recording device for readings than my folded-up piece of 8 1/2 x 11" paper... I'll have to see if there is a preprinted log book out there that I could adapt for my purposes... I guess I'll wait to see what kind of things the pump can record.

OK, I got it - it came by UPS yesterday, and fortunately my wife was home to sign for it. I was thinking, just leave it on the porch, but then I realized that this is a $5000 piece of equipment, and leaving it on the porch is probably not wise. Anyway, I got all the parts and pieces and took it all out to look at when I got home from work (and soccer and dinner at Men at Wok and after the kids were in bed). Nice and small, I like it.

They also sent a bunch of supplies, and a price list to order more - wow, expensive! 10 infusion sets cost over $100. I don't plan to buy the supplies directly from them, unless the nurse says I should (they seem to indicate that the insulin cartidges should be from them but that the sets can come from anywhere as long as they have the right connectors).

I am wearing the pump right now, though I'm not wearing a set nor do I even have a battery installed in it yet - I'll wait to do all of that when I go to the classes. I read through most of the manual, and there is a lot to it. I learn these things better by doing (it is hard to imagine what the screen looks like and how the cursor works without actually doing it - the pictures only go so far). Setup seems like it will take a while, but hopefully once it is setup, it will run pretty smoothly. I didn't take it to bed last night, nor to the gym. I'll probably wear it to the gym tonight, just to see how it feels, but going to bed with it I'll probably wait until I'm hooked up to it with saline, because without the set, it would just be sitting on the night stand.

I called the nurse yesterday to find out about the second appointment, and she could only say it would be Tuesday or Thursday of next week, because she was somewhat at the mercy of the Animas rep. Either day, at any time, was ok for me. Friday I'll be out with the rest of my team, gone to Lake Placid for an overnight trip (during whic I'll be on the saline, but still injecting, which is probably best since we play and eat a lot on these trips).

There is a training video that came with the pump that I plan to watch if I have time tonight. I'd like to watch it before my first appointment on Thursday anyway, so if tonight ends up being no good, I can still watch it on Wednesday night.

OK, Lisa, the coordinator, called and left me a voice mail. On Thursday the 16th, by which time I should have the pump, there is a class from 9am to 12 noon on pump management. That day I also have something going on for work starting at noon, so it will be a full day. Some day the next week, she did not have the full details yet, there is another time for us to get together to use the pump with saline. She is not very familiar with the 1200 I ordered, so she is trying to get an Animas rep to come to help out, which is why the date is in the air. Then, on the 27th (happy birthday to me), I would go one last time to go on the pump full time and live. This is another 3 hour visit, 9 to noon. Yikes, I can imagine the bill for all that's going to be a biggie.

Have I said thank goodness for insurance yet?

I was half-hoping to get the pump today, but it is unlikely I'll get it before Monday. I'd like to at least take a look at it and play around with it for a while before it is live. If it comes on the 14th, that will still give me a few days. I plan on wearing it, unconnected of course, just to start getting used to it. I tried to call to see if there was a firmer time on the second appointment, and they had just closed. Oh well, I'll try again Monday.

Still waiting ... I had my lowest blood sugar in a while last night - a 45. I used the event to eat a bunch of Ritz crackers, but I must have over indulged because I woke up with a 248 this morning. I'm almost out of Lantus, so I'm going to have to buy another vial today or tomorrow - I was hoping to make it without another, but that won't be happening. That's OK, though, a vial of Lantus doesn't cost too much - and I must be pretty close to my insurance plan's annual maximum, so I may not have to pay at all. I am going to need strips in the next few days, too - that's an expense that won't be going away, even with the pump. I haven't gotten a call back from the nurse about setting up a time to bring the pump in, so I may have to call to mudge them today. When I faxed in my readings sheet last week, I attached a note asked for a call-back, and never got it. Maybe the fax never went through. They need email.

Edit: I can't seem to get this posting to publish. The publisher goes forever and eventually errors out. I'm editing in case there is an issue with this post, maybe editing it will allow it to go through.

A few things ... first, in my one of my posts, I was trying to figure out if the Animas guy said that my pump would be arriving on the 12th or 14th, and I decided it had to be the 12th... well, I must have been looking at the wrong month on a calendar, because the 12th is a Sunday! So I guess I had to be wrong there, and it is looking more like the 14th. I dunno ... we'll see for sure.

In other news, my wife and I went to see Open Water tonight - the kids were all elsewhere, staying with friends in one case and with my in-laws the others. We were looking forward to seeing it, having heard it was a good movie with some scary bits. But we were both underwhelmed. It had a good nude scene, and some tense moments with sharks, but the end was too anti-climactic. I won't give anything away by saying what happened, but I liked The Village a lot more. Nuf said.

I am participating in a drug study, have been for about a year now (my first appointment for the study was in October of 2003). It is a drug that is supposed to help with diabetic neuropathy. To get into the study, you had to have some neuropathy, but not too much. I got in, so I have some. Not much - I would have guessed I had none, but they have some pretty sensitive instruments. Today I called the nurse to tell her that I am going on a pump within two weeks, and I wondered if that would affect the study at all. She called back later to say that it didn't matter, that users could be pump users or needle users. So I'm clear there.

I had some trouble on the drug earlier this year. Since the study is double-blind, you're not actually supposed to know if you're on the drug or a placebo. But within weeks of starting on the meds, I developed horrible headaches that went away when I stopped taking the drug. Based on the doctor's recommendation, I went back on and got the headaches again; and again they stopped when I went off. These were not just incovenient pains or throbbing, but what I imagine a migraine feels like - debilitating, nausea-inducing. Horrible, really. I was ready to bag the study, but the doc ran some tests (of course, all billed to my insurance!), and when he saw the MRI, he got concerned. The brain is covered by a three-layered membrane. The three layers are named the dura mater, the pia mater, and the arachnoid mater. Apparently, dura mater is an Anglicized Arabic phrase, mother of the brain, which I found interesting. Anyway, the MRI showed that my dura mater is inflamed. I guess this is bad news.

He ran more tests, including lots of blood work and a spinal tap, and eventually came to the conclusion that my dura is just enlarged naturally - there is no infection and no other problem that they could detect. However, the inflammation is probably causing the headaches when combined with something in the study drug. He prescribed Norvasc. I had no idea what it was, but I said I'd go back on the drug one more time with the Norvasc. He had me take that for two weeks before starting on the study drug again. It worked.

Turns out Norvasc is a high blood pressure drug. We tried to get the company, Lily, to pay for it, but they said they would not pay for a drug that masks the study drug's side effects, and for one that is used for something other than its indications (I don't have high blood pressure, but the doc must have known something about the drug's other effects on the dura). One thing I found funny about Norvasc is that one of its reported side effects is ... headache. But fortunately, it had the opposite effect for me. So now I am one year into a three-year study.

I have to basically report everything that I do that is health related to the nurse working with me on the study (the nurse, by the way, is very nice to look at - I just thought I'd mention that). So, that's why I called about the pump; I'll report my change in insulin (no more Lantus, for example); I had to report my use of a multi-vitamin; I also had to let them know that I may be taking Cialis at some point (and I wanted to make sure Cialis would not interfere with the Norvasc, or vice versa - they said no). My wife got some sample packs at her doctor's office a couple of months ago and once of these days we may actually have sex and give it a try. While I was suffering through the headaches, I noted each time I took Tylenol. I became silly, because I was taking six tablets a day, and eventually the nurse just said the note that I took it at some point, but exact whens and whys were not necessary.

In other news, I was sad to see Jason leave Canadian Idol last night (yes, we get some Canadian TV in Vermont, and my wife and I are addicted to the Idol shows). Though there is no one I would have picked over him - they are all great. Last season, we didn't like Gary at all, and were sorry to see Billy go, and happy that Ryan won (I keep trying to get Ryan and Billy's CDs, but they're expensive to ship to the U.S. - I'll have to visit Canada sometime soon and stop into a music store to buy them off the shelf). I like Theresa the best, then Jacob, then Kalan, but they're all good and I would like to see any of them win. We also watch Big Brother (we've been addicted to that since the first season, and I even applied to be on BB3), and I'm glad Adria is gone, I didn't really like her (nothing personal, A). Now things get good, though, as the season really winds down. And then it is time for Survivor -- can't wait! I'm looking forward to a few new shows, like Lost and The Clubhouse. Aside from that, I'm not too "up" on the new TV season, so I'm waiting for the Fall Preview to come in from TV Guide!