I was asked how the insulin pump works without hurting and bleeding continuously. I imagine a lot of people might be curious, as it is kind of interesting. So here goes...

I am a straight up Cyborg now, a machine doing the job of my pancreas.  I transmit my blood sugar wirelessly from a gold lead embedded in my skin to an insulin pump that I wear constantly and will for the rest of my life.  This is how it works.  My gear specs are Medtronic Revel MiniMed Insulin Pump.  It beeps with tones that tell me what is happening or needed without having to look at the display screen.  It shows a graph of my blood sugar readings over 3-72 hour increments of time.  I download the information and can make reports of all of the data.  The Continuous Monitor give the rough equivalent of 240 finger sticks a day. I am now trained to respond to the beeps and alarms.  Rates of insulin are programmed into the pump and I use a Bolus Calculation Wizard that accepts input of carbohydrate in either exchanges or grams.  That information is coordinated with settings of how much insulin I need personally for carbs ingested and a recommendation of units to deliver is made by the pump without my needing to calculate anything.  The wizard can deliver it all at once or in several patterns over several hours depending on how my eating patterns can change.  I use the pizza plan most of the time as that covers a normal dose of carbs immediately and slower digesting of carbs ingested with fat and protein. That is incredible data collection and has helped relate my activity to my actual blood glucose control.  I also beep and whir like an R2-D2.  Yay.

Someday, the pump and the sensors will be integrated so that the pump can work in response to the readings without instructions from the user.  This is seriously risky, though, and I am not sure I would trust technology to that extent.  Pancreatic transplants are also coming along with stem cell technology that can eliminate rejection therapy for life.  This will be sweet, but odds of it happening in my expected lifetime (20 years or so if all goes well) are not good.  I will be too old to be a good candidate for that.  So in the mean time, I am using the best available technology available to extend and provide quality of life.  I am grateful for the advances despite any complaints that follow.  The details of daily therapy with a pump can be frustrating and this choice is certainly not for everyone.

I have an active lifestyle and a young child who is rather freaked by seeing me shoot up and with the number of injections I needed daily, it was impossible to avoid him seeing it.  I remember this feeling of anxiety as I saw my mother deal with the same thing prior to her death at 53 of a heart attack related to renal failure.  She took injections of pig insulin with no feedback as there were no meters at that time for finger sticks.  The only monitoring system of success was a urine dip that was wildly inaccurate and expensive.  Using the same needle delivery system that ultimately did not prolong her life or its quality has impeded my own good management of my condition.  It seems painful, terrifying, AND pointless to me.  That is an irrational response (times have changed, I am not her, better insulin is available, meters are available), but you have to be honest with your doctor and yourself about why you may not be able to comply with their treatment and management plan.  So taking the needles out of the daily equation is very important for me.  

There is a plastic canula inserted like an IV in your arm, only it is into interstitial fluid under the skin. It drips into your juicy bits from the pump, which distributes a set amount per minute over the course of a day instead of dumping a large amount with a needle several times a day.  The amounts over the course of the day can be fine tuned to .025 units of insulin per hour.  The slow drip is more like normal insulin delivery within your body.  It is generally placed in your abdomen and rotated every three days.

It is not into your blood.  If the infusion set insertion needle does hit a blood vessel, it backs up into the tubing and you have to reinsert. Only a flexible plastic tube stays in your skin after you insert it with a hollow needle. It is attached to an adhesive disc and a linkage assembly so that you can remove it temporarily to dress or swim or do pump maintenance. It has a little cap to keep the infusion site clean when it is not attached. The tubing is about 2 feet long and is concealed under your clothes.

I have this on all the time now. I keep the pump in my pocket and it has halved my standard blood sugar readings, well on the way to normal consistent blood sugars. We expect that in about a month. I have had extremely high blood sugars with needle injection management. I am extremely insulin resistant and needle injections only deliver about 60% usable insulin. the pump is 95% efficient in its usable insulin delivery method. So less insulin on a continuous feed with greater efficiency. But it is an adjustment with a learning curve on how to use it. 

I am using a system that includes a Continuous Monitor and Transmitter. This is a gold lead that is also inserted with a hollow needle into the interstitial fluid. It measures your blood sugar by calibrating the conductivity of the fluid with the manual blood glucose readings you get from a standard finger stick meter. You have to calibrate 3-4 times a day. I would not use U500 with the pump without the monitor. That would be very dangerous. Standard insulin is not particularly dangerous in the amounts delivered with a pump.

I have not had to inject insulin with a needle in 17 days. The insulin that I require is not available in the pens (like epi-pens) you see some people use as I am extremely insulin-resistant and require U500, which is 5 times stronger than standard insulin. Not many people use this with the pump as it is very strong. But it is what I need.

It hurts slightly to insert the infusion set, but not much. The sensor lead requires a deep stick to get it in place and hurts. It requires an injection rig to place it correctly and like the infusion set must be replaced if a blood vessel is hit. It also itches a bit as it is a metal (gold) lead under your skin. But the biofeedback of the information as your blood sugar rises and falls with activity, food, stress, and other daily factors of life is enlightening. 

My BG increases as I exercise under stress. It should go down as glucose is depleted. Without the sensors, I could not know this and would not know to give myself a bolus of insulin prior to exercise. This is counter-intuitive, but explains how I feel better than the predictive model that says my bg will go down with exertion. Another fun fact: I have night terrors, a phenomenon where my blood sugar drops low during the night and then my liver dumps insulin to cover, leaving me with higher BG levels after 12 hours of fasting. To fix this, I have to snack before bedtime and decrease my standard basal rate during the night to assure that I do not go low and trigger the liver dump of stored sugar.

It is a medical miracle that the technology I am using is available for home use instead of clinical monitoring. I had a test several years ago where I wore a monitor for 48 hours and it was in an IV with a loaner machine that I could not keep. It also cost about 500 dollars and was not covered by insurance. But it is how we originally identified the Somogyi Rebound or Dawn Phenomenon.

I have a complicating factor of pancreatitis. When it is undergoing an attack (like during the last few days), my abdomen swells and retains fluid, interrupting the normal balance of fluids and hence the conductivity of the sensors. This is hard. I have accidentally ripped out the set, lost the sensor, ripped out the sensor, dropped the pump, torn the sensor out by removing a wet bandaid, lost the tubing while changing my shirt, had a tube occlude by being pinched while it was in my pocket.  I have had to change the set in a public park after finding that my blood sugar was elevating quickly because the set tubing had failed during the time that the sensor was warming up.  As I said, it is a learning curve.   And there is the mental factor of being a machine-dependent cyborg now for the rest of my life. 

Blue Cross pays for it now as a durable medical equipment payout, as do most insurance providers. It is cost effective for them as the initial cost of the device is much less than the end of life cost of diabetics with renal failure, retinopathy, amputation, heart failure, and a myriad of ways that diabetes will kill you eventually. SO the machine saves them money by keeping you healthy long enough for the karma bus to take you out cheaply and efficiently. Win-win. (forgive my dark humor, I am part machine now.) 

As of this writing, I have not injected insulin with a needle in 17 days.  This is the primary factor that makes the following "worth it" short term.  Long term, I will live longer, feel better, and have more flexibility in my lifestyle while maintaining optimal blood sugars.  It took me several years to accept this therapy and I do recommend that anyone considering it find out all that you can before jumping in.  I am overall happy with my decision so far. 

I am game and as everyone knows, I don't really hold back on the privacy factor. I don't care personally and if this helps anyone make the decision to switch from injection therapy to pump therapy, I am all for it.  This is also a reality check for people who think the pump is going to fix it for you.  

Only for the geeks who will get this:

Insulin Resistance is Futile

so you might as well make it as easy as possible !

http://en.wikipedia.org/wiki/Chronic_Somogyi_rebound

 (Disclaimer:  Only your doctor can give you medical advice.  This article is for information only and only reflects my direct personal experience.  Your mileage WILL differ.  It will probably be easier for you with normal insulin, no monitor embedded, no Somogyi effect, no weird exercise factor, no pancreatitis.  This is my personal blog and so my results only apply to my particular medical profile.  I am 44 years old, diabetic for 22 years and have no residual damage or end organ failure.  That makes me me.  SO remember that as you consider insulin pump therapy.  I recommend it if you need a large quantity of insulin or if you have an extreme reaction to needles or if you cannot use insulin pens.  If you are not into micromanaging your diabetes, it is NOT for you.  That is my personal opinion, and I am NOT a doctor, nor do I play one on tv.)