MDI through to 640g - The changes I strive for

Thursday, May 7, 2015 - 16:57


I sometimes sit and reflect on the changes that have occurred over the last 25 years. There have been only a few times over that period where the control of my T1D has become enhanced, and the way I feel directly relates to the management method.

On MDI, I lived and I had control, but I never felt as though I was in control. There were so many unknowns. For example, overnight and even during the day you have an insulin delivery that releases throughout a 12 hour period. As well created as the insulin is, it is extremely difficult (if not impossible) to fit the release times to natural body needs. I would have half of my long-acting insulin at night before bed, and half in the morning. Unfortunately my body didn't need a standard flat line of insulin and I would have highs and lows throughout the day and night. The way that those highs and lows would make me feel is a constant level of tiredness and even cloudiness.  It would be difficult to get out of bed because of the dawn phenomenon.

From here, and probably the first time in 16 years, I felt I had control by moving from MDI to a pump. This allowed for the variable rates of insulin to be set and changed for what my body needs. It also allowed me to give insulin for the food I ate, rather than feed the insulin I gave myself. This in itself is a major change and advance that meant I was able to make choices around eating and even missing a meal in specific circumstances. I remember the thought of being able to sleep in and not to have to worry about getting up at a specific time to give my injection and to eat. The pump gave me the ability to be flexible, change the way I was living, and start to take control of what was happening to me each and every day. As much as you can say that that this is possible even on MDI, I felt from a mental point of view that the pump allowed me to cope and really understand cause and effect and give me the means to change.

Throughout the early days of being on a pump, my endocrinologist informed me that they had a device that could monitor my blood sugar on a regular basis (every 5 mins) and then at the end of a few days it could be taken off and downloaded to see the peaks and troughs of how the insulin settings were performing. This was another tool that allowed greater confidence in my life with T1D. It was well and truly something that I could only use on very rare occasions to check how things were going and make some adjustments, but it was another step in control.

If all of this isn't enough, I then started on a journey where I was introduced to the MiniMed®640G pump. Fundamentally, it has the same functions as my previous two pumps, however, this would see the first real step into automation. 

Let me set the scene before I go any further. I like to have tight control and I like my HbA1c to be between 5.5 and 6.9. Unfortunately, I was having a number of lows throughout the day. Some days I would wake up low and other days it would happen in the middle of the day. Now when I say lows, this is when my BGL goes into the 2s. I can manage and get through high 3s and 4s without any effect (and yes it meant treating) but the 2s would make a difference, and I will go into that later. The lows were not welcome, however, I needed the control, and after having T1 for 25 years it had been working well and I have no other complications due to T1D (I am tapping wood right now as I say this).

Anyway, back to it. Fundamentally, it was the same, however, combined with Continuous Glucose Monitoring (CGM), it now has the ability to predict a low and shut the pump off so that it could change the curve of the low and stop the serious lows from happening. As with all technology, it would take time to trust that what they were saying was in fact true.  However, after only a day or so, where both my daughter and I stopped having any lows in the 2s, it was the next stage in my life that significant changes have had a dramatic effect on the way I feel and the way we have confidence that both my daughter and I will be safe.

Without the 2s, I finally realised the effect that they were having on me. Thinking would become easier and the tiredness would ease. I realised that for hours after a low the cloudiness within the brain would act like a dulling agent when trying to process everything. With the MiniMed®640G, and without the lows, the fog was lifted. This is not to say that going into the 2s is impossible, because it just isn't. You can still miscalculate and you can make mistakes. However, the frequency of this happening is dramatically less, for both myself and my daughter.

The other thing that helped in making this change is that the pump moved from being a simple medical device that would be difficult for everyone to understand and operate, to a user-friendly device that you need to know just a few key words and then follow the directions that it gives you. We put this into practice when training my daughter’s kindy teacher who had never had any exposure to T1D. After a 2-hour basic session with our diabetes educator to understand what it was and what it meant if it wasn't managed, we then introduced the pump. Responses from the teacher and the assistant was that it was easy to see what is happening at any one time and that they had confidence that managing our daughter's condition would be simpler, knowing that this pump was in place. We would continue to hold the teacher’s hands over the coming weeks, however, that is always going to happen. We send our daughter to kindy now knowing that the pump will alert people if there is a problem and that we can rest assured that things will be ok and she will be home at the end of the day having had a great time at kindy.

This has been an unexpected and extremely welcome change, because our quality of life has improved and will continue to get better. I know it isn't the last change that I will see, however, while on this journey, I am now dedicated to finding the solutions that will make my life and my daughter’s life better.

Here's to the next 10 years and beyond.
The patient testimonial relates an account of an individual’s response to the treatment. The individual’s account of her response is genuine, typical and documented. However, the individual’s response does not provide any indication, guide, warranty or guarantee as to the response other persons may have to the treatment. The views and opinions expressed are those of the individual poster or author and not representative of Medtronic of the third parties referenced. 1929-052015