A young adult perspective by Allison Blass
I went on the pump six years ago, when I was 15. At the time, I really didn’t know very much about it other than it was something I had to wear all the time. Having something attached to me seemed like the uncoolest thing in the world. However, I also did not want to take a shot at school. Unfortunately, my A1C and my rising lunch blood sugar indicated that I would have to do otherwise. My doctor, who was actually a huge fan of pumps, gave me two choices: Go on a pump or go on an astounding fifth shot. I went with the pump.
The process of adapting to my pump took approximately six months. My parents and I took classes in carb-counting (which are vitally important), and on basic pump management. Gradually, my reluctance gave way to enthusiastic acceptance.
These days, whenever I attend a diabetes event, someone eventually notices that I wear an insulin pump. I don’t make any attempts to hide it. The pump clips onto my pocket, with the wires hanging out, loud and proud. Most parents will ask, “Do you like the pump?” followed by, “Why?”
I tell them first that I’m a fan of pumps: I like how they replace injections (big plus) and scheduled meal plans (heaven-sent). I tell them that unpredictable schedules or erratic blood sugars are common reasons to go on the pump. Pumps mean the freedom to do things you enjoy without having to “pre-program” your life, like spending more time with your friends, going to a diner after football games, having New Year’s Eve parties, and going on vacations more easily because you can adapt better to the unpredictable nature of travel.
Then I tell them that choosing to get a pump will completely alter the way young patients and their parents manage the disease. Pumps are no longer the new kids on the diabetes block: Children who wear them have been shown to have lower A1Cs than children on daily injections. But I also add that it’s important to know that pumps are not for people looking for an easy way to avoid diabetes management. Having freedom also means using that freedom responsibly. The pump is not a pancreas. It will not test your blood sugar (despite the fact you wish the tubing was bi-directional, it isn’t). It will not program your insulin dose. And it will not make adjustments for stress, exercise, or hormones. Although it’s tempting to just push the buttons, frequent testing helps correct dose boluses (meal-time insulin) and check the basal rates (background insulin). If frequent testing is not something your child or teen is prepared for, the pump should be put on hold.
The pump can, however, give a false sense of security. Most pumps today are “smart pumps” and can calculate a dose based on preprogrammed ratios, sensitivity factors and previous doses. But pumpers should be aware of how their pump works so they are able to make adjustments based on other information the pump doesn’t have, like the type of food, activity level, and hormones. It’s also important to keep track of the ratios and insulin amounts on your own, in case the pump breaks (as technological devices are prone to do). In sum, a pump is another tool–a convenient, adaptable tool, and a great aid to kids and teens seeking more independence–but a tool nonetheless. It’s not a replacement for the individual and the knowledge of diabetes you must possess.