Friday, November 9, 2012

pump logistics

Since it's November (Diabetes Awareness Month) and since I get a lot of questions about it, I thought I'd dedicate another post to Boogie's pump.

The questions I get the most are along the lines of "was it a long surgery to get his pump placed?" or "was that something they did in a on office visit?", etc.

This is a very common misconception.  The pump is not surgically implanted in him.  It is an external device that administers insulin through a tiny needle at his "infusion site."  I'm sure in a few years Boogie will hate me for sharing this picture, but I think it's the best way to help explain how it all works.

Yikes! Right? All those devices on such a tiny little bum!

I'll start at the pump (the blue thing Boogie is holding) and work our way down.

If you follow from the pump you'll see a piece of thin tubing, this is where the insulin flows from the pump into Boogie. The next thing you come to is labeled "pump site anchor." This is what we refer to as "just a sticker." It's a halfway point between the pump and the actual infusion site where the insulin flows into Boogie.  It acts as an "anchor" so that if something pulls on his tubing (gets caught on clothing, little fingers of a curious sister, etc) it will protect the insertion and it won't all get pulled out. [hmm, did that make sense?]. It also acts as a place where we can disconnect his pump without having to completely remove the infusion site and "re-poke."  The pump itself is not waterproof so we can detach it for baths, swimming, etc. and then easily just plug it back in and not have to change the needle site.

Continue following the tubing down until you come to the point labeled "pump insertion site."  This is also referred to as the infusion site.  This is the actual point where the insulin is inserted or infused into Boogie's body.  At this site there is a tiny needle attached to the outer sticker that is inserted into the skin and stays in place. Here is a close up picture of the actual infusion site needle.

The infusion set (anchor, tubing and insertion needle) has to be changed every other day and the site in which it is inserted must be changed every time (we basically switch from one tushie cheek to the other each time). One question you might be asking in your head is "why is it all in his tush?"  The infusion site (and the CGM sensor, which we'll get to in a minute) must be inserted into sites that are "fat friendly;" body sites that are plump.  For most people this includes the bum, thighs, stomach and back of arms.  On my tiny little, skinny mini his tush is about the only place that qualifies (plus it kind of keeps it 'out of sight, out of mind.").

Going back to the original picture of Boogie's Bum, the other thing you'll see labeled is the CGM sensor and transmitter.  This is his Continuous Glucose Monitor.  It is monitoring interstitial (the fluid between cells) glucose levels 24/7.  It helps give us trends in his glucose levels and also will alert us if he's starting to crash low or get too high. This device has been a life saver, literally, and I can't imagine not having it.  The sensor is a thin copper wire that is threaded into a needle and, using a scary looking insertion device, is inserted into the skin.  The needle is then removed (thank goodness) and the copper wire stays behind.  A small transmitter device is clipped onto the outer portion of the sensor and transmits the data to his pump. Here is a close of picture of the insertion device and needle.

Ouch, right?! Thankfully, we only have to change the actual sensor once every 6 days.  Since the sensor is only FDA approved for 3 day use, we have to restart the sensor every three days, but clinical data shows that the sensor is actually good for 6 days or longer.  We have to constantly calibrate the sensor with blood glucose readings, so the longer the sensor is in, the more calibrations it has, thus the more accurate it is.

I hope that all helps answer a lot of the questions you've had about how it all works.  There's lots more to learn, but all spare you the gory details...