A Pump is Not a Pancreas

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As readers of this blog may know, I have been exceptionally frustrated by diabetes recently. Usually, my diabetes I are like cranky travel companions: we don’t always get along, but eventually we sleep in the same bed at night (and that sleep tends to range between 90 and 130 mg/dl). But recently, our reluctant partnership has become severely strained. It’s to the point that if we were actual travel companions, we would probably agree that the best thing to do would be to part ways. You want to go to France and I want to stay in Greece? Fine. I’ll see you back home. 

Unfortunately, this is not possible. I appear to have done something to insult my diabetes — curse it out too loudly, I don’t know — because it’s acting out. If I were to carry my anthropomorphizing, I’d say it’s standing in the corner with its back to me, both fingers stuck firmly in its ears. So when I yell something like, “Hey, diabetes! I ate one cup of blueberries and bolused for it — so why are you at 180 mg/dl?” it laughs smugly to itself and says something along the lines of “I can’t heeaar you!!”

Anyway, this frustration peaked this week, when I exercised three mornings in a row and had the following experience: 

Day 1: 7:30-8:45 am cross-training class. Eat a 6g carb container of cottage cheese before class. Bolus 2 units (yes, that’s right, 2) for it. Blood sugar starts around 115 mg/dl; by halfway through the class it is 190mg/dl and rising. 

Day 2: 8:30-9:15 am spin class. Eat same thing, take 2 units. Start class around 130 mg/dl. End class around 130 mg/dl with no movement. Twenty minutes later, blood glucose is at 84 mg/dl and dropping. 

Day 3: An exact repeat of day 1. Except this time, my blood sugar — which started around 96 mg/dl — drops to 75 mg/dl halfway through class, and ends at a lovely 48 mg/dl with no symptoms. Awesome. 

Now, I could see there being some differences between Day 2 (spin) and the others — namely that it was an hour later and it was 45 minutes straight cardio instead of 20 minutes cardio and then weights. But Day 1 and 3 were essentially the same. What the fuck, diabetes? What. The. Fuck. 

Anyway, at some point during all this I wrote to my endocrinologist to express my frustration at all this. I love my endocrinologist — she’s about my age and, while she doesn’t have diabetes herself, she gets that it’s unpredictable like that. When I told her I had never been able to figure out a carb/insulin ratio that worked consistently (and thus that I guesstimate), she didn’t force me into yet another insulin workshop. She listened to me. 

And when I sent her this email, she wrote back to me — already showing that she’s an excellent doctor — and it started not by accusing me of misbehaving, or even making suggestions. Instead, it began, “I am sorry to hear you are having all of these issues. I can’t imagine how frustrating it is.” 

She had me at hello. But then, later in the same email, she said something that I think should be made into t-shirts and worn at any and all diabetes advocacy events: “The pump is not a pancreas.” 

Such an obvious statement, but one that too often people don’t seem to get. I can’t count how many people have checked out my pump, listened to me explain it, and then said something like, “Oh, so you eat and it just figures out what to give you?” — and then have looked truly shocked when I say no, it doesn’t work like that. 

A pump is not a pancreas. 

I’m going to keep repeating that to myself throughout all this frustration — not to mention the next time someone asks me about this bulge in my pocket. And I’m going to keep hoping that more doctors adopt the same attitude my doctor has — one that recognizes the challenges that come with diabetes, and the unpredictability of having to live with a constant travel companion whom, frankly, you wish you could leave at home. 

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Bridget McNultyCathy LSheri Zeric Recent comment authors
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Bridget McNulty

Hey Catherine,
While I can’t comment on the pump stuff, I can totally relate to the schizophrenic blood sugar reactions… My normal response, if food or exercise doesn’t make sense, is to blame hormones. If it’s not the right time of the month for that, I’ll check if my insulin is ‘fresh’. I know a lot of diabetics don’t ever blame their insulin, but it can be really sensitive to heat and changes in environment – sometimes it’s as simple as that!

Cathy L
Cathy L

Thanks for another great post!  Now I have a snappy answer for all those people who “suggest” I look into getting a pump for my son as if this is the cure all for all our diabetes related struggles!  Just was wondering if anyone out there has experimented with eating a small portion of fermented foods with each meal in order to control spikes?  We have had some success with Greek yogurt (drain high quality natural yogurt into a cheesecloth) eaten with breakfast.

Sheri Z
Sheri Z

I love it!  I have an endo appt tomorrow and I find that my insulin to carb ratio sometimes works, sometimes doesnt.  I cant find any reasoning behind it.  I can basal test til the cows come home, but that doesnt mean that tomorrow its going to work.  I’m going to remember that as well, “A pump is not a pancreas”.  So simple.. and so true!  Thanks for sharing.

eric
eric

My dr is the same way. She is very understanding and doesn’t give me grief at all. Says that everyone is different and that I shouldn’t put so much worry into it because my basal keeps me in the right range when I am not working out. That I should monitor and remember when and how my BG responds each time and shoot for an average. Safer to keep in the 150 range for me because of the sudden drops I have. I always feel so much better after talking to her than I did with the dr before her.

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