You know those cascades of little mistakes that suddenly add up to a big one? Well, one of those cascading failures happened to Bisi and me the other day when I was driving her to a play rehearsal.
I always have her test herself in the car before we get there, since it’s a three-hour rehearsal without adults who are medically trained, so I want to know what her blood sugar is before dropping her off. I handed her the Omnipod kit, she tested herself, and then I noticed a warning light on the dashboard announcing that her door was ajar. At a stop sign I asked her to re-close it. As I started driving again I felt a little bump under the wheel.
“Mommy! My pump fell out of the car!”
She had let the case fall down by her seat (with the Omnipod, the controller, or PDM, is separate from the insulin pod), and it had fallen out when she’d opened the door. She jumped out and got it, then opened up the case. The distinctive smell of insulin filled the car—to me it smells like burnt rubber. The insulin bottle was crushed.
Bisi took a look at the controller itself. “Oh my god, the pump is totally ruined!”, she told me. “The whole screen looks like black ink.”
She burst into tears. “What are we going to do?”
I told her it was going to be okay, that I’d go home, order another one, and that it would probably be there in the morning. In the meantime, she could only eat the low carb portion of her snack at rehearsal, she could rely on her CGM to know her blood sugar, and we’d do injections for meals at home. She was not happy about the thought of going back to injections, even for just a couple of meals, but she took a deep breath, pulled it together, and went off to her rehearsal.
Omnipod said they could deliver the new PDM by noon the next day. Her pod was not set to expire until the next afternoon, so we didn’t have to worry about doing a separate basal dose, as the pod was still giving out Bisi’s basal insulin. But it was disconcerting to have a night where we couldn’t make any of the little adjustments that we often do: turning down her basal by 50% for an hour, or something like that. Also, while using a needle again wasn’t as bad as Bisi thought it would be—she says putting in the CGM and the pod hurt more—it now feels like an unacceptably blunt instrument (pardon the pun), since with the pump we can give one tenth the amount (.05 of a unit) that we’re able to give with needles, where the smallest—and still imprecise—dose is .5 of a unit.
By 10:30 am the next day, Bisi’s new PDM was up and running, and all was well. But I took a couple of lessons away from the experience.
- Take a screen shot of the carbohydrate ratios and basal doses whenever you change them, so they’re easy to recreate. I had to call up Bisi’s endocrinologist and get the settings as of her last appointment, settings that we had made multiple little changes to in the intervening months.
- Always have a bottle of unexpired Lantus in the fridge, just in case you need it (we had some Lantus, but it was old).
- Make sure you know where your PDM is before you open the car door!