![\"Bisi](\"https:\/\/asweetlife.org\/wp-content\/uploads\/2013\/11\/Bisi-with-first-Insulin-Pump-225x300.jpg\" "\\"Bisi")
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We are about to embark on the biggest transition since Bisi was diagnosed: she\u2019s about to start on an insulin pump.\u00a0 When she was in the hospital, they told us that most people are ready for this transition about a year after diagnosis\u2014that before you go on the pump, you need to understand the disease, understand how to do injections, understand how to count carbs, and understand the whole new routine of diabetes. We now know how to do all that, but still, I\u2019m nervous and hesitant about the transition, and it probably wouldn\u2019t be happening yet if Bisi hadn\u2019t been pushing for it. More accurately, it\u2019s\u00a0because<\/strong>\u00a0we know how to do all this with injections that I\u2019m nervous about switching to another method. It\u2019s leaving behind the known for the unknown. But she is beyond sick of getting shots, and it\u2019s not fair for us to delay any longer than we have.<\/p>\n For those unfamiliar with the day-to-day routine of diabetes, there are some key differences between how injections work and how pumps work. With injections, the smallest amount of insulin you can give is \u00bd a unit. So there are often times\u2014snacks, or meals where she\u2019s not eating a lot of carbs, where Bisi doesn\u2019t need to get insulin injections. For Bisi, anything below about 15 carbs is \u201cfree\u201d\u2014no insulin required. But the pump can give exact, tiny doses, so every time Bisi puts something with carbs in her mouth, we should test her blood sugar, calculate the number of carbs, and give her the insulin to match. This means that in theory you can achieve tighter blood glucose control on the pump along with less severe swings in blood sugar, because you\u2019re able to give exactly the dose of insulin needed to cover the carbs you\u2019re about to eat. But this change will be an adjustment, since I tend to use snacks to give her a \u201cboost\u201d in her blood sugar to keep her safe when she\u2019s going to soccer practice, or to extended day, or over to a friend\u2019s house. I feel nervous about giving that boost up.<\/p>\n Another big difference is how the basal, or baseline, dose of insulin is given. Right now, Bisi takes a shot of Lantus, long-acting insulin, once a day. This means that she always has some insulin working in her body\u2014essential because even if Bisi were to eat nothing all day, her liver would still release glucose, which needs to be balanced by insulin. With the pump, rather than getting a Lantus shot, she\u2019ll get a tiny drip of Humalog (short-acting insulin) throughout the day. If the pump malfunctions without our realizing it, she will have no baseline insulin in her system, and could go into diabetic ketoacidosis if we don\u2019t discover and remedy the problem soon enough.<\/p>\n When the body can\u2019t use glucose for fuel (insulin is the key that unlocks cells, letting glucose in), it burns fat cells instead. As the fat cells are broken down, they release ketones, which are toxic to the body. (In 2009, the most recent year for which stats are available, 140,000 people were hospitalized for DKA.) On the pump, this means that whenever Bisi\u2019s blood sugar goes over 250 (a fairly frequent occurrence), we have to be much more aggressive than we have been about testing her for ketones. If the ketones are above a certain level, we are supposed to immediately give her an injection of insulin. Only then should we problem solve what\u2019s going on with the pump.<\/p>\n Several kinds of pumps are on the market; together we chose the Omnipod, a little plastic case, about 2.5 inches by 1.5 inches, filled with insulin and stuck somewhere on Bisi\u2019s torso or leg. The Omnipod, unlike all other pumps, is tubeless, meaning it\u2019s stuck directly onto the skin, rather than separated from the body by plastic tubing. The other day we met with someone from Omnipod at our house, and she helped get us started by showing us how to put in all the necessary settings and how to install the pump. For the initial week, the pump is filled with saline, not insulin, so we can learn how to use it without consequences. It\u2019s controlled by a separate, small computer, about the size of a double-thick iPhone, that also serves as a glucose meter, can calculate her carbs, and stores all of her dosage data.<\/p>\n At the end of the session, we stuck the pump on Bisi\u2019s back. Controlled by the PDM (personal diabetes manager), a tiny needle inserts a little plastic tube from the pump into Bisi\u2019s back. Her nurse had told us to sing happy birthday to distract her from the insertion, but Bisi chose Taylor Swift\u2019s \u201c22\u201d instead. \u201cIt feels like a perfect night to dress up like hipsters [Bisi used to think Swift was saying hamsters instead of hipsters], make fun of our exes, uh huh\u2026\u201d POP. When the needle went in, Bisi\u2019s eyes widened and she swallowed hard. It clearly startled her\u2014she said it felt like a balloon popping inside her body. Starting next week, if all goes well, Bisi will be facing just one \u201cballoon pop\u201d every two or three days, rather than the 4-5 daily injections she now gets. She can\u2019t wait to make the trade.<\/p>\n