Woman, Independent Parent, Artist, Advocate, Artifical Pancreas.... and EVERYTHING in between.

I am blessed to be parenting two beautiful girls, ages eight and eleven. My youngest nearly lost her life at age six (August 2010) to diabetic ketoacidosis: an often fatal consequences of undiagnosed type 1 diabetes. This is OUR journey: raw and sometimes, uncensored.

Thank you for visiting wishing good health and a cooperative pancreas to you and yours.

Saturday, November 10, 2012

Explaning "Sites"

November is diabetes awareness month, and I always love it when people are brave enough to ask me questions about Diabetes.  There is no question too silly. Quite likely, no question I won't answer!

As of recently, I've had some inquiries about her insulin pump site.  I've had the chance to take some pictures to try and explain this process to the best of my ability.  Of course, if you have any questions that I didn't address, please don't hesitate to comment.

The picture below is Medtronic Mio infusion set.  There are, to the best of my knowledge, three main providers of insulin pumps: Medtronic, Animas, and Omnipod.  Omnipod is a funky little pump that has absolutely NO tubing (you'll see what I mean in a moment, bear with me).  Rowan (8) uses a Medtronic pump, and has since December 3/11

We affectionately refer to changing an insulin site as "harpooning" and will herein refer to it as such, for lack of a better term.
The lid of the Mio opens up (just like one of those bubble toy dispensers from the coin machine) the tubing is wrapped around inside. We stretch it out in an effort to straighten it and prevent any kinks.  Kinks can prevent the delivery of insulin, which really isn't good.

There is a needle inside, that is protected with a tiny blue sheath.  Once that sheath is removed, you will see that there is a tiny cannula around the outside of the needle.  As shown below. Or tried to show as below.

The cannula is difficult to see, because it is transparent. But if you look closely at the needle, the bottom half is kind of shiny. That is the cannula around it.  We draw back the inside part (white part on the lower half of the pink piece) and it 'cocks it' kind of like a gun. Don't ask me. I've never even handled a gun. But it's the only description I can think of. Wait! A sling shot.  Yes. I pull it back into place like a slingshot. Excellent! It is that exact force when it is released, that 'harpoons' the cannula into Rowan. 

Insulin pump sites can be worn on arms, thighs, abdomen, or high buttock.  Rowan hasn't been daring enough to attempt arm or thigh (one day! One day!) So we alternate, tummy, tummy, bum, bum.

She gets 'harpooned' once every three days.  As the cannula is inserted into her flesh, scar tissue will begin to form around it, thereby preventing the absorbtion of insulin.  Hence the rotating every three days.  If scar tissue is present, that spot won't be as receptive to absorbing insulin.  Rotate, rotate, rotate!  You might wonder how we are able to tell where she hasn't been harpooned recently. Basically: her buttocks and abdomen are covered in tiny healing polka dots from the site, so it's actually not that difficult to find a fresh fleshy spot.

Around the cannula is a patch of adhesive. This is how the site sticks to the body.  Unfortunately, sometimes they lose their adhesive before it's time to change sites, which means a spontaneous site change is necessary.

The insulin pump delivers insulin in two different forms.  Basal, and bolus.  Basal is the minute "background" amount that she receives every hour.  Bolus is the lump amount she receives all at once to cover carbohydrates consumed.  Because the pump delivers a basal amount, if the pump is not connected correctly, the diabetic is not receiving ANY insulin. This is NOT good, and it is only a matter of time until complications begin.  A pumper that has been disconnected can be experiencing difficulties within an hour.  Things go downhill much faster with a pump, but for our family, the benefits outweigh the possible complications. We just work to be extra vigilant.

The tubing plugs into a resevoir that is filled with insulin.  The resevoir is not part of the Mio infusion set. It's an extra piece that is purchased seperately.  Diabetes is a very expensive disease. I strongly suggest avoiding it to the best of your abilities.  Yes.... that's my dry humor. Hardy har har.

The resevoir plugs into the side of the pump, and the whole system works together to deliver the insulin.

This is Rowan's freshly harpooned tummy.  All that you've seen described above is the underside of what you're seeing now.  The adhesive is pressed firmly against her tummy.  The pink part actually can unplug from the site. Her pump is not waterproof, so it is unplugged for showers, swimming, or any other activity that might get the pump wet or fry it.  You are looking at a $7000 piece of machinery, so we VERY much avoid getting it wet. If something were to happen to it, we would not be able to replace it. So we guard it protectively!

Now if you look at the bottom left hand corner of her pump, you can see the tip of the resevoir poking out. You'll know you're looking at it, because of the transparent tubing attached to it. That tubing winds around and plugs into her site. 

If you are a pumper, and looking at this, you'll likely call me out about the message that is on the pump screen.  While we had some 'technical difficulties' it was resolved. Strangely enough, it was only by looking closely at this picture, that I realized things had gone awry!
I apologize for the shaky quality of the video. It was shot by my eleven year old daughter. As an "independent parent" I only have TWO hands, and harpooning is a two handed process. This gives some insight as to what she goes through every three days.  She does NOT like this process, and everytime it is the same. "I'm not ready! I'm not ready! Don't do it until I'm ready and I tell you. You'll know I'm ready because I'll take a deep breath".... two minutes later "Alright Rowan, you ready?" "NO!".... two minutes later "Alright Rowan, you ready?".... "NO!"...."Okay, take a deep breath, here we go!" at which point she gasps like her life depends on it, and I harpoon her. All the while muttering my site change mantra inside my head "please be good. Please be good. Please be good"

I utter that mantra because sometimes, unfortunately, during the harpooning process, the cannula gets bent by the inserting needle.  If the cannula is bent, the insulin cannot be delivered. No good comes from that, as I hope you've learned from this post.
Now some might ask: If she protests so much, WHY do you do this to her over and over again? My answer is simple, yet long winded.
Every day, twice a day, for fourteen months, I had to inject her.  The battle to inject was far worse than her pleas of "I'm not ready" You name the out of reach hiding spot, she found it. All the while howling about how she hates needles, hates her new life. That I should have just let her die in the hospital instead of bringing her home to live like this.  Oh the heartbreaking drama of a young girl.

I used to wake up in the morning, and within 45 seconds of waking, be having a full scale anxiety attack BECAUSE of the injecting battle that awaited me.  Heck, in the early days after diagnosis, I'd cry myself to sleep, knowing EXACTLY what awaited me upon waking.

So while this isn't the easiest of processes for her, the benefits greatly outweight the stress.
I hope this answers some of your insulin pump questions, and like I said, if you have any questions, please, don't hesitate to comment and let me know.  Answering questions is a key part to diabetes awareness, and.... after all, November IS diabetes awareness month.  Though you might not know it.  We're the ugly duckling hiding behind "Movember"

Wishing you and yours happy numbers, and healthy and productive pancreases!


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