I’ve been using the t:slim pump for the better part of a year now, and over the last few months (here’s a handy disclosure that you should read for context on my relationship with Tandem), I’ve appreciated the new set of options that the t:slim has brought into my diabetes life.
… man, that sounds a little formal. I’m too pregnant for formality at the moment. (My feet have officially given up on being feet and refuse any covering other than socks or flip flops, and my son is moving visibly as I type, making sitting close to my desk a challenge. Eff formality.) The reasons for the t:slim being a badass addition to my diabetes management RIGHT THIS SECOND are that I can take a bolus in a matter of seconds without scrolling through fifty different screens, I can edit my basal or insulin:carb needs with a few beeps, and the 300 unit reservoir is going to come in handy these last few weeks of pregnancy.
One challenge I’ve historically had with the t:slim pump, however, is the clip that is shipped out with it. For me, the clip was a little bulkier than I preferred and also not as secure as I needed. I wanted streamlined and secure, and as my pregnant body expands and clothing options like “pockets” and “waistbands” have been shoved into the distance. I need my pump clip to be able to hang on by a thread.
A friend suggested this clip to me and gave me one of theirs, but since trying it out, I’ve keep a spare or two on hand because it seriously solves all of my pump clip troubles. The tape is very secure and I’ve had the same pump clip stay successfully stuck for the last six months. I have no relationship with the company who makes the clip, and this is not an affiliate link or anything like that, but if you want to try out a pump clip for your t:slim (or any other pump) that is subtle, streamlined, and strong, this Nite Ize Hip Clip is worth a shot.
Hey! An informative post! Who saw that coming? Not me. Bring on the cat gifs.
Funny thing is the timing of that switch. When I packaged up my Animas pump in favor of a Tandem one, I had also just found out I was pregnant. Which means that I was adjusting to life as a pregnant PWD and also to a new insulin pump.
tl;dr – There’s stuff about the t:slim pump I wouldn’t have appreciated so soon were it not for the baby-en-route.
Because dude, if I had switched a year ago, I would have been all, “Oh, it looks so cool and the touchscreen is badass, and the fact that it’s flat all the way across the front makes it easier to tuck into my clothes,” making the wearability the most important part of my switch. Yeah, wearability matters, but not as much as ease of use and OUTCOMES does these days.
(None of the following is medical advice; remember, I’m not a doctor and currently can’t even see my feet in full these days.)
Entering a bolus is stupid-easy. And this matters, since every blood sugar counts double these days (for me and for my growing son). It takes me a few seconds to unlock the pump and bang out a bolus, and only a few extra seconds to add crucial information like my current blood glucose and the carbs I’m consuming. Part of my over-arching problem of diabetes management is keeping apathy from creeping in; the all day, every day tasks of type 1 diabetes wear on me in a way that prevents me from taking advantage of everything technology has to offer. Oh, so an insulin pump can calculate my insulin on board (IOB) and the dose I need to bring down a blood sugar back into range, or what’s needed to cover X amount of carbs? HANDY INFO! The only thing I have to do is enter that information and it spits out a result? ALSO HANDY. But having to scroll forever to enter information is enough to keep me from entering that information.
It’s pathetic, how often I was taking 2u of insulin because it seemed “close enough” to cover what I needed, instead of spending the time calculating the proper dose. Being able to input this necessary information in a matter of seconds makes me actually DO IT. My endo is very pleased with this uptick in my management, and my A1C 100% reflects these efforts.
Changing my basal rates is stupid-easy. Being pregnant means that my insulin needs are changing rapidly. First trimester brought about insanely sticky hypoglycemic events, which equaled out to dialing down my basal rates significantly and making frequent use of the temp basal option. (Again, it’s about the button pushing – it takes me seconds to set a temporary basal rate. Ease of freaking use FTW.) Second trimester showed a steady climb in my weight and insulin resistance, with a marked rise in my basal rates and my insulin:carb ratios. And now, at the beginning of the third trimester, shit is changing all over the place, with some basal rates going down a little bit and my insulin:carb ratio almost double what it was pre-pregnancy. There’s a lot of math going on in my baby-building body, and being able to change my rates after reviewing my data on Diasend and t:connect makes for easier management.
Holding more insulin is stupid-easy. The t:slim holds a ton of insulin (300u) and as my pregnancy progresses, I may need that cartridge to be filled in full, instead of the half-way filled I’ve been doing for the last six months.
Seeing my status is stupid-easy. One button push shows me how much insulin is on board, how long it will be active, shows how much insulin is left in the reservoir, the percentage of charge left in my battery, and the time. Oh, and what day it is. (This matters, as the day and time are bits of information that are being eaten regularly by intense pregnancy brain.)
Not everything is stupid-easy. This isn’t a list of perfect moments with my insulin pump. There are pros and cons, and the time it takes to change out the cartridge and infusion set is still cumbersome. I also am not a fan of the luer-lock tubing bulge, as it takes on a “third nipple” appearance more often than I’d prefer. And I’ve seen more occlusion alarms with the t:slim than I did in the past. But I’ll these cons over the pros, especially when I review my lab work from Joslin and see how strong my numbers are.
Being more on-target through my pregnancy is not stupid-easy. Let’s not make my successes as a pregnant PWD the product of an insulin pump, shall we? I am working my ass off to make sure my body and my baby are healthy, with just over 11 weeks left to go before we release this particular Kraken. But having a piece of technology that alleviates the bolus math angst, makes it impossible to forget whether or not I’ve taken my basal insulin, and being able to bang out a correction dose in a matter of moments helps take the pressure off, at least a little bit.
For several weeks, I was flipping open the charging port on my t:slim insulin pump and plugging it in while I was in the shower. But then I noticed the charging port cover was looking a little worse for the wear, and I connected with a friend about best practices. (“Best practices” standing in for “How the hell do you charge this thing without breaking the door off?”)
Turns out the door swivels. And swiveling the door keeps it from ripping.
If you were at the ADA Tour De Cure event at Freedom Plaza in Washington DC last September, you might remember this diabetes rant from the drummer:
He’s a group fitness instructor, a public speaker, and has a day job working for the government. And he’s also the drummer for the three-man, DC-based rock band Fellowcraft. Brian Nelson-Palmer is something of a Renaissance man, and he is also a person with type 1 diabetes.
Brian was diagnosed right around his fourth birthday, in 1987, and last night, he let me crash his evening via telephone interview.
“I’m not sure of the exact date, but it was really close to my birthday. I kind of consider it my 4th birthday present,” he said, reminiscing about his diagnosis. “I was going to the bathroom a lot, and I started wetting the bed. My mother suspected some kind of kidney issue, but after visiting the doctor, it turned out to be type 1 diabetes. So I was in the hospital for one night …”
“Wait … you were in the hospital for a night? Just one night?” I felt bad interrupting during an interview, but my diagnosis included not one, but two 12 day hospital stays back in 1986. Did a year between our respective diagnoses make all the difference?
“Yeah, a night, or maybe it was a few nights, wasn’t too many though. I remember hiding under the bed from the nurse. She thought I had run away, but I was just scared of the needles.”
Brian and I talked a lot about that transition from being diagnosed with diabetes as a small kid and growing up to take the reins of this disease from our parents.
“I started taking some care of myself, independently, in first or second grade. I would go to school and no one knew much about diabetes. My mom and dad knew a lot about diabetes, but out in public, I was the only one I knew who had it. My teachers didn’t know how to check my blood sugar or anything like that. So I needed to take care of things on my own,” he said.
“Did you use those old meters?”
“Yeah. Back then, each blood sugar check took two minutes on that old Accu-Chek meter. You had to put the blood on the strip, wait 60 seconds, wipe it off and stick it in the machine, wait another 60 seconds …”
“I remember that one. So you started gaining some diabetes independence in first or second grade. Was there a moment, or are there moments, where you felt that you were starting to assume big parts of your self-care?”
“The day I got an insulin pump was a big moment. I was 16 at the time, back in 1999, and I had one of the first Minimed pumps. I jumped on that bandwagon and I loved the independence. I could go to a friend’s house to sleep over without having to pull out syringes.”
“Did you feel like the syringes earned you some weird looks?” I asked.
“It was more of a desire to be ‘normal.’ Whenever I pulled the needles out, I got attention and I often tried to shy away from that attention. It wasn’t that I hid diabetes. I didn’t mind if my friends saw things I was doing and asked me about it, but I didn’t want it to be a big deal.”
“But music was, and is, a big deal. Talk to me about where the love of music came into play.”
“I’ve been on and off with music my whole life. I was in band through school – played drums from 5th grade all the way through to Florida State. But then I took a break from music. I branched out from drums and tried other activities in college and then graduated and got a ‘real job.’ Twelve years after I put the sticks down, a friend, JR MacDonald, texted me one night and said ‘Hey, I’m starting a band. You in?’ And it went from there. Even with a twelve year hiatus from drums, I picked them up again that night and started right back up.
image from Fellowcraft FB page
“And that became Fellowcraft.”
When Brian and I connected yesterday morning, he sent me a link to their album, Get Up Young Phoenix, and I spent the day listening to it. Some really good stuff on there.
“We call it rock, it’s really a fusion of blues, funk, and rock together. It’s fun for me because I am formally educated through the public school system in all types of music and percussion. Now, just like back then, I don’t just play square rock beats. Like the song A Thousand Sunsets – it started out as a really slow ballad and we noticed that it did great at one show, but at other shows it became the bathroom break for people, or the moment when people went to get a drink at the bar. It didn’t have the energy and excitement that people seemed to want. In rehearsal the next time, we changed it up and I tried a bossa nova beat. We called it ‘the remix’ for a while, and it quickly became the regular version” He laughed. “My high school band director would be so proud.”
“You’re on stage, playing and doing your job, and diabetes is there in the background the whole time. How has diabetes influenced your experience as a musician?” I asked.
“Diabetes doesn’t affect my life as a musician. That’s the wrong order. It’s about preventative care. I have a Dexcom G5 so I can see where my blood sugar is and where it’s tracking. And when I’m onstage, I can’t check my Dexcom, so I need to start in a good place. The crowd doesn’t see what I’m doing and I don’t want it be part of the show. People come for the music, not for the diabetes.”
“So you wearing a Dexcom and are you also wearing a pump, still?”
“For the pump, I wear the t:slim,” said Brian. “Thanks to some insulin resistance, the 300 u reservoir is necessary and … well, I’m a technology guy. It’s a touch screen, it has a color screen, and it’s faster to input everything. The t:slim takes less time to be a diabetic. That and the Dexcom … their products make it so much easier to be a diabetic and to do what I do.”
image from Fellowcraft FB page
“Thanks for talking with me, Brian. I’m excited to see what’s next from you guys. Any parting words for the diabetes community?”
“It’s not going to stop you,” he said, his voice firm but friendly. “Whatever your goals are for life, you can still achieve them with diabetes. I pursue anything and everything that interests me, which is why I do so much. I consider myself fortunate and lucky to have found two of the best guys, JR Macdonald and Brandon Williams, to pursue my passion for performing music with. If you find that kind of fortune or passion in your life, go for it and don’t look back. Diabetes is a part of you, but it doesn’t define you. You define you.”
Earlier this week, I flew to San Diego to visit with the team at Tandem and brainstorm some plans for 2016. It was a quick trip (managed to land right when that weird storm was picking up speed – made for a very exciting landing and also reinforced my hatred of flying), but a productive one.
On Tuesday morning, before leaving for the airport, I needed to change my pump site. In the winter, my skin has a tendency to become scalier and more irritated than in the warmer months, so skin real estate is a real issue, and site rotation is important, yet it’s challenging to find a place that wasn’t already somewhat rotten.
Against my better judgement (and mostly because I was in a hurry), I made the mistake of inserting my infusion set onto the back of my hip. Normally, this placement is awesome and totally out of the way, but that morning, I managed to stick the site exactly where my waistband was situated. It was also exactly where I would put my hands when pulling my pants on or off, making it a high traffic site. But whatever – I was in a hurry, the skin was good there, and I’d just be really, really careful when sitting / visiting the ladies room / getting dressed.
I made it about six hours before I ripped the site off completely.
This moment happened at the end of my five hour flight home from San Diego, as the plane was starting to land. Thanks to a paranoia about blot clots (hat tip to that pesky Factor V Leiden bastard), I drink a lot of water on long flights and get up from my seat very often. (Apologies to anyone who has ever sat next to me on a plane.) I wanted to duck into the bathroom very quickly before the plane landed, and in my haste, ripped the pump site out with swift precision.
Blood streamed down the side of my hip. Not optimal. In a panic, I looked at the bathroom walls and door to make sure my grossness was contained, and thankfully it was, except now I had bloody paper towels and the plane was descending quickly and fuck I needed a new site in a hurry. After cleaning myself off (stuffing the bloody paper towels into my pocket because I didn’t want to throw them in the garbage), I went back to my seat and said a silent thank you to my always-over packed carry-on. A large Ziploc plastic bag that carried snacks and glucose tabs was emptied out and became the medical waste bag. As the flight attendants were preparing the cabin for landing, I grabbed my extra infusion set and stuck it into my stomach without anyone noticing. A quick fill of the cannula and I was back in business. My horrible paper towels and infusion set garbage were contained and concealed without issue.
THIS IS WHY I OVERPACK. Every time. I get some flack for keeping an infusion set in my purse all the time and for carrying insulin pens, too, because rarely, rarely is there an issue. I could not have foreseen the need to change out my site at my seat on the plane (fuck you, Miss Manners), but when I ripped out my site, it was less jarring to discreetly change my site than to spend the next two hours driving home to Rhode Island from Boston without insulin.
The moral of this story? Insulin is necessary on the ground and at 37,000 feet. Be prepared when you travel. And for crying out loud, bring back ups because Insets are only available in first class.
I am not a doctor. I am not a certified diabetes educator. I have no medical degree. Nothing on this site should be taken as medical advice, and if you are taking it as medical advice, I suggest you contact your doctor immediately for issues other than diabetes.
This is my diabetes life - if you are interested in making changes to yours, you need to consult your doctor.
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