Ad hoc

Our evaluation after the first couple of months on the pump was, that daily life had almost immediately become easier. Emilie’s initial focus on the needle disappeared after a week or so, she quickly became accustomed to taking her boluses herself – with our guidance – and she did not feel restrained by the device that she had to carry along all the time.

So we were optimistic about the first HbA1c that Emilie had taken after two months with the pump. And we were deeply disappointed: 7,7%, it said …

7,7! That was 0,3 point up from the last HbA1c before the pump. That was not the intention and we were somewhat depressed by this result. Our endocrinologist offered monthly HbA1c-tests to monitor the progress and we continued tuning the basal rate and learning this new way of doing things. And, to our great relief, our efforts paid off.

Three months after starting pump therapy Emilie’s HbA1c was 7,3% and one month later: 6,7%. Since then Emilie’s HbA1c only twice has been above 7,0% with long periods of time around 6,5% – and a ‘record’ of 6,1%.

Her average HbA1c on pump is 6,76%. On pen therapy the average was 7,61% – which means that Emilie’s average HbA1c has dropped 0,85 point or 11 percent comparing the two regimens.

Our way of explaining the initial disappointment is, that pump therapy almost immediately removed the lowest of the low blood glucose values. At the same time we concentrated on getting the basal profile right which meant that we sometimes refrained from correcting semi-high blood glucose values with an extra bolus. Those two things had to raise the average blood glucose value and thereby the HbA1c. After the first months, the basal profile was rather good and the high blood glucose values that still could – and can – occur, Emilie and we started to correct immediately.

While talking numbers and figures we could add that the development in Emilie’s weight and height – during pump therapy as well as pen therapy – has been normal, and that her Body Mass Index has not been growing on pump therapy.

Another important issue is Emilie’s sensitivity to insulin during pen therapy, initial pump therapy and now, where she has been ‘pumping’ for three and a half year.

Before the pump, we took around 1 U of insulin to 10 grams of carbohydrate. But this rule was highly unreliable.

After a year of pump therapy, we could rather precisely calculate 1 U of insulin to 20 grams of carbohydrate.

And today, having used the pump for three years, Emilie normally takes 1 U of insulin to 12 grams of carbohydrate.

Emilie’s insulin consumption in proportion to her weight has also showed an interesting development.

On pen therapy, her Total Daily Dose was around 36 U in 24 hours. Her weight was 29 kilograms, which means she had around 1,2 U for each kilogram of bodyweight.

With the pump, her Total Daily Dose dropped almost immediately to around 23 U. After pumping for a year her weight was 33 kilograms, which equals 0,7 U a kilogram.

At present, when Emilie is in a phase of her life where insulin sensitivity drops for natural reasons, her Total Daily Dose is around 40 U and she weighs 47 kilograms. Which means that she gets around 0,9 U for each kilogram.

Still relatively a lot less than when using pen therapy.

This is the eleventh post in a series - read the first post here.

Read the next post.