Early Reluctance by SugarVal

You’re standing on a winding trail at the precipice of a sheer cliff. The ocean crashes on the rocks below. Sidle up to the cliff and peek over the edge. Certain death. Look behind you, to the edge of a forest in the near distance. Hungry wolves with dripping jaws and glowing eyes wait, and watch.

Next, you’re blindfolded and told you must run along that twisty path that follows the uneven contours of the cliff’s edge. Although you can’t see, you must run as close as possible to that edge or else the wolves will leave the forest, run you down, gobble up your toes and snack on your eyes for dessert. And, you must do this for the rest of your life.

Is this the next young adult smash hit book turned movie in the vein of Hunger Games or Maze Runner? No, it’s just a (slightly) over-dramatized metaphor for living with Type 1 diabetes.

“Keep your blood sugar low!” they tell you, even though that means coming dangerously close to sudden death from hypoglycemia, like plunging off the cliff onto the rocks below. “If you run too high you’ll lose your feet, go blind, need dialysis!” A fate perhaps worse than death, like being consumed alive by those pesky wolves.

But thanks to new, technologically advanced insulin pumps and continuous glucose monitors, this nightmarish scenario has changed. The blindfold is removed, there’s a guardrail on the edge of the cliff, and a fence between you and the forest of wolves.

Or at least, that’s what my hope is.

I was diagnosed at age 32. My onset must’ve been gradual, since I didn’t end up in the ER--I only went to the doctor after having bad foot and calf cramping at night, but my blood sugar was above 650. I started on MDI (Multiple Daily Injections). During my first years as a diabetic, my A1Cs weren’t great, but they were okay— mostly in the 7 range. Maybe I had a longer honeymoon phase than most. Fast forward 13 years, and they had gone way up, at one point even going above 10.

It wasn’t for lack of trying. I didn’t feel as though my control was any worse than before—it had always been, well, random. I could do one thing one day and get a good result, do the exact same thing the next day and get a bad result. But the numbers don’t lie and something was getting worse. Maybe it was my attitude. My natural optimism could only take so much, and the harder I tried to outsmart my unpredictable glucose levels the worse I would fail. I’d decided the return on investment just wasn’t there, that it was better to make friends with the wolves then fall off the cliff.

Last fall, my new nurse practitioner suggested I try going on an insulin pump. I’d always been resistant to the idea. I’d worn one briefly during a clinical trial many years ago, but was relieved when it was over. I took it off, shucking off the claustrophobic feeling, and happily went back to using insulin pens. But at this point, with my horrible A1Cs lurking over my head, I thought “What do I have to lose?” With the added incentive that if I went on the Medtronic 630g before the end of 2016, I would be fast-tracked onto the new 670g, the first hybrid closed-loop system, when it came out the following spring, I decided to give pumping another try. Pump users and doctors I had talked to over the years all said similar things, “You’ll love it, it’ll change your life. You’ll finally have control.” I allowed myself a smidgen of hope.

I started on the 630g pump and CGM system. But it wasn’t an easy fix. I still had highs and lows. I was also struggling with kinked cannulas on my infusion sets, leaving me with no idea how much insulin I’d actually gotten. And the Enlite sensors weren’t very accurate. At night the CGM would read falsely low, waking me up so often that I was operating in a sleep deprived haze. I ended up turning the damn sensor off completely at night, negating any benefit of low blood sugar warnings at night. To top it off, my A1C actually went up, from 9.2 to 9.3 during the 8 months I was on the pump. To say I was discouraged, depressed, and pissed off is an understatement, and my diabetic educator seemed as frustrated as I was. “Help is on the way. The 670g is coming out soon,” she said. With its hybrid-closed loop system that could react in real time to my insulin needs, it might be the answer. But I was still skeptical. Could this new pump really change my life?

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