Ladies and gentlemen, I am now plugged into an insulin pump, and have been for about the last ten hours.

When I was about eleven years old, Reebok Pump basketball shoes made their first appearance in my home town. One of my childhood friends, BM, skipped school in the morning so that he could be the first one to come to school with a pair of shoes that cost slightly more than my mind could fathom at the time. He strolled in at around 10:00am with a pair of white, blue, and black high-top shoes, complete with the air pump on the tongue of the shoe to ensure a perfect fit. (Do kids much younger than me even remember what Reebok Pumps are?) Hilariously, BM's close friend, TW, quickly left school after lunch, only to return in the late afternoon with a near-identical pair. Those two boys were so popular at school that no one saw this as the rather pathetic gesture that it was... No one except me, of course. I've always had a bit of a philosophical, analytical bent. Whore Culture made itself apparent to me very early on in life.

A couple of decades later, I find myself the very first one on my block (that I know of) with a fancy new insulin pump! Not quite as exciting, I admit, but not half bad. So, without further ado,

Here's What You Can Expect When You Initiate Insulin Pump Therapy
First of all, the pump itself is not anything to fear. It makes bolus dosing easier, not more difficult. And you don't have to basal dose, really. The pump does it automatically, and if you set it up with your health care team, it will be smooth sailing.

The rough part is the transition itself. The night before you initiate pump therapy, you will likely have to take a reduced dose of long-acting insulin. While "in theory" this should pose no problem, my experience was that the long-acting insulin quickly worse off and my blood sugar spiked. Truth be told, I woke up at 1:45 AM with a BG of 18.9 mmol/L, feeling like I'd been hit by a truck. It wasn't pretty. I took myself down with a dose of Humalog, but the fact remains that the transition was bumpy and involved an extended period of hyperglycemia. No ketones, thank goodness, but unpleasant nonetheless.

So, functionality is easy, transitioning is difficult. What else can you expect?

Well, you can expect to monitor your blood sugar carefully (read: every two hours) for a few day. You can expect to toy with your basal rate a bit, trying to find the "sweet spot." I am not yet twelve hours into my experience, and I already know I'll be a tinkerer once I get used to this thing. This is a major benefit of pump therapy. Pumps play to people like me, who enjoy fine-tuning an intricate process. Perhaps diabetic golfers, diabetic model train enthusiasts, and the like, will also warm up to this aspect of pump therapy.

Conceivably, though, people who dislike having a lot of buttons and controls - technophobes, if that's a fair word to use - will perhaps find their new responsibilities daunting. These folks might be better off on a more classic basal/bolus regimen.

You can expect to have a new object attached to you. This isn't as bad as you fear. My pump comes with "quick release" accessories, which enable me to unplug my pump for showers, swimming, or any other moment of life where you might be worried that a pump would get in the way. So in that respect, there isn't much to be concerned about.

On the other hand, if you're not used to wearing a Blackberry all the time or something, and if you're clumsy like me, you might have to take extra care to ensure you don't bang your pump on a hand rail as you walk down the stairs, or catch your keys on the tubing or whatever. This is not a serious problem, but the danger exists, and frankly it is one of the major things I have on my mind today. I've been guarding my pump almost like it's a kitten. One day, I will be so accustomed to the pump that I'll no longer be as careful, and this is my real concern. For the first couple of weeks, I'm on my guard. What happens when I let it down?

The Bottom Line
Perhaps the most significant aspect of transitioning to pump therapy is not what I've just written, but what I have not written. What I mean is that the change so far is not that major. As of today, right now, ten hours into it, all I can really say is that it has not made a big impact.

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