A basic tour of three different ways to deliver insulin in through our personal experiences of a child diagnosed at 3.5yrs and the journey towards settling for the Omnipod (for now) at the age of 10yrs

SyringeThis one is going to use my little grey cells to try and remember Bethany on the syringe, she was so little and yet at only three years old she protested that the insulin pen was horrible and screamed at the thought of us using it, her prefered option was to carry on with the syringe. The hospital that Bethany was under used an old fashioned method (I believe this has been updated now) of giving the newly diagnosed child one injection per day in the morning before breakfast of a mixed insulin, if memory serves me well this was Humalog 70/30 (70% fast acting and 30% slow acting) we used to her 9units each day, which steadily increased to 12units.

Blood sugars were all over the shop and we were finding it incredibly difficult to reduce her HbA1C each quarter. Meal times had to be rigid or else we’d risk a hypo but eat too much of the ‘wrong’ stuff and she’d be spiking through the roof. One phone call to the Diabetes Nurse (DSN) later and after we’d rugby tackled Bethany to the ground and pinned her tiny body down we could give her the shot. I recall how amazingly strong Beth was when she was Hyper.

I make light of the situation but these were terribly traumatic times for all involved, Firstly Bethany, who was manhandled in the name of love and health, then myself and Brett, who were emotionally wrecked with the insanity of it all, I mean, who would wish to force their child to do something they dread … but we HAD to. Finally there was little Lewis who we tried so hard to limit his access to these episodes but this was not always possible and I can only begin to imagine what must have gone through his tiny little 18mth old head.

Clearly our family are not the best advocates for syringe as our experiences were only limited and during the most tumultuous times, however I can certainly see the benefits of having no visible signs of diabetes on your person such as an insulin pump or Pod (we’ll come onto this later)

PenThe Pens came along soon enough, Bethany finally decided to make the change when the DSN came with her wares in a little suitcase and Bethany could look through them all. Of course being Bethany she had to be different and instead of going for the children’s favourite of the Novo Nordisk with it’s injection-friendly PenMate, she opted for the adult’s preference of the Lilly Pen which could easily be mistaken for a posh fountain pen! This choice meant that we would have to still physically inject Beth but instead of a long syringe into the top of the leg or bottom, we could do this almost anywhere what wasn’t boney or straight into muscle, plus the needle was only 4mm – a vast improvement.

My tummy still turns at the thought of the little ‘popping’ sensation you get when you push and the needle breaks to the skin (try pushing a sewing needle into a peach or a plum and you get a similar momentary resistance then ‘pop’. I have a policy, do not do something to the children which I would not be prepared to do myself, therefore if the medicine is YUK, I’ll take it too, so if the needle hurts, then I hurt too. I’ve done it all, just to a) reassure myself it’s not mind-blowingly painful and b) reassure Beth I’m with her every step of the way.

By this time Beth was working her way up to Multiple Daily Injections (MDI) and was doing 3 injections each day, two of a Humalog Mix and one of Glargine which is a long acting background insulin that works over approximately 20hrs. Mealtimes were still set with military precision and I began to develop my skills in carb counting, in fact so too did Bethany, who’s often questioned me with my maths … and been annoyingly, yet reassuringly, correct! We were not yet intensely carb counting and bolusing but it was all good practice for what was to come…

PodNow Bethany is on the MyLife Omnipod and has been for around 5yrs, oh how times flies! I remember the first week and the feeling of having to start all over again. The amount of information you had to learn to set up the handset or Personal Diabetes Manager (PDM for short) was mind boggling and maths is not my strong point so getting the carb counting spot on now was going to be a challenge. It’s one of those cliches when you can say that you look back and you’re glad Beth is on the Pod, but believe me, it’s true.

Bethany’s background basal has 12 different settings throughout the day to correspond to her natural spikes and lulls in her metabolic rates, so goodbye Dawn Phenomenon! She can eat what she want’s (as long as it’s GF of course) and when she want’s (as long as it’s not constant – really the girl has an incredible appetite!), she can swim with her Pod on, she can do her Karate with her Pod on, it beeps at us if somethings up and you can (should you wish) set reminder beeps for mealtime boluses. And the carb counting;

an apple – 20g

a bowl of GF spaghetti and bolognese sauce – 80g 70% immediately and 30% over the next hour (yes you can do that too)

a GF pizza – 80g

a bowl of her favourite cereal with skimmed milk – 55g

I’ve mentioned it before but it becomes a real party trick to have people hold up items of food and ask you for the carb content. Of course they’re placing all their trust in me to get it right but you only have to look at a packet once or weigh a bowl or cereal and measure the the amount of milk once to remember the portion size and carbs the following day.

slice of bread – 15g

chocolate biscuit – 12g

packet of crisps – 12g or 15g depending on the packet!

….. you get the point. And whilst I think of it, this is not me being complacent or unrealistic or showing off (well maybe I am a bit), if you are starting out on this journey, I put my hand on my heart, this will be you too