Crazy Idea | Glucagon Patch Pump for Illness

Part 2 of 2

For about a week I saw Caleb’s blood sugars plummet multiple times after each episode of vomiting. I took advantage of the relief he felt post-throw up to get some concentrated carbs in him to help elevate his blood sugar.

But when my other kids have a stomach bug, the course of action is to ingest as little as possible to avoid more throwing up.

We don’t have that luxury with Caleb. We often have to do the exact opposite. Illness makes his blood sugars drop. We reduce his insulin dosing to avoid low blood sugars. Less insulin and/or dehydration causes ketones. The way to counteract low blood sugars and ketones is to ingest liquids and carbs -the last thing you want to do when you have a stomach virus.

But to avoid a trip to the ER, that’s exactly what we must do. Force carbs. It makes an unpleasant situation exponentially more unpleasant.

V Go™ Disposable Insulin Delivery - Intended for insulin, but why not glucagon in times of illness?

So here is what I want for people living with diabetes who experience a stomach virus:

A glucagon filled, one time use, basal-delivering patch pump.

I seriously considered whether I had enough glucagon in the house to fill a Pod and slap it on Caleb, activating it with our backup OmiPod PDM. Why can’t something like this be made available via a quick trip to the pharmacy as opposed to an ordeal at the ER? I’ve heard women tell me they used a similar device when they were pregnant to infuse labor inhibiting drugs. Why not one for glucose?

With the benefit of a home glucose drip, Caleb’s recovery would have been much more comfortable than what it was and what it would have been in the ER.  With a steady flow of glucose, his bgs could be maintained safely without having to eat or drink.  Insulin dosing could be increased to offset the glucose flow and reduce the risk of ketones.

Am I crazy? Does this at all appeal to you as a preferred option to going to the ER for a glucose drip?

On top of that, I want the ability to infuse saline into my son. Yes – I want that at home. I am given the responsibility of infusing insulin – something that could easily kill him if not properly managed – with barely any training. I don’t think it’s too much to ask for a way to deliver saline to him from the comfort of his home. Does the ER really have to be the only option?

So I want a third pump – maybe another patch pump with a preset basal delivery rate that connects to a saline bag so that enough can be delivered. This one may be more of a stretch, but still not completely unrealistic, right?

People living with diabetes go through enough each and every day and a stomach bug shouldn’t be such an urgent, deathly situation.  I think it’s within the realm of reality that it doesn’t have to be.


Thanks to Linda for trouble shooting my hair-brained idea with me and suggesting that even saline might be a possibility with an attachment of some sort.

Pumpiversary, Podiversary

First day of Pumping with OmniPod
April 24th, 2007, 1st day of pumping - OmniPod

Three years ago, on April 24, 2007, shortly after being diagnosed with type 1 diabetes, Caleb started pumping insulin.  I remember this date as much as I remember his birthday.  There were lots of smiles and celebration.  It was a huge relief.  It meant more freedom to eat, drink and be merry.  It meant less shots and less pain.  It meant me not having to put on a performance pretending that three 50 carb meals and three 20 carb snacks, precisely timed, included exactly what Caleb wanted to satisfy his appetite every day.

Since then, Caleb has used more than 450 Pods, has pumped more than 15,000 units of insulin and consumed more than 220,000 carbohydrates.

He’s also eaten pizza, devoured cupcakes, dined on Chinese food, eaten off-schedule, partaken in indulgent Thanksgiving feasts, and enjoyed goodies from his trick-or-treat bag.  Don’t get me wrong – there’s a lot of healthy eating in between that would make Jamie Oliver proud, but those of you who understand diabetes appreciate how difficult eating pizza and carb-filled cupcakes can be.  Pumping makes it easier for Caleb, if not just simply possible.

As demanding as managing type 1 diabetes is, I think often of what it was.  I am thankful that Caleb has a pump available to him to make it less limiting than just 10 or 20 years ago.

Caleb pumps with the OmniPodThat choice was an easy one for us. Since the day he started pumping, at just 4 years old, he was able to deliver his own bolus’.  He, himself has delivered each dose of insulin while at school, including preschool.  From the beginning, he has helped change his Pod and just recently, at the age of seven, he has started doing Pod changes completely by himself.

Inside Cover

In appreciation of allowing a photo of Caleb to be included in their 2009 annual report, Insulet has made a donation of $500 in Caleb’s name to the Faustman Labs at Massachussettes General Hospital.  Dr. Denise Faustman and her team are doing such important work to find a cure for type 1 diabetes and I’m thrilled that Insulet has supported them.

Caleb also received an autographed poster of Kris Freeman with the inscription, “Dream big, Caleb!”  As you can see, he was over the moon about it.

Caleb with Kris Freeman poster

Caleb wrote thank you notes to both Kris and Insulet.  Here is his note to Kris, spelling, punctuation and all:

Dear Kris Freeman,

I think you should be proud because I am a kid that looks up to you.  Thank you for the poster.  I was really excited when I saw you on it.

You are my inspiration because when I see you, I feel like I’m not the only one with diabetes.

I would always want an American to win a race, but I would escpecially want you to win! Good luck!

extra love From the big dreamer…

Caleb!

Caleb with thank yous to Kris Freeman & Insulet

Thank you to all the pump manufacturers for making devices that make life with diabetes a little better for so many.  Please keep working to make improvements.  As great as pumps are, they are but crude replacements for a functioning human pancreas, and people who live with this every day deserve better.

To pump or not to pump

First day with the OmniPod - April 24, 2007
First day with the OmniPod - April 24, 2007

From the very beginning, when Caleb was in the hospital at diagnosis, there was talk of pumping. “Oh it will be so much easier when he’s pumping.” “Oh he’ll be able to be more of a kid when he’s pumping.” “Pumping will provide so much more freedom.”

Well why on earth are we giving him shots?

The thought of pumping at first to me was a little horrifying. I didn’t understand how it worked and my imagination formed images that I didn’t like. I envisioned a permanent “something” surgically implanted in him. It seemed very sad. Very medical. Very dependent. No one showed us what it entailed. We just heard how great it was.

I’m not sure when exactly I got over those self-formed images (which of course were all wrong), but I knew Caleb would start pumping ASAP. All I needed to hear was that it was the best way to get control, would result in the best BGs and therefore give him the brightest outlook. The rest didn’t matter. My early reading included the results of the DCCT study. Enough said. Sign us up. When do we start?

Even so, I still had reservations. In those early days I watched Caleb running around, being a three-year-old and tried to envision this device strapped to him. It seemed like the increased freedom came at the price of the loss of other freedoms. We were just picking the lesser of two evils. Sigh.

Bless our dear friends, Dan and Meri. Dan’s company was investing in this new product by Insulet Corporation – had we heard of the OmniPod? Why no. Could this be? Is there actually an insulin pump that you don’t have to be strapped to? This must be a mistake – something new and not yet approved. Why has no one else mentioned this to us????

I cannot express how fortunate we were at the timing of things. Dan’s query came at exactly the point when I was looking at the various pump options. Had he mentioned it a week later, we may have made another choice.

I did my research and I was sold. We were decided. We were going to give the OmniPod a try. Now how do we get it? And WHEN??

I was told, “Oh the insurance won’t just pay for it. Needles are cheap. Pumps are not. You will have to wait at least six months and show that you can’t control his BG on injections.” That was not appealing. I wanted to do whatever I could to keep his BGs in control. I almost felt like we were better off not keeping his BGs in range.

And that doesn’t even touch upon the fact that many insurance companies were not yet hip to the OmniPod in early 2007. Our insurance listed it as a CGMS and thus would not cover it. I was prepared for a battle. I had my ducks all lined up.

That was all misinformation however. As soon as we could, within 3 months of Caleb’s diagnosis, we submitted to our insurance our request for a pump. We were told it would likely be rejected and we would have to appeal. We didn’t. I got the call one day. “Caleb is 100% covered.” I’m sorry, can you repeat that? “This is Insulet Corporation and I’m calling to tell you that Caleb has been approved for the OmniPod, 100%.”

I was elated. It was the best news I had heard in months.

To pump or not to pump. It is a very personal decision and requires careful thought. It is not for everyone. But for Caleb we chose to pump. We are very glad that we did.