Since diagnosis and until she was sixteen years old, she was on a two daily injections of insulin. Until her early teens, she had well-control diabetes, but then it began to slip. She found her insulin regimen oppressive and limiting, so when it was changed to short-acting and long-acting analogue insulin she had a sense of freedom that she had never experienced before in relation to food and mealtimes. The problem was that around the same time she started to be concerned about her weight and decided to go on a diet. That was the start of her eating disorder that was to last for several years. She realised that she needed help and talked to her GP, whom she trusted. Eventually she was able to find a psychologist that worked with her and helped her overcome her eating disorder. Unfortunately, she developed diabetes-related complications which affected her eyesight. She was registered blind at the age of 23. She currently uses an insulin pump and her control is very good. This is a follow-on interview with Sarah. We first interviewed Sarah at the age of 27 (Interview 32).
This is a follow-on interview with Sarah. We first interviewed Sarah at the age of 27 (Interview 32).
Sarah’s life style as a performing artist involved lots of travelling and an inadequate diet that was making it difficult for her to control her diabetes. Her nurse advised her to consider using an insulin pump to improve diabetes management. Sarah agreed and obtained funding without much delay. She is registered blind.
The first year when Sarah started using the insulin pump was a period of trial and error. She found that there was a lot to learn and that first year on the insulin pump was hard. She had to do hourly blood tests for several months. These blood tests helped the diabetes team to programme the insulin pump to drip feed the amount of insulin Sarah needed for every hour, taking into account what her blood sugar levels and her hormonal activity were doing at any particular hour. Every time she ate, she had to give herself extra fast acting insulin to account for the food eaten. If there was one unit extra or one unit less, it affected her blood sugars a couple of hours later. During that year, Sarah also had to fast on a few occasions, skipping breakfast or lunch or dinner for two days and doing hourly blood test for a couple of days to know what her morning and lunchtime and dinner blood sugars were doing, and to programme the insulin pump accordingly. So, it took a long time to get everything working well and to learn all she needed to know to feel confident about using an insulin pump. It also involved changing her hectic life style for a more slow-paced one.
Throughout, Sarah has felt very well supported and reassured by her diabetes team. She had her nurse’s personal contact details in case something went wrong or if she needed advice outside working hours. Once, Sarah ended up in hospital with diabetes ketoacidosis (DKA) due to a needle blockage. Later, the diabetes care team explained why it had happened and showed her what to do if it happened again. On another occasion, Sarah by mistake used Lantus (slow acting insulin) cartridge in her insulin pump instead of the fast acting one; Humalog so her blood sugar level went very high. Sarah found the episode embarrassing, but it got quickly sorted by her diabetes nurse who put in the correct insulin cartridge.
Sarah finds the insulin pump brilliant’ because it can be programmed for both inactive and active periods of the day. For instance if she is ill she programmes it to give her extra insulin and if she does exercise she reduces the insulin an hour before. So in both situations her blood sugars are kept at a good level. Sarah stresses that insulin pump therapy requires commitment and knowledge on the part of the user.
Sarah feels that her insulin pump, her diet and exercise regimen and the use of herbal therapy are all helping to maintained good control. She says that the downfall’ of the insulin pump is the need for more blood tests but that the bonus is that it helps her keep a good HbA1C level. Since she went onto the insulin pump, she has kept her HbA1C below eight.
Sarah uses the D-Tron Plus insulin pump that she learnt to use it by touch and counting clicks, but as it was being discontinued, she is currently training on a new model. Because of her poor eyesight, she finds the training for the new pump trickier she has to go through more manoeuvres before she gets to the same place on her D-Tron Plus. She has been training for several months and her diabetes team have told her they won’t transfer her until she feels completely up to speed with the new one.
Sarah feels that the insulin pump therapy gives her the diabetes control she needs to carry on doing what she enjoys most, namely acting and singing.