The Assimilation Begins

Uncle AndrewUncle Andrew
Filed under: @ 12:08 pm

I’ve spoken/written at length regarding my desire to shed my meat-based intellect conveyance device (my body) in favor of something longer lasting and, hopefully, a little closer to the current ideal for body-mass index. Barring the cloning of a factory-fresh superman chassis on a bed of shark-collagen polysaccharides, the next best thing would be to have my more troublesome parts swapped out for after-market stuff as they degrade; either new or gently-used cellular models or, preferably, something more mechanical or cybernetic in design.

It looks like I might finally get this project off the ground with the introduction of a mechanical pancreas, otherwise known as a subdermal insulin pump.

This is the main tool in my doctor’s plan to help deal with my current and prospective renal problems. After three different MDs looked at my biopsy, the consensus as to my diagnosis was diabetic nephropathy, with some unusual characteristics. The next step in treatment is to try to keep the condition from worsening. The three main ways to do that are 1) keep my cholesterol levels low (done that), 2) keep my blood pressure in check (done that too) and 3) keep my A1C, or glycohemoglobin levels as low a possible. Mine are already quite low—my blood sugar control is excellent, which is what made the diagnosis of diabetic nephropathy so unusual in my case—but they could go lower. This is where the pump comes in.

Like many folks, I had no real concept of what an insulin pump was or how it works. The term “subdermal” made me imagine a device that was embedded completely under the skin via a surgical procedure, possibly anchored to a bone somewhere; the iliac crest of the pelvis, say. Turns out that was a complete misinterpretation. The only part of the pump that’s subdermal is a tiny bit of catheter that’s embedded about seven milimeters into the skin. The rest of the unit stays outside of the body. It’s a small wafer of electronics about the size of pager (kids: go ask your parents what a pager is). It stores about three days’ worth of both basal (long-acting) and short-acting insulin, which is delivered via a hair-thin plastic tube into the body. The pump’s electronics decide—with input from the wearer—just how much insulin you should receive, of what type and over what period of time. The idea behind the pump is to provide a continuous stream of just enough insulin to manage blood sugar. In doing so, the diabetic patient greatly reduces the peaks and valleys of normal day-to-day blood sugar levels. Even with a low overall A1C (say, 7 percent), one’s actual blood sugar levels can reach dangerous highs or lows at any given instance. These fluctuations are thought to stress the kidney and make damage more likely or more pronounced. So smoothing those bumps out as much as possible is considered crucial to maintaining good kidney function in a patient exhibiting nephropathic symptoms.

There are certainly some things to get used to regarding the day-to-day operation of this doohickey. For one thing, I’ll have to wear it at night, which means finding some way to clip it to my body so that it will ride out my frequent tossing and turning and yet survive the experience. I could try leaving it on the headboard shelf or something, but I’m terrified that I would end up garroting myself with the feeder tube in the middle of the night. I’ll have to remember to remove the thing and cover the port with a plug during my daily soaks. I’ll also have to remember to swap out the insulin packs as they deplete, about every three days. Mostly I’ll just have to get myself used to a whole new set of weird ablutions revolving around my new hardware. It’s not noticeably harder than getting used to the routine surrounding the cycle of testing/injecting/occasionally overshooting/crashing/eating everything in sight/retesting/reinjecting that I do now; just different. Different’s not my strong suit, but I’ll manage.

I’ve been in contact with various reps from the manufacturer of the device who have been helping to get me all set up as regards my insurance, payments, supplies, etc. These things take a fair amount of consumables: along with the insulin itself you need to swap out the catheter and the port (the interface between the inside of your body and the outside) every three days. All of this is going to run into some money. Thankfully my insurance is going to cover the bulk of it, but even what remains is nothing to sneeze at. Certainly it’s a lot more expensive than the cost of my current regimen of pharmaceuticals to treat my insulin deficiency. On the other hand, it’s a lot less trouble than dialisys. 😯

More on this story as it develops.

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