Crunch

"Now, we place great trust in our devices. We try to believe that they will never fail us. We place our lives in the hands of plastic and metal and batteries and medical research, sure that they will work; sure that they will always deliver some sort of base measure of performance. Like latitude and longitude. We know this isn't true. Plastic fails. Metal fails. Batteries are spent. People get sick. People die."

Those lines, from a post I wrote months ago, resonated with me in an unfortunately personal way last night.

It all started with a crunch.

In my insulin pump, there is a cavity in which a cartridge sits, and gets pushed up by a plunger, very much like how an insulin pen works. The cartridge is attached to tubing, which is then attached to me. There are a lot of plastic bits, and usually they work like clockwork, to use a figure of speech. (Or do clocks work like pumpwork?) 

(Plastic bits. Source: http://www.americandiabeteswholesale.com)

You're not really supposed to cut corners when it comes to diabetes, but the amount of "stuff" and the waste and the cost sometimes add up to doing so. There are varying degrees. Everyone I know reuses blood-testing lancets, sometimes for months. Technically we should be using sanitary wipes and changing our lancets five times a day, but almost anyone who has dealt with this condition for more than a few months tends to say "screw it" and go for the convenience and lowered cost. On the other hand, however, nobody is able to reuse test strips (unless you count my fantasy invention that doesn't exist). They are expensive, but you are stuck with them. Certain things are more and less affected by reuse. Needles blunt, but sometimes it takes a few times. Infusion sets are one-shot-only, but can last for more than the three days you're supposed to wear them, though you might get reduced efficiency. There seems to be an online bragging-rights contest to see who can successfully wear their CGM (Continuous Glucose Monitor) sensor the longest; I've seen over two weeks. Of course, I haven't tested this, as Canada is, shall we say, so behind the game in this technology that I'm not even sure I'm allowed to type those words.

To put it as bluntly as a blunt lancet, diabetes is a cost-benefit analysis. When I went on the Animas Ping, I was enrolled in a government program (the Assistive Devices Program) that pays for a certain amount of pump supplies every three months. It was my goal to be able to afford all the internal supplies on that amount (I still had everything else to pay for, after all!) I struck a few compromises. No automatic inserters; manual were cheaper. (That was okay; the idea of the automatic spring-loaded infusion set kind of made me nervous.) Confidentially, my rep whispered to me that I could reuse the cartridges once. This, PLUS the discount I managed to negotiate, was enough to get me under the line. (I have never felt so much consumer power as when I was being courted by pump reps; they want those lifetime customers!) It's amazing when you're negotiating for and calculating cost/waste savings for little plastic bits that your life just happens to depend on. Sometimes I reuse the cartridges once. Sometimes, in a pinch, more than once, but I try not to. I've generally had very good luck.

Yesterday, my luck went "crunch."

Yesterday was Super Bowl Sunday. We had family over and my dad made an absolute feast of Baltimore and San Francisco-themed food. My pump ran out of insulin before dinner and I didn't want to move from my hard-won seat, so I re-used the cartridge (for the first time, though, as authorized). As I was twisting the parts together, I heard a tiny sound, a little "crunch." It seemed a bit strange, but after inspecting and tugging on the parts to make sure they were sufficiently bonded, I thought nothing of it, and proceeded to indulge, Super Bowl Party-style.

Hours later, after catching the Puppy Bowl at midnight, I was feeling less than stellar. I had been taking little corrections through the evening, so I wasn't sure what it could be. Heartburn from the crab dip? I tested myself and almost lost my eyeballs to shock. My number was 32.2. That's 580 for you Americans. Not only was that amazingly high, but it was a number I hadn't seen in years. I couldn't remember when a number that high had last appeared on my meter, but it was certainly before I had gotten a pump. What a failure-tastic number. People go into the hospital with a 32.2. I took a correction bolus, but it still nagged at me. I hadn't actually eaten a ridiculous number of carbohydrates. I had taken quite a bit of insulin. 14? 16? okay. but over 32?

Suddenly, I remembered the crunch. I unscrewed the cap of the cartridge area...and found insulin pouring out of the top of the cartridge. My life preserver had sprung a leak. I found myself swabbing the proverbial deck, cleaning expensive, wasted insulin out of the cartridge well. A penny saved, in this case, was not a penny earned. However, it could have just as easily happened with a new cartridge. I switched both cartridge and tubing (there goes 12 more units of insulin to prime it) and corrected again. Now, the waiting game. How much insulin had I gotten from the last correction? Was I going to come down? Was I going to crash? A sleepless night was my fate, testing every half hour. 26...22...these horrible numbers were victories. I was sick, I was tired, and I was sick and tired of this.

I'm sick of the fact that one tiny little "crunch" might be enough to send me to the hospital. That's not even the smallest, stupidest thing that can happen. Plastic fails. People fail. Metal fails. The economics of people and plastic and metal are on shaky, shaky ground. Life seems to be a series of these tiny failures; it's a ridiculous balancing act, with the rope made out of plungers and cartridges and tiny metal filaments. A pancreas held together with duct tape and hope.

In the past month, my hope has been tested; I have been both the highest and the lowest since I started the pump.  Last month, a two-hour trip home from a night out ended with a mile-plus walk in heels after helping a sick friend off the bus. When I realized I felt awful, I checked myself at the next bus stop and found I was 2.1 (a little less than 38, for the Americans). Instead of waiting another maybe half hour for a bus, my partner made the smart and executive decision to pile me into a cab. Of course, the middle of the night seems to attract horrible blood sugar moments.

This morning, I crashed again. From 32 to less than 3 and falling. That low number is usually bad; coming from 32, it's devastating. I felt like a small child again; I basically had to be rescued and taken into work. I didn't think I could make it to the bus. Again, even when things work well, they can work so well they betray you. Little things making you feel so small. How could I be a professor if, this morning, I could barely get my legs to move? How can I teach people when there are so many mistakes to be made?

The one saving grace of all of this is that, even at past 2am, social media and some very good people made it possible to get companionship and support through that harrowing night. Thank both night owls and time zones, but most of all, thank friends. Plastic fails. Metal fails. Batteries are spent. But friendship? Now that's strong.

-Ilana