Edited By: Joy Jiang
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Type one diabetes is 99% horrible. My pancreas no longer produces its own insulin, a hormone that turns sugar into useable energy. Before the discovery of insulin in 1922 (at UofT!), diabetes would have been a death sentence for me and my friends in our chapter of the College Diabetes Network. For a few months before my diagnosis in 2004, I was dying. I was sickly skinny, hungry all the time, and having many more accidents than was normal for an almost-seven-year-old. This brings us to my first insulin regimen, which we learned in the hospital:
1. NPH
It ought to stand for No Pway in Hell. NPH is medium-acting insulin delivered twice a day that takes meals into account many hours before they’re consumed. At the time, I was homeschooled, meaning that my schedule (and that of my little sister, who was diagnosed a week after me) was highly flexible. I didn’t have lunch at the same time each day and I certainly didn’t know what I’d be having. There were many times where I had dosed for more food than I was hungry for, leading to screaming matches between me and my parents. If I didn’t match the food to the insulin, my blood sugar could drop to deadly levels.
2. Lantus and flexpens
Thankfully, after NPH, I got a new system. Lantus is slow acting insulin that provides a little bit of dosage over the course of a whole day. Flexpens were filled with fast-acting insulin, allowing for dosing directly before meals and more accurate matching. I still remember that I had been misbehaving the day we got them, so my parents let my sister choose which one she wanted between the orange one and the green one. Thankfully, she chose the green (in both of our favors), leaving me with the orange. The feeling of constant fear and stress radiating from my parents abated.
3. Medtronic Minimed
Everything changed when I got an insulin pump. They used to be these giant bricks, but the Animas I tried out in 2006 was about the size of a deck of cards. At first, I hated it. I hated the insertion of the cannula (small tube) into my stomach, I hated getting the tubing caught on things, and, worst of all, I hated that the tube site bled and bruised when I took it out. “I’m NEVER getting a pump,” I said. I changed my mind a year later when my sister tried and got a little, blue Medtronic Minimed. I got the purple one. After a month or so I couldn’t imagine going back. It did the job of both lantus and flexpens by delivering a constant, small drip (called basal) and doses to correct high blood sugar or for food (called boluses). My dad’s nicknames of “Cyborg” and “Bionic” soon became part of my identity.
4. Medtronic CGM
Much later, we had a brief stint with the Medtronic continuous glucose monitor (CGM). An estimation of the level of glucose in our bloodstream was displayed on the pump’s screen. Unfortunately, it wasn’t accurate enough to use for bolusing (delivering insulin) and the unbalanced design of it meant that it fell off all the time. It was also incredibly painful to insert, with three times the needle length of the pump infusion sets.
5. Medtronic Revel
In 2010, I upgraded to the newer Medtronic, the Revel. It was effectively the same device as the Minimed, but I got to have it in pink. It was very exciting to have a colorful medical device.
6. Dexcom CGM
The next revolutionary shift came in the form of the Dexcom CGM. It was MUCH more accurate than the Medtronic one (though doctors still advised very strongly against using those readings to bolus). We went from 15 blood sugar tests a day to two for calibration, from heavily callused fingertips to doubly scarred stomachs. Looks a little like an iPod, right? Truly a drawback. Whoever stole my receiver out of my backpack at a party in 2015, you can go f**k yourself.
7. Tandem T-Slim
Oh, the T-Slim. The star of my sky, the apple of my eye, so shiny and new with a touch screen instead of four time-worn buttons. Typing blood sugar readings in became so fast and easy with a number pad instead of having to hold down on the Revel’s up arrow until getting to the right one. Best of all, it’s integrated with the Dexcom, meaning I went from two devices to just one, attached to me at all times. No more worrying about theft! Another convenient thing was it charges by micro-USB, so no more purchasing Energizer AAA batteries. It’s always a laugh to charge my pump while it’s attached to me, since I’m attached to the wall as a result. Can’t very well be a cyborg if my batteries are low.
8. Omnipod?
When the United States’ so-called government decided it’d be fun to throw a wrench into the lives of millions of chronically ill people, our insurance company decided to stop offering the plan we had been using. I switched more of my prescriptions over to OHIP. Unfortunately, only a few pumps are covered, and the T-Slim, my true love, is not on that list. We have reservoirs and infusion sets to last me for a while, but I’m looking into the Omnipod, best known for its lack of tubing. The reservoir sits on the site itself and delivers insulin by wireless communication from a handheld device. It’s pretty appealing not to have to worry about doorknobs and lovers catching or ripping out my sites by accident. We’ll see how it goes.
There are all sorts of other technology on the market and on the horizon. Medtronic has something called a closed loop system, where blood sugar readings from the CGM are taken into account by the pump to make corrections either by bolus or basal, reducing insulin for low blood sugar and increasing for high blood sugar. I’ll probably adopt closed loop in a couple of years when it’s not so new and I trust that it will not kill me. There’s also development on an implanted insulin device deep within the abdomen with a refill port on the stomach. I’m not keen on that idea since it can only be adjusted by a highly specialized physician. An emergency room doctor wouldn’t know how to help me, and I like’d to have a plan for emergencies.
The 1% where diabetes isn’t horrible is the strength I gained along the way. It’s hard for people to see what I go through on a daily and hourly basis; I’ve gained resilience and perspective. A lot of this strength came from the diabetic friends I gained, modeling how to be tough and what to do when it’s extra hard.
Some of these friends and I are hoping to build that community even stronger here at the University of Toronto through our chapter of the College Diabetes Network. We’re having our launch party on March 2nd. We want to connect people affected by diabetes (type one, two, or none), so be sure to follow our social media: Facebook.com/uoft.cdn, instagram.com/uoft.cdn.
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