Back to the past

Wow. It’s fatter than I remembered it. My old CoZmo pump. I plugged in my ancient forty-three pound laptop computer, turned it on, and went to smoke a pipe while it spooled up. The CoZmo software won’t run on the house computer; it’s too new. No one upgrades software for dead insulin pumps, after all.

Eventually, laptop up and running, I opened the CoZmo application and pulled up my last saved program. There were a few things I wanted to change.

First, I’d made some basal tweaks over the last few weeks. Probably things I could have done from the Dex if I’d been paying attention, but the in-your-face nature of mySentry got me tuned into some problems that I had fixed. Reading off of Pump the Fifth’s “review basal” screen, I typed the new numbers into the appropriate boxes on the CoZmo’s software.

In the last week or so, I’d also tweaked my IC ratios: the math the pump uses to decide how much insulin to give you for a given carb load.

Then I had a couple of new things to add. Previously my CoZmo had been set to deliver my meal and correction boli over a five minute period. Somewhere, years ago, I had read that this slow-hand approach would improve insulin absorption. But… but… well, I noticed something almost right out of the box.. err.. boxes, with Revel. My post prandial spikes—the surges in blood sugar after eating—improved dramatically.

Why?

Was my old pump on the fritz and I didn’t know it before?

Did I change how I was eating?

No. I think it had to do with delivery speed. Med-T pumps, have only one speed. Fast-ish. Now I’m thinking getting the insulin on the job ASAP is really the way to go. Actually, there’s some excellent new research showing good-old-fashioned pre-bolusing is the best way to minimalize excursions. It makes sense, I guess. Onset of action for the logs is about 20 minutes. So if you start eating before the insulin is on the job, it’s only logical that you’ll go high.

That said. I can’t get my shit together enough to bolus 20 minutes before eating.

Still, if faster delivery will help, that much I can do. So I changed the CoZmo’s program.

Reviewing the options on the laptop I was happy to see some other features that I’d forgotten how much I missed. For instance: the site change reminder. Revel will show you, if you hunt and peck quite a bit, when you started a set. But that’s it. CoZmo will tell you when the next one is due. I find that quite a bit more useful. For some reason I have a hard time counting forwards. Do you count the day you started? Do you count the day you change? The whole thing gives me a headache, and the every-three-day nature of it on a seven day week just makes things worse. Please, my brain is over worked. Just tell me when to change the damn thing.

I was also happy to be reminded of the high blood sugar correction curve, a CoZmo feature that lets my corrections get increasingly more aggressive the higher my sugar is. Oh, and the ability to have pre-programed basal rates that automatically kick in by day of the week. I can have one basal rate for clinic days, one for writing days, and one for the University day. What? Days off? What are you talking about? What the fuck is a day off?

And of course, I really, really, really love the IOB (insulin on board) screen. A pump screen that shows you insulin still in play in your body, and how much time it has left. Med-T now has a “active insulin” volume on one of the screens, but it’s just a number with no context of time. It’s better than nothing, but I never quite got the hang of it. The CoZmo IOB has kept me from over-cooking my own bacon many a time.

Oh yeah. And the disconnect feature. When I jump in the shower in the morning (or when I’m cavorting with the Swedish Bikini Team), I can just tell the pump it’s off the job. It’ll keep track the basal I missed while disconnected, and deliver it to me when I hook back up. With Revel, I had been using the pre-set Easy Bolus button set at 0.6 of a unit of insulin, a typical average of the basal I miss off-pump in the morning—but having REAL tracking is better.

When I was done, I saved the program, slid a AAA battery back into Custer (my CoZmo pump’s pet name), and brought it back to life. I plugged an infrared transceiver into a USB port on the old laptop, and beamed the revised program to the CoZmo pump. And then, just like, she was ready for insulin.

Filling her up, I did realize that this is one area that Revel trumps. It’s a lot faster to change reservoirs. For one thing, the reservoir cap is built into the infusion set system with Revel. CoZmo uses a system where you have to thread the tubing through a cap and onto the reservoir. Then you lock the reservoir onto the piston, and the pump slowly sucks it down into the chamber. Then you have to lock the cap in place. It takes some time.

You also can’t pull the reservoir back out without triggering an alarm that requires you to go through a whole set-change menu. I remember several years ago Fox and I were having dinner with a diabetes virgin. (I guess I’d better clarify: the DV was a rep with a medical supply outfit. She was clueless about type 1s and pumps). Fox whipped out her pump and deftly removed the reservoir to show the DV where the insulin was. I sat mouth agape… you can do that? During my time with Revel, I did just the same myself several times when explaining insulin pumps to patients.

Still, it’s not the end of the world. I think what I’m going to miss the most about Revel will be the way the meter and pump talked to each other (as of last month, no more test strips for the CoZmo’s meter: the first circle in CoZmo’s death spiral). No more quick and easy correction on the fly. Now if I want to make a correction, I’ll need to manually enter the results from the meter into the pump. And I did like the thin profile of Revel, how she hugged my hip.

Oh, and I’ll miss having one less box on the belt.

And already, I’m suffering separation anxiety about losing mySentry.

So… I guess it’s good to be back. Kinda like putting on a well-worn pair of shoes. Maybe not sexy, but oh-so-comfortable.

But still, I know it’s only a matter of time before they stop making supplies for CoZmo and I’ll be forced to switch to some other pump.

Then what? Which lifeboat will I jump into when the RMS CoZmo disappears below the waves?