I've had a few people ask me how Noah's connected to his pump and how it works. Well, I decided to share with you how we do a site change. We have to do a site change every other day. And, what I mean by a "site change" is we have to refill the insulin in his pump and reconnect it to another part of his body, so that each site doesn't go bad. I'll try and explain that as I move through these pictures.

First things first - I need our site change supplies. We start by disconnecting his pump and removing the insulin vial already inside the pump. I need a new insulin vial, our infusion set, a syringe, an alcohol wipe, and his plunger. I have two insulin vials in the picture above, because we just had to switch to his new insulin called Humalog. After almost 3 years of using Novolog, our insurance company decided it wouldn't cover the Novolog anymore, so we had to switch. It's not a huge deal, but it makes me angry that I don't have a choice in the matter anymore. But, I'll save that rant for another day. :-)

The insulin that goes inside his pump is this little vial thing with the tubing attached. I have to extract the insulin from its container using a syringe that attaches directly to this vial. You can see that it will hold a lot of insulin, but for 2 days, we only fill it up to about 60 units of insulin. We're trying to keep it very close to what he uses, because whatever is left after those two days is thrown away and we can't waste the insulin. The tubing is actually part of his "infusion set". We screw that piece with the tubing onto the insulin vial before we put it into the pump. We have to "rewind" the pump settings to make room for the new insulin vial to be inserted into the pump.

Once it's been rewound and we put the new vial of insulin in, we have to fill the tubing. I have to hold down the ACT button, so that the plunger inside the pump can get back to the position to pump the insulin through the tubing, so we can see drops coming out of the needle that is inside that blue thing on the left. The blue thing is the needle and the needle cover. That is the piece that is pulled out once it's all been inserted. It fits perfectly into the blue plunger you'll see in the next picture.
Once the insulin drops are seen coming out from the needle, we place that circular thing inside the blue plunger and get it ready to insert into Noah. That circular thing is the sticker that holds the cannula (tiny plastic tube) on his body, so that tube that pumps in the insulin stays in place and doesn't get ripped off. The blue cover covers the needle until we're ready to insert it.

Here is a picture of the needle. The drop at the top is his insulin. That's how we know the needle is good to go. There is a plastic sheath covering most of that needle. When it is inserted into Noah's skin, the needle comes out and leaves that plastic piece inside of his body. That is how the insulin gets into him. The pump uses our programmed ratios to determine how much insulin he gets throughout the day. It is constantly being pumped into him, just a small amount each minute or so. That's to mimic how his pancreas is supposed to work. Different times of days take different ratios. Right now he will get .475 units at a time between noon and 5pm with differing amounts, ranging from .50 to .450, at other times of the day. Confusing, right?! The pump does it all for us. It's just our job to enter the right amounts and the doctor tells us what to do and what to change. That, thankfully, is not something we have to figure out on our own.

Anyway, once everything is ready to go and the sticker covers are taken off the circle piece with the needle, we place the plunger on whatever part of his body we need to place it that day. Right now we are rotating between 6 different places - left and right tummy, left and right butt, left and right love handle. On the count of three I push those white tabs at the bottom of the plunger and it pops the thing into place. I pull it off and the needle comes out with it, leaving the sticker attached to his body and the cannula inserted inside of him.

So, now he is attached to his pump. If he needs to disconnect for any reason - to take a shower, go swimming, go through basketball practice - he can unscrew, with a simple turn, the plastic piece on the top of that sticker and it comes off. He can then reattach by placing it back on the same spot and turning it into place. We then "fill the cannula" by pushing the appropriate buttons on the pump and he's back in business! The insulin, like I said, continues to pump into him every minute or so, unless we bolus, which means giving him a specific influx of insulin, when he eats food.
I wanted to take a picture of him, after I documented all of this, with his giving me a thumbs up. This goofball wouldn't cooperate...
....as you can tell!
I finally got a thumbs up after chasing him through the house and convincing him that these pictures would make his grandparents happy. ;-) Lately, the site change process has hurt him, so his confidence in getting it done has been shaken and he was a little emotional and nervous about getting it done tonight. But, it's not something, unfortunately, that he has a choice in, so he (once again) faced those fears and, thankfully, had a pain-free site change. So, there you have it. That is how we give Noah his site change. Just another day in the life of a Type 1!