Let's Do The Hokie Pokie

Let's see... Monday, Tuesday, Wednesday, Site change day!

It is the third day in and the girls' sites are starting to peel up and the cannula is looking a bit pink.  This is not alarming, but normal.  Insulin sites last anywhere from 2-3 days, (although I have met people who can get through a fourth day without issue).  We are not that lucky.

Today is our hokie-pokie day.

It starts out with a gentle reminder as I wake up the girls to get ready for school.  New sites today.  Both roll their eyes and groan.  Can it wait until after breakfast?  One daughter is almost out of insulin and wouldn't have enough to dose for the "carbohydated" whole wheat toast.  So the answer is no.  We are a family of one for all and all for one. 

I pull out the supplies.

• Alcohol swab x 2
• Uni solve x 2
• IV prep x 2
• Insulin vial
• Pink Inset 30 Infusion Sets x 2
• Pink tubing x 2
• Cartridge x 2
• IV 3000 x 2
• scissors
• paper towel
• Vaseline

The first task is to take off the old sites from the girl's bodies.  I can't do this task for them because I often cause more pain than if they do it themselves.  They use the uni solve to moisten the adhesive and slowly peel off the IV3000 tape.  It comes off like the sticky glue on a mailer and snaps into a worm-like shape once it is off.   The uni solve is used again to remove the second layer of sticky from the cannula site tape.  In a blink and with a little wincing, the cannula is pulled out of the skin and the entire site is off.  One more uni solve swab to  remove any extra sticky from the skin and then, we add a thick coat of Vaseline to start the healing process.

While the girls are busy with their sites, I am quickly working.  Paper towel put down to form a clean and sterile surface on the table.  I rewind their pumps so that I can remove the old cartridge and tubing.  Once it is out, I use my alcohol swab to wipe down the pumps.  Even the cap gets a little swish.  I carefully look over the insulin pump for any little cracks and check the battery life to see if it is time to replace the very expensive lithium batteries. 

I open the tubing and cartridge, watching the pile of garbage next to me grow.  The packaging waste is enormous and I feel a little guilt from knowing that we are throwing this into a landfill somewhere.  Nothing can be recycled into traditional methods, so I try not to dwell on it. 

Once the cartridge is open and primed, I slowly draw up the next few days' worth of insulin, watching for and removing any air bubbles during the process.  My fingers are not strong enough to tap them bubbles out, so I gently use my scissors to knock the bubbles to the top of the cartridge so that I can push them out with the plunger.  One, two, three, the only thing left in the cartridge is insulin.  I thread the cap through the tubing and twist the two pieces back to together to load into the pump.

After priming the tubing, I open the insets and prepare them to be injected into the girls.  They are waiting impatiently for me to be done and sit quietly, holding hands.  We agree that today's site will be the arms (we use flank, stomach, bottom or arm in a rotation).  The girls grip each other harder and hold their breathe, even though I remind them to breathe. 

                                                       


A quick swish of the IVprep pad on the site and then we wait for a moment for the skin to dry.  No blowing is allowed, even though the girls want this to be over with quickly.  We instead wait for the skin to stop shining.

Click!  It is done.  Then, I quickly move to the second child.  Click!  This child does not like being poked and starts to cry.  The other hugs her tight and says, "It wasn't so bad." 

And my eyes burn a little watching them. 

I keep going because there is more to be done.  Picking the scissors up once again, I cut a little hole into the IV3000 and stick it to the top of the site.  This is our little extra insurance that the site will not be yanked out during the school day, although, it does happen from time to time.  Then, I click the tubing to the site and prime the cannula. 

The garbage and the inset needles must be carefully put away. But first, I must poke them again to check their blood sugars and then, pre-bolus them with their breakfast insulin.  Only then, can we be done with Type 1 Diabetes for a few hours.

I give each of the girls hugs and kisses and tell them to finish getting ready for school. 

Sometimes when I pause for a moment it hits me, how many people have to do this hokie-pokie dance before sending their children to school in the morning? 

My eyes burn a little bit more... but then it is time to serve breakfast, help fill backpacks, make lunches and retrieve lost library books and gym shoes.