When to reveal your insulin pump

Having diabetes is a full-time job that goes beyond balancing blood sugar levels, writes the author of The Smart Woman’s Guide to Diabetes. You have to worry about how to feel sexy with a plastic pump attached to your lower back; how to still feel desirable with bruises on your stomach from insulin injections; and when in your relationship to tell your new boyfriend he’ll need to run and grab orange juice if you start to pass out.

Author Amy Stockwell Mercer was 14 when she was diagnosed with Type 1 diabetes. Her book includes her own experience of living with diabetes, as well as advice from other diabetic women on topics ranging from dating and diet to travel tips and motherhood.

According to a University of Toronto study, teenage girls with diabetes are twice as likely to develop eating disorders. “Diabulimia,” Mercer explains, “is characterized by a person with diabetes who is intentionally skipping insulin therapy to keep blood glucose levels elevated, which in turn causes dangerous weight loss.”

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One woman cited in the book, Charla, hated being chubby as a child and remembers suddenly losing weight when she was 16. “God was answering my prayers!” she thought as she continued to eat gluttonously without gaining weight. “I also couldn’t get out of bed and knew something was wrong.” Her parents took her to the hospital where she was diagnosed with diabetes. Once she started insulin, “I gained 14 lb. I felt like the Michelin man. The day I got out of hospital I started skipping insulin because I had to lose weight.” She eventually started taking just enough to survive, “one shot at bedtime.”

By her thirties, Charla had developed eye complications—diabetic retinopathy. She finally found a supportive, female endocrinologist who advised Charla to switch from injecting insulin with a needle to wearing an insulin pump. “When I first started wearing the pump, I hated it. I felt like it was a scarlet D on my forehead. I almost gave it back. I stopped wearing dresses. I hated wearing it on my belt because you could see the tubing. Then I figured out I could hide it in a pants pocket by putting a hole in the pocket and stringing the tubing through the hole. Once I figured that out, it was much better. I’m glad I stuck with it.”

In a chapter on puberty, Mercer warns that women with diabetes have more menstrual problems than their non-diabetic peers. Expect long cycles and heavy menstruation. “Usually, a woman’s insulin requirement goes up 10 to 15 per cent during the last three to five days of the menstrual cycle because of the hormone progesterone. Rising levels of progesterone counteract the action of insulin. The only way to manage changing insulin requirements right before your period is to measure your [blood glucose] often.”

Most of the women in Mercer’s book agree it’s best to tell your friends and dates as soon as possible about your condition. “I was a little self-conscious about carrying syringes around. I didn’t want anyone to think I was a drug addict,” explains Stella Biggs. Another woman, Kristin Makszin, tells Mercer, “I think that diabetes can be a good way to find a caring person. If it’s the right person, they will care and want to learn more.”

Another woman, Maia Caemmerer, shares her solution for birth control. “I chose to get a Mirena [hormone] IUD. The consistent release of hormones evened out my blood glucose. It was one of the best choices I made for my diabetes, and it took one thing off my daily health-related to-do list: no more birth control pills!”

In a chapter on travel, a woman warns that the battery in her insulin pump sets off the metal detector at the airport. She’s learned to wear the pump on her waistband, outside her clothing, when she’s travelling and to “never, ever wear a long skirt going through the checkpoint. There is nothing more humiliating than a TSA agent frisking your inner thighs while the whole world is watching.” And don’t forget, “eastward travel means a shorter day. If you inject insulin, less may be needed. Westward travel means a longer day, so more insulin may be needed. Keep your watch on your home time zone until the morning after you arrive.”