For the last two and a half years, Madeline has been using an insulin pump. In that time, I have been the only set-changer in our family.
Anyone who has had the responsibility of changing out an insulin infusion set knows the complexities of this process. At one point, I made a basic flow chart to guide someone else in carrying out the task, in case I was not available in a time of need or if something were to happen to me. That flow chart is practically useless, though, because changing an infusion set is a refined skill that can only be learned over time, given unlimited practice (and failure) opportunities. Infusion sets require finessing: the tubing is uncooperative in its tangled loops, the loading of the cartridge with insulin is a fine exercise in visual-motor coordination, and the inserter itself is a temperamental bitch that’s sprung out of position to impale my fingers with its fat needle more times that I care to admit.
Over time, I’ve learned to coax them all into compliance with the task they’ve been designed to do. Yet, because of the complexity of the process, I have been reluctant to try to teach it to Madeline. This goes against everything I believe about developing her independence with T1D management, and yet, I’ve struggled to figure out how to instruct her in set-changing skills.
No matter. You see, Madeline figured out how to tackle this dilemma on her own.
Tonight she was due for a set change. I asked her for her insulin pump and told her to meet me upstairs. After handing over her pump, she raced up the stairs and pulled out our supply bin. “Don’t do anything, Mommy,” she said. “I want to get everything ready.” She proceeded to pull out every item we needed: the cartridge package, the infusion set inserter, the adhesive wipe, the alcohol wipes, the baby oil gel, and the insulin vial. Then, she suggested something brilliant. Something that had never occurred to me. “Why don’t you teach me one job? That’s the job I will do when we change my set, and I have to learn it and do it on my own before I’m ready for the next job.”
Madeline decided that the job she wanted to learn was preparing the infusion set inserter. I admit that I discouraged her from selecting this as her first job, and tried to lure her with the easier (and less exciting) tasks of loading the cartridge or running the pump through its preparation menus. She refused my efforts and declared her determination to learn this job. She would learn how to upwrap the plastic and carefully peel off the paper from the set adhesive without dislodging the set. She would learn how to unwind the tubing and secure it in the special notch made to tame it in place so that it doesn’t stick to the adhesive. She would learn how to remove the protective cover from the insertion needle and pull back the spring device to prepare the whole deal for insertion into her skin without unwittingly impaling her own fingers.
Preparing the infusion set inserter is, by far, the most challenging job of the whole set change process. And Madeline is taking it on with excitement and pride. All by herself.