Is a pump for me?

[DaftThoughts]

I only started MDI in January (so 9 months now) and I've been doing pretty well - my A1C went from 58 to 50 in 6 months time, which I'm alright with. (Hopefully last week's lab results come in even better, I'm hoping for 48 or lower!)

I don't feel like MDI are a bother to me. I have pretty decent control as long as my diet isn't too shoddy (bingeing is sometimes still an issue, but I've been doing better there). I'm not yet 100% comfortable injecting in public, but I never let myself be shooed into a (public) bathroom and take care of myself whenever I need to, no permission asked.

I'm also currently staying at home on disability so I feel my management is made easy by not having to be out and about all the time. I'm going back to school for a college degree coming January. I've already arranged to have a scooter/moped instead of my bicycle because it's a 90 minute cycling commute every day and my knees can't handle the hills, so I'm down to only 40 minutes per day commuting with no risk for exercise induced hypos. I'll have to manage my diabetes during classes, but the school specializes in people with disabilities and is extremely accommodating, so I don't foresee issues there either.

People have been suggesting that I look into a pump to make my life easier, but so far the thought of a pump terrifies me. Right now, my chances of going into DKA on MDI is very low. Toujeo is a very long acting basal insulin and even after missing some shots by over 6 hours, I've never had any issues calculating a new 'temp' basal rate until my next usual injection. I've never had a hyper from failed needles or pens, I can't remember having been higher than 15 since January, and even then my usual highest is 'only' 12 because I made a calculation error or got sick. Pumps on the other hand seem to mess up more frequently than what I experience right now, from kinked to clogged tubes, infected infusion sites, air bubbles blocking insulin flow and so forth. I don't mind wearing a device on me 24/7, I'm just scared of the potential issues from relying on an electronic device to deliver my insulin that my pens just don't have.

Am I just not seeing a bigger benefit to pumps over MDI? Or am I just 'too okay' with MDI to make a pump worthwhile for me? I have no idea how things will change for me at school, maybe the fact I have it so easy right now is purely because I'm home so much!

I have my quarterly checkup with my DSN tomorrow morning and I'll bring it up with her too, but I'd like to go in a bit more prepared. Any thoughts/feedback are more than welcome.

 

[Deleted Account]

I have had a pump for about 18 months now. I would say my bg control is better but I do not find my life any easier.
The main advantage of the pump is that you can vary your basal. A long acting insulin assumes your basal needs are the same for 24 hours. Some people find this is not the case: they may need more basal at night; or less basal when exercising; or more basal in the morning to deal when dawn phenomenon; etc.
There are other benefits like being able to spread a bolus dose to deal with something like pizza which may take longer to get into your blood stream.
Not needing to inject is good but the other side of this coin is that you need to change your "sets" regularly. This means replacing your cannula, refilling your cartridge and rewinding your pump ... whilst not getting flustered by your pump beeping because it's notice you are not attached. This is also the step that can go wrong if you don't get your cannula in properly so you do not get any or enough insulin ... which is your constant basal as well as your bolus.
When on MDI, generally you have spare insulin during the day (because they need more at night and can only have the same basal for 24 hours) to "mop" up when you under count carbs. For some people this means they can snack or eat some sweets without needing to inject. Because a pump should more accurately reflect your basal needs at different times of the day, you don't have this spare insulin. As a result you need to be more accurate with your carb counting.

I was on MDI for 13 years before I went on a pump. I was reluctant at first because of the idea of being constantly connected.
Now, my control is better throughout the day but I don't like set changes and I really dislike the physical appearance of my pump which I struggle to hide (whatever I do with it, I have a bulge which I am self-conscious about).
Overall, I know the pump is better for me. But I never felt a desire to throw my pens to the other side of the room.

So, is a pump for you? Only you and your consultant know.
Are you willing to put in the extra carb counting effort, go through some possible challenges setting your pump rates correctly and risk not getting your cannula in properly (although this improves with practice)?
What are the chances of getting a pump? Some hospitals put a lot of hurdles in place as they are expensive to fund?

If, after some discussion with your consultant, you are given the option on a pump but you are unsure, remember you can go back to MDI if that is what you prefer.

<Sorry for the long waffling message>

 

[DaftThoughts]

<Sorry for the long waffling message>

That was actually incredibly helpful! I didn't fully consider that MDI basal acts as a 'buffer' of sorts and that a pump means even stricter carb counting than I already do.

I actually have really good control over my basal, I do experience seasonal sensitivity changes but once I have my ratio, my background levels are pretty much rock solid. So I don't know if a more flexible basal will give my any real overall improvements.

I'll keep this in mind, I don't even know if I'd qualify for a pump, but I'll definitely take it up with my DSN and see what she has to say about it.

 

[Snapsy]

I've loved my pump for the one year and eleven months I've had it, after 29 years on injections.

I love that I'm no longer ever needing to be chasing excess insulin with food.
I love the fact that I can turn the basal insulin up or down like a tap to deal with exercise or illness.
I love the fact that although it's attached to me most of the time, the hosepipe doesn't bother me (in itself that was waaaaaaay less of a big deal than I'd first feared) and I can 'drive' the pump with its remote so I don't have to keep hoiking it out.
I disconnect it to shower, swim and *coughs* sometimes when partaking in certain bedroom activities.
I have a much steadier 'line' in blood glucose terms.
I don't go low after meals then high later.
I don't go high after meals then low later.
I am on around 30% less insulin than I used to be.
I have the confidence to exercise without risking hypos.

I don't like the fact that whenever my cartridge needs changing it comes at a really inconvenient time (not the pump's fault - more to do with my haphazard time management and ridiculously chaotic routine-absent life).
I don't like that sometimes my skin doesn't like the cannula adhesive.

It took me decades to actually get a pump. Since starting pumping, my HbA1c is lower. My weight is lower since I started pumping - it dropped off me and I find it's really stable.

It was a pain in the neck for the first two months. It took six months for it to become second nature. It's no less hard work than I was doing on MDI, but oh boy, it's hard work that I SEE and FEEL the results of on a daily basis. I never had that level of confidence in my diabetes management on MDI.

I love my pump.

I've had two cannula failures - the first was on my second day of pumping in October 2015.
Sometimes the sticky stuff irritates my skin.
I've tangled the hosepipe on a door handle once. It pulled the cannula out but didn't hurt - I found it the funniest experience ever, was able to clear up the mess and there was no lasting damage to me, the pump, the door handle or indeed Mr S's pride-and-joy-yet-ridiculously-impractical cream carpet.
My pump handset (the meter/remote), NOT the pump, had a problem with its on/off switch. So did its replacement. Number three is doing fine so far.

But I love this box of tricks. Life-changing stuff.

 

[himtoo]

Hi @DaftThoughts
you have had 2 superb replies from @helensaramay and @Snapsy.

I agree with everything that has been said.

only you along with your care team can make your decision.

all the best !!

 

[Dianemacfaden]

I've loved my pump for the one year and eleven months I've had it, after 29 years on injections.

I love that I'm no longer ever needing to be chasing excess insulin with food.
I love the fact that I can turn the basal insulin up or down like a tap to deal with exercise or illness.
I love the fact that although it's attached to me most of the time, the hosepipe doesn't bother me (in itself that was waaaaaaay less of a big deal than I'd first feared) and I can 'drive' the pump with its remote so I don't have to keep hoiking it out.
I disconnect it to shower, swim and *coughs* sometimes when partaking in certain bedroom activities.
I have a much steadier 'line' in blood glucose terms.
I don't go low after meals then high later.
I don't go high after meals then low later.
I am on around 30% less insulin than I used to be.
I have the confidence to exercise without risking hypos.

I don't like the fact that whenever my cartridge needs changing it comes at a really inconvenient time (not the pump's fault - more to do with my haphazard time management and ridiculously chaotic routine-absent life).
I don't like that sometimes my skin doesn't like the cannula adhesive.

It took me decades to actually get a pump. Since starting pumping, my HbA1c is lower. My weight is lower since I started pumping - it dropped off me and I find it's really stable.

It was a pain in the neck for the first two months. It took six months for it to become second nature. It's no less hard work than I was doing on MDI, but oh boy, it's hard work that I SEE and FEEL the results of on a daily basis. I never had that level of confidence in my diabetes management on MDI.

I love my pump.

I've had two cannula failures - the first was on my second day of pumping in October 2015.
Sometimes the sticky stuff irritates my skin.
I've tangled the hosepipe on a door handle once. It pulled the cannula out but didn't hurt - I found it the funniest experience ever, was able to clear up the mess and there was no lasting damage to me, the pump, the door handle or indeed Mr S's pride-and-joy-yet-ridiculously-impractical cream carpet.
My pump handset (the meter/remote), NOT the pump, had a problem with its on/off switch. So did its replacement. Number three is doing fine so far.

But I love this box of tricks. Life-changing stuff.

Hi type 1 on MDI for 48 years. Thinking of considering a pump. How do you fund yours? Not sure if I qualify as reasonable control but sick of chasing hypos etc?,!

 

[Dianemacfaden]

I have had a pump for about 18 months now. I would say my bg control is better but I do not find my life any easier.
The main advantage of the pump is that you can vary your basal. A long acting insulin assumes your basal needs are the same for 24 hours. Some people find this is not the case: they may need more basal at night; or less basal when exercising; or more basal in the morning to deal when dawn phenomenon; etc.
There are other benefits like being able to spread a bolus dose to deal with something like pizza which may take longer to get into your blood stream.
Not needing to inject is good but the other side of this coin is that you need to change your "sets" regularly. This means replacing your cannula, refilling your cartridge and rewinding your pump ... whilst not getting flustered by your pump beeping because it's notice you are not attached. This is also the step that can go wrong if you don't get your cannula in properly so you do not get any or enough insulin ... which is your constant basal as well as your bolus.
When on MDI, generally you have spare insulin during the day (because they need more at night and can only have the same basal for 24 hours) to "mop" up when you under count carbs. For some people this means they can snack or eat some sweets without needing to inject. Because a pump should more accurately reflect your basal needs at different times of the day, you don't have this spare insulin. As a result you need to be more accurate with your carb counting.

I was on MDI for 13 years before I went on a pump. I was reluctant at first because of the idea of being constantly connected.
Now, my control is better throughout the day but I don't like set changes and I really dislike the physical appearance of my pump which I struggle to hide (whatever I do with it, I have a bulge which I am self-conscious about).
Overall, I know the pump is better for me. But I never felt a desire to throw my pens to the other side of the room.

So, is a pump for you? Only you and your consultant know.
Are you willing to put in the extra carb counting effort, go through some possible challenges setting your pump rates correctly and risk not getting your cannula in properly (although this improves with practice)?
What are the chances of getting a pump? Some hospitals put a lot of hurdles in place as they are expensive to fund?

If, after some discussion with your consultant, you are given the option on a pump but you are unsure, remember you can go back to MDI if that is what you prefer.

<Sorry for the long waffling message>

Hi. Not sure if I qualify for a pump? Lifetime of MDI type 1 since 1970 but would like the chance to try one to see if life is easier. Would I qualify?

 

[Deleted Account]

Hi. Not sure if I qualify for a pump? Lifetime of MDI type 1 since 1970 but would like the chance to try one to see if life is easier. Would I qualify?

Different CCGs seem to have different hoops to jump through to get a pump. So only your consultant can answer that.
There are many threads on this forum about how to prepare to ask the question/have a pump review.
The main things to consider are
- why do you think you need a pump? how would it help your control?
- are you willing (and able) to invest the time, effort and brain power necessary to get the most out of a pump?

 

[Snapsy]

Hi type 1 on MDI for 48 years. Thinking of considering a pump. How do you fund yours? Not sure if I qualify as reasonable control but sick of chasing hypos etc?,!

If your consultant agrees you fit the NICE criteria they can apply for funding for a pump for you - https://www.nice.org.uk/guidance/ta...n-pump-therapy-final-appraisal-determination2

If you don't fit the criteria, there are the ABCD criteria which they can also take into account - https://www.nice.org.uk/guidance/ta151/documents/association-of-british-clinical-diabetologists2

INPUT are useful if you come across problems getting a pump - http://www.inputdiabetes.org.uk/

And the whole of the Insulin Pump forum on here is brilliant!
http://www.diabetes.co.uk/forum/category/insulin-pump-forum.14/

 

[tim2000s]

I think I'd disagree with @helensaramay on her point about having to carb count "even more". If you are remotely active, or have a good Hba1C level, which you do, the carb counting between pumping and MDI is no different. Especially if you've been using a bolus calculator device or programme. The other side to that is that while some people may use basal to mop up, others of us use correction doses to deal with inaccurate carb counts, and the same applies whether you're on a pump or on MDI. The only real difference between the two is that with MDI you have to inject every time.

When I moved onto a pump it was entirely because I was seeing DP and doing a lot of exercise that was harder to manage with basal insulin.

 

[cumbria-pumper]

If you suffer from lots of hypos I am sure that should be reason enough. A good A1c based on lots of hypos isn't a good thing.