Re: Would you prefer to be on insulin injections or on a pum
Apologies in advance - very long post.
My daughter was diagnosed just over 2 years ago, just before 5th birthday. She has had the pump for 13 months. Some of what I say below may be dis-regardable, considering she was a scared and headstrong child.
Our experience with pump has not been good, although it is finally improving and we seemed to be in the minority with all the problems we had and the length of time we had problems for.
When starting pump we were told to give it 2 weeks to settle in, getting the hang of cannula's/getting doses right etc but we had problems practically every day, on top of being tired having to do checks through the night to check dosages. However, I was on facebook groups (for parents of diabetic children - so I was discussing it with like minded - whereas people reading this may be adult suffer-ers) so at first I got alot of support but I think they even got fed up of my constant complaining and when other people posted about pump v's mdi I would give my opinion but the original 'poster-er' would not thank me. The one thing that annoyed me was that everyone said it is difficult for a couple of weeks, but did not say specifically what to expect whereas I would list all our problems in the hope that the 'post-er' would know what can possibly go wrong.
Here is a list of the problems we suffered.
Cannulas not sticking. At one point I had to use 4 tegaderms a day, despite using cavilon. SOLUTION. After a long time of mentioning to my nurse with no solution, I got hold of another nurse who told me that when you spray the cavilon, then insert the cannula, you then have to spend a good 5 mins rubbing and breathing on it to heat it up, which increases the stickiness.
Cannulas not working. I would say that for up to 8 months at least half would go wrong. In other words instead of changing every 2 days we might have to change 3 days in a row. The way you detect a cannula is not working is that BG's go high and despite correcting after 2 hours then leaving another 2 hours(so 4 hours overall), the BG's have still not declined. You then need to check for ketones and change cannula.
Pump failures. Many possible reasons.
Regarding cannulas not working and pump failures. Many scenario's incorporated into 2 headings, but back when I was on facebook I thought they were all separate issues, I have learned alot since then. So - possible reasons ....
Repeatedly using same sites - my daughter would only allow us to use her thighs, the same sights she had been using for MDI's since diagnosis, therefore the legs got very bruised and fat lumps formed. This could have caused the cannula to not be able to deliver insulin AND can cause the pump to fail, as it thinks there is a blockage. Pump failure automatically prevents it form even attempting to deliver further doses - ergo you HAVE TO change cannula. In our case it was always failing between midnight and 5am, causing many sleepless nights considering you then have to check BG's and do corrections 2 hourly.
Type of pump case being worn in bed. Another possible reason we had the problems with cannulas/pump failure, was the case she was using in bed. The line exits the case at he back of the pump, agains the skin. Picture this - the line exits the pump at the side, so it then has to back up to exit the case at the back. in our case it is possible the line was getting pinched against the 'corner' of the pump. We now use a camera case which holds the pump so that the line is pointing up and made a hole in the case at the top, so the line exits the pump in a straight line.
Many confusing pump functions. I had my confidence knocked when Hannah ended up in hospital with DKA. As the pump only uses fast acting (delivers tiny amounts constantly) if insulin stops being delivered for any reasons ketones can develop very quickly. Hannah had been ill (not eating) so I had done a temporary reduction in the basal rate (the tiny amounts I mentioned), then the pump failed at approx 5am. An hour later she vomited and I discovered her ketones were 5+.
Important lesson learned if hospitalised with DKA. I didn't take ketone blood meter as I expected hospital to have one. Apparently not. They were testing with urine. Luckily our nurse was there from late afternoon and she argued for us that once urine test went below 2 we should be allowed to go, as ketones are present longer in the urine than in blood. She was right, when we got home tested with blood and ketones were 0 despite being 2 in urine.
Cannula wounds take longer to heal than injections. Hannah is getting bruised up to the same condition on sites we have only been using for approx 4-5 months, compared to 1 year of injection sites.
In my opinion the pump can double the problems. If at school (or an adult out and about/working) and pump/cannula fails, have to get home to change cannula. Depending on what the problem (how long it goes on for, you may need to correct with pen so always have to have those supplies as a back up. This is as opposed to MDI, where, once you have injected you are sorted until next injection required.
I have been typing this for almost 1 hour now so I will leave it there. Food for thought! I will round off by telling you why things have improved. After being on pump for approx 8 months I rang doctor and threatened to go back to injections. Despite months of complaining and asking for answers it was this threat which got results. I will never know what was causing our problems as 3 things were changed at the same time. 1 - we got a new pump. 2 - we got a different type of cannula which made it easier to persuade Hannah to try different sites and 3 - we swapped pump case.
The one good thing I will say is that since the above changes and things settling down, her HBA1C is the best ever (but still slightly high at 8) and you can correct if high without need for additional injections. Also nice to be able to give insulin for snacks instead of either ignoring snack and the correcting at next meal or giving extra injections.
If you made it this far, thanks for reading.
