Injections. Or pump?

[Snapsy]

Wow @donnellysdogs - is that an insulin pump?!

Am so grateful for today's technology (although I'm looking forward to tomorrow's.....!).

 

[donnellysdogs]

It was one of the first insulin pumps...bit like the first blood meters that went in a shoe box!!

 

[Applenerd81]

Pumps can be great, but you only get results with the effort you put in with monitoring, diet etc etc and I found the pump required much more day to day effort than injections for (in my case) only a slight improvement in control.

I have been insulin dependant for over 22 years, spent the last 2 years using the Cellnovo system, I achieved great results (reduced hba1c and reduced frequency of highs and lows) when used in conjunction with a low carb diet (which I started 2 months after going on the pump) and regular monitoring - after taking a pump break I found I could get almost as good results on MDI but without all the excess daily baggage I had to carry round (spares) and without set changes every 3 days etc. I feel a lot better for not having a device strapped/stuck to me 24/7. I came to realise through using the pump that my main problem managing my diabetes was the amount of carbohydrate I was eating and the amounts of insulin I needed, not how the insulin was being delivered. I am back on MDI now and use in conjunction with a Freestyle Libre and feel its (almost) the perfect combination (for me), I am still aiming for the elusive 5.X% hba1c and getting closer each test.

My next diabetes check up will be my first since going back to MDI, I am looking forward to seeing if my results have worsened/stayed the same. The only think I miss about the pump is the discrete/ease to bolus in day to day situations.

Good luck with your choice whatever it is.

 

[donnellysdogs]

@Applenerd81, I was like you. On pump, back to Mdi But DP and waking phenomenon means waking at 4 everyday toncope and again an hour before waking properly to give extra correction boluses.

I would do anything instead of going back to a pump
If I could but 4am waking is not sustainable constantly when not sleeping till 1-2am each night...

I went back to pump(s) recently and hated it all..hated having to wear the 640g on my waistband and visible etc.. then my old combo sets kept failing on me. I hate thought of going back to a pump again and actually having counselling to deal with it. I
literally hate the
Idea of having this "thing"
stuck to me on my waistband when my combo and insights were hidden on my arm.

I so prefer mdi. My biigest preference and non appreciated to be honest.

If I had a pump that had a long tube, remote, stainless steel 4.5 mm set I would be happy. The DANA pump would have been ideal but my hospital despite offering all types of pumps won't give DANA as they had battery problems and just dying. DANA also not selling as new pump due out in early 2017...

I so wish I could get my head wrapped round having a pump more visible. Its difficult. My mastectomy makes me feel very self conscious and Inhave to have steels as I'm so thin and flex ones block. All Accuchek sets have probs in my skin.

For me, I am at a complete loss... getting up at 4am and testing, pre correcting on mdi is killing me and hubby. Pump mentally throws me into a huge downward spural..

It is important for all T1's to consider pro's and cons... it can be a novelty to start off with but 6 years ago I remember people being more bothered by colour than functionality etc... its good to see more aspects being considered nowadays...

Whether injections or pump(?)) is down to finding a happy medium... it is unlikely that 100% of all aspects will be met currently.

 

[Nnora]

From a perspective of an engineer and Medtronic pump user, I would prefer injections. Why? Because the insulin called 'rapid' is really slow comparing to physiological, reaches the maximum concentration in blood after 40-60 minutes and remains active for 3-5 hours. All these characteristics are perfectly designed for MDI therapy. However, in case that you need low doses of insulin, you are facing a problem. The producers are feeding the market with no less than 100 units per ml concentrations, which brings you to the insulin pump market.
And there we are, attached 24h to the 100 or 200 units that are loaded in the pump reservoair.
I am sure that there are many satisfied pump users here, but beware - the pumps can malfunction.
Just few weeks ago, it happend to me. After the reservoair replacement the message on the device was normal, 'connect the set to the body', but I observed persistent drops coming out from the needle, very slowly... For the next 5-10 minutes it did not stop and absolutely no warning message from the device!? I could have connected it and it could have disposed everything from the reservoair into the body.
The next morning I read about the people found in coma next to their recently replaced Medtronic sets with absolutely no evidence in the device event logs. Seems so much similar...
As an engineer, I know that the startup of every machine/process is critical but from users point of view, the Medtonic device is higly unreliable and even dangerous as it has no sensor detecting and recording the unprogrammed movement of the pistol.
Good luck!

 

[Applenerd81]

@Applenerd81, I was like you. On pump, back to Mdi But DP and waking phenomenon means waking at 4 everyday toncope and again an hour before waking properly to give extra correction boluses.

I would do anything instead of going back to a pump
If I could but 4am waking is not sustainable constantly when not sleeping till 1-2am each night...

I went back to pump(s) recently and hated it all..hated having to wear the 640g on my waistband and visible etc.. then my old combo sets kept failing on me. I hate thought of going back to a pump again and actually having counselling to deal with it. I
literally hate the
Idea of having this "thing"
stuck to me on my waistband when my combo and insights were hidden on my arm.

I so prefer mdi. My biigest preference and non appreciated to be honest.

If I had a pump that had a long tube, remote, stainless steel 4.5 mm set I would be happy. The DANA pump would have been ideal but my hospital despite offering all types of pumps won't give DANA as they had battery problems and just dying. DANA also not selling as new pump due out in early 2017...

I so wish I could get my head wrapped round having a pump more visible. Its difficult. My mastectomy makes me feel very self conscious and Inhave to have steels as I'm so thin and flex ones block. All Accuchek sets have probs in my skin.

For me, I am at a complete loss... getting up at 4am and testing, pre correcting on mdi is killing me and hubby. Pump mentally throws me into a huge downward spural..

It is important for all T1's to consider pro's and cons... it can be a novelty to start off with but 6 years ago I remember people being more bothered by colour than functionality etc... its good to see more aspects being considered nowadays...

Whether injections or pump(?)) is down to finding a happy medium... it is unlikely that 100% of all aspects will be met currently.

Your right in that neither is ideal. I also suffer from DP, but I have found it manageable through eating minimal carbs after 7pm and taking a bolus (3-5iu depending on what/how much I ate the night before) upon waking which is around 5-6am, even though my alarm is set for 7.30! BG still rise but only to mid 7s on a bad day, usually no higher than 6. It does mean I can no longer lie in or binge eat which I sometimes used to do on a weekend.

For me
Cons of pumps:
-Constant reminder of diabetes
-more tech to charge daily (handset, pump batteries)
-Pump anxiety (impending set changes, IC failure, cannula failure)
-Diabetic burnout (I was fed up of micromanaging my insulin)
-Once a set fails for whatever reason, blood sugars rocket (with basal insulin you always have something on board)
-Set changes laborious and too regular (3 days is too much for me)
-Extra stuff to cart around (I like to travel light, a pen and Libre is enough)

Cons of pens:
-Higher number of hypos, 1iu is a lot of insulin for me and its current the smallest unit I can inject with my pen, need a 1/2 unit or ideally less. (pumps can deliver tiny amounts of insulin)
-Injecting (pump more discrete)

 

[tim2000s]

What's interesting to note is that all those who have mentioned disliking pumps and returning to MDI don't seem to have struggled with insulin absorption issues. I personally get much more regular and consistent absorption with Pump use, whereas the MDI injections cause more hyperlipotrophy, which can also be a huge problem. Changing sets every three says I find less bothersome than changing the needle on a pen 6 times a day as well.

As we always say, YDMV.

 

[noblehead]

-Higher number of hypos, 1iu is a lot of insulin for me and its current the smallest unit I can inject with my pen, need a 1/2 unit or ideally less

Hi @Applenerd81

The HumaPen Luxura HD pen delivers insulin in half unit increments.

 

[Applenerd81]

What's interesting to note is that all those who have mentioned disliking pumps and returning to MDI don't seem to have struggled with insulin absorption issues. I personally get much more regular and consistent absorption with Pump use, whereas the MDI injections cause more hyperlipotrophy, which can also be a huge problem. Changing sets every three says I find less bothersome than changing the needle on a pen 6 times a day as well.

As we always say, YDMV.

It's interesting that you have more problems with lipohypertrophy with mdi, it's usually more likely with pumps due to the amount of insulin being delivered to one area.

 

[tim2000s]

It's interesting that you have more problems with lipohypertrophy with mdi, it's usually more likely with pumps due to the amount of insulin being delivered to one area.

Seems to be the needle trauma with me, rather than the insulin.

 

[Applenerd81]

Hi @Applenerd81

The HumaPen Luxura HD pen delivers insulin in half unit increments.

I'm wanting a the Savvio version, the luxura pens are good quality but heavy and large! Will be ordering one soon

 

[shivles]

Pumps seem to be like marmite! My T1 OH said he will never have one, I have to agree if I was diabetic unless I had really uncontrollable BS on MDI I wouldn't want one either, people keep pushing us to get our 17mo on a pump but we are waiting until she can decide for herself unless things get out of hand, for now we are doing okay and just working out normal tweaks.

I agree with the worry of malfunction, I feel there's a lot less scope for error with MDI but it's a thing that everyone has to weigh up individually, there's no right or wrong answer

 

[CarbsRok]

Pumps seem to be like marmite! My T1 OH said he will never have one, I have to agree if I was diabetic unless I had really uncontrollable BS on MDI I wouldn't want one either, people keep pushing us to get our 17mo on a pump but we are waiting until she can decide for herself unless things get out of hand, for now we are doing okay and just working out normal tweaks.

I agree with the worry of malfunction, I feel there's a lot less scope for error with MDI but it's a thing that everyone has to weigh up individually, there's no right or wrong answer

With respect your reply just shows how little you and your husband know about pumps and their capabilities in the right hands. It also reeks of fear of the unknown which is understandable but also so very unfortunate for your daughter. There is a lot less error using a pump and plenty of options for the type and length of insulin delivery. Basal can be delivered at 0.025units per hour or even turned off if needed this can not be achieved using MDI. But as you say it's your choice

 

[shivles]

With respect your reply just shows how little you and your husband know about pumps and their capabilities in the right hands. It also reeks of fear of the unknown which is understandable but also so very unfortunate for your daughter. There is a lot less error using a pump and plenty of options for the type and length of insulin delivery. Basal can be delivered at 0.025units per hour or even turned off if needed this can not be achieved using MDI. But as you say it's your choice

With respect your reply is very close minded as you know nothing of our family or our situation. Just because lots of people like pumps doesn't mean everyone will. It would be unfortunate for our daughter if she was suffering, which she is not, which is why we have her consultants approval to continue with MDI, I'm sure he would be the first to tell us if he thought we were putting her at risk.

Kindly don't make assumptions a pump is a very personal choice

 

[Snapsy]

bit like the first blood meters that went in a shoe box!!

Am so glad my pump's smaller than that!

My first blood meter (I remember it costing a fortune - mid to late 80s!) was the length and width of a house brick, but (only) half as thick. Testing took over 2 minutes, and it BEEPED at every opportunity......!

Discreet it wasn't!

 

[CarbsRok]

With respect your reply is very close minded as you know nothing of our family or our situation. Just because lots of people like pumps doesn't mean everyone will. It would be unfortunate for our daughter if she was suffering, which she is not, which is why we have her consultants approval to continue with MDI, I'm sure he would be the first to tell us if he thought we were putting her at risk.

Kindly don't make assumptions a pump is a very personal choice

I stand by what I said in my previous thread I also seem to remember on another forum you ranting how dehydrated and unhappy your daughter was or hypo all the time and it was causing her loads of damage in the long run. You didn't appear to appreciate the advice you were given from other mum's who had been there and worn the T.shirt one of those mum's was deeply offended by the rant you directed at her. Testing 200 times a week would be reduced massively for her little fingers as well. But as I stated it's your choice as to what you want to inflict on her.

 

[azure]

With respect your reply is very close minded as you know nothing of our family or our situation. Just because lots of people like pumps doesn't mean everyone will. It would be unfortunate for our daughter if she was suffering, which she is not, which is why we have her consultants approval to continue with MDI, I'm sure he would be the first to tell us if he thought we were putting her at risk.

Kindly don't make assumptions a pump is a very personal choice

It is every person's individual choice and we all have different lifestyles and different priorities, ambitions and fears

MDI doesn't put your daughter at risk at all

However, I truly believe that many people misunderstand pumps. I was one of them. I thought they were a last resort and a hideous thing to be 'tied to a machine like a prisoner'. In fact, the opposite is true. My pump didn't make me a prisoner - it gave me back my freedom and made me feel normal for the first time since diagnosis.

Some people don't want to have a pump and there's absolutely no reason why they should. However, it always makes me sad when they have preconceptions about pumps and reject them based on those.

People enthusing about pumps here are doing so out of a wish to 'spread the good news'. If other people then look at that 'news', examine it and decide it's not for them, that's fine. We are all different.

Some people are perfectly happy on two injections a day and that's fine too. All our choices are equally valid. Let's just make sure we base them on facts

Please note @CarbsRok and @shivles that you have both had your say here, but further arguments or combative posts may be removed.

Please can we now move on and concentrate on positives not negativity

 

[catapillar]

There is undeniably an "ick factor" when it comes to considering a pump.

John Harris is a medical ethicist who talks about (usually v controversial) medical advancements/possibilities and says the reactions are one of two extremes: 1) wow that's amazing or 2) yuck that's gross (nb I don't think he actually talks about insulin pumps, not controversial enough!) and he talks about how you go from yuck to wow as part of a philosophical thought experiment. Basically he says to get from yuck to wow you just need to be cold hearted deadpan rational. But he is just doing an abstract though experiment - the process of doing that for real life decisions when you are the subject is just so much more difficult! What he says are silly irrational preferences that should be taken out of the equation are my silly irrational preferences and I like them, they colour all of my decisions and that's what make them my decisions.

I'm not saying don't try and be rational, I'm not saying don't have an open mind, I'm not even saying don't try and overcome what you might recognise as a "silly irrational preference" (I don't think all irrational preferences are silly, that's just what I'm choosing to call mine). What I am saying is real life people give weight to lots of different factors when making complex decisions, stripping it down to what one person determines as the rational/logical stuff would just make us all robots and we don't work like that! It would be far too simple.

I was definitely coloured by the ick factor when I first though about pump and learning more about pumps, what they were really like, what they could do, how they really worked did help me to turn that ick reaction off. That's why I would say if you are thinking about a pump make sure to educate yourself on it as much as possible, even if the idea does turn you off at the moment, who knows what a little bit more information might do.

None of the things that I thought I would hate about having a pump have been an issue for me, it's perfectly comfortable to wear, it's easy to apply, I often forget where on my body it is, it's easy to hide, people don't notice it. I've not had any malfunctions/technical issues. The broader range of management tools that are afforded via a pump does feel freeing/empowering - I definitely don't feel "tethered" to anything, which I think was my main concern with a pump.

Yeah it is a funny idea having something connected to you all the time, and yeah I do love it when I get to have a shower without anything stuck on me, but I'm so glad I overcame the ick factor. The benefits of a pump far outweigh any ickiness - to the point where I am now convinced my pump is actually really cool!

 

[rockape37]

If your on a pump, what happens if you don't, or can't eat? Does it still inject you with insulin?

What if your stuck in a tree or something!

You can also set up aTemp Basal Rate for other activities, you could of course call yours "Tree Basal Rate" lol.

Regards

Martin

 

[rockape37]

With injections though not all the units are used 100% due to absorption, but a pump, although not 100% efficient uses more of the dose, so less units for one particular meal than you would normally need when injecting.....

I can vouch for that as when on MDI a few months ago one of my meals would need to inject 30 or more units now its about 50% less.

Regards

Martin