Is an insulin pump just another insulin delivery device?

[Marie 2]

You have a good point, some people would prefer it be "easy". My mother in laws boyfriend would take the exact same dose at every meal, no matter what and then wonder why he dropped sometimes in the middle of the night. Dropping so bad that emergency was called. Yet "the doctors" from his words couldn't figure out why he dropped. He was quite old and I'm not sure really capable of learning carb counting or changing doses for the amount of carbs. This is someone that completely went by what the doctors told him to take and did not change anything until the doctors told him otherwise.

Attachment to a pump also does make you think of your diabetes more often during each day. A CGM does too. I remember when I first got my CGM, I started looking at it all day, (I still do) and thinking I am a little ocd about my numbers now. When I was on shots, I would virtually ignore my BG until a meal time, bedtime or if I felt bad.

So I guess yea, you can "ignore" this disease easier without a pump and some people will be happier being that way. And I am one for whatever works for you is what's best. And I know reading some stats for the US, that 25% of type 1's have a pump, but control was not better in adolescent and young adults even though more of them had a pump. But as you got older if you had a pump control had improved. With insurance it's more of a choice here and I know even though my endo had been bugging me to get one, I waited because I really didn't want to be bothered with learning and dealing with a pump. I had this vision of tubing and pulling it loose, talking to customers and it starting to beep, needing to put insulin in it at work. Those are all things I should have not worried about, but I didn't know, nor did I care to really find out.

Now I wouldn't change having it!

 

[Cobia]

In the UK, people are put on MDI first, then a pump if they really need it. But does it matter which way we give people insulin? Do you need to start on injections then move to a pump, or would it be legitimate to simply start people on pumps?

After all, when we start a person on MDI, they are started with a guessed basal and bolus amount. It would be no different on a pump, just using fast acting insulin only, and would provide far greater flexibility as someone moved through the honeymoon period.

I reckon it doesn't matter, and that if you were to start someone on a pump they'd do as well as someone on MDI (appropriate training being applied in both cases, of course!). What do you think?

In general i agree a pump is just another way to administer insulin but i do think a person should be able to carb count and administer insulin via pen for a while first...

Sorry just a point of view.

 

[Cobia]

Whilst I don't believe pumps (or CGM or Libre) should be a reward for active diabetes management and I don't think we should have to jump through lots of loops, I believe money should be spent on treatments for people that get the most out of them.for starting

If people that have good control of thier diabetes shouldnt get a pump or any form of CGM in your eyes.....

Does that mean with out your pump you cant control yours?

Should the NHS uuuummmmm give yours to someone else more deserving?


Just putting it out there..

 

[Deleted Account]

Hi @Cobia

Thank you for highlighting the need to clarify my point.
I meant to emphasise that a pump is not a reward.
Some people maintain good diabetes management with injecting by doing many injections which effectively mimic variable basal. Some people maintain what is perceived as good diabetes management (low Hb1AC) through many hypos.
It was not my intention to suggest these people do not deserve a pump. In my eyes, they need a pump to improve the quality of their lives.

As you point out, I have a pump and I find this helps to manage* my diabetes. I exercise frequently and, without the ability to adjust my basal, I found my BG spent a lot of time either too high or too low, depending on the type of exercise.
My pump has various basal profiles depending up on the type of exercise I do which is not possible to achieve with slow acting basal insulin.
To set these up has required a lot of trial and error and understanding how the pump works.
To go back to my post that you partially quoted, I believe I have the "interest/motivation/ intellect" to get this value from my pump.

I would not use the term "deserving" of the pump. I consider it in terms of the value to me and to the NHS.


*I try not to use the term "control diabetes" because I do not believe this is possible. I try to use the term "manage diabetes" as a manager would manage their staff and cannot control them from being ill or stressed or stealing from the company.

 

[Cobia]

Thanks @helensaramay for making my point. Which i know in that other post you had 3 different perspectives.

In reality the ones who have a good hba1c by hypo..... havnt learnt how to handle insulin.

And in my job the exercise requirment changes every day i had to find around that with mdi... with 0 hypoes for the last month... which here id have tobe loosing my feet and eyes shot to buggery to qualify for subsdised libre or CGM. Which is why i self fund it.

Take the electronics away id bet id be a lost cause.....,

 

[Deleted Account]

In reality the ones who have a good hba1c by hypo..... havnt learnt how to handle insulin.

That is a huge generalisation which I think is unfair to many people with type 1 diabetes.

As I mentioned, i would hypo when exercising with MDI. I understood insulin but did not have the tools (pump) to use it to its best advantage. Then, as I mentioned, there was a lot of trial and error with the pump to set the right basal rates. Even now, my exercise may not turn out as I expected. For example, I need extra insulin when climbing but, if my climbing partner needs a “relationship download”, I may climb less than expected and see my BG start to fall with the extra basal.
And as diabetes (and life) is rarely predictable, no matter how much you carb count, use variable basal rates, set CGM alarms, etc. I do not believe it is possible to completely avoid hypos.

 

[MeiChanski]

Thanks @helensaramay for making my point. Which i know in that other post you had 3 different perspectives.

In reality the ones who have a good hba1c by hypo..... havnt learnt how to handle insulin.

And in my job the exercise requirment changes every day i had to find around that with mdi... with 0 hypoes for the last month... which here id have tobe loosing my feet and eyes shot to buggery to qualify for subsdised libre or CGM. Which is why i self fund it.

Take the electronics away id bet id be a lost cause.....,

Wow, you cannot clump everyone who has a good hba1c through hypos as “haven’t learned how to handle insulin”.
I was diagnosed before smart phones was a thing, before pumps and cgms are sleeker and smaller. There are diabetics who micro manage their condition with good hba1cs and they were qualified for a pump. Depending on CCG, some are prescribing libres under the new guidelines. With CGMs, we as adults have to lose our driver’s license for it because of hypo unawareness.

There are some diabetics who have the full kit - pump, cgm and libre and show no improvement of their control.
There also some diabetics who suffer hypos through no fault of their own, sometimes 0.5 units is too much for some adults, sometimes food packaging is wrong and end up hypo, some women face more hypos during their time of the month or going through pregnancy (it can go either way, high or low). It’s not just insulin we have to manage, we have to look at various things. I also know some diabetics don’t learn from their numbers. But that’s not fair to say those who face hypos don’t know how to handle their insulin.

 

[kitedoc]

But there are studies showing diabetics, TIDs, who manage with or without pump and cgm, with or without looping to achieve HBAICs in the low 5 %s or less. With minimal hypos.
That seems to me to be the full enchilda, as they say.
So it is possible.
That is not saying those that have not been able to are at fault necessarily.
The problem is to do with current prevailing paradigms of diabetes management, the food industry's profit over health mantra,, guidelines influenced by the food industry and Big Pharma, the influence of medico-legal paranoia, poor health professional education, infiltration of health professionals' under- and post graduate education by one religious sect, Big Pharma and the food industry, that thing called willful blindness ( see reference in my post above), thecexistence of multiple autoimmune conditions or other illnesses in individuals, the disadvantage of poor socioeconomic circumstances and poor education and yes, as always, human behaviour.
Yet despite all this it is possible.

 

[Marie 2]

It is so unfair to group everybody into a package you perceive being the best way. I think it is so wrong to be saying if you are not doing it my way you are doing it wrong. We all have our different beliefs and how we treat ourselves in our care is one of them.

Diabetes is a very variable disease per person, and if a pump can make that easier, so be it.

 

[kitedoc]

There are some ways that work better for adults and children - shown and proven.
I am just stating that as fact.
Some may use pumps some may not, i did not differentiate between in my post above.
Yes all are entitled to our own beliefs, but if one does not occasionally question those beliefs and what they are based on then we may assume there is no problem and be right or wrong.in terms of the effect on our future health.
And who and what do you trust?
What are all the known things that would reduce that variability in managing diabetes and are we doing everything individually to be the best we can?

 

[Fairygodmother]

It’s very sad that we’re still ready to find fault with T1s who for one reason or another don’t achieve ‘good’ management without hypers and hypos. It’s a condition which seems to affect each of us differently and, to repeat an oft stated truism, is perhaps the only one where it’s left to the patient to find a good way to control it. We also have tools to do so which are certainly better than they were half a century ago but are still at the outer edge of mimicking the extraordinary fine tuning of the uncompromised human endocrine system.

 

[firdosa4]

I'm glad I started with mdi and then moved onto a pump. To program a pump to give a good baseline you would need to do a lot of testing. I liked how everything was done step by step. Yes, I was higher first few months and felt hypo 10, but alongside my dsn we brought it down gradually and let my body slowly get used to healthy normal. It was strange and hard to remember, bringing all my new gear. With pumping you need to carry more things. I needed to buy a big bag which was a sad moment. Imagine having to buy an even bigger one, that might have bought me to tears. It was very strange getting used to a pen (NovoMix and then a combination of Novorapid & Lantues) having saved my life. It played on my mind a lot and I was grateful I could put it in the fridge and forget about it for a few hours. With a pump there is no escape. I loved changing from NovoMix to injecting more often. They started me on that as it involves a lot less injections. But to me, only eating when I wanted was more important than eating using a strict regime. I as 19yr really loved the idea of having late breakfast and nothing till early dinner. If I went out or did excerise I ate half a bar of galaxy chocolate and I didn't go hypo. Carried emergency £1 or a Lucozade if I was going somewhere I didn't know where the closed shop was. I carried meter and out the door I went. My hba1c was great. I didn't carry my novorapid unless I was going out for food, or going to college but I had an insulin pen in my college bag. Yes, I had lots of different bags. I felt free of diabetes. As long as I injected the times I ate and having taken lantues. There was no need to consider diabetes at other times.

With pump, it is a physical reminder all the time. You would need to do dafn asap instead of memorizing staple meals and the correct dosage for it. Yes, dafne was easy and straight forward for me but at the beginning it would have been harder to change my eating. Food used to be for pleasure more than survival. I believe it would have been damaging for someone like me to have started with a pump.

However, few years ago I searched about different ways to improve overall diabetes control. Dafne course was recommended and followed by getting a pump. Did dafne but was refused a pump. Got pregnant and whilst pregnant third time was offered a pump. The pump reduced my hypos by 80% yes my hba1c did then rise but only to 48 which is the recommended rate. Yes, as you can see I benefited greatly from having a pump. But I'm still glad I had mdi first. Less things to carry (which I for unknown reasons struggled more with than having to inject myself), no constant reminder that I have a disorder/ illness (basically my body being to weak and silly to kill an essential part of itself), not feeling spied on (the pump stored information on how much carb you ate and when) and the pump needs to be stored somewhere to stop others asking about what is that protruding from your dress? Not only do you need to hide it from yourself you need to hide it from others. When newly diagnosed you might not want to interact with others about your diabetes. You might want to hide it. It is much harder to hide a pump than a pen. Funny, I never tried to hide my pens, but the pump I do hide. Maybe it is because people ask to see it and I have no interest in showing my stomach or thighs to anyone (except husband and doctor/nurse when needed).

 

[Marie 2]

I agree it’s smart to learn shots first and learn the basics, for one in case your pump breaks you know what to do.

It was more freeing to not think about diabetes as much without a pump or CGM. You just gave a shot and went on with it . You can do that with a pump too but you just don’t? I guess you think about it more because it’s so easy to use more. So it’s a trade off, some people decide to take time off from a pump.

I had to switch to a larger purse instead of a small one too. But I know a couple of people that just carry syringes, strips and reader and not all the paraphernalia with them with an Omnipod. They just make sure there is some kind of insulin supply still in the pod. Since the reader is a meter and you can pull insulin back out of the pod, it cuts down on what you carry until you get back home.

Young kids take to pumps pretty quick usually it seems like.