Type 1 To Pump or not to pump.

[jaychi89]

Hello All,



I would like to hear your feedback and suggestions on a question I am asking myself.

I am 52 and have been a type 1 since I was 9.

And I think best way to start with a before and after.

I used to have 5 to 7 injections daily. 3 x Novorapid of 20u a day and 2 x Lantus of 45 u I had a hba1c of between 34 and 36.Using the trendy new way of gauging control I was in range 67-70% of the time. And I have been on Dexcom G7 for over a year.

Three months ago I started on an insulin pump. A Tandem T2

I was initially excited no more injections. And it would take the reactionary mindset away.

But I have a concern, on my very first night on the pump I went low, G7 said I went as low as 2.1. So after three days of trying to contact the Diabetes Clinic my formula was changed. This was also after the resultant three nights of lows as well.

Since then I have been running high for the resultant 10 or so weeks. My time in range after starting the pump has 54- 63%. My time in range has dropped and my Hba1c has risen 39. The trusteel adhesive gives me an allergic reaction. To keep on top of the highs. Prepump I floated between 3.4 and 7 number wise. Mind you I wouldn't feel a low till I was in the mid 2's. Now I hover between 6 and 10.

Also in the preceding 3 months my carbs have dropped for roughly 180 grams a day to 90 a day.

My diabetes nurse is useless and I have given up on even asking them questions. And on my six weekly post pump appointment I for want of a better term ‘ tore her a new one.’ They could hear me in the waiting room. Really a week to wait for a 5 minute phone call?

My skin allergy to the adhesive got so bad I went 'pump free for two weeks to give my skin a chance to recover which it did and went back to pens Novorapid and Lantus. My TIR went back to 72.

Also, I'm supposed to use 90U of Novorapid in the pump a day and change it every 3 days. But in reality because I am slipping high I'm changing every two days. I'm going through a script which is supposed to last a month in just over 2 weeks.

But the most annoying thing is the near constant beeping from the Dexcom app and pump.

SO my questions are:

1) Is it worth staying with the pump?

2)Anyone else had similar issues?



Any feedback or suggestions welcomed.

 

[EllieM]

Hi @jaychi89

I am so sorry you are having all these issues.

We aren't allowed to give medical advice but after using the tandem for two years, with varying success, here are some thoughts.'

Firstly, the tandem gives great results but depends on the user manually setting good basal rates. Ideally your clinic should be helping with this but if they aren't are you able to read up on calculating basal rates and adjust them yourself? I have 4 programs and swap between them depending on my circumstances. I was finding my results disappointing at one stage but after I revisited my basal rates my time in range improved dramatically. Having said that, I find the tandem algorithm useless if my blood sugar goes much above 10, because my insulin resistance goes up, so I ruthlessly add extra insulin if I go high and stay high.

As for the cannula issues, I would contact your tandem rep for advice. My clinic told me that there were two other cannulae available if I had issues with the truesteel, but luckily I didn't need them. There are also creams you can apply for skin allergies - I use cavilon for my dexcom.

Just my opinion, but 3 months isn't long enough to learn how to use the tandem. In my experience, just as I needed to learn how to adjust my insulin doses, I also needed to learn how to adjust my pump basal rates. I know my clinic are very busy, so I haven't bothered them much, but they did talk to me in my beginning pump stage, so I agree that your clinic appear to be being seriously remiss in your care.

I went on the tandem because hypos and reduced hypo awareness were becoming a big issue for me. The pump has massively reduced my hypos.

As for the beeping, go into device settings and turn them onto vibrate?

Good luck

 

[ElenaP]

. The trusteel adhesive gives me an allergic reaction. but

I am sorry to read that you are allergic to the adhesive in TruSteel cannulae. I have been using a t:slim for almost four years. I started with teflon cannulae, but those resulted in bad inflammations. Fortunately, my skin does not react to the adhesive, so TruSteel suits me.

As for having hypos during the night, I would recommend that you eat your last meal, or snack, five/six hours before bedtime. That way you will only have basal insulin in your body, and the pump should stop insulin delivery if your readings go low. In my case, the one thing I like about the t:slim is that I get fewer night-time hypos.

Good luck.