Advise how to get pump

[AliBal1]

Hi . I am an active runner trying g to train for a half marathon . Still on MDI, everything I read days pump use makes management safer and easier on a pump but my area are very backward with prescribing. Have libre 2 patches over with juggluco to make cgm but seeking any advice on how to evidence need for pump moving forwad to support exercise needs . . Everything I read seems to be supporting only poorly managed conditions .

 

[Juicyj]

Hello @AliBal1

The first place to start is with building a good relationship with your DSN, they can tell you how to access pumps in your area based on their current guidelines.

Also take a looks at NICE guidelines for pump access too, I gained access to a pump because my t1 was impacting my quality of life with testing over 10 times a day, 6+ injections, micro management and still not obtaining good control.

 

[etmsreec]

Pumping, or Continuous Subcutaneous Insulin Infusion (CSII) doesn’t make it easier, it just makes it different. For one, it’s a steep learning curve as a lot of what one learns for MDI has to be relearned for CSII. It’s a different paradigm.
Advantages:
- basal insulin can be adjusted for the time of day, so if one is repeatedly going high at a particular time then more basal can be programmed onto the pump;
- exercise can be accounted for with a planned drop in basal an hour before the exercise, rather than needing to take extra carbs;
- everything can be bolused for, whether it’s a small snack or a main meal;
- no more needing to get needles and insulin pens out to jab before a meal;
- greater flexibility, as no need to be clockwatching for basal injection time
Disadvantages:
- only Omnipod presently available as a non-tethered pump;
- tethered pumps need to be removed and then reconnected before showering, swimming, etc.;
- limited capacity (e.g. 200u for Omnipod) which can be too little for some users;
- only U100 is officially supported in pumps at the moment;
- relearning about “my” diabetes;
- there’s no long acting background insulin, so it’s possible to go into DKA more quickly if the cannula becomes blocked or if the pump runs out of insulin;
- not all diabetes teams have a pump service;
- the patient’s local ICS (the successors to CCGs) have to agree funding, and that funding is for four years. Pump companies are still going with four year contracts, even though the initial outlay on devices like Omnipod is much lower;
- pumps are not suitable for all patients, and vice versa;
- closer monitoring and watching for patterns required, so it’s not less work than MDI

In my case, I was referred to the pump service in Liverpool, and they have been brilliant. I see the consultant about once a year via a video call, but have appointments with DSN and dietician more frequently. Both they and my consultant are available by email, too, so easy to get between appointment problems resolved. They also arrange Pumpers’ Evenings - seminars either in person or (more recently) Zoom to bring us up to date on developments and upcoming news. Recent ones have included feedback (pun not intended) on the Hybrid Closed Loop (HCL) trial, and a presentation by Partha Kar. The Liverpool pump service have quite a geographically distributed patient-base, and don’t just work “in area” - great for me as I’m in Cheshire rather than Merseyside. Dr. Weston, my consultant, is one of the leading lights with the HCL trial/work.

 

[EllieM]

Thank you for sharing @etmsreec .

I'm not a pump user but have been offered it in the past because of dawn phenomena (currently not too bad so suspect I might not get the offer again). managing with MDI but I like to keep considering a pump.

 

[Deleted member 527103]

only Omnipod presently available as a non-tethered pump;

It may be the only non-tethered pump available at your clinic but there are others available in the UK.
For example, I have been using Medtrum's patch pump for 3 years.

However, many people prefer tubed pumps as it provides more flexibility for placement. Taking off the pump for a shower is no great disadvantage.

 

[Captain_Sensible]

Pumping, or Continuous Subcutaneous Insulin Infusion (CSII) doesn’t make it easier, it just makes it different. For one, it’s a steep learning curve as a lot of what one learns for MDI has to be relearned for CSII. It’s a different paradigm.
Advantages:
- basal insulin can be adjusted for the time of day, so if one is repeatedly going high at a particular time then more basal can be programmed onto the pump;
- exercise can be accounted for with a planned drop in basal an hour before the exercise, rather than needing to take extra carbs;
- everything can be bolused for, whether it’s a small snack or a main meal;
- no more needing to get needles and insulin pens out to jab before a meal;
- greater flexibility, as no need to be clockwatching for basal injection time
Disadvantages:
- only Omnipod presently available as a non-tethered pump;
- tethered pumps need to be removed and then reconnected before showering, swimming, etc.;
- limited capacity (e.g. 200u for Omnipod) which can be too little for some users;
- only U100 is officially supported in pumps at the moment;
- relearning about “my” diabetes;
- there’s no long acting background insulin, so it’s possible to go into DKA more quickly if the cannula becomes blocked or if the pump runs out of insulin;
- not all diabetes teams have a pump service;
- the patient’s local ICS (the successors to CCGs) have to agree funding, and that funding is for four years. Pump companies are still going with four year contracts, even though the initial outlay on devices like Omnipod is much lower;
- pumps are not suitable for all patients, and vice versa;
- closer monitoring and watching for patterns required, so it’s not less work than MDI

In my case, I was referred to the pump service in Liverpool, and they have been brilliant. I see the consultant about once a year via a video call, but have appointments with DSN and dietician more frequently. Both they and my consultant are available by email, too, so easy to get between appointment problems resolved. They also arrange Pumpers’ Evenings - seminars either in person or (more recently) Zoom to bring us up to date on developments and upcoming news. Recent ones have included feedback (pun not intended) on the Hybrid Closed Loop (HCL) trial, and a presentation by Partha Kar. The Liverpool pump service have quite a geographically distributed patient-base, and don’t just work “in area” - great for me as I’m in Cheshire rather than Merseyside. Dr. Weston, my consultant, is one of the leading lights with the HCL trial/work.

A brilliant and very informative answer! I love the pros and cons - Thanks for sharing

 

[jmp21551]

I have been using a pump for many years (17). Various degrees of success. However I have started using the pump with a sensor. A hybrid system. This improved my TIR dramatically. I still had to do calibration fingerpricks twice a day. Now I have upgraded to the sensor that does not require calibration. An improvement.
However whilst I can get stunning results (90+%TIR) most of the time, the hybrid system has a mind of its own and can do the unexpected.
But I suppose it does have to cope with the human body. What is the number of things that can alter your diabetes control? 47.

One downside is I have to self fund the sensors.

 

[steve_p6]

Having just been approved for Omnipod, there isn’t a tie in for 4 years from their perspective so if patch pumping doesn’t work out you can keep open the option to switch to a tuned pump.