Benefits and Drawbacks of an insulin pump

Hello Diabuddies!

I hope you are well

I had a brief conversation with my consultant on the phone, in regards to my hypoglycemias and being unaware of it during the night.

A short start: I am on novorapid and levemir.

I was prescribed Tresiba by my new consultant on 2nd April.as a way to reduce hypos and as we all know, Tresiba is a flat profile insulin. I started this on the 3rd April starting at 9 units. From then onwards I was experiencing hypos during the night and with the libre, my boyfriend was able to help me. I took it every day at 21:10 at night and because of the hypos I switched to take Tresiba during the afternoon around 12:15, then I was experiencing hypos during the day and wake up low during the morning without novorapid on board.

Fast forward to 15th April, I spoke to my GP asking about what I should do, because I don't see my consultant until June and I'm going back to university for my final year living by myself this september. GP said it is out of their expertise but only referred me for therapy.

17th April - a DSN contacted me because of my urgency and in need of help and advice, she told me to reduce my Tresiba by 50% so 4 units and ask my consultant about the technologies that are available because I'm hypo unaware during the night (my boyfriend did witness this on my libre).
So after that conversation, I contacted my consultant to talk about my concerns. He said he would refer for pump therapy but even then I might experience hypos with a pump. I said I understand that as well, but my main concern is I could be dead during my sleep and being away from home, I have no one to call for help if I needed it. He also said a CGM wouldn't help in safeguarding my hypos either. In the end he said if I can reduce my hypos on MDI, it'll be better for everyone and myself. (I know pumps are expensive).

So other than reducing my insulin doses, I feel I've exhausted my options I am on minuscule dosages of novorapid and small dose of Tresiba.

My question is: In theory, how would a pump help my situation if I were to be given that opportunity to have one?

Juicyj said:

Hi @MeiChanski

Can I check when you were going hypo during the night did you check in your BG meter too ? The Libre when compressed during the night can give false low readings, a few of us here have experienced them. I do always check any Libre reading when high/low against my meter anyway to double check.

Click to expand...

Yes I've been without the libre for some time now and it's all finger pricks with hypos.

Juicyj said:

Ok just needed to check as you didn't mention using a meter.

The difference between using Tresiba/novorapid and a pump is the pump works solely on novorapid, Tresiba takes up to 36 hours to deplete from your system, whereas novorapid in the pump up to 4 hours so making adjustments can happen much quicker on the pump, also your dosing in 0.1 units compared to using 1 unit of insulin on injections meaning you can really fine tune your doses, you add basal settings depending on activity levels or illness and can adjust your basal settings many times during the 24 period so can drop basal setting right down at night if your going low then and increase for the morning if you tend to run higher then.

The pump does require a bedding in period where a lot of work will be required to changes ratios and adjust so you would need to be prepared to deal with this and do the work to get settings adjusted, but if your consultant has suggested this then I would seize the opportunity with both hands and go for it, it's certainly helped me reduce my HbA1c right down and I much prefer it to injections now.

Click to expand...

Thank you, sorry I didn't mention using my BM. In that case then, could people still abuse the pump and still have hypos and hypers? My consultant is the only person who can initiate the process for the pump. But i'm trying to understand his theory/perspective of going low on a pump.

Juicyj said:

Hi @MeiChanski You generally find people who are using the pump have tried and exhausted themselves on multiple daily injections, so folk who are committed to looking after their diabetes but who are not succeeding in good management and who are prepared to put the effort in, the NHS don't hand pumps out due to cost hence why they are prepared to review cases where patients are showing willing in making it work for them but meet NICE criteria.

The pump alone will not avoid hypos/hypers but with careful monitoring and adjustments it can make hypo and hyper events less severe as your taking smaller doses of insulin. I still have the same amount of hypos a week but they are very mild now and easier to treat and recover from.

Click to expand...

Thank you again, I thought I cracked the code by taking my Tresiba during the day, but hypos during the day is lesser than the two evils. Awkwardly I don't feel them but I am alive during the day so it is easier to treat. I understand the pump alone isn't a miracle product but as you say you can fine tune dosages and manage yourself better. Along with small doses of insulin, it is more manageable than taking two different types of insulin.

Could you think why some people would say the pump wouldn't work for them?

Geordie lass said:

I too am hypo unaware. I live alone and I always have hypo's overnight...my Consultant was very worried about this and I was last year funded for CGM. I have been using a Medtronic pump for years now and I currently use the 640G, which links up with the CGM Enlite sensors provided by Medtronic, to read my BGL's 24/7. I still have to test my BGL's a few times during the day to callibrate my pump & CGM, but it has been a life saver for me, especially overnight.

This is great because I can set my pump so that when the CGM suspects me going low it suspends my insulin pump until my BGL's rise above a certain level. It is definitely worth getting a pump and using it along with CGM, especially as you have nocturnal hypo unawareness. You should push this with your Consultant as you should be funded for the CGM alongside an insulin pump, especially not being hypo aware! Good luck!

Click to expand...

Thank you for your input, I don't know what the CCG here offers in terms of pumps and CGMs. I've been worrying about overnight hypos since my accident in 2013 and I did DAFNE last year for a deeper understanding of carb ratios. I will be living alone during my final year of university and I have expressed this to my consultant. He said very briefly he'll consider me for one if Tresiba is making my go hypo from now until I see him in June.

Have you had any troubles or frustrating moments with your current kit?

Geordie lass said:

Yes, I've had a few issues with my sensors not working properly. They are supposed to work for 6 days, but sometimes they only last 3-4 days. I've reported this to Medtronic on many occasions, and I must say, they have been very good in sending replacement sensors for me as well as a replacement transmitter! But, other than that the CGM's have been a lifesaver for me over the last 18 months of wearing them. I would be totally lost without them now. My pump also alarms and tells me when I am heading towards hypo stage, so that is a double bonus for me. Sometimes when I'm asleep I don't always hear my alarm, but that doesn't bother me as I know my pump will suspend insulin when I reach a BGL reading of 4.5! And, it doesn't resume insulin until my BGL numbers are in the safe zone!

Click to expand...

I'm glad to hear that Is the alarm obnoxious or quite a soothing beep?

Chowie said:

Hi,
I have the Medtronic 640g with CGM. I have disabled the hypo prevention as the sensor connectivity to the pump is very problematic and unreliable. They have just released the new sensors in Australia and they maybe better.

Pros
Better control
More flexibility with eating
Fewer Hypos
Fewer Hypers

Cons
Poor quality control of the pump (Medtronic)
Not able to calibrate the sensors when you need to (pump and sensor are having a hissy fit)
A few obnoxious call centre staff
Door handles (Medtronic) the tubing jumps out and wraps itself around anything it can
Skin damage from the adhesive tape sometimes causing ulceration and pain half way through the life of the sensor (Medtronic)
I kept putting off going onto a pump, I wish I had done it sooner.


I don’t have an issue being tethered to it or carrying it around or sleeping with it I let it roam free in the bed and I toss and turn all night. With a little thought QA and sone good managers in the company this could be an exceptional device, however I wouldn’t go back to MDI even with all it’s faults.

Click to expand...

Thank you Why is it unreliable? is the accuracy is incorrect? Would you have picked another pump/CGM? Oh dear, I'm sorry to hear that you've been unable to calibrate. I understand the skin damage, freestyle libre has left me some marks and bruises after taking it off.

helensaramay said:

@MeiChanski as others have mentioned an insulin pump in itself does not stop hypos.
However, the amazing benefit is that you can change your basal requirements throughout the day.
A slow acting insulin like Tresiba assumes your basal requirements are exactly the same 24 hours a day.
However, with things like Dawn Phenomenon, we know some people need more background insulin at certain times of the day.
If you are often having hypos in the middle of the night, this could suggest you need less background insulin at night so you can reduce your basal dose whilst you are sleeping.
I use a pump and find it incredibly useful when I exercise as my insulin needs plummet during, for example, a Spin class so I can turn off basal rather than stuffing myself with biscuits before I get on the bike.

I assume your consultant's suggestion for a pump is to allow you to match your basal dose to your body's needs rather than assuming it needs the same amount all the time.

Click to expand...

Hello, you are indeed correct, fortunately Tresiba is good during the day and unfortunately I drop during the night and waking up low. I was told to reduce it by 50%. When I was on levemir I was constantly tweaking it as well.
I understand an insulin pump doesn't stop hypos or hypers, from what you're saying an insulin pump does give you that space to alter needs throughout the day or within the 24 hour period. From my consultant and his tone, he would refer me for a pump but at the same time he wouldn't.