Benefits and Drawbacks of an insulin pump

[kitedoc]

Hi @MeiChanski,
I agree with @helensaramay about all her pump pros and cons.
Although it is not so much the appearance of the pump on oneself that worries me per se, it is the fact that.
although attached, it is an expensive and rather vital bit of kit - so when I know I might be in crowds or
queues where I might get jostled I do not wish it to be pinched/stolen/lifted -so I have 2 neck wallets for those
occasions, one for the pump, the other for my wallet ! (think of the gun toting bandito with bullet belts slung
crosswise over his chest )! No, better not to!!
The cannula sites are the weak point of any pump : some have trouble if they are thin with the cannulas hitting
muscle, or in all of us with cannulas bending - the pump does not always alarm if the cannula is bent and not
providing insulin at the programmed rate. The 90 degree steel cannulas have been a godsend for me -
they do not bend/kink etc.
What the pump did for me though was prevent the night-time hypos which were occurring after 45 years on insulin
injections and solved the Dawn Phenomenon issue. (see Home page, question box right upper - type it in there).
The pump is still a bolus device for meals similar to MDI with the added ability to do extended dosing - say 50% of the dose now and 50% an hour later without having to remind oneself !
The basic question remains:
Do you eat and use insulin to control the resultant BSL rise or do you eat to match the pattern of your insulin dosing?

 

[MeiChanski]

Going back to my pen was a little bit of a pain for 2 days until I got a replacement pump but mostly because of the basal - I had got used to the variable basal and I had to take it as soon as possible after my pump failed which was not a convenient time of day. But as it was for a short period (2 days out of over 3 years), I do not think it is something to worry too much about as long as you keep your pens (and insulin in date) as a backup.

The only other pump "problem" is airport travel as it cannot be x-rayed. I fly a lot (at least one return trip a month) so have got used to politely telling the security guy that I will not go in the body scanner. Most of them (in various countries) understand what this means. Heathrow were once nasty and told me I chose to have diabetes (I reported her to her manager) and, I learnt, in Brussels, not to wrap it around my thigh as it meant I had to lift my dress up in public to prove it to the security person!

Apart from that I think I have covered everything.

I think I expressed an interest in the pump in September. I then had to go on the DAFNE course (this is a prerequisite in most areas to ensure you know how to carb count) which was 6 weeks long (one night a week for 6 weeks). And I got my pump in January.
I think if I had already been on the DAFNE course, I think I would have got it quicker. But as you say, all CCGs seem to be different.

Oh that's understandable, my dad always complains why I carry so much in my bag, I keep saying it's my life supply in there - hypo treatments, lots of strips and needles as backup. Oh dear, I didn't know that. I did have a lot of trouble going through security with insulin pens on my to NYC. They kept pulling me out of the queue and checking my bag several times and through my medication. Chose to have diabetes? absolutely r u d e.
I was suppose to do DAFNE a very long time ago but couldn't do it because of university commitments and grabbed the opportunity to do it last year 2018. So I don't know if it'll be any quicker because I've heard people waited years or months, but again CCGs are different.

 

[MeiChanski]

Hi @MeiChanski,
I agree with @helensaramay about all her pump pros and cons.
Although it is not so much the appearance of the pump on oneself that worries me per se, it is the fact that.
although attached, it is an expensive and rather vital bit of kit - so when I know I might be in crowds or
queues where I might get jostled I do not wish it to be pinched/stolen/lifted -so I have 2 neck wallets for those
occasions, one for the pump, the other for my wallet ! (think of the gun toting bandito with bullet belts slung
crosswise over his chest )! No, better not to!!
The cannula sites are the weak point of any pump : some have trouble if they are thin with the cannulas hitting
muscle, or in all of us with cannulas bending - the pump does not always alarm if the cannula is bent and not
providing insulin at the programmed rate. The 90 degree steel cannulas have been a godsend for me -
they do not bend/kink etc.
What the pump did for me though was prevent the night-time hypos which were occurring after 45 years on insulin
injections and solved the Dawn Phenomenon issue. (see Home page, question box right upper - type it in there).
The pump is still a bolus device for meals similar to MDI with the added ability to do extended dosing - say 50% of the dose now and 50% an hour later without having to remind oneself !
The basic question remains:
Do you eat and use insulin to control the resultant BSL rise or do you eat to match the pattern of your insulin dosing?

Hahaha, I'd be absolutely petrified if it were to be stolen, tugged on or ripped off my body. I have read some lean people are having trouble with the cannula. I'd assume I won't because I'm slightly juicy. So you were able to catch the low BG before it tumbles lower? for the liver dump, I take some novorapid and go off to do something and by then I'm ready for breakfast and in better range. I have tried cheese for the liver dump and it has helped to some extent. I carb count to match my insulin needs and correct or add extra if my BG is out of range or slightly out of range.

 

[LooperCat]

I’m very late to the party here - I spent 20 years on MDI and got my first pump last August. It’s been amazing, almost as good as having a pancreas. I’ve got the tubeless Omnipod system, which is so unobtrusive that I often forget where I’ve placed it! I could never get a handle on dawn phenomenon or monthly insulin resistance when injecting, and it’s enabled me to deal with those by adjusting basal rates for certain times of day (and month!). Yes, if it fails, levels can get out of hand fast, but I always carry a spare pod, a vial of insulin and an old school syringe in my handbag, so I can give myself insulin another way if I need to. If I’m away from home for any length of time I take pens with long and short acting as a backup.

I didn’t find the transition period to be too onerous, because I’d been keeping meticulous records of my doses (up to 18 corrections a day) in the run up to getting it, to show how much I needed one. We set a programme based on that, and it needed minimal tweaking. I now have a few programmes, for lazy days, work days, and the week before my period, when I need about 30% extra.

I wear my pod pretty much everywhere - upper arms, torso, thighs, calves... I don’t care if it’s visible because I need it to live. My Libre+MiaoMiao is often visible too, I’m always happy to tell someone what it is if they ask.

 

[MeiChanski]

I’m very late to the party here - I spent 20 years on MDI and got my first pump last August. It’s been amazing, almost as good as having a pancreas. I’ve got the tubeless Omnipod system, which is so unobtrusive that I often forget where I’ve placed it! I could never get a handle on dawn phenomenon or monthly insulin resistance when injecting, and it’s enabled me to deal with those by adjusting basal rates for certain times of day (and month!). Yes, if it fails, levels can get out of hand fast, but I always carry a spare pod, a vial of insulin and an old school syringe in my handbag, so I can give myself insulin another way if I need to. If I’m away from home for any length of time I take pens with long and short acting as a backup.

I didn’t find the transition period to be too onerous, because I’d been keeping meticulous records of my doses (up to 18 corrections a day) in the run up to getting it, to show how much I needed one. We set a programme based on that, and it needed minimal tweaking. I now have a few programmes, for lazy days, work days, and the week before my period, when I need about 30% extra.

I wear my pod pretty much everywhere - upper arms, torso, thighs, calves... I don’t care if it’s visible because I need it to live. My Libre+MiaoMiao is often visible too, I’m always happy to tell someone what it is if they ask.

No problem, Mel.
Would you say your levels are much more manageable now since having the pump?

 

[LooperCat]

No problem, Mel.
Would you say your levels are much more manageable now since having the pump?

Very much so! But it does require some work, sometimes more than some are willing to put in. You have to be very accurate with your carb counting, and if low carb, with counting and dosing for protein as well.

 

[Bluey1]

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.

The pump says "lost connection with the transmitter move pump closer" This is random I can go up to 3 days without a problem then 8 times a day. throughout the life of the sensor (6 days) I can guarantee on at least 20 times for up to 2 hours each time. When it really gets upset it starts vibrating. It would beep if it could, but I have one the faulty ones that doesn't make any sounds anymore. You can't calibrate while it's having a hissy fit, and sometimes it just finishes having a hissy fit, you try and calibrate and starts off again. The accuracy seems pretty good.

 

[MeiChanski]

Very much so! But it does require some work, sometimes more than some are willing to put in. You have to be very accurate with your carb counting, and if low carb, with counting and dosing for protein as well.

I've bumped into the right man to do it with me. my bf has to be extremely accurate - we were working at the carbs for dinner and it came to 7.7g of carbs and I said i'll do 8 units. my pens either do 0.5 or whole units. He said "is there that a pen that does 0.25 units? asking for a friend"

 

[ann34+]

@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.

Totally agree, the base rate flexibility is why the pump is so good, any doubt at night and you just take the base rate down, if more doubt then i take it further down, maybe for just 2 hrs. Have been on pump 10 yrs, but i well recall ago how nights on MDI were for me - always a worry, i did not sleep thru even one night as i had to wake myself every single night due to erratic hypos, i never felt safe and the wooly head and half alive feeling the next day after just one hypo at night meant waking to check was a small bother if it stopped the hypo. But i had a poor quality of life, i had always used little insulin at night and no insulin around at that time seemed able to give me a small enough dose. But the pump gives me as much or as little as i want, and the rate can be changed hourly and every day if needed. I dont have libre, CCM or anything else, just pump and tests, i have never been offered any more.

 

[Marie 2]

Hi! I believe changing the doses has already been mentioned, but I have an Omnipod and I have a lower basal dose set for night. When you give a shot it does have peaks and lows but it's meant to last over a 12 or 24 hour period so not a lot of adjustment if you are sleeping and need less, same with exercise and needing less. But a insulin pump you can really change it up. So for example, I also have dawn phenomenon, so my basal settings are
12am-2 am .6
2am-5:30am .8
5:30am-8am 2.2
8am-11:30am 1.4
11:30am-12am 1.

Then you give yourself a bolus for what you eat or adjustments if necessary. It's just a push of a couple of buttons and I can give a tenth of a unit or 5 units etc if needed. So that snack of 5 carbs, really easy to dose for it. The pump will do all the calculations or you can bypass that if you want. I have mine programmed for different carb ratios for different times of the day too. You can also suspend dosing, but I prefer the temporary decrease/increase route and you decide how much to decrease/increase for how long. I use the temp decrease when exercising or the dentist office!

Sometimes I change my basals all the time and sometimes I hardly ever do. I used to dip even worse at night and had even lighter settings at night. But this means you can ease up at night and not worry as much. I used to have Libre CGM but have now switched to the Dexcom CGM which has alarms. Kind of loud ones that repeat so you can't ignore them. You can set the loudness and what they go off at pretty much. You can also download the ap Miao Miao that someone mentioned for your Libre, there is a charge for that, but I have never used it, people do seem to really like it. I am in the US so my insurance covered the Dexcom completely. ( I pay towards my insurance each month though)

 

[MeiChanski]

Hi! I believe changing the doses has already been mentioned, but I have an Omnipod and I have a lower basal dose set for night. When you give a shot it does have peaks and lows but it's meant to last over a 12 or 24 hour period so not a lot of adjustment if you are sleeping and need less, same with exercise and needing less. But a insulin pump you can really change it up. So for example, I also have dawn phenomenon, so my basal settings are
12am-2 am .6
2am-5:30am .8
5:30am-8am 2.2
8am-11:30am 1.4
11:30am-12am 1.

Then you give yourself a bolus for what you eat or adjustments if necessary. It's just a push of a couple of buttons and I can give a tenth of a unit or 5 units etc if needed. So that snack of 5 carbs, really easy to dose for it. The pump will do all the calculations or you can bypass that if you want. I have mine programmed for different carb ratios for different times of the day too. You can also suspend dosing, but I prefer the temporary decrease/increase route and you decide how much to decrease/increase for how long. I use the temp decrease when exercising or the dentist office!

Sometimes I change my basals all the time and sometimes I hardly ever do. I used to dip even worse at night and had even lighter settings at night. But this means you can ease up at night and not worry as much. I used to have Libre CGM but have now switched to the Dexcom CGM which has alarms. Kind of loud ones that repeat so you can't ignore them. You can set the loudness and what they go off at pretty much. You can also download the ap Miao Miao that someone mentioned for your Libre, there is a charge for that, but I have never used it, people do seem to really like it. I am in the US so my insurance covered the Dexcom completely. ( I pay towards my insurance each month though)

Hello, Thank you for your input. I think the UK diabetics are still waiting for the freestyle libre 2, which has alarms as well. it'll be an interesting competition between that and the dexcom. My consultant was considering me for a pump but he hasn't referred me for anything yet. I'll have another discussion with him in June and it'll interesting to see if he has anything to offer. However I have discussed the CGM with my mum, brother and boyfriend and they like the idea of it, but I said i'll wait until what the consultant will say.

Totally agree, the base rate flexibility is why the pump is so good, any doubt at night and you just take the base rate down, if more doubt then i take it further down, maybe for just 2 hrs. Have been on pump 10 yrs, but i well recall ago how nights on MDI were for me - always a worry, i did not sleep thru even one night as i had to wake myself every single night due to erratic hypos, i never felt safe and the wooly head and half alive feeling the next day after just one hypo at night meant waking to check was a small bother if it stopped the hypo. But i had a poor quality of life, i had always used little insulin at night and no insulin around at that time seemed able to give me a small enough dose. But the pump gives me as much or as little as i want, and the rate can be changed hourly and every day if needed. I dont have libre, CCM or anything else, just pump and tests, i have never been offered any more.

Hello, that is understandable, I'm currently living the zombie life and trying to finish my degree. It's not nice at all, I'm hopeful for that day where I can sleep a good full 8 hrs and wake up with a smile on my face. Heck, i'll be happy with 6 hours without any disturbance.

 

[Capt-Slog]

It's no problem, I'm just speaking in a theoretical sense whether a pump could be beneficial or not in my case. I just want to be able to sleep at night and tell my parents and bf that i'm okay. unfortunately my parents don't know about my accident in 2013. If I tell them about it, they'll go to hospital up in arms asking why nothing has been done. (They too, have seen me on the floor prior to going to university and they are incredibly worried. They sometimes call university security to check up on me, because they do a route around university).

I've seen some people on instagram that have had an oopsie moment when there is a pump failure and BG does go up into scary levels. is it avoidable? or not really? I've seen some patch pumps and it's slightly thicker and wider than the libre so I don't know how I feel about it, but do let me know.

Would you say you are worry free to some extent? compared to me living life worrying all the time.

Hi,
I just wanted to offer some more information that you may find useful. Apologies if you already know.
There seems to be two different things that bother you and your family. The first is that you are aware of what your blood sugars are doing at all times (especially when you are asleep) and the second is whether having a pump is going to make your life any better.
I am in the throws of getting a pump. Tomorrow i have to go to the hospital to meet all the reps and ask sensible questions because apparently asking them if their pump is the best will not get me a sensible answer!!
Everyone i have spoken to seems to say that getting a pump is a right pain at first, but if you persevere it does improve your life.

As far as keeping an eye on your blood sugars, i wanted to set the record straight about the Libre. I wanted to get a G6 but i just can't afford £159 a month (especially as i need to replace my ageing car, so i know where your boyfriend is coming from!).
So i took the time to explore the MiaoMiao transmitter for the Libre. It cost me about £160 as a one off purchase.
What a lot of people are mentioning is the ability of the G6 to do calibration finger prick tests.
What they are NOT mentioning is that after you get your MiaoMiao, you can then couple it to a piece of software called xDrip+ on your mobile phone. xDrip+ uses your phones Bluetooth to talk to the MM. The MM talks to your Libre.
xDrip+ DOES have the facility for you to enter as many calibration readings as you wish and it modifies the readings from the Libre and pulls them inline with your BG meter. I find that by using xDrip+ my CGM data is very accurate.

Another thing that your parents and boyfriend might be interested in is a program called Nightscout.
xDrip+ can use your phones WiFi or Mobile Data signal to talk to Nightscout on the internet. Nightscout stores your data online and spits it out onto a web page. The webpage doesn't mention your name or any personal details. You setup an account and a username. You can then give the URL of this webpage to anyone you wish. Parents, Boyfriend, colleagues, even the University Security team. They can put it onto their phone.
This will allow them to see, in real time, your Blood Sugars for the last 24 hours. They can see where it is now and they also get a graph showing if it is going UP or DOWN. Almost as importantly, NightScout can be set to play any sound clip that is on your phone, if you go above a certain reading, or if you go below a certain reading. I recorded a message on my phone of me saying "JELLY BABY TIME!" and set it to go off if i went below 5.0.

I have an old mobile phone at home which permanently displays my BG reading which sits next to my bed, so i can glance at it at night if i wake up feeling a bit funny. The people that work in the office next to me have a monitor i gave them showing the webpage all the time. This is because i work in an office on my own most of the day.

So... there are things that you can do that don't cost TOO much and will make your loved ones very happy.

Unfortunately Nightscout also allows them to see if you have stuffed a big cream cake in your gob on Office Birthday days and forgot to take any insulin! (Oh, maybe that is just MY problem!).

XDrip+ is free......Nightscout is free and everyone i know has at least one old mobile phone.

Don't get me wrong, i would probably still use a G6 if i had money to burn, but Libre-MiaoMiao-xDrip+ are pretty good too.

Hope this helps
Tigs

 

[LooperCat]

I can give you a discount code for a MiaoMiao if you go down that route. I’ve been using one for a year now, and it’s fabulous. Takes the Libre to a whole new level!

 

[MeiChanski]

Hi,
I just wanted to offer some more information that you may find useful. Apologies if you already know.
There seems to be two different things that bother you and your family. The first is that you are aware of what your blood sugars are doing at all times (especially when you are asleep) and the second is whether having a pump is going to make your life any better.
I am in the throws of getting a pump. Tomorrow i have to go to the hospital to meet all the reps and ask sensible questions because apparently asking them if their pump is the best will not get me a sensible answer!!
Everyone i have spoken to seems to say that getting a pump is a right pain at first, but if you persevere it does improve your life.

As far as keeping an eye on your blood sugars, i wanted to set the record straight about the Libre. I wanted to get a G6 but i just can't afford £159 a month (especially as i need to replace my ageing car, so i know where your boyfriend is coming from!).
So i took the time to explore the MiaoMiao transmitter for the Libre. It cost me about £160 as a one off purchase.
What a lot of people are mentioning is the ability of the G6 to do calibration finger prick tests.
What they are NOT mentioning is that after you get your MiaoMiao, you can then couple it to a piece of software called xDrip+ on your mobile phone. xDrip+ uses your phones Bluetooth to talk to the MM. The MM talks to your Libre.
xDrip+ DOES have the facility for you to enter as many calibration readings as you wish and it modifies the readings from the Libre and pulls them inline with your BG meter. I find that by using xDrip+ my CGM data is very accurate.

Another thing that your parents and boyfriend might be interested in is a program called Nightscout.
xDrip+ can use your phones WiFi or Mobile Data signal to talk to Nightscout on the internet. Nightscout stores your data online and spits it out onto a web page. The webpage doesn't mention your name or any personal details. You setup an account and a username. You can then give the URL of this webpage to anyone you wish. Parents, Boyfriend, colleagues, even the University Security team. They can put it onto their phone.
This will allow them to see, in real time, your Blood Sugars for the last 24 hours. They can see where it is now and they also get a graph showing if it is going UP or DOWN. Almost as importantly, NightScout can be set to play any sound clip that is on your phone, if you go above a certain reading, or if you go below a certain reading. I recorded a message on my phone of me saying "JELLY BABY TIME!" and set it to go off if i went below 5.0.

I have an old mobile phone at home which permanently displays my BG reading which sits next to my bed, so i can glance at it at night if i wake up feeling a bit funny. The people that work in the office next to me have a monitor i gave them showing the webpage all the time. This is because i work in an office on my own most of the day.

So... there are things that you can do that don't cost TOO much and will make your loved ones very happy.

Unfortunately Nightscout also allows them to see if you have stuffed a big cream cake in your gob on Office Birthday days and forgot to take any insulin! (Oh, maybe that is just MY problem!).

XDrip+ is free......Nightscout is free and everyone i know has at least one old mobile phone.

Don't get me wrong, i would probably still use a G6 if i had money to burn, but Libre-MiaoMiao-xDrip+ are pretty good too.

Hope this helps
Tigs

Hello, thank you and that's an interesting input. A few diabetics have mentioned about the miamiao and I agree to an extent that diabetes is a rich man's disease. I've discussed it with everyone but I'm waiting to see what my consultant suggests with my difficult situation, then hopefully before I go back to university, there will be something in place whether it is CGM or something else.

 

[LooperCat]

Hello, thank you and that's an interesting input. A few diabetics have mentioned about the miamiao and I agree to an extent that diabetes is a rich man's disease. I've discussed it with everyone but I'm waiting to see what my consultant suggests with my difficult situation, then hopefully before I go back to university, there will be something in place whether it is CGM or something else.

It can be expensive, I got all my family and friends to chip in a tiny amount instead of a birthday present last year - best gift ever, and they all feel they’ve contributed something to my health

 

[MeiChanski]

It can be expensive, I got all my family and friends to chip in a tiny amount instead of a birthday present last year - best gift ever, and they all feel they’ve contributed something to my health

Oh yes, unfortunately I knew about the new technologies when I joined this forum which was after my birthday, maybe I could ask as a small gift for completing this semester.