Best control, Pump or Pen?

[Landor]

Hi,
I have had type 1 for over 40 years and for the majority of it used a pen. A little over a year ago I started having massive problems with high blood sugar levels. Several people have told me to go onto a pump as it is easier to control blood sugar levels. Looking through the forum it seems there are a lot of fors and againsts.

Just putting that out as a general question, what do people think is best, Pump or Pen?

It also seems like I have to be an alchemist to create one as they are so difficult to obtain on the NHS!

Cheers
Col

 

[Deleted Account]

Best control is definitely a pump because, by allowing your basal to be adjusted throughout the day, it mimics a healthy pancreas better.
That is not to say it is easy - that extra configuration to set up your different basal rates can take some time to set up; the ability to adjust your basal for exercise or illness or stress is great but you can over adjust, the ability to stretch your bolus over a longer time is great for pizza, etc but you may get it wrong, ... and, as you have no "spare basal" in your system, you may need to be more accurate with your carb counting.

I have been on a pump for two years. The motivation was to reduce hypos and improve my exercise - it has definitely helped this.

 

[catapillar]

This is a useless question. Whether a pump or mdi is "best" really depends on what problem you are trying to solve.

@Landor what exactly are your "massive problems with high blood sugar levels"? Is this dawn phenomenon? Or pizza effect? In which case a pump could help by offering bespoke basal rates and extended bolusing. If it's something else, you should be able to obtain control on mdi, potentially with a bit more work at it.

You should have a look at input diabetes for how to get a pump on the NHS. The criteria are fairly broad, and if your consultant isn't supportive they can point you to an alternative hospital that does support pumps.

 

[Didi61]

I have been a diabetic and on the pen for 10 years but my sugars were all over the place. I recently switched to a pump 6 months ago and my sugars have been much better. My HbA1c went from the 15s percentile to about 7.4%. It's not great yet but there were drastic improvements to my HbA1c within 3 months of going on the pump.

 

[Chas C]

@Landor I do not think its a useless question, but as @catapillar mentioned it would help to understand why your having high BG's only in the last year.

FWIW I moved to a pump after around 44yrs MDI as it was the best move I ever made.

 

[Landor]

Best control is definitely a pump because, by allowing your basal to be adjusted throughout the day, it mimics a healthy pancreas better.
That is not to say it is easy - that extra configuration to set up your different basal rates can take some time to set up; the ability to adjust your basal for exercise or illness or stress is great but you can over adjust, the ability to stretch your bolus over a longer time is great for pizza, etc but you may get it wrong, ... and, as you have no "spare basal" in your system, you may need to be more accurate with your carb counting.

I have been on a pump for two years. The motivation was to reduce hypos and improve my exercise - it has definitely helped this.

Thanks Helenaramay

 

[Landor]

@Landor I do not think its a useless question, but as @catapillar mentioned it would help to understand why your having high BG's only in the last year.

FWIW I moved to a pump after around 44yrs MDI as it was the best move I ever made.

Thanks Chris

 

[Landor]

I have been a diabetic and on the pen for 10 years but my sugars were all over the place. I recently switched to a pump 6 months ago and my sugars have been much better. My HbA1c went from the 15s percentile to about 7.4%. It's not great yet but there were drastic improvements to my HbA1c within 3 months of going on the pump.

Thanks Didi61

 

[Landor]

This is a useless question. Whether a pump or mdi is "best" really depends on what problem you are trying to solve.

@Landor what exactly are your "massive problems with high blood sugar levels"? Is this dawn phenomenon? Or pizza effect? In which case a pump could help by offering bespoke basal rates and extended bolusing. If it's something else, you should be able to obtain control on mdi, potentially with a bit more work at it.

You should have a look at input diabetes for how to get a pump on the NHS. The criteria are fairly broad, and if your consultant isn't supportive they can point you to an alternative hospital that does support pumps.

Thanks (I think) Catapilar a bit of an aggressive response albeit a fair question.

I avoid complex carbs as they are too difficult to manage, I have unexpected high readings (mid to late 20's) for no reason, my ratios seem to change daily (what worked for the same meal one day wouldn't another day. I've tried several fasting days and still had high blood readings (late teens). I've invested in a Libre sensor and have been scanning every hour, I also maintain my finger pricking morning and night and before mealtimes. Some months I've had a cold or infection so expect an increase in blood sugars.

After a recent check-up at the local eye hospital I've been told I have approx 3 months and if my control isn't improved I will probably have to have monthly injections in my eyes as they are deteriating fast.

Cheers
Landor

 

[catapillar]

Thanks (I think) Catapilar a bit of an aggressive response albeit a fair question.

I avoid complex carbs as they are too difficult to manage, I have unexpected high readings (mid to late 20's) for no reason, my ratios seem to change daily (what worked for the same meal one day wouldn't another day. I've tried several fasting days and still had high blood readings (late teens). I've invested in a Libre sensor and have been scanning every hour, I also maintain my finger pricking morning and night and before mealtimes. Some months I've had a cold or infection so expect an increase in blood sugars.

After a recent check-up at the local eye hospital I've been told I have approx 3 months and if my control isn't improved I will probably have to have monthly injections in my eyes as they are deteriating fast.

Cheers
Landor

Sorry, wasn't intended to be aggressive. But the point it what's best for me might not be best for you. And frankly, what's best for me on Monday might not be best for me on Tuesday. It's a bit like asking what's best: round or square? And that depends what shaped hole you've got. And what you really mean by "best", because that can mean different things to different people too. I might think pumping is best because I really hate injections, but you might not give a monkeys about injecting and find the cannulation gubbins a massive faff. What's best: pump or pen? Isn't a question that it's possible to answer objectively because the answer is too dependent on the individual, what they may be struggling with, what they are trying to achieve and what their preferences are.

I guess your aim is to achieve a bit more consistent control. I don't think either pump or pen will achieve that until you figure out why you are getting unexpected readings in the 20s. Are there any patterns to when this happens? Are you a man or a woman? Could they be hormone related? Could they be stress or illness related? Could they be linked to nights of poor sleep? Or insulin pens being out of the fridge for too long? Have you been investigated for any other health conditions that might cause erratic flood of hormones increasing blood sugars: things like hyperthyroidism, pituitary gland issues causing too much adrenaline.

The first step, for both pumping and mdi, is to get basal rates right. Have you done any basal testing since you've been having these issues? Here's a guide on how to basal test - https://mysugr.com/basal-rate-testing/

How do corrections work when you have these unexpected highs? Do you correct? There's not really a lot of point fasting and expecting not eating to correct blood sugars in the teens. Being in the teens is also too high to start a basal test. If you start a basal test euglycaemic and end up in the teens that suggests your basal dose is too low. Do you know what your insulin sensitivity factor is?

 

[Landor]

Sorry, wasn't intended to be aggressive. But the point it what's best for me might not be best for you. And frankly, what's best for me on Monday might not be best for me on Tuesday. It's a bit like asking what's best: round or square? And that depends what shaped hole you've got. And what you really mean by "best", because that can mean different things to different people too. I might think pumping is best because I really hate injections, but you might not give a monkeys about injecting and find the cannulation gubbins a massive faff. What's best: pump or pen? Isn't a question that it's possible to answer objectively because the answer is too dependent on the individual, what they may be struggling with, what they are trying to achieve and what their preferences are.

I guess your aim is to achieve a bit more consistent control. I don't think either pump or pen will achieve that until you figure out why you are getting unexpected readings in the 20s. Are there any patterns to when this happens? Are you a man or a woman? Could they be hormone related? Could they be stress or illness related? Could they be linked to nights of poor sleep? Or insulin pens being out of the fridge for too long? Have you been investigated for any other health conditions that might cause erratic flood of hormones increasing blood sugars: things like hyperthyroidism, pituitary gland issues causing too much adrenaline.

The first step, for both pumping and mdi, is to get basal rates right. Have you done any basal testing since you've been having these issues? Here's a guide on how to basal test - https://mysugr.com/basal-rate-testing/

How do corrections work when you have these unexpected highs? Do you correct? There's not really a lot of point fasting and expecting not eating to correct blood sugars in the teens. Being in the teens is also too high to start a basal test. If you start a basal test euglycaemic and end up in the teens that suggests your basal dose is too low. Do you know what your insulin sensitivity factor is?

No apology needed I'm a big lad now and can handle comments x

I did the fasting in an attempt to get my background insulin at the correct level and I think I may just have it. I had on a single dose of background insulin for over ten years until I had a check-up and the diabetic nurse said I should be on 2 doses per day so not good.

I've changed my injection sites and moved them from arms to arms, legs and stomach. I've mentioned to my clinicians it could be insulin resistance as I've been on the same insulin for well over a decade but they don't think it's that.

I haven't tried the Basal testing but I'll try that and have a look at the link you've sent (cheers)

I don't know what my sensitivity factor is atm. It was 2:1 am 1:1 lunchtime and 3:1 evenings but that's like a fairground merrygoround atm 'round and round and round it goes, where it stops nobody knows' lol.

One good step forward is that I've left the motorbike in the garage and I'm walking to work which seems to be having a positive effect, albeit a small one atm.

I have hyperthyroidism but that's in good control and last time I checked I was a bloke, am a bloke. I have only just started correcting, that does bring my levels down but if you looked at my Libre' scan graph you'd get motion sickness as it's like a roller coaster ride all the peaks and troughs.

Cheers
Landor

 

[MinaRotter]

As a type 1 diabetic for the last 40 years, I have tried most things - back in the day, urine testing and glass syringes and re-usable needles the size of toothpicks sterilised in boiling water was the norm

I was on the pen system for around 15 years with an Hba1c of 8% if I was lucky; I had a really bad dawn phenomenon and couldn't adjust the background insulin to compensate without having hypos all day long.

Started the pump 10 years ago and since then my highest HbA1c has been 6.8%. As you can adjust your basal rate on a 1/2 - 1 hourly (depending on the pump) interval, it gives tremendous insight into what your insulin requirements are thoughout the day. It also allows for easy meal skipping and exercising without carb preloading and complex carb or fat loaded meals (eg indian or pizza) are easily catered for by using what's called an "extended bolus". For example I can easily split my bolus for a curry into a dual bolus - giving about 37% of the bolus stat and extending the other 63% over 3 hours. This can be easily tailored to your requirements, once you've been taught and is done using a single bolus profile. In my opinion it is the best thing for diabetes control and flexibility available today.

It's not for everyone though. Some are quite happy with their mdi regime and manage to get good control with that and aren't "tethered" to a pump all day - although there are pumps without the tubing becoming available now. There aren't many that have tried the pump and gone back to the pen/mdi method but there are some - mostly it seems, those that have good control with the mdi method. However, if you are struggling on the pen/mdi, I would strongly advise you to try the pump - it's hard work initially but great after that and if you find it isn't for you, you can always switch back.

 

[Landor]

Thanks Minarotter!

Ah yes the clinitest tablets and the ace test, remember them well .

Catapilar gave some good tips and there’s a couple of things I need to try but i’m swaying Towards a pump.

I’ve looked at purchasing one but it looks like that’s the easy part, it’s getting the supplies from my local PCT etc. Which can be a pain.

Thanks for your response!

Landor

 

[Chas C]

Hi @Landor its good to see you have a Libre, I use a Dexcom and sugar surf with my pump. So take insulin to correct BG movements if they go up. I used to have similar but less severe increases like yourself.

Having been IDD for so long finding the best location for a cannula and maintaining a good rotation using the best sites can be a challenge. Also one of the other big issues is to try not to over treat highs or lows and creating the yo yo effect whilst updating using BG readings.

It will take some time to get it all stable, hopefully you will soon get it resolved.

 

[richyb]

I went on a pump last year after 51 yrs.
It's really good, more precise.
But will not suit everyone

 

[Codythechef]

I have been a diabetic and on the pen for 10 years but my sugars were all over the place. I recently switched to a pump 6 months ago and my sugars have been much better. My HbA1c went from the 15s percentile to about 7.4%. It's not great yet but there were drastic improvements to my HbA1c within 3 months of going on the pump.

Were u carb counting as accurate when on injections?

 

[Chas C]

You do need to be able to carb count correctly for both pump and pen - if you don't then neither will be much use.

I found that the advantages of a pump over a pen for me were:

• being able to adjust basal over the day to suit my personal needs, eliminating the morning issues
• being able to use multiwave bolus and extended bolus (much harder to do these with a pen and to keep track of where you are).
• being able to lower or raise my basal dosage to cope with illness and activity, I don't but some people have multiple basal ranges in their pumps and move between them as needed.

I still carry pens as a backup and did need to use them last summer when on hols and my pump died, was surprised how easy it was to switch back also found that I was using my pen much like I would bolus with a pump (as best I could). Although now wearing a CGM makes life so much easier.