How good is Insulin Pump ?

[AndyWatt]

Hi all ! I'm new to the site and I was looking for some advice on Insulin Pumps ? I am at the early stages of waiting on an Islet Cell transplant as I have lost all Hypo awareness, I have had a couple of tests done and have completed the DAFNE course. I have now been referred for an Insulin Pump and I have been told they are really good and will make a big difference. I was looking for some advice from any Insulin Pump users. Any advice would be much appreciated.

 

[Spiker]

Well they do in general lead to fewer hypos. That's from statistical evidence, but I don't specifically know why they give that benefit, and whether it would still apply with no hypo awareness.

If you have no hypo awareness you might be eligible for a continuous glucose monitor (CGM) which are otherwise rarely funded by the NHS.

Has your loss of hypo awareness proved to be not reversible? Often it is reversible if you can avoid hypos for a while. That is something else the pump can help with. It can also reduce hypos caused by the uneven action of basal insulin, because a pump can shape the basal dose delivery much more accurately and finely to what your body actually needs.

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[AndyWatt]

Well they do in general lead to fewer hypos. That's from statistical evidence, but I don't specifically know why they give that benefit, and whether it would still apply with no hypo awareness.

If you have no hypo awareness you might be eligible for a continuous glucose monitor (CGM) which are otherwise rarely funded by the NHS.

Has your loss of hypo awareness proved to be not reversible? Often it is reversible if you can avoid hypos for a while. That is something else the pump can help with. It can also reduce hypos caused by the uneven action of basal insulin, because a pump can shape the basal dose delivery much more accurately and finely to what your body actually needs.

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Thanks Spiker, i have had no Hypo awareness for a couple of years now, my wife even finds it quite hard to tell when I'm having a hypo, she used to appear with dextro tabs or glucogel and my blood machine but now she's as surprised as me when we sit down to eat and my blood sugars are anything between 1.1 and 2.6, which is quite a lot. When they are as low as that, I feel fine.

 

[Flowerpot]

Hi

I started to use a pump 12 years ago after beginning to lose hypo awareness. I tried all the usual tactics of keeping my blood sugar higher but to no avail, I kept going unconscious without warning and my life was quite terrifying. Using a pump didn't give me back any hypo awareness but it vastly improved my control, the obvious benefits are receiving only minute amounts of insulin every few minutes rather than injecting 4 or 5 reservoirs of insulin per day through MDI. Night times became safer as I wasn't injecting any long acting insulin and the pump can deliver tiny basal doses which is what I need to avoid night hypos.

I started going down the islet cell transplant route because despite infinitely better control with my pump I still had no hypo awareness. I was very fortunate at this point to start to use CGM continuous glucose monitoring which has proved invaluable and saved my life.

A pump is a fantastic way to get much better control over blood glucose due to the choice of modes and rates you can set to deliver insulin. Using a pump may or may not help you regain hypo awareness, in my case it didn't but I would definitely give a pump a try as it has helped me massively.

I wish you well whichever route you decide to follow.

 

[AndyWatt]

Hi

I started to use a pump 12 years ago after beginning to lose hypo awareness. I tried all the usual tactics of keeping my blood sugar higher but to no avail, I kept going unconscious without warning and my life was quite terrifying. Using a pump didn't give me back any hypo awareness but it vastly improved my control, the obvious benefits are receiving only minute amounts of insulin every few minutes rather than injecting 4 or 5 reservoirs of insulin per day through MDI. Night times became safer as I wasn't injecting any long acting insulin and the pump can deliver tiny basal doses which is what I need to avoid night hypos.

I started going down the islet cell transplant route because despite infinitely better control with my pump I still had no hypo awareness. I was very fortunate at this point to start to use CGM continuous glucose monitoring which has proved invaluable and saved my life.

A pump is a fantastic way to get much better control over blood glucose due to the choice of modes and rates you can set to deliver insulin. Using a pump may or may not help you regain hypo awareness, in my case it didn't but I would definitely give a pump a try as it has helped me massively.

I wish you well whichever route you decide to follow.

Thanks Flowerpot, i would quite like to try the pump. My Diabetic team have assured me that the Islet Cell transplant will definitely give me back my hypo awareness but its the thought of taking anti rejection tablets for the rest of my life as well as still take insulin and check my blood sugars.

 

[CarbsRok]

Hi Andy the bottom line of having an insulin pump is that they are only as good as the user. If you put the work in then they are great if you don't then it's an expensive waste of kit.
Re your hypo unawareness, have you tried different types of insulin? I was thinking more along the lines of the animal insulin's as some people have warnings with them and not analogues.

 

[AndyWatt]

I am definitely keen on trying the pump and have been told there is a lot of work needed to get the best out of them. As for changing insulin , I have never been advised on that, I know there are a lot of different insulin's but never new they could possibly make a difference. I will make sure I mention this at my next appointment. Thanks CarbsRok

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[iHs]

Andy, how often do you test yr bg levels? If its not about 6 times a day, then there will be a good chance of you having hypos esp if you are controlling them too tightly without realising how low you are going. There are targets that diabetics should aim for to try and keep themselves ok......and for someone like yourself, it probably needs to be 7mmol before a main meal, then allow bg to rise up to about 9.5mmol 2.5hrs later and then by the time the bolus has finished its action, yr bg should be back to about 6-7mmol again with no hypos. If your bg is only 5mmol before eating and you dont test mid way, then unless youve got your insulin to carb ratio sorted, theres a good chance that the bolus action will unfortunately, cause to go hypo about 3hrs after the bolus has been given. So, testing is key to eveything really esp with figuring out the correct bolus and the basal.

Pumps are great when the settings are correct but this can only be achieved through constant bg testing as there are times when bg levels can just change sometimes for a reason such as the pump not working correctly and sometimes just because the bodies need for insulin just decides to change. So they are good and bad in one and demand a fair amount of attention.....bit like a baby tbh.

 

[Engineer88]

the only thing I can recommend along with Spiker is a pump and CGM combined. I couldnt imagine life without mine now infact I went 24 hours without my CGM (still pumping) last monday and all hell broke loose with my BG (I was glutened also). I wouldnt understand why your team wouldnt have already recommended one unless they are technophobes like mine.

Most hospitals can loan one out for a week, why dont you give a CGM a try?

 

[AndyWatt]

Hi, I'm testing my BG about 7-9 times a day, I'm sorry , but I should have said at the start that most of my troubles are at my work, I work in a brewery and do 12 hour continental shifts. So much manual , physical work . After I completed the DAFNE course, they changed me from Humalog to Novo Rapid and from Lantus to Levemir. Because I work from 7 till 7 , dayshift or nightshift, I take my Levemirgat 6.30 am + pm, I take 10units am+pm but I'm working I knock 2units off. My Novo Rapid, I'm on a 1:1 ratio and because my work is so physical , I started knocking 1 unit off each injection, I was still going hypo so kept knocking more off , to the point that I had halved my insulin at work but then my BG's were sky high and I was doing the same work, sometimes maybe more. I know my carb counting is correct as its all microwave meals and packets with labels but just can't get it sorted at work. Thanks

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[iHs]

I think that while bolus and basal insulins continue to flourish, the demand for cgm will also increase

 

[Flowerpot]

Hi Andy you can set more than one basal insulin profile on a pump which would be ideal for your work pattern, you can set a basal pattern that will reflect your reduced insulin needs during strenuous work and a non work basal profile where your insulin requirements are higher. A pump will be a much more specific tool to use to try and avoid hypos rather than reducing your MDI injections by a unit or two.

Like some of the other posts have said do ask your diabetes team for the loan of a CGM sensor and transmitter as it unfolds the secret life of your blood sugar 24 hours a day and is a real eye opener as to what is going on..

I stopped going down the islet transplant route due to the impact the anti rejection drugs would have, the relatively short time span that the cells might function for and the probable need for some background insulin on top. If I had not been given the chance to use CGM I would still be on the list as loss of hypo awareness is such a frightening thing to live with. CGM doesn't give you awareness back but the pump sends you warnings when your glucose levels are falling and my pump suspends insulin delivery if my levels continue to fall dangerously low. There is some great technology out there to help, it may take a lot of fighting for but it is worth the battle.

 

[Spiker]

1:1 is a surprisingly high carb ratio for someone on only 20 units of Levemir a day. Have you now reduced it to 1u:2g? That's still quite high. I think it is better to adjust the ratio rather than knocking units off. If you find the right ratio you may see both hypos and high BG reduce.

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[Sarah22]

Hello Andy, I'm new to the forum (joined about 5 minutes ago actually) and I can give you an insight into using a pump. I've had mine for just over 3 years now and it has changed my life for the better. I've been diabetic for 20 years, diagnosed after my 2nd pregnancy, and after having a 3rd baby (my 1st diabetic pregnancy) things started to get a lot more difficult. About 5 years ago my levels were swinging wildly, no matter how hard I tried I could not stabilise my control. I was having frequent hypos, particularly overnight, and ended up being too scared to go out in case I had a hypo. So I was recommended for a pump by my GP and it has been a life saver. My HbA1c has gone from a terrifying 16 5 years ago to 6.4 at my last check-up. I feel it gives me more freedom, I can eat or not whenever I want and I definitely have more control. It's not been plain sailing all the way, but with the help of the team at my local diabetes clinic, I'm a lot happier and healthier. I haven't been able to regain my warning signs though, I lost them quite some time ago and the only answer is frequent testing in my experience, and even then I can still get caught out by a 1.3 level without realising! Good luck with whatever you decide.

 

[AndyWatt]

Hi all, thanks very much for all the good advice, just got my next hospital appointment so I'm full of questions . Thanks very much

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[kkkk]

It might not be the same everywhere - but I was told that if I wanted CGM then I had to try the pump for at least 6 months before they would even consider supporting me in a case for CGM. So I pay for CGM - but am just starting on a pump which has a CGM receiver with it - so it does in a very small way cut down on one of the large start up costs of CGM. I think it is worth a try if you are up for it, I am hoping that the smaller dosing and ability to turn it down or set different basal rates will help...it will take work and still take fiddling with to get stuff right as I diabetes always likes to throw in the odd curve ball when you think you have everything sorted However it does all the maths for you, and you can adjust the ratios and all that stuff and it remembers for you rather than you having to remember for you....so I am hoping it will take a little of the work load away and lots of people find that they have less hypos on them so hopefully it will help you, if not then you still have the islet cell option if you need.