Hi
@Bluemarinejosephine, Thank you for your question !
## I have edited the answer first I first posted it!!
At the 45 year mark on insulin I was suffering from night hypos despite lots of testing and 8 + insulin injections per day.
Being stubborn and fiercely independent I had warded off what I saw as the dependency-forming aspect of insulin pumps for ages but now had to admit defeat. Also pumps are a bit like mobile phones, full of technology but the basics are often all one needs and help is readily available to deal with more complex matters which only rarely arise.
Since starting on an insulin pump 6, nearly 7 years ago I have not looked back. Without the pump, the hypos would have led to me losing my driver's license, curtailing my employment and suffering an even more rapid decline in my intelligence !!
Also, on one occasion I stopped breathing during a particularly severe hypo so I owe my continued life to the diligence and action of my wife and since then also the use of the pump. My HBA1Cs have been around the 48 mark since and hypos are much, much reduced.
Pumps consist of a hollow block of metal/plastic containing the reservoir/syringe of insulin and a pushing device to push the insulin from syringe into a needle or tube and needle as described below (think of it as a miniaturised insulin pen) plus a mini-computer with screen and sometimes buttons (instead of keys) or there is a separate tablet/mobile device that controls the mini-computer. The syringe/reservoir is attached either directly to a needle which is placed through the skin or to a tube which is linked to a needle insert device some length away from the pump. In common parlance the former is called a tubeless pump and the latter, a 'tubey' pump.
If you read the threads on the Insulin pump forum you will see discussions of the pros and cons of tubeless vs tubey pumps.
How one acquires a pump will depend on which country you live in, sometimes to do with health insurance cover , and always the high jumps or suitability criteria for being prescribed an insulin pump. I assume you are living in the UK so will let your fellow citizens advise you. Down under in Australia we have some different rules.
The change over procedure from multiple injections to the pump was straight-forward for me. I think being on Levemir as my long-acting insulin helped as this insulin does not take a long time to wear off completely compared to insulins like Lantus (? up to 48 hours) and Toujeo, Tresiba (? 72 hours).
I hear from others that the longer it takes for the previous insulin to wear off the longer before the pump's insulin regime can be sorted.
I use Novorapid insulin in my pump. Others will be prescribed another short-acting insulin. (no long-acting insulin is used)
The so-called basal rate of the pump, where small amounts of short-acting insulin are programmed to be injected slowly under the skin over time 24/7 is designed to deal with any predicted changes - such as the Dawn Phenomenon(DP), see the home page and under Type 1 diabetes for an explanation. This beats being on multiple insulin injections and having to wake at say, 4 am, to inject some insulin. The amount of basal or background insulin required can vary during the day and night. It is the skill of the prescriber initially to 'scuplt' the rate of insulin infused per hour (as the basal rate). This is not something that can be done anywhere near as accurately with a single or twice daily dose of a long-acting insulin.
Also the pump can be programmed manually to lower or raise the basal rate to deal with exercise or stress. E.G. I reduce my basal rate by say, 20% for 4 hours to allow for walking 30 minutes to the shops, shopping, and carrying shopping home; for an exciting movie (= adrenaline provoking) I increase my basal rate 10 to 20 % for several hours. (as the glucose release from my liver due to the effect of adrenaline ups the BSL unless extra insulin is there to control the level.) My insulin requirements go up 30 % + for 4 to 5 days following my annual 'flu injection, so I can increase my basal rate plus bolus amount to cope with this.
Bolus doses are calculated by the pump's computer 'brain' according to some guessimate at how one's BSL responds to a given amount of carbohydrate per unit of insulin. This is something your pump prescriber will initiate and you then discuss any alterations based on response. The amount of insulin for X grams of carbohydrate at breakfast can vary from that required to achieve satisfactory 2 hour after meal for the evening meal. So one may have several settings of carbs counted vs insulin given. Similarly the pump has settings to help with working out how much insulin to give as a dose to correct a high BSL. My pump also has an 'insulin on board' feature to prevent frequent multiple doses of short-acting insulin building up and causing hypos.
Some brands of pump also support what is called Continuous Glucose Monitoring (CGM). Since Australia does not subsidise the expense of CGM except for those T1Ds under 21 years of age (and I am grateful the Government at least does that) I tend to call it CEM (Continuous Expense Monitoring). CGM is very useful in particular situations, but independent monitoring systems are available too, again a some cost. In the UK it may be that in particular situations a person's CGM costs are paid for. CGM is achieved by a separate device much smaller than the pump being placed on the skin with a needle residing under the skin. The BSL is checked with a glucose meter twice daily to calibrate the levels measured by the device in the tissue under the skin vs the blood level. Newer devices may not need the finger-prick levels done. One brand of pump has a feature which when used with CGM will reduce the basal infusion rate if the BSL gets too low.
Tricks and traps: pumps have there own quirks and need for caution. It is not just a matter of 'set and forget'.
Sometimes pumps malfunction and need replacement. To know more please look up the thread in the Insulin Pump forum called "Preparing for Failure".
Also they can run out of insulin, or battery power at inconvenient times.
To cater for both failure and loss of supply (insulin or power) I try to prevent problems by changing a pump's insulin supply early to avoid an away from home run out and I regularly carry with me, short and long acting insulin (complete failure means going back to multiple injections whilst waiting a day or two for a replacement pump), (short acting plus spare syringe/reservoir and needle inset/tube to do a refill of syringe/reservoir etc), spare battery or battery charger and I always have my glucose meter kit topped up with test strips as I need to test before eating a meal so that I can calculate how much insulin to bolus in for that meal) That
overall emergency kit/baggage is more than I used to carry when on multiple insulin injections!. (of course jelly beans or similar are always part of the kit)
Sometimes a needle insert (think a 'port' that persons receiving chemotherapy have but much simplified and very easy to place if you are used to giving yourself injections) and under the skin, not in a vein) goes in bent, or bends during use, or leaks - leading to less insulin is infused and thus to an unexpected high BSL. Alarms signalling partial obstruction of the needle do not always work. This has happened a number of times to me and the only sure solution is, if in doubt change the needle insert.
When the pump is not providing enough insulin the short-acting insulin wears off much more quickly than if you stopped your short and long-acting insulin on a multiple dose regime. I get sicker quicker, ketones form more quickly so I have to be extra vigilant.
On some pumps the battery connection can fail. There is no alarm for this as the alarms all work off the battery, Again vigilance and regular replacement of battery caps prevents this.
I remove my pump for things like showering/washing, short time of swimming and for sexual activity. You cannot do this easily with tubeless pumps.
Overall I love my tubey pump. (affectionately called Limpet). I know of some who find the pump too intrusive, or react to the adhesives and cannot tolerate any alternatives so there are not a panacea for all T1Ds.
## Compared to riding a bicycle ?
If you can use the basic functions on a mobile phone, give an injection, do carbohydrate counting, are prepared to do regular glucose monitoring with a meter (CGM as a luxury type item), not fussed by depending on a pump instead of multiple injections - there is every chance you can hand an insulin pump.
I hope the above helps and that you can gleam more from other posts and the forum and threads.
Please keep asking questions as you go.
