Insulin Pumps

Dont know that with your hba1c being so low and you saying you hypo aware, how you would fit in to the criteria that NICE guidelines say you should have to get a pump...
I.e you have tried all methods of injections to get a way to manage your levels but you cant.. That is just one criteria.

What reasons was your consultant suggesting to you that would make him/her think that you would fit the guidelines or would it benefit you?

It sounds like you don't fit the NICE criteria, but if they're offering you a pump bite their hand off and take it.

So far I've only read good things about the pump, some people moan about having a device hooked to them for 3 days or whatever, but one device hooked up to you for 3 days at a time -v- 15 injections.

Roberto said:

Thanks for the reply...

The main reason they were giving me was due to my worry of hypos. I've read the nice guidelines and don't see how I'd qualify.

I do think however it would improve things. I hate having to worry about hypos. For instance if I know I'm in a long meeting at work I'm in the bad habit of putting my levels up to make sure I don't go hypo.

It's strange how all of a sudden I worry about my diabetes a lot more, HBA1C is good, have no complications etc

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Hi

Just to put you at ease a tiny bit, I got my pump funded on the very grounds that you have mentioned. Trying to keep 'tight' control at the expense of having mild lows every day and then feeling that my awareness was starting to change and resulting in some degree of anxiety.

Will a pump make you feel much better etc..... Pumps work in a round about way to control bg levels so that people dont go too low or too high but this comes through getting the hourly basal rates correct through not eating any carb and then juggling with the bolus a bit when carb is eaten, until you get the control the way you want it to be.

Its hard to know what will end up being more of a 'must have' device....... insulin pump or cgm. Cgms are now getting more accurate and the vibes do seem to look positive as more companies enter the market..............

Hope this helps you a bit..............

Hello Roberto, A couple of things - pumps do not eliminate hypos (unless your basal and bolus and everything else is so spot-on and nothing in your life ever changes). However from personal experience I find that they are milder and I seem to be able to recover quicker from them.
In terms of NICE guidelines, my DSN pushed for a pump on a few criteria, including a HBA1C of 8.9 but also on the grounds that I was so feared of HYPOs at the time, having suffered my first full-on disabling one in work, that my quality of life was suffering as a result. This also played made my HBA1c higher as i never wanted to see my BSs lower than 10 at the time! I know for a fact that they also had bought 10 or more pumps and were desperate to get them issued - incredible really but I dont think there was much appetitie for them in our area. I was reluctanct at the time but it's been a really good move for me even though it takes a lot of time and effort in getting things right even now 15 months on. I think the more common place they become the more people will want them though.
Good luck in your quest and maybe push for one on your fear of hypos.

My original posting soinded a bit damning... Not intended...

I hope you can get a pump.... At least you are prepared to test 10 times a day already!!!!

I do love my pump.... But I just so mot want you to think its easy or hypo's will go.

As far as I'm concerned hypo's will never go for a totally honest, cgm monitored, life enjoying diabetic...on human insulin.... There will always be a hypo of some sort around the corner.....at some point.... Esp with pumps, meters, cgms giving such hugely varying BG levels... Which do you believe???

Pump is great for me. I would never go back to injections by choice....

I think (personally), we all mature in attitude at some point with D....T1 especially...you've just reached yours now...

A pump and a cgm is the best relaxation gift for hypos...

A pump has not personally for me reduced hypo's... But my cgm has. The cgm has... Although Mine is not good with its accuracy....My cgm reads anywhere from 1 to 4 bgs lower than my actual blood readings.. So when it warns me my levels are dropping or raising too quickly I can act to prevent...Highs or lows..

If gou talk to your consultant try and get a pump that is cgm compatible... Mine arent... Two different manufacturers with two different abilitys of reading levels...

Neither pump or cgm will eliminate hypos.. But both allow better control if the patient wants more effort to do so.. A
Cgm really allows activitys such as sports.. Gardening with me and walks without fear and dread and what if's.

Personally I think a pump gives a greater amount of flexibilty to get less peaks and troughs.. Which mdi never gave me.

When I garden (my job) depending on cold, heat, how often, and whether digging or say pruning.. I know I will get my levels right gradually... Friend of mine says I should accept levels going up or down when gardening as I have a cgm, but I dont accept I should go higher or lower because of my job. Eventually as the seasons and my workloads change I do get balanced so I can stay at about 6.0 .... But without my pump and without my cgm... I would never have achieved this.

Good luck in your quest... Keep positive I'm nearing 30 years without complications and intend to keep it that way.

Read items on the pump forum... A lot of intersting views and comments... May be worthwhile posting same question there....
Ddx

Roberto said:

Thanks again for the advice....

I'll take a look at that forum, I never even noticed it :lol:

This week I'm going to look into the DAPNE course. Never done it. Had a look at this for a few hours last night, was interesting reading.

http://www.bdec-e-learning.com/welcome. ... -839850473

Just a wee carb counting course online, I do carb count and have done for years but this certainly had some good advice!

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Hi

I didnt go to a DAFNE course at a hospital before I got myself onto a pump, instead I had a look at BDEC online carb counting and then read loads of msgs on this forum from diabetics telling what their insulin to carb ratios were. I then put two and two together and realised that they were using the NICE blood glucose guidelines to determine those ratios and instead of using guesswork to calculate my bolus, I then started to figure out my correct ratio by dividing my bolus into the amount of carb I was eating and using bg tests to work everything out. A big help was also to get hold of insulin pens that deliver in 0.5u increments. By using these, I was able to round up my bolus to the nearest half unit.

It will be essential really that you will need to know all about using ratios to work out the bolus even though pumps have a bolus wizard. You will need to enter the ratios into the wizard for the pump to calculate correctly.

Can I also suggest that you do all your bolus injections in another area on the body for a while instead of your tummy as infusion sets usually go into the tummy and if loads of injections have been done already, then there may be a problem with some degree of scar tissue which may then affect how insulin is absorbed through the cannula............

Do have a really good read of all the msgs left on the Pump section of the forum and then you will be able to see all the pros and cons of having a pump............

If your hospital insist on you doing a carb counting course before they will consider you to be suitable for a pump, then do it or try to figure it all out using the online carb counting........

Regarding your breakfast...... if you went hypo within 2hrs of doing the bolus, then alter the ratio to allow you to eat more carb (like 1u for 15g carb instead of 1u for 10g)......

Today though its fairly warm in my living room (22 C) and that's with the heating off so I'm needing to be careful today with my bg levels as warm to hot weather usually makes my bg levels drop because the insulin's action is speeded up......

Hi Roberto,
A pump had definitely helped me with sports and excercise it's a bit trial and error at first but I've been on a pump for comming up to 7 years and I find it a lot easier than injections. Before excercise sometimes 1 sometimes 2 hours before I can turn my basal rate down depending on how active I think I'll be. It really helps to stop having to have a breather half way through biking or kayaking etc to have some lucozade. With eating things like porridge as well it helps as instead of giving the bolus all in one go I can split it or do an extended bolus. which saves going low then high. There are still bits that I want to hone in on to help me even more and that's why I'm saving up for the cgm bits that go with my pump. I think a good year on this will really smooth out my bumps and bring my HbA1c down further with less hypos.
Laura

Pros - no one can see you inject, less swellings on injection sites. Pumps are a great way to gain more control

Cons - the line can get stuck on handles and other things. Also my fiance has had the line blocked a few times causing his bm to rocket high.


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