Pre-Pump Assessment Clinic Appointment...

[silvarbullet1]

Hey all,

I moved to a new area (Chertsey/Surrey) around a year ago and at first was just under care of my GP.
However, I asked to be referred to the hospital and have now seen a really nice Dr and team of REAL diabetes specialists (My GP is nice but said 'ah, I wouldn't bother with carb counting'). After my first appointment (where I mentioned I would like a pump), the Dr said she'd refer me to this 'Pre-Pump Assessment Clinic' with the Diabetes nurse.

Wow! That was such a more positive experience regarding pumping than with any other Dr I've ever seen. Previously, it's felt like they're stalling somewhat. I think that things have moved along a lot in the last couple of years too, with consultants aware that pumps really are beneficial for many T1s to lower their HbA1c.

So, my question is: what to expect? I was given brochures for the Medtronic, Accu-Chek Combo and Animas pumps on my way out and told to 'have a read on the internet about them'.
I really like the look of the Accu-Chek Combo and have read some positive things about it, does anyone want to recommend the Animas or Medtronics devices??

What will they assess at the appointment? I already do carb-counting and have switched to their system since my first appointment in preparation (they count carbs per 1u insulin, I used 10g carbs = ? insulin). Is anyone else being assessed or remembers what the process was?
I think they have to do all the paperwork to approve the funding so I'm curious how long this will take?

Thanks for your help!


T1 Dia.1999
HbA1c 8.3 - Q1 2011(Lowest ever)
HbA1c 9.0 - 11.0 '99-'09

 

[SophiaW]

Each pump has a slightly different set of unique features so it's difficult for anyone to tell you what pump will be best for you. That's something you have to decide on yourself. Do a lot of reading and work out which features on which pumps suit you and your lifestyle best. Also ask to see a demo model of each pump and have a play with it. Scroll through the menus and get a feel for the pump. My daughter has the Animas 2020 pump. We chose it because of the fact it's waterproof, it has a customisable built in carb menu and we found the pump menu to be very intuitive to navigate. The disadvantage of the pump is that there's no remote which is something we would have really liked to have had. Congrats on getting the go ahead for a pump. It took us about 6 months from the time our consultant recommended the pump until getting it all through, it probably varies from clinic to clinic though.

 

[sugar2]

My preassessment was not very involved at all..do you carb count, can you handle hypos etc etc.

I ahve teh combo and love it. I like the remote, as it means that I can wear the pump stuffed in my bra, hanging from my bra, inside my clothes etc, and so can give myself doses of insulin without having to faff around inside my clothes! the remote is also a "wizard" you need to set it up with you carb ratio, and the level of BG you are aiming it. Then, if you test your blood before lunch etc, and you get a reading of say, 6.0, you put inthat you are about to eat, say 20g carbs, and it works outthe insulin you need to cover the meal, and any adjustment dose etc.

I have to say though, I was not given a choice of pump, so I have never experienced another model, so can't really compare them.

 

[spideog]

I had a choice of the Accucheck Combo or the Animas 2020. Before going to actually pick a unit I was thinking I'd go for the Accucheck due to it's extra gadgetry-ness ith the remote, but on actually seeing them, how the menus worked and the two things together etc I went for the Animas and very happy with my choice.

Have a play with the demo units, ask any stupid question that pops into your head, have a look at what colours they are available in even.

 

[jopar]

Each clinic have their own procedures when it comes to pumps..

Pumps now have pretty much with the exception of Veo (and I can't remeber the other one) which have CGM caperbilites (at an additional cost and self funding) the others the difference is in area's such as screen size/text size colour and how you navigate through the menu, then there's a slight difference between the setting/adjsutments when it comes to available basal profiles, basal time slot adjustments etc..

The first pump is probably the hardest, as yes you can look at all the menu layout, the size of screens and whether you want the choice of colours etc.. But what you can't determine is how the different settings/adjusments differences will effect you..

My first pump I wanted the Animas I felt it best suited my needs, but alas it was the Accu-chek Spirit or face a futher battle to get my right to choose (I already battled for 3 years to get pump funding) mind you looking back having a bare basic pump that the delivery dose incredments meant I have to find a workaround to at times get a correct dose has taught me a lot about insulin pump therapy that I probably would never have learnt otherwise..

Now no I wouldn't go for the Animas purely on it's basal profile adustments limitations would cause me problems not enough available adjustments in 24 hours to program in my basal changes needs..

Best thing is take a look around at different forums where pumpers are too, read their posts, see what problems they have with their pumps and ask questions..

A couple of good places to look at is

www.input.me.uk containes all the info you need about pumps

www.insulin-pumpers.org This also have a mailing list you can join and asked futher questions etc

 

[SophiaW]

After having been on the phone to Animas this morning to order more consumables I also thought it valuable to mention that customer care is an important consideration too. I don't have experience of the others but can say that Animas have been brilliant with ordering consumables. They answer the phone quickly, are very helpful and friendly on the phone, have all our details on screen so even if I forget to order something they will remind me what I ordered last time and ask if I need those items again - I nearly forgot about batteries. Delivery of the consumables is within 2 working days. It's always a pleasure to phone them and I get the order quickly which I think is important.

 

[iHs]

I think the best way to see pumps is to meet up with other pump users at your hospital. Most hospitals will now allow you to have a choice but unfortunately most dsns will only have knowledge for one or two pumps so might not be able to answer all the questions you may want to ask...

I have the Accu chek Combo which I chose because of the remote and I live a few miles away from Chertsey. If I can be of any help to you in showing it with the range of infusion sets, I could meet up with you at the airport. Let me know by PM

 

[ebony321]

Hey,

thought i'd give my 2 cents

Firstly glad you've got what seems like a great team now, very positive with encouraging carb counting and no fuss with getting you on track with a pump!

All pumps are similar but depending on what you want from your pump, some will sway you more than others.

When i researched pumps i particularly like the accu chek combo, because of the remote and it seemed so have all i was looking for.

My hospital only do one pump, this is quite common as they strike a deal to get them cheaper so result being they can buy more pumps for their budget.

My hospital luckily do the accu-chek combo so i got what i wanted out of pure luck.

Definately research all the pumps and what each one can offer you, you can also ask on here as there is a wide range of pumpers with most pumps you can get, if not all!

My hospital told me they chose accu-chek as they liked the service most, someone always at the end of the line if you need help, on most occasions i have found them to be brilliant!

It really does vary with time, some people can get it all done in a few months, mine took over a year but only because the pump nurse was off long term sick, but worth waiting for!

My lowest hba1c pre-pump was 8.4% and now it's slowly come down to 6.6% all thanks to the pump and reward of hard work that a pump takes.

These are a few things i had in mine whilst 'shopping around' :

whats the lowest dose it can give - mine gives 0.10U some can go as low as 0.025. So if you are insulin sensitive this can be important.

What infusion sets are available with the pump - Steel, teflon, sizes etc

Does it have a bolus wizard - meaning a bolus calculator so you enter the carbs and it will work out the dose for you. Easy and quick!

Is it waterproof - mine is water proof up to a certain depth but i wouldnt try intentionally dunking it, it's nice to know if i get it wet it wont kill it!!

How big is the pump - i wanted mine to be easily concealed, i consider my pump to be nice and small

colour - some pumps you can get them in purple, blue, mine comes in black but you can get coloured skins and clips etc.

Durability - if i drop it will it break - i've dropped mine only once, its a tough cookie i reckon!

data/graphs - howmuch info will it hold, will it show me graphs of my results and does it have software - it's all a yes with my pump.

It it easy to use - i think you CAN stuff too much into a 'gadget' complicate it that much with brilliant things that some people may find it hard to use. Mine is pretty straight foward and user friendly i think.

If you go on websites, they may do the same as the accuchek one, you can 'demo' the pump online and see the dimensions etc. maybe other manufacturers will do this too, very good idea!

Keep us updated on how you get on, and ask any questions you like, we were all in your boat at one time or other so we know how intruiging and complicated it can get at times when first looking into things

 

[josie38]

Hi,

Im glad that you are being looked after well and feel positive about having a pump.

During my assessment for a pump i had to do a Dafne course for the carb counting and show that i could bring my bs levels down and my hba1c.........then had a weeks trial with a pump to see if it fitted with my lifestyle and whether i liked wearing it......did my own research about pumps and decided on a accu-chek combo. The reason was simple.....i have two small children and my 3yr old son is very nosey about anything mommy does so with the remote i could fool him about not touching it and for his very curious hands it enabled me to keep the keys on the pump locked and still be able to use it with the remote.Just until they were used to me wearing it and gradually over time they have seen me use it and ive always answered any questions they have. Now they choose how i should wear it eg either in my clip or in a skin or in a special bag i have for it and when i am going out they check that it cant be seen through my clothes. They think it is great fun!!!!!!

I have found it a positive experience and ordering consumables is easy as sophia says. it can all be deliverd in two days and they do have all your order on the screen. I changed my infusion sets cuz the teflon ones kept kinking, after i had put in an order for the change accu-chek rang me back asking if i had ordered right!!!!!!

Hope this helps.......keep talking to the HCP's now you have good care!!!!

Josie

 

[jopar]

Different clinics will have different protocol when it comes to ordering, so worth asking about this, as sometimes you've go to put orders via clinic, and their are several that make you pick your order up from clinic..

I now have a standing order with Roche, one they workout your ordering they tend to put you on standing order which then you only need to phone if you need to change anything. I know with Roche if you work and it's more conveniant they will deliver at an alternate address, place of work, neighbour other family member etc..

For what I hear concerning other manufacturers customer services, they are pretty much all the same and odd glitch here and there but no major problems..

Time scale will again depend on your clinic protocol, there's some good clinics about who provide pump and training ASAP then you get clinic's where if you need a pump you got to go through loops..

I did a 3 year battle to get my pump, which meant that I had to study insulin pump therapy so that I could build my case for one, how it would help me, how if I had a pump I could have adverted an hypo by using the pump etc.. Then when I won my battle I had to wait another 6 month before I actually got it..

 

[LittleSue]

I've just started on a Medtronic Veo and absolutely love it. I had a choice of that or the Animas and chose the Veo mainly for its CGMS capability. (Since then, Animas have brought out their model with CGMS.)

Most pumps seem to have similar features, but maybe different names for them or they emphasise different things in their brochures. Weigh up which features are most important to you. I was given the model names and told to look at the websites, so when I attended the initial meeing I already had an idea of what was involved and which pump I'd probably go for. They gave slideshows about each pump but it was broadly the same info as on the websites.

The most valuable part was the chance to ask questions about how it'd fit into my life, see demo pumps and assess the size/weight/look of them etc.

Do make sure the information you compare is up to date and read the small print. At the meeting we were given a sheet showing why Animas was best, but it was well out of date. Its comparisons with Medtronic related to an earlier Medtronic model, and most of the advantages they were pushing are now the same or better on the Medtronic Veo.

Check what's included - I thought I'd have to buy a Veo remote if I wanted it, which at over £100 didn't seem worthwhile for the amount I'd use it. In fact, the remote, wireless BG meter and a case with a belt clip were included.

A few days after the meeting we had to say whether we still wanted a pump and if so, which one. The DSNs applied for PCT funding, which they estimated at 2-4 weeks but actually took 3 months. Then I had to confirm which pump I wanted (could've changed my mind then if I wanted) and choose the colour. They ordered the pump but it was 6 weeks before I started on it, partly due to DSNs holidays. Meanwhile I got my GP to add insulin in vials (bottles) to my prescription. (The pharmacy had to order these in, so was glad it wasn't delaying my start date.)

I was well worth doing the research before the meeting, so I knew what questions to ask, and didn't get swamped with new information. Eg one person worked at the airport and needed to know if it was safe to go through airport security several times a day. Whereas one person didn't realise you had to keep it on overnight....

Good luck!

 

[silvarbullet1]

:shock: Wow! Thanks everyone for the replies

I wrote this last week but forgot to post it....

"I had the appointment this morning and I have to the say, the service was top notch!! 10/10 for the NHS so far...

The specialist Diabetes 'pump' nurse showed me 4 different pumps that are available... Medtronics Veo, AccuChek Combo, Animas 2020/Vibe and Dana Diabecare R.
She had them all there on the table to look at so I got to compare them side-by-side which is pretty good... She said that they pretty much all have the same features in terms of the management/control, the main differences were the Animas being waterproof (although it seems to me that the others are fairly waterproof, I only swim occasionally) the Combo and Dana having wireless blood test/remote controls.

I had been given the brochures for the Veo, Combo and Animas pumps so I have looked into those as much as possible, but apparently the Dana is new.

I like the look of the Dana as it is smaller and lighter (both pump and remote) than any of the others (see picture below I snapped on my phone) but I think that usability will be more of an issue day-to-day. I realised this whilst I was there and got the nurse to show me how to administer a bolus using the carb Wizard on each of the machines, however it wasn't quite true to life as we didn't actually do a blood test on the Dana or Combo... The Dana seemed more convoluted to get to what you wanted to do, i.e. you have to press more buttons. Having said that, now I've played with the virtual on online a bit more, I'm not sure it's that different.

Although I'm wavering I still think I'd like to go for the Combo. Whilst the Dana looks smaller, it's not a massive difference. I'll still have to carry a pouch with lancing device, test strips etc. so although you can hang the Dana remote round your neck or slip it in a pocket, you still need your bits to do a test...

Showdown.
--The Paradigm Veo seems like it doesn't offer any unique advantages (size=same, ease of use=same, remote=none, waterproof=no) over the other devices, so that one has been automatically disqualified.
--The Animas pumps are very attractive in their build quality (they have the best 'feel') and seem the most durable and obviously the much touted 'waterproof'. The screen is also the best (very clear and easy to read, and bigger than the rest) and the menus looked easy to navigate. However, no remote. Which also means manually typing the BT results in. I think this is a sizeable disadvantage for me.
--The Dana ranked similarly to the Combo in my mind, because of its remote and compact size. Disadvantages: I'm unsure about ease of use. Also, using special batteries is not a plus point (the others use AA). The last big one: support. If less people have it, will there be the same level of care available?
--The Accu-Chek Combo only loses out to the Dana on it's size. Pretty much everything else is either the same or better on the Combo."

Well, since writing that I ascertained that no one in my PCT has a Dana and I think the Combo is a proven tried-and-tested bet, so seeing as the only advantage to the Dana is a sliver off the size I've emailed the nurse and told her I'll go for a Combo.

Eeeeep!!!!!!!

She said it would be around a month from when I told her which one I wanted to go for, which seems really soon! It could be longer of course but she said the PCT is usually really quick

I'll let you know how it goes.... And big thanks iHs for the offer, I've PMd