Pump Advice Please

DiabeticDadUK said:

I've been reading a little about pumps and had a brief chat with my DN about one last year. I wondered if you kind folk might offer your opinions on a few questions for me:

- How quickly did you adjust to a pump from injecting?
- How comfortable is it? I assume not very at first but you adjust?
- Did it improve your BG without bringing on too many hypos?
- Any negatives you've discovered?

I appreciate your time. I've been injecting since day 1. Improved control lately but wondering if I can get that consistency with a pump instead.

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Pumps do bespoke basal rates (so if you need a load of basal to combat DP but you don't want to hypo at 3am, a pump can do that) and temporary basal rates for exercise, stress, illness and more accurate bolusing, delivering insulin in smaller increments that half a unit you can get on mdi.

It was a pretty quick adjustment. I had read pumping insulin before the switch and I had a CGM which helped.

I've used an omnipod, which was always totally comfortable. There wasn't really any adjustment to that. I'm using a Medtronic now and I find that a bit more of a adjustment, but mainly cos it's awkward with a dress.

There's no reason pumping should bring on hypos.

DiabeticDadUK said:

I've been reading a little about pumps and had a brief chat with my DN about one last year. I wondered if you kind folk might offer your opinions on a few questions for me:

- How quickly did you adjust to a pump from injecting?
- How comfortable is it? I assume not very at first but you adjust?
- Did it improve your BG without bringing on too many hypos?
- Any negatives you've discovered?

I appreciate your time. I've been injecting since day 1. Improved control lately but wondering if I can get that consistency with a pump instead.

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I took me a couple of,days to adjust (mainly to become comfortable with wearing it and the cannula site).
It felt weird at first but I soon forgot I was wearing it and I don't feel it at all.
Yes, it improved my BS because it smoothed it out.
The only negative for me is having to rotate the sites, but the same is true of injections too.

DiabeticDadUK said:

Thank you. Very useful. Quick Q about the actual site for the cannula; Are you switching around as often as you would when injecting? Or can the cannula sit there for longer?

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It depends what type of cannula I use. Teflon ones I change every 3 days, steel ones every 2 days

Hope you, @azure , and @catapillar , don't mind me intruding on this thread, but, like @DiabeticDadUK , I've been pondering about moving from mdi to a pump.

I manage reasonably well on mdi, have done so for almost 30 years, but my consultant recognises that I quite like "fiddling" with 1u adjustments, 5gm carb nudges, so he reckons, correctly, that I'd be very engaged with getting to grips with the challenges of a pump.

But, yet, the main thing putting me off is the number of posts I've seen here from pumpers who say for a wide variety of reasons, from the technical such as cannula problems, to the more prosaic such as they pulled it out rolling over in bed, they've ended up with some serious, serious DKA going on.

I can absolutely see the advantages of pumps, but, recalling that my only experience with dka was at dx and I didn't like it much, my question is how common is it for pumpers to end up DKA?

I don't know the answer to that @Scott-C Its something all pumpers are warned about as we have no long-acting insulin on board. I've used a pump for 13 years and haven't had DKA. I test lots and have back up pens.

And pumps are rarely pulled out. It's just a rare occasion. They're pretty tough.

azure said:

I don't know the answer to that @Scott-C Its something all pumpers are warned about as we have no long-acting insulin on board. I've used a pump for 13 years and haven't had DKA. I test lots and have back up pens.

And pumps are rarely pulled out. It's just a rare occasion. They're pretty tough.

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Thanks.

Scott-C said:

I can absolutely see the advantages of pumps, but, recalling that my only experience with dka was at dx and I didn't like it much, my question is how common is it for pumpers to end up DKA?

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I don't know how common it is. I have ripped my pump out in the night and ended up in dka, but I think that was just an unfortunate coincidence of bad luck. It rare for pumps and cannulas to become detached, it's only happened to me maybe 3 times, and the other times I knew it was happening immediately so no big deal. They're usually pretty secure.

And they do give you good guidence on what to do if you get a pump failure (like ripping it out) to avoid dka, it's just my mind stopped working with the hyper rather too quickly to put that into practice and I live alone.

That was the first time for me in dka and it was awful and recovery took a long time. But I still don't think I would go back to mdi.

catapillar said:

I don't know how common it is. I have ripped my pump out in the night and ended up in dka, but I think that was just an unfortunate coincidence of bad luck. It rare for pumps and cannulas to become detached, it's only happened to me maybe 3 times, and the other times I knew it was happening immediately so no big deal. They're usually pretty secure.

And they do give you good guidence on what to do if you get a pump failure (like ripping it out) to avoid dka, it's just my mind stopped working with the hyper rather too quickly to put that into practice and I live alone.

That was the first time for me in dka and it was awful and recovery took a long time. But I still don't think I would go back to mdi.

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Thanks, @catapillar , it is a big decision, so your input on that is really helpful.

DiabeticDadUK said:

How quickly did you adjust to a pump from injecting?

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Straight away, I was quite excited about giving my first bolus dose at lunch, seemed strange not having to inject

DiabeticDadUK said:

How comfortable is it? I assume not very at first but you adjust?

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I'm using a tubeless pump and comfort wise it's fine, admittedly there's been a couple of times where I've had to change the pod early due to some discomfort.

DiabeticDadUK said:

Did it improve your BG without bringing on too many hypos?

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Steadier bg levels for sure, my SD has reduced since using a pump and I credit this to the bolus delivery options, using ones like the Dual-Wave Bolus is ideal for difficult meals like those that are high in fat. Hypo's, I would say I have less now than I ever did.

DiabeticDadUK said:

Any negatives you've discovered?

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TBH I struggle to think of one but I've only been pumping for just over 2 years.

Scott-C said:

I can absolutely see the advantages of pumps, but, recalling that my only experience with dka was at dx and I didn't like it much, my question is how common is it for pumpers to end up DKA?

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I'd say your more at risk of DKA using a pump than using injections, but with careful monitoring of bg levels and spotting trends should reduce the risk somewhat, plus you always have back-up pens in reserve.

Admittedly @Scott-C DKA was a concern for me prior to starting on a pump as I've never had to be admitted to hospital due to DKA or hypoglycemia, but I think once you start pumping these fears are soon put aside.

DiabeticDadUK said:

I've been reading a little about pumps and had a brief chat with my DN about one last year. I wondered if you kind folk might offer your opinions on a few questions for me:

- How quickly did you adjust to a pump from injecting? Physically less than a day - it was amazing not having to inject. But mentally I was ready to throw the pump away after the 3rd or 4th day -- I somehow felt as though I had lost control of myself -- that a machine was making all my decisions for me --my numbers were running high at first due to excellent help from my DSN who started me off on very conservative basal rates ( about 50% of my previous MDI basal ) I hated being above 10 -- but within 7-10 days bloods started to behave and after that I have never regretted changing .

- How comfortable is it? I assume not very at first but you adjust? very -- I never notice I am wearing it

- Did it improve your BG without bringing on too many hypos? it has made a big difference but my A1c has gone up rather than down. on MDI my A1c was always between 5.7% and 6.1% . Since pumping ( 19 months ) A1C has been either 6.4 or 6.5% but with a big reduction in number of hypos ( around 2-3 per month now ) and those hypos are treatable with around 5 carbs rather than 15 or 20 carbs
- Any negatives you've discovered? when going anywhere you still need to carryall the back up pens, needles , and insulin cartridges as well as all your pump supplies , so the Kit takes up more space in carry on luggage. ( a very small negative )

I appreciate your time. I've been injecting since day 1. Improved control lately but wondering if I can get that consistency with a pump instead.

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