Pump users

[Amina9191]

My doctor advised me that I should consider getting a pump due to the amount of hypos I get.
What I don't understand is how using a pump is any different to injecting.
I understand that a pump delivers continuous basal insulin, and bolus to cover carbs. How is this any different from injecting as you use background insulin, this stays in your system for about 24 hours and novorapid (or whatever type of insulin you're using) to cover food. I'm really confused, could any pump users please explain to me what the difference is.

 

[catapillar]

The way a pump delivers your basal is different from injecting a basal insulin - on MDI the basal insulins rise, plateau & fall over 12/18 hours so it can be difficult to ensure 24 hour coverage. The injected basal insulins aim to have a flat action, but your requirements for background insulin might not be flat - you might need more first thing in the morning etc - with a pump it can be programmed to adjust your basal insulin to match your needs across 24 hours. Also, as you are only getting fast acting insulin a pump can be much more responsive & you can adjust basal rates to have an impact within 3 hours.

 

[Type1Lad]

There's a pump section on here, i have found im hypoing more on the pump atm, but thats all trail and error with basal testing ect,

 

[Snapsy]

Depending on the time of day I have basal rates ranging from 0.4u per hour to 0.7u per hour, and my glucose levels are very very much steadier as a result. I also have different programmed-in ratios for bolus insulin for different times of day. I can spontaneously reduce, suspend or increase my basal rates depending on what I'm doing (exercise, illness, being more busy, less busy, stressed) - things that are not an option on basal insulin injections, where you take it once (or twice) a day and once it's in, it's in.

It took my over 29 years of type 1 on injections before I pushed for a pump. 7 months in, and I have not wanted to change back. It's phenomenal.

 

[Snapsy]

PS I had frequent and crashing hypos on MDI. No longer.

 

[catapillar]

PS I had frequent and crashing hypos on MDI. No longer.

How? How do you achieve this? I'm currently trialing a saline filled Omnipod (like it a lot) I'm hoping to be on it, up & running by the end of July. I have no hypo awareness (my dexcom sensor died on day 22 last night so no CGM all night, I woke up at 2.8, drank some orange juice & wrote the above post, probably still under 3), I'm hypo maybe twice a day, maybe a bit less recently, because I am trying hard to avoid them, I frequently adjust my basal doses to try to match my menstrual cycle. I want the pump to help me reduce the number and severity of my hypos (it's not that unusual for me to drop well under 2 & not notice, maybe twice a month, although I've never needed third party assistance) but I don't understand how to use it to achieve that - is it just a case of intensive basal testing and adjustment, hour by hour? I'd love to hear how you have actually used it?

 

[tim2000s]

How? How do you achieve this? I'm currently trialing a saline filled Omnipod (like it a lot) I'm hoping to be on it, up & running by the end of July. I have no hypo awareness (my dexcom sensor died on day 22 last night so no CGM all night, I woke up at 2.8, drank some orange juice & wrote the above post, probably still under 3), I'm hypo maybe twice a day, maybe a bit less recently, because I am trying hard to avoid them, I frequently adjust my basal doses to try to match my menstrual cycle. I want the pump to help me reduce the number and severity of my hypos (it's not that unusual for me to drop well under 2 & not notice, maybe twice a month, although I've never needed third party assistance) but I don't understand how to use it to achieve that - is it just a case of intensive basal testing and adjustment, hour by hour? I'd love to hear how you have actually used it?

I use it the opposite way, to avoid early morning DP highs, but the way it works is similar and fairly straightforward.

You start with a profile based on your basal insulin, and then you basal test in batches: https://mysugr.com/basal-rate-testing/

This helps you identify the times when you go up and down, so you then adjust the basal rate of insulin being delivered up and down to stop either crashing lows or massive highs. For different times of the month, you can set different rates, again based on testing, and use them when necessary. For me, I had been using the Libre, and it showed me the morning DP highs, so I had been getting up at 5am and taking a Novorapid shot. When I created my initial basal rate, I factored that into the background level, so I had additional insulin going in over 3 hours that was the equivalent to that correction. It worked really well.

Given your lack of hypo awareness, it might be worth you considering the Medtronic 640G for its SmartGuard technology, or talking to Animas about when their next gen pump with Hypo/Hyper minimization algorithm.

 

[himtoo]

How? How do you achieve this? I'm currently trialing a saline filled Omnipod (like it a lot) I'm hoping to be on it, up & running by the end of July. I have no hypo awareness (my dexcom sensor died on day 22 last night so no CGM all night, I woke up at 2.8, drank some orange juice & wrote the above post, probably still under 3), I'm hypo maybe twice a day, maybe a bit less recently, because I am trying hard to avoid them, I frequently adjust my basal doses to try to match my menstrual cycle. I want the pump to help me reduce the number and severity of my hypos (it's not that unusual for me to drop well under 2 & not notice, maybe twice a month, although I've never needed third party assistance) but I don't understand how to use it to achieve that - is it just a case of intensive basal testing and adjustment, hour by hour? I'd love to hear how you have actually used it?

my issues prior to pumping sound similar to @Snapsy . Very frequent hypos , impaired awareness being the main two.

starting on a pump was a bit disheartening the first week as my DSN effectively started me on 40% of my basal dose on MDI
and over the next 4-6 weeks we tweaked it up with loads of basal testing and and now my basal rate is 76.4% of what it was on MDI.
but the swing in rates per hour is quite staggering
my lowest point in the day is between 5-6pm at 0.45u per hour.
my highest rate is at 3-4am when it is 2.05u per hour
I have a total of 16 different rates throughout the 24 hours of a day.

I have reduced hypos to about 2 or 3 per week.( from 10+ per week )
My median BG level and standard deviations are tightened up as well on range.

 

[CarbsRok]

With a pump you use quick acting insulin only.
You set the pump to deliver the amount you need by the hour for your basal.
Bolus and corrections as long as you set the pump up correctly will deliver the amount required after you have told the pump your blood sugar levels.
It can take awhile and a lot of hard work to set up the pump to your own personal needs, so you get out of pumping what you put in, basically the pump can only do what you tell it so not a plug and play solution.

 

[Snapsy]

The hard work of setting up the pump gave me a much deeper insight (pardon the pun!) into my glucose patterns and where - and WHY - they were dropping, and on Lantus, I had quickly identified that I was going low in the early hours and also late afternoon. Now I'm pumping, I've got my lowest basal rates kicking in a couple of hours before these times, and that means I am not dipping low then on a regular basis.

I still have hypos, of course I do, but these are more often down to problems or mistakes calculating carbs when it's something I haven't cooked myself, or because of spontaneous exercise I haven't tweaked the pump for, rather than the '***?' type of unidentifiable hypos I used to have. They're not the unexpected sudden crashes I used to get that were the result of basal rate being too high plus miscalculated bolus overdoses (accidental yet often unavoidable).

Testing, testing, testing. Full on. When I started pumping it was before I had my Libre, so yes, it was hardcore hard work to start with. With the Libre though I have an insight... sorry again for the pun - into where my patterns are and identify where I can adjust.

 

[catapillar]

Given your lack of hypo awareness, it might be worth you considering the Medtronic 640G for its SmartGuard technology, or talking to Animas about when their next gen pump with Hypo/Hyper minimization algorithm.

Thank you!

If it's just a case of basal test until you figure it out, while it doesn't sound like much fun, at least I know what to expect and what I need to do to get there. I have been trying to basal test, but all the instructions say don't bother if you have been hypo in the last 6 hours. Which is a bit like trying to find a unicorn...

I'm not keen on enlite as I'm up & running with my dexcom now. I doubt I'll get funding for an integrated one (despite no awareness etc) because my ccg hates diabetics. I've looked into the animas vibe, which is offered by my clinic,but it doesn't currently do low suspend, I don't think & I sort of think that is shutting the door after the horse has bolted.

I don't want to wait for someone to release a pump suitable for my specific needs. I hope the change of switching on to the pump will just allow me to accept running a bit higher for basal testing etc - maybe I won't feel so guilty for the hypers if it's for a purpose? & I'll feel like there are more tools to try to find the middle ground (5-8) rather than having to choose between 2 & 12, which is what I feel like I'm doing on MDI.

 

[catapillar]

Thank you @Snapsy & @himtoo - at least I can see there is a route to get there!

 

[noblehead]

How is this any different from injecting as you use background insulin, this stays in your system for about 24 hours and novorapid (or whatever type of insulin you're using) to cover food. I'm really confused, could any pump users please explain to me what the difference is.

@catapillar explanation on basal rates (#2) is a good one.

With regards to the advantages of using a pump over injections to cover food, on a pump you can use the bolusing features like the Dual-Wave (this allows you to bolus some insulin upfront an to extend the remaining dose over many hours), this is ideal for difficult meals like those that are high in fat which would often mean 2-3 injections.

 

[CarbsRok]

I don't want to wait for someone to release a pump suitable for my specific needs. I hope the change of switching on to the pump will just allow me to accept running a bit higher for basal testing etc - maybe I won't feel so guilty for the hypers if it's for a purpose? & I'll feel like there are more tools to try to find the middle ground (5-8) rather than having to choose between 2 & 12, which is what I feel like I'm doing on MDI.

If you go for the Animas pump then you would be in line for the newest model so to speak as they are due to bring out a new one fairly soon. How it works is that if your Animas vibe goes wrong and there's a new model on the market then you are upgraded

 

[tim2000s]

If you go for the Animas pump then you would be in line for the newest model so to speak as they are due to bring out a new one fairly soon. How it works is that if your Animas vibe goes wrong and there's a new model on the market then you are upgraded

I read today that the "new" model that has been the talk of social media over the last couple of weeks has disappeared again. Apparently the press release or details were too early and the pump is delayed.

 

[CarbsRok]

I read today that the "new" model that has been the talk of social media over the last couple of weeks has disappeared again. Apparently the press release or details were too early and the pump is delayed.

I did hear from my rep awhile back that the new pump would be out this year but they making sure it is right due to the major b up that Roche made.

 

[Snapsy]

@CarbsRok - I must've missed the Roche thing you referred to - but I didn't start on their pump until last Oct - is there something I need to worry about? Thanks!

 

[CarbsRok]

@CarbsRok - I must've missed the Roche thing you referred to - but I didn't start on their pump until last Oct - is there something I need to worry about? Thanks!

Roche had an awful lot of teething problems with the insight pump, I have no idea if these have been solved. Bottom line is though if you are happy with what you have then don't worry about it.

 

[tim2000s]

@CarbsRok, here's the latest about the next gen Animas:

http://diatribe.org/jjs-onetouch-me...il&utm_term=0_75cdadd67f-bbaf4e7282-411787657


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[Sammy Wilkinson]

Pumps are set with different profile specific to the user so the insulin delivered is the right amount for that particular person. You'l have to go onto a course before you get one which may teach you to control your levels without the need for a pump. However, If you've been offered one take them up on it. Love my pump it changed my life.