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Starting pump therapy and I'm stuck

MisterMints

Well-Known Member
Messages
49
Location
United Kingdom
Type of diabetes
Type 1
Treatment type
Insulin
Good news! I've been offered a switch from MDI to pumping.

Bad news! I have no idea where to start.

My consultant has said I can pretty much have whichever pump I want, which is awesome, but I just don't know what to choose and why. They seem to be pushing the T-Slim and Medtronic 640g models, but I'm not too keen on these. Whatever pump I decide on, I'm stuck in a 4 year contract (with the exception of Omnipod) and this is why I'm hesitant to choose. They've now sent me away to read reviews, learn about the pumps on offer and come back to them once I've made up my mind.

I've thought about what I want from pumping:
  • More flexibility in lifestyle (e.g. going for a run takes a reasonable amount of planning at the moment on MDI, I'm hoping a pump will make spontaneous exercise easier to do)
  • More flexibility in eating (I'm hoping that issuing a corrective dose when I've miscalculated that pizza will be easier with a pump than it is on MDI)
  • Reduce the huge fluctuations in BG I'm getting from MDI
  • Reduce/remove the dawn effect and all the late night corrections I'm currently having to complete
  • Being able to finally get some sleep!
  • Have the option to move to a loop system in the future
And about me:
  • I'm 37 and been T1 since I was 14
  • I work a pretty standard, 9-5 office job
  • Pretty active (regular 5k to half marathon distance runner, 3-4 times per week)
  • Get pretty rapid BG climbs and spikes after running which need 2-3 units to correct
  • Don't have a huge insulin requirement (I have an I:C of about 1:12 to 1:14 depending on the meal/time of day) and 16 units of basal
  • Despite the above, my A1C is 50 (6.5% in old money) and my care team think I have pretty good/tight control
  • Currently using NovoRapid and Tresiba
  • Insulin resistant at night (my glucose often starts rocketing at about 10pm, and I end up taking quite large corrective doses of NovoRapid to stay within range at night - 4 or 5 units is not uncommon just to prevent a further rise and slowly bring me down)
  • Not insulin resistant at any other time of the day
Its the looping desire that has eliminated a lot of the pumps on offer, but has also restricted me to the following, as I'm on Android and don't use or can't afford to use the Dexcom G6 system, and the NHS won't fund it for me (I'll be using Freestyle Libre + MiaoMiao as my CGM - already on that and like it!):
  • Accu-Chek Combo
  • Accu-Chek Insight
  • Dana RS
  • Omnipod
I realise the Omnipod is currently only loopable on Android with a Raspberry Pi and RileyLink, but that work is being done to get RileyLink and Omni working with AndroidAPS. But I've included it as pumping is new to me and there's no 4 year contract so I could try it for say 6 months, decided pumping isn't for me and then give it all back - I can't do that with the others.

  • Which would you choose and why?
  • What's good/bad about each of the pumps listed?
  • Which ones work well or not so well?

I'm not intending to start looping straight away. I really need to get my head around life with a pump and what works for me, but I don't want to be stuck and have to wait another say 3 years, before I can switch to a new loopable pump.

Thanks for reading that much longer than expected post, and thank you for any help, advice or reviews you can give me. Looking forward to hearing them!
 
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Hi I've been on my Medtronic 640g for 4 years (just been upgraded to it) and it is the best thing to happen to me if I'm honest. I can't comment on the other types of pumps as I never got the chance to try them. As for exercise I weight train 4 times a week and run Temp Basal setting after exercise as I hypo after my training so the pump gives me the flexibility to do spontaneous exercise or anything else that I don't have to plan for. Which ever pump you go for always have a spare canula with you (I have ripped one out at work and didn't have a spare or a insulin pen so home I had to go). I genuinely feel that it has gotten me my control back and would highly recommend one. You can also run temp rates for your basal and also split doses to cope with extra carbs/fats coming from the likes of pizza and any other foods that combine the two.

sorry I can't be of much more help to you as to which pump to chose, it is a daunting thought but I had the help of my DN who helped me tremendously with the transition from MDI. I'm more than sure that other pumpers will be here soon with better advice than I.
 
Hi, @MisterMints , I'll tag @Mel dCP who has recently started looping with omnipod, libre, miaomiao but with Loop on ios, but I imagine it's broadly similar to AndroidAPS.

I think @h4kr might be going down a similar route too.
 


Thank you @helensaramay that's really helpful.

I probably should've mentioned in my OP that I'm not really all that fussed between tubes and patches. I've tried out the dummy Omnipod and to be honest, I was surprised at how small it was! Was expecting something closer to a deck of cards. Plus, I already wear Libre+MM and its not much different in size to that.

Clothing isn't too much of an issue for me either. I'm just a jeans and T-shirt kind of guy, so other than when I'm running, I rarely wear anything else.

And after nearly 24 years of being diabetic, I'm past trying to hide it or be discrete. I'll stick a pump or canula wherever is convenient.

However, it is the "permanently attached" bit which is probably going to take some getting used to! I do like the freedom of my NovoPens - all I have to do is change the needle. I don't need to worry about carrying extra supplies around incase of a kink in the tube, or I need a new canula. I don't have to worry about refilling or running out - I just stick a new cartridge in when it's empty, and I do like that aspect of MDI.
 
I personally never changed to pumps for a number of reasons, these won't help you select which pump is right for you, but give you my opinion on why I never made the transition.

Firstly, I like the freedom of MDI's I inject when I need to and apart from that I am not attached to anything.
Its much easier for me to workout at the gym and do martial arts.
There is a higher chance of lipohypertrophy from insulin pumps as a foreign body is inserted under the skin for several days (cannula), this can affect insulin absorption in the long run and even if you decide to go back to MDI's later.
You still need injections as spares should anything go wrong.

The only reason I would change to a pump is for true closed loop control without manual carb counting, but until then I can't see it offering much advantage to me personally, as nights are my biggest concern and even then I don't have many hypo's or hyper's. With the current insulin we have I personally do not see the benefit of having a pump constantly trickling insulin into the body as it still has a 3-5 hour activity period.

But you have to weigh up what would work best for you, both in terms of day to day practicality and short/long term control.
 
The Medtronic 670G should be out by now, but quite expensive and Medtronic’s customer service is appalling. You will find a pump amazing the way you can control your BGL. I don’t notice being tied to the pump. I live in the land of Oz, so it’s get out of bed time. I had to check just then that we were still together as I just got back into bed. I had out of habit grabbed my pump wandered around without consciously being aware I did that. I’m new to the pump only 18 months. You have the correct approach of get used to the pump before looping.
 

Exactly, that's why I mentioned I personally never changed and these were the reasons. What is better for me isn't necessarily for others, but its better they get a rounded view on what advantages and disadvantages a pump can bring.

For you it obviously works well, for me it doesn't. Even though I know you can detach the pump for training, the infusion set is always there, something secreting a known substance to cause fatty tissue, under the skin all the time (until you change it) just doesn't sit right with me. But if it makes life easier than MDI's for some, then that's a decision for them personally.
 
For me, one of the main reasons for going on the pump was to reduce my lipohypertrophy. Pretty much all my injection sites were slowly going hard and unusable, so one needle every two/three days sounded like a good option. It's worked well in that respect.

The reason I picked (or, actually, my consultant picked) the Medtronic 640 was because of the larger reservoir size. If I go out on the first two days of a reservoir I don't need to take backup cannulas, reservoirs etc., just as I didn't take backup pen needles and cartridges.

Another thing I like is that if something doesn't go as calculated, I only have the one insulin to work with. I found out through a couple of bad experiences that if I inject levemir and humalog too close they change each others timings. Not great.

I was worried about having something permanently attached, so much so I refused to try the pump for a couple of years. On first getting the pump I went out and got a lycra pump belt and a pump-pocket belt. They haven't been used for over a year. Now, I just shove it in my bra and forget it until I want to eat (OK, not an option for you). A few times I've shoved it in my pocket, gone to the loo, sat down and thought - that strange tugging sensation is the tubing of my pump pulling. Totally forgotten it was there.

Make sure the pump you pick lets you set up a pattern of changing basal rates, I think they all do, but best to check because this will really benefit anyone whose insulin resistance rates change throughout the day like yours.
 
Muneeb said:
There is a higher chance of lipohypertrophy from insulin pumps as a foreign body is inserted under the skin for several days (cannula), this can affect insulin absorption in the long run and even if you decide to go back to MDI's later.
Click to expand...
It's not as simple as that. Sure, injection for injection, the cannula is more likely to cause lipohypertrophy. But it's not injection for injection. For me (and I know I'm an extreme case) it was one cannula or over 50 syringes. Six months after going onto the pump my lipo was decreasing, three years later there's very little left.

Insulin absorption is affected by the rate at which the insulin is injected. Pick the slow bolus rate on the pump and the insulin absorbs better than if a large dose is given all at once via a syringe. There is a 'threshold large dose' below which it doesn't make any difference, I suspect its user dependent. This theory is brought to you via a group of diabetologist and endocrinologist consultants trying to figure out why I don't react 'normally' to insulin.
 

MDI's or multiple daily injections is not more likely to cause lipohypertrophy than canulla's, if the injection sites are rotated properly. If you constantly inject in the same fatty tissue or reuse needles etc, lipohypertrophy will definitely increase with MDI's.

Im not sure about the insulin absorption rate, but the nature of insulin leads to lipohypertrophy and the fact that with a pump you constantly have insulin in a single location for several days means that chances of lipohypertrophy are high.

Dr Bernstein recommends against pump usage as he states he has never seen a well controlled diabetic on pump therapy due to lipohypertrophy and issues with insulin absorption. In general Dr Bernstein's diet is low carb (30g per day) and therefore insulin requirements are generally on the low side anyway, but he still observed this.
 
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