What pump does everyone have?:)

[Gracetype1]

Hi! I'm 26 years type 1 diabetic, 29 years old, Libre sensor user with a A1c at 49 (6.5 in old money).
Diabetes was uncontrolled for a very long time, including childhood and I have many diabetes complications to show for it.. unfortunately.
They have been well controlled since 2021 - when I was pregnant with my son- A1c dropped from 100 to 51 pre pregnancy so quite the lifestyle change since then!

I've been referred for pump therapy by my consultant and I've been regularly seeing a dietician to get cal counting down to a T before doing the DAPHNE course, to hopefully jump me up the list! However, I'm completely new to this whole thing really.

I've been on lantus and humalog for the past 10+ years and nothing has really changed in that area for me so I am completely unaware and would love for some advice.

My consultant mentioned the pump they have in mind is to replace long acting insulin? So I'd still inject for meal times. Which seems a little pointless to me as my background insulin is not causing any issues, my dietician is confident I'm on the right amount etc. or am I missing the point, maybe?

Is there not any pumps available on the NHS that do short acting insulin instead that I could possibly talk to my consultant about?
I'm seeing him on 20th April and would like to take some questions to him about all of this.
Has anyone got a pump that does either both or anything? I'm not even sure what you'd call that so I hope that makes sense!

Is there anything I could ask him to maybe draw out some other options that maybe they are cautious to mention because of the price tag?
I live in South Wales, if that helps! I'm not sure if it varies according to where you live.

Also, to pump users, how long did it take you from being referred to actually starting on pump therapy please?

Thank you so much everyone!

 

[EllieM]

Hi @Gracetype1 and welcome to the forums.

I'm not in Wales, or in the UK, but I may be able to help a bit.

I'm T1 for the last 54 years, and can relate to the poor childhood control (given my first glucometer in my early twenties and encouraged to get my average bg below the teens). My control since then has been what I would describe as mediocre (good during pregnancies when I temporarily lost hypo awareness, less good the rest of the time until the last ten years, when access to a self funded cgm led to fairly consistent hba1cs in the low 50s high 40s.)

Like you, I've spent the last ten or fifteen years on lantus and humalog. My team first mentioned a pump to me 4 years ago (complaints about lantus and issues with dawn phenomena) and last October they suggested it to me again (after sleepless nights with lows).

So I finally started my pump two weeks ago and despite a few hiccups I am very happy with it (tandem tslim x2). It's a tubed pump but there are also tubeless ones out there. (New Zealand just has two pumps available via the public health system, so I don't know much about tubed pumps)

Now I don't know what pump you are being offered but my understanding was that all pumps deliver fast acting insulin. Your lantus is replaced by a background steady trickle from the pump, which can be tuned to your particular metabolism so that you can have varying basal at different times of day. Your meal time doses are calculated and delivered by the pump based on the carbs you are telling it you are eating. So I am wondering if you have misunderstood the consultant?

Anyway, hopefully someone more experienced than me will post soon.

Once more, welcome.

 

[Deleted member 527103]

Is there not any pumps available on the NHS that do short acting insulin instead that I could possibly talk to my consultant about?

All pumps use short acting insulin ... only short acting insulin.
They provide basal by dripping the short acting insulin.
Then, when you need bolus, you tell the pump how many carbs you are eating and what your current BG is. The pump will then calculate how much short acting insulin you need.

Do you know why your consultant is considering a pump for you? The usual reason is varying basal needs. By dripping short acting insulin, the pump can change the amount of basal every 30 minutes to cater for Dawn Phenomenon, for example. Or, in my case, adjust my basal when I exercise.
The Hybrid Closed Loop systems work out how much basal you need based on the readings from your CGM.
Unfortunately, injected insulin does not work as fast as the stuff a healthy pancreas produces. Therefore, a pump cannot detect when you have eaten and predict far enough in advance to give you your bolus. You still need to carb count.

Also, to pump users, how long did it take you from being referred to actually starting on pump therapy please?

This varies greatly. Some people can wait 12 months. Others can only wait 2 or 3 months. Some clinics build up a "class" of people so they can all start pumping at the same time.
For me, it was about 4 months from when I expressed an interest. During that time, I was required to attend the local equivalent of DAFNE. I think that was for a few reasons - to check I could carb count, to check I had the ability to deal with the additional complexity that pumps can cause and to check I was willing to invest the time and effort into learning how to use a pump.

As for the title of your thread, the important question is "what pumps does your clinic offer?" There is little value in knowing what pumps I use and why I think it is great if it is not available at your clinic. Some clinics offer lots of pumps but some, like mine give a choice of one or two.

I recommend researching pumps and making a list of what is important to you. Do you want a remote control? Do you want a phone app? Do you care about size? Do you want the option for hybrid closed loop? Do you want tubed with a choice of cannula or patch pump? How much insulin (basal and bolus) do you use in 3 days? A pump cartridge needs to be changed every 3 days so it needs to be big enough.
I am sure there are more things to consider when you start researching.
When you meet your consultant, I suggest asking what your options are so you can limit your research to the pumps on offer to you.

 

[Antje77]

I've been referred for pump therapy by my consultant and I've been regularly seeing a dietician to get cal counting down to a T before doing the DAPHNE course, to hopefully jump me up the list!

I'm not on a pump, so nothing to offer on that part from me, except agreeing with the reactions above.
But just to make sure, was cal counting a typo? I hope the dietitian is not working on cal counting with you but on carb counting, it's the carbs you need to count to find your ratios.

And well done on getting a grip on your diabetes now!
Good luck with the pump, I hope it will improve things even further for you!

 

[Gracetype1]

I'm not on a pump, so nothing to offer on that part from me, except agreeing with the reactions above.
But just to make sure, was cal counting a typo? I hope the dietitian is not working on cal counting with you but on carb counting, it's the carbs you need to count to find your ratios.

And well done on getting a grip on your diabetes now!
Good luck with the pump, I hope it will improve things even further for you!

Hi! Thank you for your reply. Yes! Sorry, my bad. I did mean carb counting. I've got the carbs and cals app and it's been helpful but still trying to work out ratios. At the moment I'm on a different ratio in the morning (3:1) and afternoon/evening (2:1) but finding I get some higher readings after lunch for some reason. So I'm not sure if I need to readjust those ratios. I will bring it to the dietician and see what she thinks.
Thank you so much for your reply!

 

[Gracetype1]

Hi @Gracetype1 and welcome to the forums.

I'm not in Wales, or in the UK, but I may be able to help a bit.

I'm T1 for the last 54 years, and can relate to the poor childhood control (given my first glucometer in my early twenties and encouraged to get my average bg below the teens). My control since then has been what I would describe as mediocre (good during pregnancies when I temporarily lost hypo awareness, less good the rest of the time until the last ten years, when access to a self funded cgm led to fairly consistent hba1cs in the low 50s high 40s.)

Like you, I've spent the last ten or fifteen years on lantus and humalog. My team first mentioned a pump to me 4 years ago (complaints about lantus and issues with dawn phenomena) and last October they suggested it to me again (after sleepless nights with lows).

So I finally started my pump two weeks ago and despite a few hiccups I am very happy with it (tandem tslim x2). It's a tubed pump but there are also tubeless ones out there. (New Zealand just has two pumps available via the public health system, so I don't know much about tubed pumps)

Now I don't know what pump you are being offered but my understanding was that all pumps deliver fast acting insulin. Your lantus is replaced by a background steady trickle from the pump, which can be tuned to your particular metabolism so that you can have varying basal at different times of day. Your meal time doses are calculated and delivered by the pump based on the carbs you are telling it you are eating. So I am wondering if you have misunderstood the consultant?

Anyway, hopefully someone more experienced than me will post soon.

Once more, welcome.

Aw that's so helpful, thank you so much! I think I definitely misunderstood the consultant! The first conversation we had about a pump was last year and it was very brief. He said I'd have to do the dafne course first and it was a long waiting list for that, but if I see the dietician frequently it should hopefully push me up the list a bit. I've been seeing them since October 23, so I'm hoping it's not too long now.
I will definitely speak to him in more depth on the 20th about it all as I'm very clueless (clearly) but excited to get one!

Thank you so much for taking the time to reply to my post!

 

[searley]

I have the tandem tslim which is very good and massively increased my control, almost 4 years since I got it..


I’m considering the Medtronic 780g for the next pump as I think it’s slightly more aggressive in the way it controls with lower targets - but there are downsides to this pump in relation to this pump

Your pump choice will also be affected by how much total insulin you need over 3 days

Some pumps hold 200u or less others hold 300u.

 

[Juicyj]

Heya - am also a T-slim user with Dexcom G6, great hybrid closed loop system as will read your levels and make adjustments based on predicted outcomes, so does alot of the work for you, means sleep levels are stable and controlled, less hypos and less severe ones at that too, however it's not so sharp on managing high levels, takes a while to get them back into range which is frustrating, other hybrid systems such as Omnipod are more intuitive at managing high numbers but depends if you are ok with a tubed set vs a pod. Also depends on what is available to you so ask the question as it will help you decide.

 

[Prancy]

I have the tandem tslim which is very good and massively increased my control, almost 4 years since I got it..


I’m considering the Medtronic 780g for the next pump as I think it’s slightly more aggressive in the way it controls with lower targets - but there are downsides to this pump in relation to this pump

Your pump choice will also be affected by how much total insulin you need over 3 days

Some pumps hold 200u or less others hold 300u.

I was undecided for quite a while. I was MDI for about 20 years, but I really struggled. I stayed as controlled, but barely. Once, I got hospitalized with DKA. My first pump was Medtronic 670 with integrated CGM. It was rough, but eventually, I improved. I still could never get more than 78% time in range. A few weeks ago, I upgraded to Medtronic 780g. This is their latest model with automatic micro boluses. It’s been a struggle. I admit it has not gone smoothly, But I’m seeing success! For the first time in my life, I think this is going to work for me!

For the last 24 hours it has kept me in range!

This is pic from pump screen.

 

[Heathero]

I was undecided for quite a while. I was MDI for about 20 years, but I really struggled. I stayed as controlled, but barely. Once, I got hospitalized with DKA. My first pump was Medtronic 670 with integrated CGM. It was rough, but eventually, I improved. I still could never get more than 78% time in range. A few weeks ago, I upgraded to Medtronic 780g. This is their latest model with automatic micro boluses. It’s been a struggle. I admit it has not gone smoothly, But I’m seeing success! For the first time in my life, I think this is going to work for me!

For the last 24 hours it has kept me in range!

This is pic from pump screen.

Hi wondering about this re my pump review Weds do u need Apple phone for this? How large bulky is CGM pump. I currently use Omnipod/ Libre.