Who are pumps best for?

I've just started on a pump due to having a quite active lifestyle that MDI regime didn't allow flexibility for the control.
For a few years I was getting very frustrated as my doctors said I had superb control due to my HB1AC always being in target around 6.8%, but what the HB1AC result doesn't detail is how that result is getting achieved.
I spent 6 months BG testing every hour to detail exactly what was going on when I did activity and also proved the basal (Lantus) dosage was spot on when I didn't do the activities by fasting.
The spikes I was achieving were out of control and I did all I could with adjustments to my injection times and compensations that ended up with me taking 8 jabs a day of small doses but this was the only way I could try to maintain my BG levels between 4 & 8.
The spikes can have a significant factor on your long term health with retinopathy etc, so what every you do you need to ensure you minimise this as much as possible.
For me I couldn't from one day to the next predict 24 hours in advance what activities I would be doing with either hill walking or cycling which if I had to much Lantus the night before would leave me fighting to keep above 4 and constantly eating and drinking lucizade and digestive biscuits.

Pumping isn't for everyone, but my lifestyle requires flexibility in my dosage levels to vary my daily activities. This is where the pump comes into its own and you can change your dosage levels within an hourly window to compensate for what your doing, it is life changing if you are fighting the MDI.

Hi @SugarBuzz In an ideal world every type 1 would have one yes, however it's a cost issue and attached to that is the point that if you are currently cruising along with poor control and very little regard for your type 1 management then it won't ultimately be a useful tool for you and won't improve your HbA1c. People who are interested in gaining access to one are doing so because they know it can improve their control and HbA1c, but for one reason or another cannot do it on MDI alone and better control is illusive, the NHS are interested in helping those and they know the pump is therefore an investment for these people. Giving someone a pump who doesn't manage well already isn't a magic wand, it doesn't offer brilliant control as it relies on the user to manage it efficiently and invest time in managing it, otherwise it's a wasted pump.

I have tight control and can see where a pump would be useful to me in the morning. I take a small dose for bf, then another small one an hour or so later then yet another one 2 hours after to stop the morning and activity rise. So two extra injections along with my meal and lantus. So these extra injections are my version of the pump. At this point I'm still ok with it but times may change later.
I did just change insulins and this might resolve some of it. It seems a tad stronger with a longer duration and much smoother. Keeping my fingers crossed.

It is useful for many T1's, even more so for those who have an indepth knowledge of their condition. A lot of people (diabetics included) are under the impression that the machine does it all for you - it's quite the opposite actually.

What a pump does offer, if it is used correctly, is more flexibility, accuracy and efficiency in terms of insulin delivery.

You can have a look through the following site, it gives a lot of good information regarding pumps and pump therapy:

http://www.inputdiabetes.org.uk/alt-insulin-pumps/

@SugarBuzz an excessive number of injections for optimised control is a quality of life issue for which pump funding is a solution.

Input diabetes has a great guide on what criteria has to be met for pump funding - http://www.inputdiabetes.org.uk/alt-insulin-pumps/is-it-provided-by-the-nhs/

But you do have to be able to carb count to use a pump. Whether your diet is good or not hasn't got anything to do with carb counting so that makes me question whether you actually understand what carb counting is? It's literally counting the carbs in what you are eating and then important bit of it is matching your insulin does to the number of carbs your taking in. So you need to understand your insulin to carb ratio and how to adjust your bolus dose, and consequently how to check your basal dose is correct, to be able to use a pump.

It's possible your fluctuating blood sugar could be caused by not having the right basal dose at the moment and not carb counting?

SugarBuzz said:

Hi. Thanks for the responses everyone.

My bloods have generally been out of control for 20 years. This is in effect due to an active lifestyle. Although I've never really carb counted as such my diet hasn't been that bad - partly shown through the fact that my cholesterol levels have always been spot on (with higher end HDL and lower end LDL). Often I've been baffled as to why why my blood sugar levels would fluctuate so much. Say if I had an average of 9 it would more than likely be due to 3's and 15's rather than being, 'around 9' all the time.

Anyway, during the last week I've got my Blood Sugars down to an average 6.2 (it was 11.4 for the month of March). But I've done this by injecting insulin between 10-12 times a day and testing my blood sugar the same amount of times. So much so that I've already got 'scabs' forming on my side fingers and I've actually almost ran out of test strips.

Needless to say I don't think this level of 'care' would be sustainable in any normal kind of life. I'm wondering how long I could actually keep it up for.

Click to expand...

If you don't know how to carb count then it's no surprise that your BG is out of control. It's a fundamental process required for controlling BG - is there a reason why you don't know how to do this?

As for the 10-12 injections, I can imagine that the majority of those are correction doses? Correction doses from both incorrect amounts of bolus administered for meals (through incorrectly estimated carbs) and a lack of basal insulin; that's certainly my guess.

A pump is a tool, and is only as good as the person it's connected to. I'm not being patronising here @SugarBuzz, but unless you are fully competent at carb counting and understand ratios, basal rates (including how and why you'd change them) then a pump would prove entirely useless to you. It would definitely mean less physical injections, but your BG control issues would still be present.

Have you ever adjusted your basal insulin dose by yourself, tested your duration of insulin action, calculated your I:C ratio, TDD, correction factor, etc?

The statistics for T1 diabetics achieving an HbA1c <53mmol/l (in Scotland) are pretty horrendous, only hovering about the 10% mark - and only slightly better in England. As far as HbA1c stats go for those on pump therapy, 10% of pumpers are still >86mmol/l and 61% of pump users are still >58mmol/l. That means that most pump users do not make their targets, in the same way that most T1D's on MDI don't either.

Further, the mean HbA1c for a pump user vs a non-pump user are 66.5mmol/l and 68.9mmol/l respectively. In my eyes, the differential between the two is simply not big enough and further reiterates my statement about the machine only being as effective as the effort and knowledge applied. There is no denying that pump therapy improves HbA1c's overall, but just not by enough in my opinion...

I'd imagine that the above statistics are largely based on the fact that a good proportion of pump users just simply don't know how to utilise the technology correctly. Nor have any idea what any of the terms in the previous paragraph mean...

I'd suggest the following literature before considering pump therapy, it will give you a good understanding and also give you the techniques required to improve your current situation on MDI. Every T1D should be reading this first book and IMO the NHS should be advising them to do so:

https://www.amazon.co.uk/d/cka/Thin...naging-Diabetes-Insulin-Completely/0738215147

http://www.diabetesnet.com/dmall/pumping-insulin

I'd also ask your Doctor if you could take part in a carbohydrate counting course. They have lots of different names depending on where you are in the UK. Typically, there is an introductory carb counting course that's just one day - and then a more advanced one which is around 4 days.

SugarBuzz said:

I mean if they were best for everyone - then surely everyone would have one (or be trying to get one) right?

Click to expand...

In a ideal world But of course there's people who are quite happy on MDI and don't wish to be attached to a pump.

SugarBuzz said:

Anyway, during the last week I've got my Blood Sugars down to an average 6.2 (it was 11.4 for the month of March). But I've done this by injecting insulin between 10-12 times a day and testing my blood sugar the same amount of times. So much so that I've already got 'scabs' forming on my side fingers and I've actually almost ran out of test strips.

Click to expand...

Great achievement but you cannot possibly keep that up, in the long-term your injection sites would suffer as a result and diabetes would ultimately dominate your life and everyday thoughts.

Ask about a pump with your diabetes consultant stating the ABCD Recommendations Excessive number of injections for optimised control & Specific quality of life issues. Good luck.

SugarBuzz said:

Hi. Thanks for the responses everyone.

My bloods have generally been out of control for 20 years. This is in effect due to an active lifestyle. Although I've never really carb counted as such my diet hasn't been that bad - partly shown through the fact that my cholesterol levels have always been spot on (with higher end HDL and lower end LDL). Often I've been baffled as to why why my blood sugar levels would fluctuate so much. Say if I had an average of 9 it would more than likely be due to 3's and 15's rather than being, 'around 9' all the time.

Anyway, during the last week I've got my Blood Sugars down to an average 6.2 (it was 11.4 for the month of March). But I've done this by injecting insulin between 10-12 times a day and testing my blood sugar the same amount of times. So much so that I've already got 'scabs' forming on my side fingers and I've actually almost ran out of test strips.

Needless to say I don't think this level of 'care' would be sustainable in any normal kind of life. I'm wondering how long I could actually keep it up for.

Click to expand...

If you don't carb count, it's like driving with a blindfold on. Carb counting is crucial for good control, and if you don't carb count that would explain your fluctuating sugars.

I highly recommend learning to carb count and adjust your insulin. That should help enormously.

I've had a pump 13 years and I love it, but it does take knowledge and work as you have to be able to adjust basal rates and count carbs to get your bolus correct. The pump is simply another insulin delivery system. It doesn't control your blood sugar automatically. It's only as good as its user.

Hi @SugarBuzz Have you done a basal test yet? Whether pumping is right or wrong for you, your current situation suggests either your insulin doses or your carb counting is out, and quite likely both. Everyone here will willingly help and advise, but I really recommend you do a basal test first, to get the foundations right, then work out you I:C ratio and correction factors, and you need to carb count to do all this. This will, at the very least steady your BG, and reduce the number of injections you need. Unfortunately, without understanding these things, you would spend all your time fighting the pump, rather than it working for you. You may want to consider reading a book like Sugar Surfing, or Think Like a Pancreas - both were a great help to me. Best of Luck, P

After pumping for just over a year, I agree with some of the previous comments.
Pumps are best for those who are willing to put in the effort.
You MUST carb count and be more accurate than MDI.

You have flexibility for "combo doses" that inject over a longer period of time for food with low GI. But you have to know when to use them.

You have the flexibility to adjust your basal dose for short periods of time when you are exercising, for example. But you have to understand how your exercise affects you and for how long.

My control is better with the pump but I have to work a lot harder than I did with MDI.

I'm 61 and had one for the last 3 years wouldn't want to go back to injections

SugarBuzz said:

Nope. I presume that would incorporate a 24 hour fast?

Only thing I was told (3.5 years ago) about basal was to give it once a day (18 units) and that it lasts around 16 hours.

GP (not a specialist) I saw recently suggested I increase it to 22 units.

Click to expand...

Basal testing doesn't incorporate 24 hr fasting because such an extended fast would create a liver dump and make the test unreliable. Here's a guide on how to basal test - https://mysugr.com/basal-rate-testing/

Many people find there is a need to split their basal dose, so take one shot in the morning and one in the evening, so they are actually covered for 24 hours.

Some of my type 1 friends have excellent control with mdi. My hospital was able to do a cgm test for two weeks that confirmed long lasting insulin/basal wasnt working for me. Before the pump my ha1c was 9 and now with a pump for the last 10 months I've got to 6.9! Pumps are not any easier just works more precision doses and mimics a pancreas closer. You still have to count carbs and test blood sugar if not even more....

I was on an insulin pump for two years before being taken off for a new insulin (long acting) called Trsiba. What a difference this has made. It has no peaks which gives you better control

I don't mean to deviate from this thread but when I read the responses - the first thought that crossed my mind - how do you afford it/pay for it? The last time I was inquiring about a pump, where I live, amounted to thousands of dollars and I just didn't think it was worthwhile considering the price and my diabetes control wasn't that bad. Interesting thing - I live in Canada - the land of universal healthcare - but it's a bit of misnomer as the average person with diabetes in Canada who is living from pay check to pay check can barely afford the test strips let alone a pump. Interesting article about Pumps and Strips where I live - http://www.cbc.ca/news/canada/princ...tes-budget-insulin-pump-test-strips-1.4066368 - Fortunately my own private health plan covers the cost of strips but only partly reimburses me for a pump. What about people in the UK - is the pump and test strips affordable to most people or does it require creative accounting and good health plans?

Hi @fletchweb, the UK doesn't have health plans,. more universal care. The NHS pays for all pumps, but you have to qualify for them according to a set of criteria. As a result, only about 8% of t1s in the UK are using pumps.