why do some people get the choice of a pump?

LauraC27 said:

Ok. thanks for your help.
although this is what my diabetic nurse has advised me to do.. just stick with the levemir morning and night. but you are right.. if I eat little later than usual at meal times i do find I can start to feel low. But generally I'm having my meals roughly at the same time each day at the moment (especially during the week because I'm at work etc) so it isn't really causing me a problem. But I do see what you are saying.. I'll speak to my nurse about it. thanks!

Click to expand...

Stick with what your nurse told you. People on here are not supposed to give you medical advice.

teacher123 said:

If you eat high carbohydrate foods (lots of bread, rice, pasta), takeaways and sugary foods then it won't last very long because you are effectively killing off the remaining cells that produce insulin. If you can reduce your carbohydrate intake then this will prolong the honeymoon period as your pancreas isn't getting a hammering every meal time trying to regulate glucose levels.

Click to expand...

RuthW said:

Do you have any research to back up that statement?

Click to expand...

There is quite a bit of research linked to the diabetes vaccines that shows that the T-Cells that attack the beta cells are attracted to proinsulin, which is created as part of the insulin production process. Ergo, if you eat foods that require a greater production of insulin, there is more proinsulin to "attract" the T-cells and you encourage them to attack the beta cells. It's a cognitive jump rather than research I would suggest?

I'm not aware of any specific research relating to honeymoon, food types and duration. There are a number of anecdotal examples of LADAs that have continued without insulin for much longer than the acknowledged honeymoon norm by moving to a very low carb diet and so restricting insulin production, but I'm not fully aware of the actions of the immune system in LADA to argue whether this is due to a reduction in T-Cell action.

Laura and toomuchglucose
Take a look at Tims graph. As said on your other post toomuchglucose.. Tim knows his stuff.

A note to @RuthW... We are allowed to give advice if it is termed.."this is what we would do" etc....

I would have had severe problems returning to MDI if I had followed my nurses advice of one levemir x20 units once a day. Tim's graph and knowledge worked better than I have ever had before in 30 years....

donnellysdogs said:

Laura and toomuchglucose
Take a look at Tims graph. As said on your other post toomuchglucose.. Tim knows his stuff.

A note to @RuthW... We are allowed to give advice if it is termed.."this is what we would do" etc....

I would have had severe problems returning to MDI if I had followed my nurses advice of one levemir x20 units once a day. Tim's graph and knowledge worked better than I have ever had before in 30 years....

Click to expand...

Yes, I know. But there was a very specific piece of advice which was not phrased in that way. And when you are experienced with your diabetes, you know not to make too many changes at once or in quick succession. When you are new to it, you don't know that stuff. Her DN may just be pacing the OPs learning.

LauraC27 said:

Oh! ok..
why do you find its more to think about? do you mean worries about it coming out etc ? x

Click to expand...

@LauraC27 More to think about because you have to make sure it's working (DKA can come on quickly with pumps as there's no long acting insulin in your body) and you're thinking about things like whether you need a temporary basal rate, if your high blood sugar is due to wrong basal rates, is it time to change your cannula, etc, etc.

Actually, the pump cannula coming out rarely enters my mind : D

A pump is fantastic, but it's no easy option and you have to be prepared to work hard to get the best from it and good blood sugars.

dancer said:

I was injecting for over 30 years and wasn't happy with my control for over 20 of them before I was offered the pump.

It's only offered to those who can't get decent control on MDI and meet the NICE guidelines.

Click to expand...

there are also other criteria such as fear of hypos, high insulin sensitivity, etc.

I fit in those categories finding it difficult to maintain effective control without fear of, in particular, exercise related hypos.

tim2000s said:

It's important to remember that dose size makes a very large difference to the action of Levemir. As the clamp graph shows, at doses below 0.2u/kg of body weight, whilst there is a peak, it's incredibly soft and the duration of the action is about eight hours with a long tail where it does very little for the next eight hours. What this means in practice is that it kicks in after about an hour, and I find that it doesn't really have a "sudden" effect. Once you get up to larger doses, the peakiness increases and gets pushed out to about eight hours.

This is why splitting the Levemir dose is a good idea. It reduces the impact of that peak.

Click to expand...

Interesting, explains why I never really had any peakiness with levemir on around 0.05 U/k twice a day

one other reason for split dose levemir is that it also allows more flexibility to tailor doses to activity patterns.

Lots more reasons to keep the exercise up and the carbs down.

So 20 units of Levemir a day? That seems like a lot I was on 14 and that was too much for me a split dose might be a good idea but to have some fast acting with meals would probably be good so you can reduce the Levemir.

donnellysdogs said:

Laura and toomuchglucose
Take a look at Tims graph. As said on your other post toomuchglucose.. Tim knows his stuff.

A note to @RuthW... We are allowed to give advice if it is termed.."this is what we would do" etc....

I would have had severe problems returning to MDI if I had followed my nurses advice of one levemir x20 units once a day. Tim's graph and knowledge worked better than I have ever had before in 30 years....

Click to expand...

I did look at the graph, but it's a bit confusing haha but obviously taking two injections would reduce the peak something I may have to experiment with.

TooMuchGlucose said:

So 20 units of Levemir a day? That seems like a lot I was on 14 and that was too much for me a split dose might be a good idea but to have some fast acting with meals would probably be good so you can reduce the Levemir.


I did look at the graph, but it's a bit confusing haha but obviously taking two injections would reduce the peak something I may have to experiment with.

Click to expand...

Every person is individual - there is no such thing as high doses or low doses... We have to take what we need with insulin......

RuthW said:

Stick with what your nurse told you. People on here are not supposed to give you medical advice.

Click to expand...

The nurse's advice goes against the current NICE T1 guidelines which are to put newly diagnosed people on basal-bolus immediately. While it has been normal to give just Levemir or just mixed insulins to the newly diagnosed, that is no longer advised.

As @TooMuchGlucose explained it is better to use a mix of basal and bolus otherwise a fixed basal dose will result in hypos when ever meals are skipped or reduced. As a very experienced T1 @RuthW you are well aware this is true.

tim2000s said:

There is quite a bit of research linked to the diabetes vaccines that shows that the T-Cells that attack the beta cells are attracted to proinsulin, which is created as part of the insulin production process. Ergo, if you eat foods that require a greater production of insulin, there is more proinsulin to "attract" the T-cells and you encourage them to attack the beta cells. It's a cognitive jump rather than research I would suggest?

I'm not aware of any specific research relating to honeymoon, food types and duration. There are a number of anecdotal examples of LADAs that have continued without insulin for much longer than the acknowledged honeymoon norm by moving to a very low carb diet and so restricting insulin production, but I'm not fully aware of the actions of the immune system in LADA to argue whether this is due to a reduction in T-Cell action.

Click to expand...

There is not a lot of conclusive research on what does or doesn't extend the honeymoon period. But as Tim says there is in vitro work that suggests an increased autoimmune effect proportional to insulin production from beta cells. There is also the view and practice of Dr Richard Bernstein with his patients. He sees evidence of hastened resumption and longer duration of the honeymoon period when he gets them on low carb. That's not research per se but it's a lot of experience.

Regardless of whether reducing the load on the pancreas increases the honeymoon period or not, it will reduce the BG variability of the T1 person because it will reduce the number of situations where the insulin demand exceeds the residual capacity of the pancreas to produce insulin. So if we reduce the demands on the pancreas, the pancreas can take the role of fine tuning the BG. Now this could be accomplished with more external insulin rather than with less glycemic load (carbs and sometimes protein). The advantage of lower carbs rather than more insulin is that the inevitable dosing errors and uncertainties increase in magnitude when insulin is increased. These increased errors mean a certain increase in the incidence of hypos and hypers, putting additional stress and strain on the person and her pancreas.

RuthW said:

Stick with what your nurse told you. People on here are not supposed to give you medical advice.

Click to expand...

@LauraC27

What I try to do is consider what my nurse/doctor says to do, and consider the suggestions, ideas, and experience of what people say online, then if I can I discuss the options with my nurse/doctor and reach a decision for myself, or if it's a relatively minor issue I don't need to check with them and I decide on my own.

Both health professionals and people online can be wrong. As you get more experience managing diabetes, it will become easier to figure out what is the best thing to do in a situation.

Some online suggestions are more reliable than others. The factors I look for are: does the suggestion make logical sense? how many posts and likes does the person have? What do I know about their experience from the info in their signature and elsewhere? Did they provide links to any supporting information or references? Are other posters generally supporting or challenging what they say?

But if the problem is urgent or serious then I go straight to a professional, through calling a helpline or seeing them in person.

A professional has the advantage of their training, knowing more about you, being able to examine you or see all your results, and being able to provide treatment and observe what happens next.

People online have the advantage of time to ponder an issue, several viewpoints to consider it, and in some ways, better access to details about how you have been doing. They also know what it's like to live with diabetes and use insulin or drugs. This can be really valuable.

In the end, I think in the forum we are all just trying to increase our knowledge and help others build their knowledge, which is a good thing.

Hi Laura! I've been diabetic for 20 years. I had three babies (separately!) and they changed my metabolism completely. I lost my hypo awareness (seizures) and became ultra sensitive to insulin... Unfortunately unless you fit the "criteria" you can't have one, which is rubbish as the NHS would save millions in the long run. Xxx

This has been a great discussion, but I am here fraudulently, because I am T2!!

I am on Levemir 32 units am and 36 units pm plus Novarapid 12/15/12 before meals, so my insulin program appears similar to many T1 members, but here in Australia under no circumstances can a T2 get a pump!

What is the UK situation?

Zoot said:

This has been a great discussion, but I am here fraudulently, because I am T2!!

I am on Levemir 32 units am and 36 units pm plus Novarapid 12/15/12 before meals, so my insulin program appears similar to many T1 members, but here in Australia under no circumstances can a T2 get a pump!

What is the UK situation?

Click to expand...

The NICE guidance is pretty similar. Getting a pump as a T2 always used to be completely off limits. They've updated it so there is s bit of a chance, but CCGs are unlikely to pay for it.

Hi guys,

This might sound weird but I just wanted some opinions. I've had type 1 diabetes for 20 years! I've asked my doctors time & time again about the pump because I've heard so many people saying it was a godsend. When I was admitted with DKA a few years back due to being completely burned out & not caring I begged them for an alternative to injections & I was told they wouldn't "waste a pump on someone who cares so little"...I found this hugely upsetting considering I felt completely **** about landing myself in hospital in the first place so I find it weird that my team of doctors seemed to only offer pumps to well controlled people. It doesn't make sense to me so I was wondering what ye think.

My hospital is one that will not offer patients a pump if they have had a DKA incident.
The criteria set by NICE is really for people that have tried and tried to gain control and have problems with hypo's.
Hypers are seen as controllable. Hypo's aren't.
Pumps take a lot of self management and testing. It is seen by some consultants and CCGs thst if a patient can't make the effort to control themselves on injections that a pump would be wasted compared to somebody that has tried and tried and tried.
We are not well controlled.. We have dangerous hypos that need to be eliminated and many also need cgms as well.
I know of a young lady who never controlled herself on mdi, was constantly in DKA numerous times, got given a pump and within 8 weeks it was in a box in the shed. She still does not use it, and still dors not look after herself on MDI either.