Please let me say, I am not telling everyone they should be on a pump. Everyone has different, needs, wants, concerns. A pump isn’t for everyone! I get that.
But this past week, my husband had some surgery and we were in pre-op & as usual not a lot of privacy when nurses are getting things set up.
There was a gentleman in the next cubicle and he was giving the nurse his info. Diabetes, taking insulin, sliding scale(shocked to hear people still use this treatment plan) and than he said how he had a low a few hours ago and had to eat. And he ate a lot. The nurse told him, they would probably have to cancel the surgery due to all the food in his system. And I thought of all the surgeries I have had or fasting tests for my many trials. With my lovely little pump, I just suspend the insulin for an hour or so, and I come right back into line and just turn it back on. No food, no juice no canceling of surgeries or treatments.
Felt so bad for this poor man. Because you schedule your work and life around these things and to have it canceled. So just another possible reason to pump. Because once you give that injection, you are done. Can’t take it back. I can turn it off. Love my pump and the flexibility but do realize there are good and bad to every treatment plan. Pumps have their problems also. But I do love it!
Totally with you there, but I’d be really curious to know what the percentages are. I was stuck on it for 20 years largely b/c it’s what generations of GPs were taught, and if you can’t get a referral to a specialist, as I couldn’t, it may still be the default for a lot of people. Takes a LOT less knowledge on the GP’s part than basal-bolus MDI, and they mostly don’t see that many T1s. “You’re doing fine, let’s not change anything” was what I heard for years.
First time I had surgery (orthopedic) I was still on R/N sliding-scale. IIRC, they just told me not to take any the morning of surgery, and scheduled me first in line for the OR that day. It was outpatient surgery so it wasn’t a big deal. Second time I had surgery I was on basal-bolus MDI, and they did the same thing: scheduled me first and told me not to take my Lantus in the morning. But that time the surgery required me to stay in-patient for 3-4 days, and they were going to treat me with R/N sliding scale during my stay. Had a huge wrangle to dissuade them.
Haven’t had surgery since being on the pump (about 5 yrs), but everything I’ve heard says it’s a much better deal. Hospital rules require that all medications are administered by hospital staff–that was the problem when I was on MDI, and I eventually worked out a deal where I told them what to give me and they administered the shot (which was so stupid that they basically just let me do it). But I gather that if you have a pump, these rules don’t apply. I guess because it’s officially a prosthetic device? something like that. I’m hoping not to have to experience it, but this has come up in other discussions and that seems to be the deal. I know when I’ve had to have a “procedure” (a.k.a., colonoscopy) they don’t have me disconnect from my pump or anything, just put it on the bed next to me.
Big upside, if you can call it that, is that irrespective of treatment regimen it’s SOP to bump T1s to the top of the schedule in order to minimize BG/insulin issues. So there’s that, anyway.
I totally agree. I love the temporary basal feature on my pump and being able to suspend if needed. I use it all the time not only for things like getting ready for surgeries but also because my work and daily schedule varies greatly. And hormones change things up greatsly as well.
Sometimes it does backfire. I had a low last night at around 2:00 AM, and I didn’t feel like eating so suspended my pump for an hour. That shot me up from 3 mmol/L to 11 mmol/L. I did the same several nights ago and the same thing happened. I wish I could suspend my pump for 15 minutes, because sometimes I think that’s all it would take to reverse a low or nudge my BG up a bit. But my pump is limited to temporary basals rates in 30 minute increments (I don’t use the actual suspend feature because I’m too scared I’d fall asleep without turning insulin delivery back on).
It is a huge benefit getting scheduled first because of the diabetes. But when I was in the clinical trial for stem cells with ViaCtye, one of my explants was scheduled at 3 and it was late. The surgery ahead of me was a brain surgery, and was very happy to let them take their time with that one. And again with the pump and CGM it was no problem for me to go that long without food.
And a very sad note, when I was in ER observation over night, they wanted to take the pump off. Had to put my foot down and said either I keep it on or I’m checking myself out. Had to sign a whole bunch for forms to keep doing what I always do. Hospitals can be a very scary place.
I know each pump has different features. And on 5ose nights when I have to fast and I have had to suspend, my pump beeps way too often to remind me i’m In suspend. It drove me nuts for hours while I wanted for the lack of insulin to take hold. Last time I just let it ride and disconnected it, and set my alarm clock to get me up in 2 hours.
Worst thing about R/N was that horrible straitjacket about eating to your insulin dose, rather than the other way around. Even basal-bolus MDI is vastly better in that respect. I remember the week I started on Lantus-Novolog and the day when for the first time in 20 years I crossed my fingers and delayed lunch a half hour… an hour… an hour and a half… and nothing happened! I literally cried it was such a relief.
Yeah, it was so hard to eat even when not hungry. But you knew you had to because the Insulin was peaking. When I first went on a pump, that was when I really discovered what being hungry felt like! I no longer had to get up at the same time due to injection timing. Or if I didn’t want dinner at 5 pm but wanted it at 7 pm, with a pump no problem with injections of Lente, no choice, I had to eat.
I had that “hunger=danger!” thing so deeply ingrained that it’s really only fairly recently I’ve gotten my head around the concept that you can be hungry just because you’re, y’know, hungry; doesn’t necessarily mean you’re crashing. Thank you pump (and more to the point, CGM)!
@DrBB I too have had several Ortho surgeries on MDI, and am usually scheduled early in the AM. One time however I was scheduled at 1 pm, and told to take half dose of Lantus the night before and no Humalog after 10 pm. At the time I was dosing Lantus 2x daily. By the time I was checked in, and doing pre-op they checked my sugars - +500 mg/dl. It was seriously sad because I tried to inform Anesthesiologist re: basal needs, but they always know better right? Instead I got a lecture that day about better blood sugar control and had to re-schedule the surgery. That was the last time I ever dealt with that Ortho/Anesthesiologist team.
I remember skipping a meal for the first time in my 20s, too. I’d tried to do the same thing when I was about 13 and it did not end well (in other words, I passed out).
Yep totally agree, I will never go back to mdi except for emergencies, not sure how I survived that. I feel so much safer now just to turn off or increase my insulin as needed. That man could just have taken some glucose tabs and still had the surgery prolly. I did that for a low before my colonscopy and they said it was ok.
I have been pumping over 20 years. Switched before insulin pens were available/popular, so have never used a pen ! As backup, I use syringes, and wonder if I will ever try using a pen.
Some are so surprised to hear that I have never used pens.
Do you use lantus pen with your pump?
No. Someone else posted about doing that recently–was it you?–but to me it seems like it would be too confusing.
Yes this is all true. BUT if you are having surgery of any kind, and are on the pump, make SURE to explain to the surgeon, and especially the anesthesia team, that they should NOT TAKE IT OFF. Before my appendectomy, I explained to the surgeon that I was on the pump and he nodded as if he understood, and didn’t ask a single question. The day of the surgery, I assumed everything would be fine. But when I woke up after the surgery, my pump was in a plastic bag on the table next to the bed. They had ripped it off. I sent my husband back home for insulin and an infusion set, and had to pull my addled brain together enough to get the pump inserted and set up again. Luckily there was no complications, and my BS only went up to about 225. But It was absolutely shocking. This and other experiences over my 50 years of diabetes have shown that non-endocrinologist physicians don’t necessarily know anything about insulin pumps — or diabetes, for that matter. So always explain carefully, especially to the anesthesia folks and to your surgeon, and anyone else involved. And make sure to bring an infusion set and insulin with you, just in case.
By “Luckily there were no complications” I meant complications that would have caused me to without the pump for hours or longer.
That’s very alarming. He completely ignored everything you said. I’d be very upset at that point.
Exactly, I was furiousand dumbfounded. Especially after I raised the issue with the surgeon and he just shrugged the whole thing off. My experience with surgeons — I’ve had 5 minor surgeries, mostly structural — is that they’re interested in the surgery, not the patient.
They must have much smarter doctors where I live than a lot of other places…
My experiences have been completely the opposite, intelligent questions have been asked about my insulin usage, clear instructions given and expectations on both sides articulated… although I do use long acting instead of a pump. I’ve never once encountered an incompetent physician in dealing with diabetic patients on insulin…
As a general note, I would feel unsafe with a pump just for the sole reason that a single mishap can lead to an emergency… blood sugars can start skyrocketing in just an hour if the pumping is interrupted… with tresiba I would have a full 40+ hours before it even became a concern…
When I was young and stupid, I didn’t pack spare infusion sets in my carry-on on a particular trip. I put them in my checked luggage instead.
I accidentally ripped out my infusion set on a layover. Looking back, it would’ve taken only a few hours for me to get home. I should have just taken the flight home.
Instead, I approached the airline attendant and asked if they could recover my luggage from the plane because I needed my infusion sets. The airline attendant was naturally very alarmed and called an ambulance.
This layover was in Columbus, Ohio aka the worst place in the U.S. to have a diabetic emergency. The ambulance took me to the hospital. It took a few hours to see a doctor. He told me he had to test me for DKA before he could give me any insulin because if I am in DKA then I need a specific formulation from the pharmacy.
The test apparently takes hours! It took several additional hours before they came back with the test results that showed I was not in DKA yet. He seemed almost disappointedly surprised. I imagine at this point he had realized that I truly was well-controlled (as I said), and that I’d simply had an unfortunate incident and moment of stupidity when packing. My blood sugar was over 1000 at this point. It’s honestly crazy that I wasn’t in DKA. Knowing what I know now, I would’ve simply walked to a pharmacy and asked for syringes.
The nightmare doesn’t end there though. They put me on some ridiculous insulin/glucose IV machine. I told the doctor that as I approached normal levels, they would need to back off on the insulin.
…no one listens to me though. I fall asleep because i’m completely exhausted by this point. I wake up puking with my blood sugar in the 40s. Basically, I’m just in Columbus, Ohio to destroy my body.
I made it out alive, but who knows what amount of damage may have been done. I filed a complaint with the hospital when I finally made it home. The complaint was legitimate enough that I received a call from their legal department asking if I was planning to file suit. It’s also worth noting that they were unwilling to give me any syringes for the trip home (I had my insulin in my carry-on), and I just couldn’t wait to get the F out of there that I figured I’d be better off ending the day in the 300s than figuring out some other scenario with this crazy hospital.
People who think that ER doctors know anything about diabetes are being naive. Period. They don’t know what they’re doing. They don’t care about you. Knowing what I know now, I’d be an incredibly demanding patient if ever I had to visit a hospital again. I wouldn’t put up with that ■■■■ now. That being said, I was demanding insulin every other minute from when I stepped in that hospital. Really, avoid Columbus at all costs.