Is an insulin pump really a good viable option for me? For a while I thought oh yes this sounds great but I want to know if it really sounds ideal. I feel like my insulin needs are currently changing and it's becoming a very frustrating thing for me where I'm wavering on the pump idea a liiiiitttle bit . I've been diagnosed with diabetes since June of last year so just over 8 months now, and have been using insulin since September (I had a misdiagnosis problem) .
I want to know if I'm being reasonable about my possible pump decisions. I'm currently still looking at the Medtronic Minimed 530g and the Animas Ping.
Things I find to be a pro for pumps:
-More precise dosage. I know I can't get perfection but I struggle with how to dose my insulin sometimes. My carb counting is not the problem but on my ratio I find if I need like 4.8 units it's hard to tell what to do as sometimes going for just 4 is fine but sometimes it leaves me hyperglycemic and using any more than that makes me hypoglycemic. I also find that I have trouble correcting based on the sliding scale , there might be another solution for this than a pump but I feel like it might be better to correct the 150-199 mg/dL range with somewhere between 1 and 2 units but not 2 units? Like 1.5 or 1.6 . I've heard reusable pens can do this, but aren't as effective as a pump with half unit dosages. 1 unit of correction is often too much for me if my blood sugar is between 121 and 149 mg/dL (which is what is on my sliding scale) .
-a more long lasting constant basal dose that might be more correct for my body. I find Lantus is great but lately it hasn't been covering me very well I don't think. I know I did have a defective pen with a leak that I used on accident and gave me an absolute nightmare of a bad day but in general I feel it's less effective now. It might require a dose change on lantus but I figure it might be easier with the less than 1 unit add on that a pump can do? I'm aware I could split my dose but I don't have a regular sleep schedule where I wonder if a pump could be a better idea?
-The comfort of a CGM if I go with the 530g or can get a dexcom of some sort to go along with another pump. Not to replace finger sticks, I know those are still necessary, but I want to know if it maybe could lead me to understand my swings and figure out what to do about it? Particularly when I'm sick or near my time of the month it seems veeeeery hard to figure. Currently the idea of a pump and a cgm seems more and more appealing for the peace of mind involved with the better sounding basal dose method and the cgm combination.
-This might be a minor pro but the convenience of being able to press a few buttons and bolus when going out to eat , like I know I'd still need to test my sugar and that's not the problem here and I'm fine with that and can do that quickly, it's just when I go out to eat a lot of times I feel shooting up takes a long time compared to pressing a few buttons...unless I'm all wrong on this.
I just hope this is reasonable, and I'm not expecting perfection, I just want to maintain better health and have less obvious swings and be able to pick up on them and treat them effectively as possible . that's my main goal in all of this. Regardless, I will be bringing it up with my endo on my next appointment (valentines day) and maybe see about chatting further with my CDE over it.
i think you are being very reasonable. at the beginning, changing from MDI to a pump is always a huge effort, so the first few weeks/months might not be perfect, but you seem to be very informed, and i think there is nothing wrong with talking about it with your endo. you can still contemplate about it later… wishing you good luck with your decision.
also, feel free to join any of our pump groups, and look into their discussions or post one on your own, maybe you can see there more of what a pumper is dealing with…
SC
Your thinking is sound and it is normal to be apprehensive and any change to your regimen since diabetes takes a lot of work. For me, I love how pumping allows me to nail down my basal need separately from meal insulin. I use temp basals and Super Bolusing frequently. I consider the ease and convenience of pressing buttons vs pulling out syringe and vial to be a significant improvement in my QOL as well.
I'll read them until I get one , I think that's a good deal. I kinda lurk around the insulin pump related things on here anyway (which is how I'm on the idea of 2 pumps now instead of like all of them and being unsure at all lol. Still also considering the tslim though even but that's the possible 3rd option, I think having 3 might be a good idea to start with instead of 2...) . I'm willing to deal with the beginning being a bit challenging if it brings better results in the end though. I'm pretty patient with my treatment but I do want something that is effective more than anything else so I feel good. I'm a college student and will have a job HOPEFULLY after I'm done in May and I want to feel good for that.
Really the only negative I'm gonna have problems with is getting test strips for testing, I'm totally willing to test 8-10 times a day and would prefer to over 4 times a day but I'm not sure if my insurance would allow for it even if I go for the ping and continue to use one touch ultra blues. I am aware of test strip assistance programs though and I might take advantage of one of those if it'd make it possible to get 8 test strips a day for a month or every 90 days or whatever works best?
Even with pens I feel like there has to be a QOL improvement with the pump because messing with a tiny pen needle in a bathroom is what I have to do a lot since I don't wanna scare someone that's needle phobic and wanna clean up myself if I make a mess with insulin when priming the needle or something.
Do you know if I am able to use another meter with the pump? Like I get I'd lose the link feature but I have 4 meters already (2 one touches , a relion confirm, and a bayer contour next that I just got today because I saw a deal for cheap test strips with it at walmart. Diabetes impulse buy lol ) .
Ok, I know there are lots of reasons to go with a pump. It certainly offers a lot more control. But let me just point out a couple of reasons to not go to a pump. First, it can cost more than MDI, sometimes a lot more depending on your insurance. Second, it can be brittle, when it fails (like a site fails), you can have very high blood sugars within hours so you need to pay more attention and handle more exceptions. Which brings me to a third reason, it is more invasive in your life, since you have more control you will check and make more and finer corrections to your control. And finally, my last point, you may not get big improvements in blood sugar control. After all, your A1c pretty sweet at 6%.
For me, in addition to the advantages you cite, it was a HUGE advantage that the pump kept track of everything. Even without the CGM, I discovered that having a very solid log of my BG and the automated charts to keep track of it for me was something I could use that I was never going to do on my own. I know many people do this on their own, use apps, have spreadsheets, write it down or whatever but I ***loathe*** logging but, when I started pumping, I had a log. It made a big difference in what I've been able to achieve. I totally agree that the CGM will likely show you a few things about how food behaves and how you can control your BG.
You are spot on as well about the lower doses. 1/2 unit pens are great but the Medtronic pumps will allow you to bolus in .025U increments, much more precise. While perhaps the medical industry, or pen salespeople might suggest "it doesn't make a difference...", I've tried various fine tuning experiements and they almost invariably work, which makes me think that many of the problems that PWD face are because the medical industry doesn't give us enough credit to try stuff like oscillating basal rates (.775U/ hour for 1/2 hour combined with .8U/ hour for 1/2 hour, to fake a .7875U basal rate, a recent experiment I tried that has worked GREAT for me...)
Well the thing is my a1c was 6% when I was having absolutely nothing over 130 mg/DL on my meter, I've had a lot over that lately between being sick twice in December then now where my blood sugar is just making me very uncomfortable. I don't feel comfortable with seeing 180's, 190's and even low 200's now. I get that perfection is a non existent thing, but when I'm having weird symptoms and higher numbers out of nowhere, it makes me veeeeeery uncomfortable. I get stressin' over it is bad for me too, and I'm aware how expensive pumps can be if the insurance isn't good about it (though I think OTHER THAN STRIPS my insurance is great and I might be able to get more or an override or something) and it is expensive to try something that might not work, but I do think it's worth a try. I'm aware sites can fail and whatnot and testing more is NOT a problem for me if I actually can get the strips because I want to test more than I do already I rather test 6-10 times a day over 4 because I feel I have way less control now with that and tend to use a second meter to get 2-3 more tests in anyway. Like for the past 2 months I've been out of what I'd consider control , I'm often 170+ after breakfast and then I over correct highs really easily even though I swear I'm counting everything right , it's just I need a correction between 1 and 2 I think to really get the best out of corrections and end up on a middle ground that's not 160 from a 170 high with 1 unit correction or 56 from a 158 high with 2 units correction.
I mean I guess I can stay on mdi forever but I really don't feel confident in it anymore.
I already log how much my blood sugar readings are at meals and how much insulin I use, I'm not sure if I have to log every single blood sugar test but I do log every meal one in detail with the time I took my first bite and how much insulin I used...so I don't think that's too hard unless I have to do a lot more than that which might be a bit more challenging. I used to log my lantus dose but I've kinda slipped on that even though I do take it at 10pm every night where it's kind of a given and I'm very good about that. But for the most part I log everything I take in and my sugar at the time of that.
But thanks for this response as it it kinda reaffirms what I think I need a pump more, better sounding basals and the increments that aren't like half units and are more like 1/4th units or 3/4th units where that might be better , since that'd make it more stable I think than adding an entire extra unit or even a half unit in some cases.
I just worry I'll get judged if I go for it because it's expensive, and my family doesn't have much money and the insurance is very questionable at this point and I'm not sure if I wanna call insurance up before I talk to my endo about it and have something going for me before going seriously for info and stuff.
I think the chart thing varies by pump. I had an endo appointment last week and he kept complaining about the Animas charts. He said the Minimed pumps produce much more useful and easier to read charts. I find the Animas charts near useless. Not to mention, even though I can record an exercise session in my Ping meter it doesn't actually show up anywhere in the charts ... I don't get the point of having that option there to record. So, the logging thing is not an advantage for me with the pump, but I have heard people on Minimed say it is.
For me the biggest advantage is the variable basal rates. Lantus just did not cover my basal needs well. The biggest disadvantage (for me) is site failures. Sometimes when you're high, it's VERY difficult to figure out if it's food, hormones, or a site failure. I have more issues with that than a lot of people, though, and switching to metal sites (and not using Skin Tac) has solved most of them, thankfully.
I also find the pump does take more work than MDI. There are more decisions to be made and more maintenance tasks. But overall, most (not all) people find that the advantages of the pump outweigh the disadvantages.
I have also heard of some people who have problems getting a pump when they are newly diagnosed. I've heard some doctors and/or insurance companies want you to have a year of experience with MDI before covering one. I've heard the same with A1c, some have the same problems if they have a good A1c. An insurance company might claim that something like 6% means you have great control on shots and don't need a pump. I didn't have either of these problems when I got mine (but I'd been on shots for 15 years and my A1c was above 7%), but I did notice on the form my endocrinologist filled out that he had to check off several "reasons" for needing the pump, like wide excursions in blood sugar, suboptimal A1c, problems with the dawn phenomenon, and so on. So just keep those in mind if you do go for one.
I wonder about the Tslim, that one has kinda peaked my interest (ironic as they have a recall right now for the cartridges but I won't hold that against them if it's a quality product) and how well it does with logging? I'm really liking the animas ping based off what I see on everything though and the medtronic 530g also seems great so I'm thinking those 3 will be the first ones I look into for sure. The only pump I'm completely uninterested in is the Asante Snap, unless they make a novolog version then I'd be into that one too lol.
I figure the first few weeks to months with it will be veeeeeery trial and error if I can get on one but in the end whatever works I'm willing to put up with some frustrating times with it if it means excellent control that fits my life, possibly better than mdi, possibly not. We're just gonna have to see. What you mentioned there is very good to know but sounds very ymmv. I just won't know anything really until I try a pump for myself at all.
I feel like the 6% a1c won't stick around, not to say I entirely doubt myself but since December I haven't seen as good as numbers as I did when I got the 6% A1C (where I don't think I saw a number above 140 at the very most but more 120 in a loooooong time and no hypos) and changed literally nothing with my regimen and very little otherwise in my life. I've heard so many things though I've heard if your A1C is good that's better and proves you have good enough control to use a pump or I've heard your A1C has to be bad, this is very confusing. It is quite possible with the paperwork and crap involved though that it'll meet the year of me being a diabetic point too. I'm not sure but I kinda don't think it'll happen that quickly, though I figure I'll have diabetes at least 9 or 10 months before anything even starts up which is a pretty decent time and I've still been using insulin long enough to figure out how it works and I have already demonstrated effective carb counting and I triple check it all of the time anyway.
I get that pumps require a lot of maintenance and all but how often is it that you have to slow yourself down while on a snack or meal break for work or school just to have a snack? With MDI I feel like it's such a hassle and hogs up a lot of time that I could probably reduce it down to just finger stick and pressing a few buttons and keeping all of my non-emergency pump maintenance at home? Is that reasonable or am I wrong? I mean I feel like it'd make it easier to eat meals and snacks on the go entirely and make handling my insulin a lot easier in general in public when I don't have to go hide in the bathroom to deal with it. It's not that I don't wanna carry all of the stuff I know that's a bad reason and that's not why I want a pump it's just overall convenience involved with it once it's all set up and good to go.
The day-to-day blousing is faster with a pump than MDI. But, for me at least, it's balanced out by the alarms that go off at the most annoying times, or having to get up in the middle of the night to refill a cartridge or replace a battery ... But I didn't mind MDI that much, anyway. I used to just do shots wherever I was, even some on buses and trains. I used to use a Cozmo and I use an Animas now, and find being able to bolus directly from the meter the most freeing. The Cozmo was okay, but having to pull it out of your pocket with tubing felt almost as conspicuous as doing an injection sometimes.
I wish I had the sanity to deal with injections in public but I fee like if I do I get a big ol' lit up sign that says I AM INJECTING SOMETHING INTO MY BODY STARE AT ME. Whereas, at least I'd think with a pump, it'd be more like getting out a cellphone, even though it's attached to me with a tube it'd probably still be less obvious. I just mostly fear scaring people with needles as I know far too many needle phobes where I feel like unless I need a glucagon I don't want to expose people to seeing my needles if they don't absolutely need to. My mom can handle it as she had a type 2 insulin using friend who she ate lunch with a lot who'd inject it wherever and not give a crap but I don't know if everyone around me can.
You can over time become more comfortable with all this stuff. Your need to test and inject is not a burden on anyone and if someone has a needle phobia, it is their job to look away and not stare. These days I don't consider other people opinions about my testing and injecting relevant. I am out, I will test and inject whenever and wherever I need to. If they have a problem with my testing and injecting in public that is their problem. I hope you will feel more comfortable over time as well.
ps. And I inject through my clothes all the time. Usually, unless you are looking really hard you wouldn't be able to see me inject anyway.
pps. For a while, my wife (who has a needle phobia) was uncomfortable with my injecting in front of her. I told her she just had to get over it, I continued injecting and now she is not bothered.
I agree with Brian about testing/injecting in public. You have as much right to be alive as the next person. Taking insulin and testing keeps you alive and is just as important to you as breathing is for everybody.
I know it can feel like it sometimes but everyone is not looking at you. People are naturally more concerned with themselves than they are with others. When you need to take care of business, just do it.
It's easy to be discrete. I don't like to inject through my clothes because every once in a while I get a bleeder and I don't want to stain my clothes. It's pretty easy to just unbutton one button on my shirt and inject my abdomen. It's over so quickly, most people don't even catch it. I know a woman's wardrobe is a bit different than a man's but I'm sure you'll figure something out.
As to needle phobics, they certainly can just look away. If they're truly needle phobic, they will. You're should not have to run to some dimly lit and dirty restroom to inject/test.
I'm gonna respond to several things here. First of all, since you have type 1 most insurance companies will cover the number of tests your physician Rx'd. I have coverage based on 10-15 tests a day. (I have an Animas Ping aND A dEXCOM4 cgm - BUT I PAY OUT OF POCKET FOR THE cgmn SO I DON'T KNNOW IF MY INSURANCE KNOWS ABOUT IT). aNYWAY, IF YOU THINK ABOUT TESTING WHEN YOU WAKE UP, GO TO BED, BEFORE AND AFTER MEALS, BEFORE AND AFTER MAJOR Ooops hit the capital button - don't want to type everything over) physical activity and whenever you et behind the wheel of a car - 10-15 strips a day isn't all that unreasonable. And pumping is more discrete. I was in an airport restroom getting my syringe ready. A woman( nosy) ran out and got security. "She's shooting drugs!" The security guard looked at me, looked at the syringe and looked at the insulin vial. He told the busybody to mind her own business, nothing bad was going on here. And (I quote the guard) "Look, her dealer gives her the drugs in a nice sterile pharmaceutical vial" I could have hugged him.
Another benefit of pumping is the combined bolus. Especially helpful when going out to eat. You can divide your bolus into a phase 1 and phase 2. That allows for the slower metabolization of higher fat (which restaurant meals often are) meals.
And on a lighter note, as you read through the insulin pump posts, there are lots of options to be a pumper and a fashionista at the same time.
I agree, needle phobics can look away and the needle is so small anyway I think it is barely visible. You need to do this to stay alive so don't restrict yourself. I test/inject in public frequently- I don't do it while teaching but that is my choice not to. I don't like to inject through clothes because I can't tell where I'm injecting and if it really got into me. I usually inject into my hips, thighs so I pull clothes around a bit without exposing myself at all really, lol.
you can get 1/2 unit syringes, that's what I use for my bolus, basal, corrections, etc...i draw up from both vial and pens - i can't say that small increments on a pump are any more accurate then drawing up small doses on a pen - syringe, at least with a syringe you know it's going in. The pump is NO panacea, it takes a while (for some a long while) to get stable and those on pumps are also, it seems, continuously making adjustments. It's a lot of work. I've tried the pump a few times, just would go too low or couldn't get BG's down for days and would eventually go back to shots. I'm going to try the pump, again, in February. It helps too if you do know what your MDI lantus - basal is. As Jen said, the pump seems really helpful for those who need different basal rates, i.e., DP, a lot of highs - lows from basal on MDI.
My doctor is on board with the idea of an insulin pump. My diabetes educator set me up for a pre-pump meeting thing on the 14th of March at 11am ! So I'm on the path of a pump. So far it looks like my main option is the Medtronic Minimed 530G . Would anyone here like to tell me the thinks they like/dislike about this pump? I mean going by my research it seems like a good pump itself but the cgm is kind of hit and miss?
