Feel quite disapointed with self today that after all preparing to go onto the pump from shots i bottled it at the final hurdle. I was looking for way out after hearing how difficult it would be for first 2 weeks doing intensive carb counts and trying to find correct dose and possible expecting a few very high and very low sugar levels. With the set in my hand and the Animas rep and healthcare staff watching i said i need more time. Guess am looking for someone to tell me how stupid i am being and just give it a bloody go! Sticking with what you know even when its not perfect seemed the best option. Door isnt closed on pump therapy but need to know pumps are better than injections.
Chris: I very much understand. It’s that final step that makes it tough – going from what you know to what you do not know. If you have a good team working with you, the transition should not be difficult. My fear when making the transition was the overnights-- I had a big problem getting low while asleep. My educator recommended starting out with basal rates that were probably a little on the low side, to avoid lows. We then adjusted to get to the right levels. Highs and lows are parts of our lives, as are carb counting and adjustments.
Go for it!! Once you are used to it (a week) and feel that your basals and boluses are moving in the right direction, it will become second nature. Plus, it is going to be a lot easier to take a bolus when you are sitting across from your great date than it is to excuse yourself to go take an injection!! Trust me on that one.
You can always decide that pump therapy is not right for you. It is not irrevocable.
Hi Chris. I won’t tell you that you are stupid.
I think that the level of control that I can get with the pump is much better than what I could achieve with shots. BUT I also think that I started on the pump before I was ready. My doctor really pushed it and I decided to go for it. My control got worse on the pump, because I did not figure out how to use it effectively.
I think that you did the right thing. If you feel comfortable on injections and you can find ways to maintain good control, then that’s right for now.
I think if I had waited a year longer, I would have had a better start on the pump… so it’s good to know that it is still an option… for the future.
Your anxiety is understandable. I think most of us who lived on injections for a long time can relate. That being said, you have nothing to lose! The worst that will happen is that you’ll give it a go for a few weeks or months and decide it’s not for you. Then you can always go back to injections. On the other hand, you might love the pump as much as most of us do, and you might kick yourself wishing you’d done it sooner - that’s how I’ve always felt about it 
Either way, you always have options, so trying something new doesn’t mean you have to commit to it forever and ever.
Hi Jonathan
Thanks for response, i think it was the fear of the unknown initially without being sure what to expect during the initial bedding in period. On the induction there was so much talk of the negatives that the positives were easily forgotten. I left feeling some relief but later in day felt really low about choosing the easy way out…my fears also include night time hypos ar extreme highs but you are right, giving it a go is only way to find out.
Thanks again
Chris
Hi Kirstin
Thank you for responding. I think i needed to hear your words of reassurance and affirmation that its ok to work at my pace and not feel rushed into it. Think i just felt like i had let myself down as i am normally a person who gives things ago, so if i am being honest felt a little weak willed.
It also reassured after hearing your experience that you wished you had waited longer before starting pump that its maybe not the magic pill therapy for diabetics everywhere.at any time. How do you find the pump now?, do you think you would still use pump even if could achieve good levels with injections?
Chris
Hi Chris!
I definitely feel that the pump is a big decision and you should not rush into it. The pump is not a magic pill, but in some ways, it’s the closest thing that we have to a magic pill!! So I DO recommend trying it again, when you are ready and I think that you need to stick with it at least six months to know if it works for you.
That said, you are not the first person to decide NOT to pump. So it isn’t for everyone…
I LOVE the pump… I recently took a week off from the pump and it had me thinking about that exact question of whether i would someday go back to injections. I might switch back to injections someday just to see if I can keep as tight of control. I am thinking about pregnancy and trying to get my A1c under 6-- I don’t think that I could do that with injections. So I will stay on the pump for at least a few more years before trying injections again.
The reasons that I think my control is better on the pump:
- I correct EVERY blood sugar, even when they are just slightly high. It is hard to correct just slightly high blood sugars with injections
- I exercise more with less lows because i can turn my basal rate down to 50% one hour before exercising-- this is amazing!
- I can live with more flexibility, because if I ate, checked my sugar, then want to eat more, my pump can process all that data telling me what to do without going high or low (it remembers how much insulin is active in your system-- something that is hard to keep track of unless you write down every move).
- It’s easier for me to give boluses early. You should give your bolus 15-20 minutes before eating. I can often do this while walking to get lunch, while cooking, etc. I think that with injections I would often forget to do this.
- I have different basal needs through the day. In fact, most of us do. So the pump can give me more basal insulin in the late evening than in the early afternoon. You can replicate this by splitting your long- acting insulin dose. With the pump, if I have good blood sugars and do not eat or bolus, they will stay good all day. The basal really works as a background insulin. When I used injections, I could not go 12 hours with eating, which means sometimes I was feeing my long acting insulin.
This LONG answer is to say that I don’t think that you are stupid. The pump is a huge commitment that may help you achieve better control when you are ready to try it again. I would definitely recommend trying it again for a longer time… perhaps you can set a time frame for yourself. First trying to improve control without it… but I would not spend your energy beating yourself up about it, but i also wouldn’t dismiss the option that the pump might be right for you, in the future.
Keep in touch about how it’s going!!!
Hi Chirs!
I agree with all the things that Kristen has said about why she loves her pump and how it helps to improve BG control. I love my pump as well and can’t imagine being on shots again, even though I wasn’t on them very long to begin with. I think everyone should move to a pump at their own pace. It might depend on what type of person you are too. The pump does take some work to figure out. I’m the kind of person that likes to plan things and problem-solve, and also likes new technology, so it was a no-brainer for me. I also like to be in control, which was the real motivator
Some suggestions for easing into it might be:
- Talk to your Diabetes team and see if there is a way that you could simulate using the pump for a few days to get the feel of it, while still maintaining your BG control with injections. When I first got my Omnipod, I wore a pod filled with Saline for 3 days, just to see what it felt like.
- Try to plan to minimize factors that you can control when you first start on the pump, so that you can figure out your ratios as quickly and safely as possible. Your Dr. should be able to give you a very good place to start for basals by looking at how much long-acting insulin you currently take. I set my alarm and checked my sugar during the night for the first week but felt comfortable sleeping through after that. The bigger danger for lows I think would be miscalculating on carbs and/or having a carb ratio that doesn’t work for you. My suggestion is to pick something that you like eating, weigh the components, and figure out exactly how many grams of carbs, protein, and fat are in it and use it everyday for a week or so, until you feel comfortable with the ratios you’ve chosen. I would actually pick 3 things I liked, one for every meal. That way, you can take the carb-counting a little bit out of the picture until you’re sure that you have the correct ratios.
Good luck and keep us posted as to what you decide and remember you can always switch back to injections!
Hi Julie
Thanks for taking the time to respond, i have been looking into omnipod but found not available in UK yet. I did trial animas pump for week with saline and was getting used to the whole attached thing. On the day of deciding to start with insulin the healthcare nurse was concerned i wasnt 100% as they had a very good percentage of pump starters who later stopped they encouraged me to hold fire for while. I dont know how many people in states on pump compared to shots but in UK less than 1% so yours and others on heres positive feedback has been invaluable. Since stalling on pump i must admit been out and injecting has been a chore and i have wished i had been on pump. My biggest concern is that at present i go hypo 2 or 3 times a day with no logical reason why my sugars should rise or fall as they do and am concerned pump will make no diff or worse.
Chris
Hi Chris,
I assume you’re on long-acting insulin? When I was on MDIs and my basal rates were controlled by Lantus (long-acting) I went low several times a day. I had to have snacks all the time. I would often go low around the same times of the day. My endo said that this was largely due to the fact that long-acting insulin doesn’t time-release at a constant rate in your body. It has hills and valleys, so sometimes you are getting a bit more and sometimes a bit less. Pair this with the fact that everyone’s body needs different amounts of basal insulin at different times of the day and you could easily be getting lows that have nothing to do with eating or carb-counting.
In my opinion, this is one of the best benefits of the pump. Because you’re only using short-acting insulin, you set your basal rate to what your body needs. It’s fantastic! I have my pump set to divide each 24 hour period into 7 different time slots customized to what my body needs at that time of day and the amount of basal given differs by as much as %175. In addition, as Kristen stated, if you are going to be more physically active, you can decrease, or even suspend your basal delivery for as short or as long of a time as you want and avoid a low. I even set a reduced basal sometimes (-%20) if I’m just going to be doing a lot of errands. I’d say a decrease in the number of lows and the freedom of eating when I want to are two of the biggest pump benefits for me.
I couldn’t find any actual data on how many pump users are in the U.S. but did come up with a few stats that would cause me to hypothesize about %10 of T1s and rising. I’ll ask my endo when I see her this week if she has a better idea. Strangely, I do know that it is Americans who are slow to switch to the pen and give up the syringe. My endo told me last year that while the majority of Europeans switched to the pen, most Americans on MDIs are still using syringes. I’m sure the U.S. pump phenomenon has something to do with the fact that most (all?) of the companies are based in the U.S. and our Dr.s offices are littered with glossy propaganda from pump manufactures.
Hi Julie
Yes, i am on lantus and what you say appears to make sense as to whats happening with regard to unexplained high and low sugars. Your response has both encouraged and convinced me that pump therapy is what i need. I am due to see healthcare nurse next week so will let her know what i have decided.
I have to think long term and accept that in the short term things maybe difficult in finding correct dosage and how my body is managing insulin thesedays.
My work is always pressured and highly demanding so having some bedding in time feels difficult but probably essential.
It was interesting to hear people in states still using syringe to inject where in England nearly all are on pen. We do lag behind though with pump treatment which i think is down to funding rather than efficiency which explains the low rate of people on them.
This whole issue and problems in management of diabetes has affected me in ways people and friends are now commenting. I am usually positive and not take life too seriously but feels like having dark cloud hanging over me lately.
So thanks again Julie, your help in hugely appreciated!
Chris
“Bedding in time” sounds like a great idea until you figure things out. I bet you’ll be feeling better inside of a couple of weeks. Good Luck Chris and keep us posted with how things are going
Chris, I think that Julie, Lee Ann, and Kristin have given you excellent feedback about pumping. I’m not sure what I can add, but I want to offer my support as well. I made the switch 8 years ago from MDI to a pump after 10 years of injections. It took me a full 2 years for my endocrinologist to talk me into it! I don’t think I even had a basic understanding of what it would be like - I remember when the rep told me to remove the introducer needle from my abdomen and I was stunned that the needle didn’t stay in. I had thought it would.
I was afraid of being dependent on a machine. Now, it’s as familiar and innocuous to me as my wrist watch. Yes, I’m dependent on clocks to tell me what time it is and need to wear one on my person, but it sure beats estimating what time it is and being late to every meeting! I don’t have to carry around the supplies I used to and have everything I need in the touch of a button. I don’t know now why I thought I was freer on injections. The last 8 years have been amazing.
As “smart” pumps have come onto the market today that do so much of the calculating for you, it just gets better and better. I’m on my fourth pump model now in 8 years. I’ve watched it go from a glorified IV drip with a clock and a backlight to a report-generating, average-calculating, customizable nurse educator in my pocket. My current pump is capable of so much! I have carb counts for my favorite foods stored in it, my glucose history at a glance…I can even name it. I recommend to you a book I’m reading now that Kristin often mentions - “Pumping Insulin” by John Walsh. It makes that 2-week period you fear very simple to navigate. Since starting on my latest pump, I can just go chapter by chapter fine-tuning my dosage needs. Yes, it takes effort to fine-tune, but you’re not starting from scratch. I hope you eventually give it a go. Like Lee Ann said, worst case scenario is that you try it and don’t like it. Most pump companies have a 30-45 day trial period. And if you don’t feel safe or stable, you can just yank it out and pull out your pen, right? Best of luck. We’re here for you. Let us know how your next doctor visit goes.
Hi all,
(Hope Chris doesn’t mind me adding to his thread as a non-pump user.) Wanted to add my support anyway that you shouldn’t feel in the least bit foolish for not doing it until you’re ready & feel at ease with the decision.
I’m conflicted about going on the pump–fear of the unknown, stories about bubbles in lines, pump failure, infections, bad scar tissue. I also have discomfort thinking of something attached all the time. My biggest concern, however, is how complicated it sounds. I admit to feeling totally intimidated by everything I read about dual waves, setting ranges, turn it on & off, ratios. I already count carbs, so that part doesn’t bother me. Like everyone, I want greater control to avoid & prevent the highs & lows. Have a friend on the pump, a recent pump user though he’s been diabetic for 33 years. He visited recently & he was constantly making adjustments & doing math. Have to say that all that turned me off to using one.
Thanks Gerri, you said out loud what is in my mind but has felt to difficult to put down in one discussion. I want to live a life that means i am not thinking of my diabetes constantly, maybe as a recent pump user your friend has to go through the inevitable intense few weeks finding correct dose but this is my biggest worry. I can handle i think the attachment and the frequent sugar counting and carb counting, but if my life is full of diabetes thoughts the quality of life seems not worth it. Some people are gadget people, i am not but i just want to live a healthy life with or without the pump. On shots its not working that great at moment so the big question is will the pump give me a better quality of life. The great feedback i recd yesterday indicates that it might but who knows maybe until i give it a go. Thanks again Gerri, Chris
Chris: I want to add a little bit more about the complexity issue. Before I was a pumper, I did not really do carb counting and, frankly, was “winging it” on how much of each kind of insulin I should take with each meal. I ignored “insulin on board”, and usually under-estimated portion size and carb values.
The message never got to me that, whether I was on a pump or on MDI, I needed to be better about counting carbs. While on MDI, and then on my first pump, I always found the carb counting to be difficult, taking into account different carb ratios at different times during the day.
I’m not going to be a salesman for any particular pump, and I only know about what I have, but the Minimed 522 has a built in bolus wizard that takes my programming of carb ratios, insulin sensitivity, duration of effect of insulin and desired BG range (done once with my educator and updated as necessary with the educator or endo) and then figures out what my bolus should be – all I need to do is enter the carb content and current BG.
I cannot imagine having done that when on MDI. I feel like I would need to have a calculator with me for every meal and need advanced calculus to make this all work.
If shots are not working for you, perhaps you need a change. You know better than anyone. Life is going to be full of diabetes thoughts. But, that is going to be the case whether on a pump or MDI if we are going to take our health seriously. Yes, depressing, frustrating, annoying at times. But there are lots of joys to be had. And, hopefully, long, high quality lives in which to enjoy them.
The decision is always going to be yours, whether to pump or not pump and whether to continue it or not continue it. If you try it and it does not work, stop and go back to MDI. If it does work, you benefit. Good luck!! You will make the right decision, no matter what you decide.
Hi Chris,
I’m already so used to my pump figuring all my calculations for me that I didn’t even consider it as one of the best features of having a pump to tell you about! Jonathan states it well…it’s sooo much easier when you have a pump to figure out how much insulin to take. So easy, in fact, that all you need to do is enter the number of carbs. Even better if your pump is integrated with your meter (Omnipod and Cozmo….dont think there are others?) then you don’t even have to enter your BG. You test you blood and your pump politely asks you if you plan on eating and if so, how many carbs? That’s it! You don’t have to mess with extended boluses and other functions at all if you don’t want to but once you become accustomed to a pump, it’s hard to resist the urge to see what would happen Honestly, trying to remember what it was like to figure out how many units of insulin my current meal would translate into given my carb ratios for that time of day when I was on MDIs is a bit like trying to imagine when you had to actually memorize phone numbers and then hunt for a pay phone. I’m perfectly happy to have my cell “know” the numbers for me, even though it’s a bit of a pain to have to enter all the numbers in when you get a new phone
Chris, you deal with basically FOUR settings that are programmed into your pump and many of them you deal with on injections, too, but have to do now in your head.
- your insulin-to-carb ratio - how much you take per amount of food you eat
- your active insulin time - how long the insulin stays in your system (usually 3-6 hours)
- your correction factor - how much insulin you take to correct a high BG
- your basal rates - which right now you cover with a long-acting insulin - they will start these levels at rates that correspond to your weight, age, and current insulin needs and this is what you’ll fine tune
You deal with these calculations now. In the pump, they are stored for you and you just plug in the numbers. And it stores a history of what you’ve taken, eaten, and what your blood sugars have been. There are pumps that are more gadgety than others, but some are very simple. There’s not a bad one out there. You’ll have to see if there’s one that fits you well and that you feel comfortable using.
Kristin: I’m interested in your statement that you correct every blood sugar. I usually do the same, but sometimes run into problems with over-correcting or having too much insulin on board. How long do you give a correction to take effect, and will you still correct even if you may have enough insulin on board to cover the high?
Does anyone else do this too?
Thanks.
What I meant above is that I correct even blood sugars that are not high. For example, I correct a blood sugar of 110 (which I would never “correct” on injections) to get it down between 80-100.
But you raised a good question about correcting when you have insulin on board. From the time that I give my “fast-acting” insulin, it takes about 25 minutes to start working. (A good way to test how long this is for you comes from Dr. Bernstein. When you have a blood sugar of over 100, take a common size meal bolus and test every 5 minutes to see when you first drop by more than 5 mg/dl). That means that if I correct and test within an hour, I won’t see a lot of the effect. My pump (Cozmo) calculates if I need additional insulin based on my current blood sugar and insulin on board. If I do, of course I give that.
If I have enough insulin on board, sometimes i just wait it out, knowing that my blood sugar will come down. What I usually do is correct and if possible give the bolus for the next meal or snack (even just 10g of carbs if it’s too early to eat the next meal) when I give the correction bolus, but I only eat the meal/snack 1-1.5 hours later. You need to be careful that you don’t just force yourself to keep eating more, but this can bring down the highs more quickly.
One way that I have prevented many highs is to give my insulin early. I wait 20-30 minutes after giving the bolus to eat (if my blood sugar was above 100, if not then I wait 10 minutes). I also sometimes wait 1.5 hours to eat some of the carbs. For example, I will bolus for a lunch of 30g of carbs by giving a bolus for 36g. I wait 20-30 minutes and then eat my lunch, then an hour later (1.5 hours after the bolus), I eat a 6g chocolate bar. I like working the chocolate into my routine and it makes me less likely to snack at other times. If you are snacking during the day and giving a bolus right when you snack, you are facing a full day of “postprandial” highs.
If you are trying to lose weight, this may not be the best plan, but I find that working my snacks into the routine leads to less spontaneous snacking. I would love to hear what other people do to correct high blood sugars when you have insulin on board.