Considering a pump - pump vacations, where to put the pump, what takes getting used to? (looking at t-slim)

I’m currently using the InPen and am considering a T-slim pump. I’m a 42-year-old woman, T1D since 18. I’ve been very reluctant to do the pump since I wasn’t crazy about being tethered to something. I’ve had the Dexcom G6 for a while and I’m more used to “wearing” something.

I have a few questions that I’m hoping folks who switched to a pump late in life can help with.

Did it take a while to get used to wearing something like a pump? For women, where did you put the pump in terms of clothing?

How often do you do pump vacations, and how does that work? I tend to go to the beach often and I don’t love the idea of having a visible pump at the beach, even if I can disconnect it to swim.

What about doing activities like a water park, white water rafting, etc.?

Does insurance usually pay for supplies to use on a pump break? Is it a bottle of insulin vs. a pen? (I have Cigna; I’m sure it varies by insurance company.)

It says t-slim is okay in water for up to 30 minutes - is that true?

Where does the pump go when you sleep?

What about what to do with it during sex?

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I’m afraid I don’t have answers to all your specific questions. (I am a man and have never done white-water rafting).

Overall, though, I would say that I was very worried about being tethered to a pump and that I got used to it more quickly than I expected and that many of my fears were exaggerated. I would encourage you to give it a try. If it’s not right for you, you can always go back to MDI.

In terms of everything water related (waterparks, swimming, kayaking), my strategy is to detach the pump and keep it somewhere dry where I can return to it periodically to give myself any needed boluses – a waterproof bag, a locker, my backpack on the beach, in a plastic bag next to the pool. I think the 30-minutes waterproof is mostly for splashes or an accidental fall into water, not for having a pump on while you are swimming, though maybe there are people who do that. Overall, I am more bothered by not having access to my CGM while swimming than I am by detaching from my pump. It’s very easy to detach and reattach and you can use little boluses to make up for lost basal if necessary.
In terms of waterparks specifically, it’s a big bother finding a safe place for stuff. But, that would be true of all your diabetes supplies (especially CGM) anyway, so the pump is just one more thing.
For sex, I detach it. You might think that having the infusion site on your abdomen and potentially rubbing against someone would be uncomfortable for them, but my wife says it isn’t.
I have syringes and different kinds of insulin which my insurance pays for in addition to paying for the pump supplies. I don’t use pens, but my guess is they would pay for them, too.
When I sleep, I always wear pajamas with pockets and stick my pump in a pocket. Sometimes, it falls out and I can get a little tangled in it, but that’s never caused a big problem (like pulling out the infusion site or something.) You can create a pocket by sewing a sock onto pajamas (or a nightgown) without pockets, but I don’t bother.

T2 here, but have been on a pump for 18 years. Some of your questions I can’t answer, but here’s what I can answer:

  1. Sleeping…I sleep in nightgowns and wear the pump hooked to the front of the neck. I toss and turn a lot, and sometimes end up on my stomach, but the pump stays between my boobs which is like having it in a naturally padded little area. Never bothers me.

  2. Clothing: I don’t wear dresses, and most of my slacks have pockets, so that’s where I keep it. If the slacks don’t have pockets, I just clip it to the waistband near where a pocket would be, and that keeps it out of my way. I know some women who clip it to their bra, in the front between the cups, which would work if you’re not to small. There are also leg holders and waist holders you can buy for wearing under dresses.

  3. Beach: I, too, don’t want to wear a pump at the beach, but I detach and take it with me. I always have my BGM with me and I check frequently so, if I start to go high, I can just attach and give myself a bolus. As Tnyc said, you can give yourself little boluses to make up for missing basal. Also, it’s important to wear something over the site when you’re swimming…I use Quicksets, and each one comes with a cap to use when detaching. I save 'em up and only use them in the summer at the beach. I agree with Tnyc here…I don’t think any pump is truly waterproof and, given the expense of replacing a pump, I wouldn’t risk it.

As for pump vacations…I’ve never taken one in 18 years. Once I got my basals and bolus ratios correct, I never wanted to go back to shots.

P.S. You don’t wear them in the shower, but unless you’re in there for more than 10 minutes, you can just detach, re-attach after the shower, and not worry about missed basal.

Thanks! These tips are so helpful. I mostly wear pants, so I’m not worried about dresses, but the idea of altering or sewing things into my clothing like I’ve seen many people mention just doesn’t appeal to me.

For beach days, I would typically wear a one-piece so it would be a pain to reconnect without going to a bathroom - do many people just take small shots throughout the day? It’s been almost 23 years since I’ve used a syringe since I’m so used to the pen, so the idea of switching back to that just doesn’t really appeal.

For women, is it difficult to wear one-piece suits? Or do you end up having to wear a two-piece?

How often does the pump give you basal? i.e. if you took a bath for an hour or went into a hot tub for a while, is that a big deal?

What about doing a spa day?

A lot of questions I know… but so much of this is super foreign to me.

It’s giving you basal constantly. Not getting any basal insulin for an hour will, all things being equal, cause your blood sugar to go up unless you bolus to compensate.
That said, it can be fine to not have a basal dose for an hour. The T-Slim (with Basal-IQ) will suspend your basal on its own if you are going too low for up to two hours, I believe. You may also want to suspend or at least significantly reduce your basal for exercise. So, if you’re swimming, not getting basal could work out fine. Sitting in a bath, you might want to make up for it by bolusing a little before and a little after possibly.

All the reasons you mentioned are why I chose OmniPod. You can leave it on in the shower, beach, wherever.

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My son is 8 and on the Tslim so obviously not all your questions apply, however:

  • For water park activities he has sometimes worn the pump in a waterproof pouch, but usually disconnects and reattaches periodically to bolus for missed basal. I’ve seen a magazine ad for a pump (I believe it was the Medtronic 670G) featuring an elite female whitewater kayaker. The T-slim isn’t rated as waterproof as the medtronic, so my son will be using his in the waterproof pouch for kayaking and rafting (he was diagnosed at the end of last Australian summer so he hasn’t been rafting since then - his mother and I were on an 8-day Franklin river trip only weeks before he was diagnosed).
    -the other beach issue if you disconnect is ensuring the pump doesn’t get too hot and cook your insulin (obviously the same applies if you had an insulin pen in your bag).
  • When swimming he’s usually active enough that he doesn’t go high despite the lack of basal, so it’s easiest to just disconnect. He did once spend nearly an hour playing in the ocean wearing his pump before we realised it wasn’t in the waterproof pouch - after carefully rinsing it off and making sure all the sand came out of the USB port it has been fine (now 2 months later)
  • Don’t assume that the infusion site needs to be on the abdomen. He usually wears his on his upper buttocks just below the underwear line, and has no problem attaching/detaching by feel. As far as attaching/detaching whilst in a one-piece swimsuit, it shouldn’t be a problem finding a suitable site that stays hidden, but where you can slip a hand in to attach/detach the tubing. Many people also use sites on their arms or thighs, although these are of course obvious when you’re i a swimsuit.
    -for showering some people continue to wear it in a belt or put it on a shelf, but it’s also when many choose to recharge the battery. For an hour-long bath I would probably give half the hour’s basal in advance and disconnect, then follow up with the missed basal on coming out. Or you could just leave the pump attached, but sitting on the shelf beside the bath next to your wine glass :wink:
  • at only 8 years old my son has a while to go before the sex question comes up, however I can attest that loud pump alarms going off kill the vibe somewhat! One of the loudest alarms is the “All deliveries stopped”, which is the best state to leave the pump in while detached so you don’t forget to put it back on. So you won’t just need to think about what to do with the pump and infusion site, but also managing the risk of forgetting to reattach it afterwards if you have taken it off.

Out of curiosity, what waterproof pouch do you use? I haven’t found anything I like. (And, I’m assuming, since you are Australian, you are a pouch expert :slight_smile:)

Did it take a while to get used to wearing something like a pump? For women, where did you put the pump in terms of clothing?

It took me 1 day to get used to having a pump.

How often do you do pump vacations, and how does that work? I tend to go to the beach often and I don’t love the idea of having a visible pump at the beach, even if I can disconnect it to swim.

I took ONE pump vacation for 1 year, since 1996. Big mistake. The vacation gave me worse control, so I went back to my pump and will never do that again. Can’t help you with how you feel about pump visibility.

What about doing activities like a water park, white water rafting, etc.?
I’ve removed my pump for a few hours and keep a pen handy “just in case”.

Does insurance usually pay for supplies to use on a pump break? Is it a bottle of insulin vs. a pen? (I have Cigna; I’m sure it varies by insurance company.)
My endo gave me pens and insulin so I dunno.

It says t-slim is okay in water for up to 30 minutes - is that true?

Where does the pump go when you sleep?
Clipped to my underwear. not a problem.

What about what to do with it during sex?

I learned not to remove it, as if I fell asleep, I’d be without my basal. BAAAD idea!

I haven’t seen many options, the one that my son has (marketed as an insulin pump case on many diabetes sites) is this one:
https://aquapac.net/shop/waterproof-radio-mic/radio-mic-case-158a/

Unfortunately it requires removal of the Tslim case for the pump to fit in easily. He uses the aquapac case inside a SPI-belt instead of using the belt it comes with - just provides a bit of extra protection against snags or cuts and is more comfortable against the skin (wearing it on the outside of clothes would be a surefire way of snagging the tubing and ripping out an infusion site at the water park!).

After an hour or more use in on the water slides and swimming in the pool (would have dived down to 1.5m on multiple occasions) at a resort it had a tiny amount of condensation in it which shouldn’t harm the pump but nixed operation of the touch screen. I got plenty of water forced right up my sinuses on the same water slides so I think the performance of the case is satisfactory. The rating of this case is only IPX6 (the pump itself is rated IPX7) so we’re only really using it as a bit of extra safety buffer - better safe than sorry!