Considering pumping, will it really help me get control?

Diabetes Technology Insulin Pumps
1

I have had diabetes for 25 years and have only ever once had my A1c around 7. I have been running with 9+ for the past 5 years and am getting scared as new complications are starting to creep up. I have a thorough understanding of insulin to carb ratios and carb counting, I just lack control when it comes to sticking to a meal plan or taking extra insulin if i snack.

Based on your experiences with pumping is it the answer I’m hoping it will be? I have major reservations about having something attached to me all the time. And am extremely phobic about dropping low and passing out which is why I probably am not as aggressive with my insulin as I should be.

But I’ve come to the point where I don’t want to have a shorter lifespan because I’m too stubborn to do something about it now. Any feedback would be greatly appreciated.

2

To be honest, no. An insulin pump will not give you the control. If the reasons you have high blood sugars are that you "lack control when it comes to sticking to a meal plan or taking extra insulin if I snack" a pump will change absolutely nothing.

You need to confront the issues that are interfering with your control, and it sounds like you are beginning to feel the urgency to do so which is great! Start somewhere and work on coming up with a meal plan you can live with - not a super strict one that you will give up on in a few days - but something you can live with. If you decide to modify it later, that's cool. Also take insulin for any carbs you eat. You don't erase the effect of the carbs you eat by not bolusing for them; you just put yourself at risk for longterm and shortterm problems. If your fear of dropping low is truly phobic and you are underbolusing insulin because of it then make an appointment with a therapist or start a support group where you can work that through. Finally you say "I have a thorough understanding of insulin to carb ratios and carb counting" but it doesn't do you any good if you don't use them. Make sure your basal is covering you correctly between meals/waking and bedtime. Then once you get to the eating plan you are comfortable with check your I:C ratios by writing down everything so you make sure they are correct. If you've been underbolusing for awhile you probably need to tweak your numbers.

Finally if you do this for awhile and start to feel confident that you have things in better control then you might consider a pump.

3

I had a much easier time taking insulin with snacks and meals with the pump than MDI. Having the insulin right next to my already hooked up, no poke required made it a lot harder to say, “you know I’ll just eat this with that shot”.

As for being connected to something… I got used to it fairly quickly. Once I realized that very few people notice it or care… And I remembered where it was/ that I had it on, it became second nature.

I even move it around in my sleep sometimes to make myself more comfy without ever waking up!

4

If I recall, studies show that moving to a pump for T1s with an average A1c of 8% resulted in an average A1c improvement of 0.5%. A pump is not a magic bullet. It is a tool. And the end result is primarily a function of how you use that tool.

I do think if you address other factors, your concern over lows, setting a proper basal rate, your diet and diligence about accurate boluses, you could make dramatic improvements. And then a pump can be a big win.

ps. The book "Pumping Insulin" by Walsh is really helpful. If you are serious about the time, money and effort in a change to a pump, it is well worth buying.

5

I found that a huge benefit was the data recording. I was (and still am...) extremely averse to logging. I also wasn't bothering to count carbs pre-pump and was just guessing but did ok at it. The pump keeping track of everything and kind of making me think the way shots didn't. Not that you can't think without a pump but it definitely made the process more organized...so that things made sense and fell into place. It almost worked like a "coach" for me?

I was also averse to being plugged in but that's been pretty much a non-issue for me. It also made it much easier to manage lows with the additional tool of knowing more precisely how much insulin is "on board" when I'm drifting down.

6

My 14 year old was diagnosed in February 21st of this year; the MDI's were a drag...staying up late for Lantus a drag, having to choose between another shot and a snack or going without a drag.....by May 1st, he was on a pump, running on saline for one week. The transition was not without it's bumps in the road....there are night time BG checks that have to be done during the beginning, and settings which need to be adjusted based on your carb ratio, bolus and basal rates. Now, no longer feeling sleep deprived, it has been wonderful. He has tightest control of his BG's, the ability to combo bolus for high carb/high fat foods like pizza, and if he wants a snack there are no additional needles added to his day. I think he is less self-conscious eating out at restaurants...no insulin pens to pull out, and delivery of the insulin can be done right from his meter without anyone seeing. It is the next best thing to a new pancreas....Good luck with your decision.

7

I think it depends on what your reasons are now for not having control. For me, the pump gave me better control because I am now able to correct highs that on MDI were going uncorrected. But I was not correcting on MDI because I am so insulin sensitive that a unit or even a half a unit would frequently drop me too much. So, if I was say 180 or 190, I would not correct because I would end up too low. In addition, I am very physically active and I was having a hard time managing my basal insulin in light of all my physical activity. My BGs were bouncing around all over the place.

For me, the pump has served as a tool for correcting these two problems. With the pump, I can dose in increments as small as 0.025, which means I can correct highs that were going uncorrected before. In addition, I can adjust my basal rates for exercise, which means I'm not "running high" for periods of time simply because I know I want to go for a run later in the day.

I've now had three consecutive A1cs in the low 7s, which for me is absolutely fantastic. The pump has definitely made my control better.

If your issue with snacks is that you don't want to take insulin because you can properly dose it for the snack you want, a pump will help with that. With a pump, you don't have to stick to as rigid of a meal plan because the small dosing increments allow you to dose for small snacks/meals. I know that if I eat anything over about 8g carbs, I need to bolus.

In addition, the pump helps me keep track of my data, which for me has helped improve my management. Because I don't have to manually log stuff (the pump and its meter capture everything), I am MUCH more efficient at uploading my data, reviewing it, and making adjustments.

The pump is a lot of work. It's not a cure and I don't think it necessarily makes diabetes any easier. There are infusion sets to change and you have to constantly be vigilant about failed sites and DKA. BUT, it is a tool that, when used properly, will give you better control.

If you think that the smaller dosing increments and adjustable basal rates will be of help, I would encourage you to give the pump a try. It's not permanent and if you don't like it, you can always go back to shots.

I would encourage you to read Pumping Insulin (by Walsh and Roberts, available on Amazon). They just came out with a new 2012 edition and it's a fantastic book. Highly recommend it. This will give you a good idea of the fundamentals of insulin pumping and may help you decide if the pump is right for you.

Also check with your endo to see if your local hospital or diabetes clinic has an insulin pump seminar. At these seminars, reps are usually there from each pump company. You can operate the pumps and get a general feel for whether it's something you're interested in.

Finally, if you do start on a pump, be prepared for a somewhat rocky few months. It takes awhile to get the basal rates worked out. Some folks get this down within a few weeks, other take months. For me, by month 2, I pretty much had it all figured out and was seeing significant improvements. One thing I have noticed on the pump is that my lows and highs are not as severe. My lows in particular are easier to catch.

Oh, you also have to be really diligent about testing BGs. On a pump, you have no basal insulin in your system, so if the pump fails, you can get in trouble fast. I test anywhere from 8-14 times per day.

8

(This is my first ever post so hi everyone!)

I am/was in a similar situation...T1 for 16 years and A1Cs around the same. I started with an OmniPod in December and absolutely love it.

For me, what has made it easier to stay on top of it is not having to excuse myself when I'm with friends and have a snack or a drink to take insulin. Just pull the PDM out and dial up your bolus and it's done. Most of the time people just think I'm sending a text. It's made it much more convenient , and I'm all about easy!

Like others have said, it's not a magic tool that will automatically drop your A1C. Mine is still working it's way down. It WILL make you more aware and more apt to want to take control over what your body is doing, once you can see and understand what is happeneing with the pump.

Good luck with your decision. It was easily the best choice I've made in tems of taking care of myself and I wondered why I waited to long!

9

I think the social convenience is a good point. When I was on MDI and would go out to lunch with coworkers, I have to admit (gulp) that I sometimes skipped taking my shot and instead "dosed" once I was back at my office. I did this on a number of occasions because I just didn't want to take the time to go to the bathroom and do what needed to be done. I am sort of embarrassed to admit that I even did this, but I always justified it because I felt I needed to not miss something.

Anyway, on the pump, it is so much easier to bolus when eating out with people. No one even notices what I'm doing! They just assume I'm playing with my cell phone (which apparently is more socially acceptable when eating out than giving yourself a shot of life-saving insulin). Go figure.

10

I don't have a phobia about lows but I do despise them. Pumping won't really address your phobia but being able to customize your basal and not use MDI for basals might eliminate some lows.

11

i am D for about 25 yrs. i was very resistant about going on the pump, but my family pushed and pushed. i didnt want to have anything hooked up to my body, either. and i was so good w/ my syringes(a true master). finally, after not being able to get the tight control i wanted, and after suffering w/ some of the complications w/ D, i decided to go for it. in the beginning, it was too much info to digest. i was anxious, nervous, frightened. but the support staff at Metronic were with me every step of the way. one rep came over to my home and spent an entire day with me, teaching me all the basics. he was wonderfully patient and as scared as i was, i was very comforted by his generosity.

it took me about a year B4 i was a qualafied pumper. Now i have been on the pump for 11 yrs. i cant imagine my life w/out it. my control is amazing. there are so many possible settings that can be programed into this micro computer. its like having a working pancreas clipped onto your belt. my A1Cs came down from 9+ to 7s. i feel better physically. no aches or cramping. no exhaustion. better sleep.better control. and an over-all sense of well being. you would be surprized how quickly you will get used to it. now its as second nature as when i first learned how to inject. i used to have to give myself upwards of 10 shots a day (I am VERY brittle) and was on 3 different types of insulin (been D for 25+ yrs) now, i fill up my pumps resevoir, stick in the infusion set, and thats it until 2 days later when i need to refill and change sites.one injection versus 10. easy choice!!!!!LOL.there are so many other options you have with the pump. it is life altering. any questions, dont hesitate to ask. i'm a big pump fan.

12

I am also on MDI and pretty happy. If it isn't broke...right?

There is a TuDiabetes chat this Friday that I'm really interested in.

The chat is 1-2pm PDT (not sure of your timezone). And if you've never participated in a TuDiabetes chat, they are pretty cool and you'll have the chance to ask these authors some questions.

I'll be there!

13

I think for the OP, there are definitely things that can be fixed without needing to go over to a pump to fix them.

I was on MDI for 25 years and was in that "if it ain't broke" camp too. The problem was, there were things on MDI that were broke, mostly having to do with basal delivery, that going over to a pump did, in fact fix. i never would have known how broke it was without actually making the switch.

14

For me, I did ok for a long time but, in retrospect, I struggled a lot. The pump put it all in one place, insulin, clock, food/ carbs and then logged it intelligibly. I was in a pretty decent place at the time, I had started to work out a lot and lost some weight and felt good. I never gave MDI w/ 'log/ Lantus a try and went from R/NPH to pumping, in 2008. I was able to get a handle on diabetes pretty quickly. It was also about the same time that I discovered message boards (the ADA one...) and hung out online picking stuff up through osmosis and my own trial and error but it fell into place very quickly.

I don't think that it will be a huge benefit if you want to hide behind fear of lows as a reason for eating without bolusing. Lows are a good thing to be wary of but they are also part of what we can run into and it's important to approach them with confidence. And jelly beans...


(I know they organic crowd loathe HFC in jelly beans, there's other options out there...)

15

I agree with alot of what others are saying here. I also know that MDI is not for everyone, my daughter and i were both doing MDI and getting no where. we were so fed up and frustrated that we both started on a pump, the results after months of adjustments were amazing. my daughter was 14 yrs old and i was diagnosed at 15 yrs old, but a pump was not in my budget and insurance was a joke at that time. we both had insurance to cover the pumps we chose, no we did not get the same one. I had to work with 2 sets of adjustments and learn 2 separate pumps while dealing with the problems when they would arise and get the trouble shooting instructions. I find for us the pumps were a god send, we both had the determination to be in control just not the right amounts at the right times and the pumps did that for us. we hated shots so the pump was easy to use for meals and snacks. getting a teenager to manage an over whelming amount of information and still willing to cover snacks is not an easy task. good luck in your choice, but the reasons for using a pump need to be for improving your control and determination to stick with it.

16

I had T1 for 22 years before I got on the pump and I am now at 26 years. And I have finally got it under control or at least have the tools to do so.On the pump my A1C has been usually been under 7.5. It is so hard after 20+ years to always remember or want to stick yourself with every morsel that goes through your mouth. With the pump you have the flexibility to eat or not. To have a taste and stop or decide you want the full meal. I regularly fast with my church on the pump.

You should be directed to a pump class in the beginning to understand the equipment and adjust your basal rate.

I am a huge fan. I am 37, a busy mom and business owner, and I my quality of life is so much better