Does the pump make sense for me?

Diabetes Technology Insulin Pumps
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Hi People!!

It has been about 5 months since my LADA/Type 1 diagnosis. Everything is going pretty well in terms of my diabetes management. Quick info about me: 5’ 6" female, 21 years old, 105 lbs, active. My latest A1C was 6.3.

Now that I have started basal insulin (3 units of lantus every morning) and am still taking 3, 4, or 5 units of humalog (depending on carb amount) with every meal, I have been interested in getting the pump. I know that my total daily dose of insulin is on the lower side, but being 21 and in college, my life is not super routine and injections are pretty inconvenient. I have no qualms about being attached to something and I feel this would give me a lot more freedom.

Given these quick things about me… do you think going on the pump makes sense for me? Can pumps accommodate only 3 units of basal? I have read in numerous places that pumps are actually ideal for people who require small, precise amounts of insulin so that made me pretty excited, but I’d love everyone’s thoughts!

Thanks,
Kelly

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I wood not do it. Blockages of your infusion set is a real possibility. Also the use of little insulin is not good for the insulin because after 1 week you have to replace your insulin caused by to many plastic of the reservoir.

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i think you need to ask your endo. these boluses you are now taking may be excessive and should perhaps be part of your basal. that’s my experience. anyway, everyone’s different.

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I started pumping when my TDD was only about 12u… it was IMMENSELY helpful since Lantus did not match my basal needs very well at the time… taking enough to have good fasting #'s, I would crash bad in the afternoon every day. Once I was pumping I actually had 0 basal rates set for early afternoon to avoid lows, and I could definitely see that I needed more insulin overnight.

You can fill the pump with however much insulin you anticipate using in 3 days… you don’t have to “fill it up” if you are worried about that insulin going bad. Humalog is now labeled for 7 days in a reservoir now, so if you are pumping Humalog it’s almost a non-issue. However, I can say that I always filled it up and just used it until it was empty and I never had problems doing so.

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Pumps are very good at delivering minuscule doses of insulin. I’ve heard reports, however, of people getting poor absorption from a site when delivering very low basal rates. I’ve also read about some people’s immune systems in a very low insulin flow situation creating activity at the cannula tip and causing blockage that way.

The best way to ascertain whether it is a problem is for you to try it out for a week or so. Is there any way, through your doctor’s office perhaps, to try out a pump for a while? Then you will know if it’ll work for you or not – no speculation needed.

I would never load more insulin than you expect to use in three days. Sites can go bad and lose absorption over time and overuse of an area can lead to scar tissue – definitely not a good thing.

Pumps are very convenient to use, especially in social situations. You can discreetly deliver your dose and move on. Pumps also have great memories. You’ll never wonder, “Did I take my insulin for dinner?” You can, with the push of a few buttons, just look it up.

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Many pumps can deliver basal rates as low as 0.025U/hour (0.6U/day). I have seen a study where a rate of 0.1U/hour (2.4U per day) was not found to result in any increases in risks of occlusion. So, a pump should be fine for your basal needs, but it would be a good idea to confirm this with your doctor and with pump manufacturers. [quote=“kaplageman, post:1, topic:52254”]
I have no qualms about being attached to something and I feel this would give me a lot more freedom.
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My schedule is often busy, hectic and unpredictable, and I do not have any issues with having something attached, so the pump works really well for me.

I am not sure what this means. An infusion set is replaced and a new pump reservoir is filled with new insulin every 3 days or so, regardless of how much insulin you use with a pump.

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You may be in a honeymoon period where you still make some insulin and therefore don’t need very much…yet. So maybe you could wait and see. Given your weight and activity you may probably won’t need as much insulin as someone heavier and inactive. I needed very little initially but now take about 25 units a day total. Also, it depends on how your glucose varies thru the day and how many carbs you eat. If you have a lot of lows, then the pump is nice because you can stop insulin for a given amount of time – for example, during vigorous exercise, I dial my pump down to 50% or so, sometimes less. If you have a lot of highs, or if you bolus often, the pump is very handy. If your sugars are at all questionable, I would consider a continuous glucose meter – for me, this is more critical than the pump. I use the Dexcom CGM with my Tandem pump and it checks my sugars 288 times a day which is the KEY for me in managing diabetes because I have the information to act upon (without poking my finger 288 times). However, this is a separate device you have to wear. You could look at the Tresiba forum as some pumpers have claimed to given up their pumps in favor of using it (but this is only like lantus but perhaps a bit longer acting – you still have to bolus short acting). PS - Miss Idaho wore a pump in her 2014 competition.

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I haven’t read all the responses, but I’ll share my experience. I went on the pump a year ago and love it. My daily basal is six units and I average between 9 and 14 units of bolus per day for a TDD between 15 and 20. I love being able to match my basal to my body’s needs, especially at night. During the day, the option of giving tiny corrections has been immensely helpful in keeping my BG on a more even keel. I have the Animas Ping. I went with that one because the meter is also a remote for the pump. Sometimes the pump is hidden in a place not easily accessible in public and the remote is great for that.

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I think now that you have an understanding of how insulin works and how to match insulin to carbs, it might be a good time to try a pump. But do your research. There are pumps that do dose very small amounts. When I got my t:slim, which I love, I wasn’t worried about how low the basal could go. But now I have 2 four hour basals set at .1 and really need to be lower but can’t because that is he lowest I can set. So now we have to play with rates before and play with carb ratios to see if we can help reduce the lows. And very surprising one of those low basals is overnight. Go figure.
But I will say the best thing for me is once hose basals are set, the joys of sleeping in and the joys not having to eat, it makes my life so much easier. If you have the coverage to go with any type, research and have fun. Some companies will let you try them out. Good luck and let us know how it goes and which one you decide on and why. We all learn new things about pumps and mine this time was maybe we need to be concerned about how low they can go.

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I resisted the pump for quite a while for two reasons–I wasn’t using “that much” total insulin and I feared my pets (small dogs and cats–all “lap hogs”) would dislodge any tubing. My solution was the OmniPod, a RFID-type device with no tubing! I am able to use even less insulin and can fine tune basal rates to decrease lows at night and early morning highs. My overall control and A1c is vastly improved! If your insurance likes it, it definitely is worth it!

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Some pumps may handle the smaller doses better than others. I, too, am LADA and was on a pump before going back to MDI. Alarms won’t be triggered if an occlusion occurs if one’s basal rate is very low, not until glucose levels have been very high for many hours. <3 my Dexcom G4. Others with diabetes have much larger basal rates, so an occlusion triggers the alarm within minutes. Also, being off by 0.1 unit per hour may not make much of a difference to them; that amount is crucial to keeping our blood sugar below 400.
I liked my pump for awhile, and pens have their own problems. Some even do syringes because one can fudge the amount by a bit. A chacun a son gout

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In terms of your amount of basal, I use an Animas Vibe and pump a total of 5 units of basal per day. (I also take 5 units of Lantus by injection which is called the Untethered Regimen.) Previously when I used an Animas Ping, the pump would occasionally “lose Prime” and quit delivering insulin when I had low hourly rates. I wonder if my Ping was defective because this has never happened with my Vibe.

Some pump advertise basal increments of .025 units but have a minimum of 0.1 units per hour. With Animas pumps I think that you can have a starting rate of .025 and I think Medtronic is the same. I think that both the Omnipod and the Tandem start at .1 per hour but have smaller increments. Thus you can have a .125 rate, but not a .025 rate. These are important things to understand if you decide to start using a pump.

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Welcome to the club no one wants to join! :slight_smile: I’m 6 feet 3 inches, 155 pounds, and use about 14u for my basal. So I haven’t got personal experience with really low basal rates. But I can share my experience as a somewhat low rate pumper.

What I really, really like the most is that I have my pump deliver a basal rate at night which completely counters my raging dawn phenomenon. When I was on Lantus I just accepted high waking numbers as ‘the way things are.’

Coming in a close second, I can bolus for a meal with 3.3U instead of 3U (and go higher than I wanted) or 4U and go lower than I wanted). I was seriously considering syringes instead of pens due to this.

I’m not sure I’d worry about occlusion due to low rates in advance of actually wearing a pump for a while. My steel infusion set doesn’t seem to have this problem: I dial down my basal a lot when on a long bike ride. If it did occlude at low rates, I’d be sorely tempted (I’m an inveterate tinkerer) to set a basal pattern of something like one hour at .000, one hour at .200 and so on. Or, since I have different goals, I’d program for my night time basal and leave it at .000 the rest of the day and use a smaller shot of Lantus to make up the rest of my basal. (Minimed 523)

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I’ve been pumping for about 12 years, and for me I would never go back to injections. The specificity of doses that I can have with a pump is incredible. I have different basal rates for different times of the day, and my carb ratio is also different depending on the time of day,. A pump also provides info on how much insulin - from a previous dose - is still active. I would recommend the book Thank Like a Pancreas by Gary Scheiner and Pumping Insulin by John Walsh. They both explain how exogenous (from the outside) insulin works and will help you decide whether or not to pump. I have only had one occlusion of tubing my over 12 years of pumping. As was mentioned earlier, you may still be in the honeymoon (well explained ih both books) and your insulin needs will change. But for now, it is so much easier to dose in micro amounts with a pump (in my opinion) than with a syringe.

Once you decide (if you decide) to pump, you will most likely need to show that you understand carb counting, keep good records - mainly for insurance coverage. Either your Endo practice, or the pump company will provide training and I made the transition quickly. As I said above - I love my pump and wouldn’t give it up without a fight.

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I think if you’re interested in trying a pump you should do so!
A lot of the companies offer some sort of trial period, and even if you keep it after that, you still don’t have to use it for life, which is something I feel like a lot of people forget.

There is a decently steep learning curve to using a pump well, so I wouldn’t attempt a pump start, say, during finals week, or right before going on a vacation; and I wouldn’t bother testing one if they didn’t give you at least 3 weeks with it as it takes some time to work out all of your rates and ratios (they’ll likely adjust at least a little from when you inject) so that you’re in a good place and actually get to have some fun and easy time with it to see what it can do.
As to small doses, I don’t need them, but all the kids I know use the Omnipod and they (and their parents) are pretty happy with it so it must do a good job with tiny increments.

I have gone back and forth between pumping and MDI several times over the last 2 (or is it 3 now?) years for various reasons, and what I’ve learned is that there’s no one-size fits-all answer, everyone’s experience is different, and even your own experience can be different depending on what pump, what season, what activities you are doing and what your current priorities are, and what you know to compare against. When I first moved from injections (of R & NPH fixed doses, no carb counting) to a pump in 2002, my life changed and it was the most amazing thing I had ever experienced. Eight years later I switched brands, learned that every pump behaves just a little bit differently and the new one solved some problems I didn’t know I was having, but did some things I hated that I had never thought to consider. Two years after that I ditched that pump and went to injections of Lantus and Humalog, and that too was the most amazing thing I had ever experienced! I use(d) an app that calculates doses like a pump, and my control was the same back on injections as it had been with a pump, so I got all of the control benefits with none of the baggage (both literal and figurative). For a few months I tried the untethered approach (Lantus + pump) and that was pretty awesome too for various reasons. Then a few weeks ago along comes a company offering a free trial, and today I’m pumping only, but I’m not really thrilled with the results/equipment so I’m not sure I’ll keep this one, and I’m fine with that because I feel like I have a good handle on what some other options are and how they compare.

Long story short, the only thing you have to lose by trying a pump is not knowing which works better for you at this place in your life!
(Okay, and probably several hours that will be taken up with appointments with endos, pump trainers, CDEs, etc, but even if you don’t keep the pump you can probably learn some good things from them.)

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I used a pump for 16 years and decided recently to take a break from pumping and try Tresiba. I liked the pump and I was able to get fairly good control with it.

The control you are getting with shots though is excellent and I would consider the down sides as well as the upsides of pumping