I have worn my pump while in a hot tub frequently when I was beginning as a pumper. Nowadays, I just disconnect and depending on the trending from my CGM, I will sometimes bolus for the missed basal insulin after I’m out. The CGM and the trending line is really helpful here.
For hot springs, where the side of the “pool” isn’t convenient to rest my pump and stay connected, I have always just disconnected. Note that my pump, which isn’t available in the US any longer, is effectively waterproof. I don’t believe all pumps are.
Omnipods are waterproof and Mac-compatible with Diasend as beacher said, but be careful about hot tubs. I would wear mine in the hot tub when I was on the Omnipod and the heat from the water usually cooked the insulin, forcing me to change the pod soon after. Tubed pumps can be disconnected and are much better for hot tubs. I don’t find disconnecting for 20-30 min to be a problem, and you can always take a small bolus to cover the missed basal while disconnected.
Also, I’ve used both the Omnipod (for almost 4 years with the old and new pods) and the Medtronic (for 7 years and again since January) and prefer the Medtronic by far. It is more reliable in my experience, and the greater reliability is worth having to be tubed to me which isn’t a big deal honestly. If you’re concerned about sites working tubed pumps will be better for you too since you can try different infusion sets. With the pod you are stuck with the one type which I never found worked well in a lot of places on me. That said some people have wonderful experiences on the pod and you might too.
This is all very useful feedback to consider! Medtronics offers a 6 week
trial with their pump, which might be a good way for me to begin. I’m much
more prepared to consider trying it out, and talking with my doc about it,
with the help from y’all in this forum:)
I’ll be the one to raise a caveat from my own experience changing from MDI (Lantus/Novolog) to a pump: make sure to set your expectations realistically. It isn’t an instantaneous switcheroo from success with one to equal results with the other. Even if you know all about carb counting, I:C ratios and all that, taking a single (or double) shot of basal insulin that lasts all day differs in significant ways from having a pump delivering micro-doses of short-acting insulin every five minutes around the clock. I think it’s true in general that pump trainers tend to be very cautious about getting you dialed in because the stuff is being delivered constantly and can get out of control if you’re too ambitious. Also it’s a much more complex system, and with complexity comes more failure points. Some people seem to take to it relatively easy; in my case there were many times I wanted to throw the damn thing at a wall, and I consider myself reasonably tech savvy. It was at least a couple of months before I felt like I had everything adjusted to where I was doing as well as on MDI. I wouldn’t go back, but the transition wasn’t nearly the rosy scenario I’d been led to expect. I think I’d have been less frustrated if I’d had a better feel up front for the many ways it was going to be a PITA to get there. YDMV of course.
Yes. I still have my own uncertainty that the pump will be right for me, and when I spoke to my doctor’s nurse yesterday, her response was essentially “WTF do you want to do that for”. Would you please tell me why you chose to change from MDI to a pump, and what factors made it worthwhile? It sounds like you (and most everyone), is more satisfied pumping. Is it the convenience that overrides the simplicity?
One more question: Does the user have complete control over basal settings on the pump, or are they preset by a doctor/trainer and unable to be changed?
I’m assuming this nurse does not have diabetes. Her comment is ignorant of the 24/7/365 grind that is diabetes.
Factors that make the pump a better choice than MDI
Lifestyle - It’s convenient for your insulin delivery system to be within 30 seconds of discrete insulin dosing whether you are in a concert hall, subway car, airplane, walking with friends, in a classroom, or just about any other setting in the real world.
Better memory - On MDI you’ll take at least one basal injection and if you eat three meals and two snacks per day, that’s five more injections. Add to that two corrections per day and you’re up to 1 + 5 + 2 = 8 injections each day. That’s 240 injections per month and 2,920 per year. If you have a great memory and discipline and only forget to dose one half of one percent of the time, that’s about 15 times per year. That’s 15 times per year when you’re wondering whether you should take a dose to replace the maybe forgotten one at the risk of double dosing.
Advanced pump functions - I know everyone does not use all the functions a pump can deliver and it took me many years to adopt these functions. But I wouldn’t want to live without them. They include super-bolusing, temporary basals, and square and dual wave boluses. These advanced tools can mean the difference between OK and great control.
You won’t leave home without it. - We’ve all experienced leaving the house in the morning without some key belonging. It might be the cell-phone, wallet, or glasses. If you’re on MDI, how many times in the last year have you left home without your diabetes kit? With a pump this is as likely to happen as leaving the house without your pants!
I could go on, but you get the idea. I can’t get over your nurse’s attitude. She works at her job about 2,000 hours per year allowing for a two-week vacation. You live with diabetes 8,760 hours per year and you don’t get even a two-hour vacation from diabetes much less two weeks!
My endo is type 1 himself, at the top of his field and wears a pump. If there was no advantage, I don’t think he’d wear one himself. Many in the medical field I’ve encountered who don’t actually have diabetes don’t understand. They read literature, tell you to dose accordingly, and are happy as long as your numbers are within ADA/CDA guidelines and you don’t have too many low blood sugars. My first endo didn’t see why the pump was necessary until he saw my results with one and quickly changed his tune.
@Terry4 gives a great answer to the other question so I’ll weigh in on this much simpler one: these settings are entirely under your control, though to begin with it’s pretty standard to have a CDE or Endo guide you through it pretty closely as you’re getting acclimated and figuring out what your body is doing.
As far as
“WTF do you want to do that for”
goes, this SO sounds like the response I got for years and YEARS from my non-specialist PCPs when I just wanted to move from the old R/NPH regimen to MDI. THEY didn’t want to change because THEY didn’t want to have to guide you through it because THEY didn’t have the expertise and the whole business of having people under their care who are taking a potentially dangerous drug multiple times a day without medical supervision goes against every medical instinct they have. This is understandable, but it’s not THEIR quality of life that is at issue. As you can tell, I still have some resentment about it…
It’s crazy that they were so against MDI considering the old insulin regimens led to extremely dangerous low blood sugars if you didn’t eat on time and often at night.
To @Terry4’s excellent list I would add one safety factor that might cut more ice than the lifestyle points: one thing you can’t do with Lantus (or the equivalent): you can’t suspend or reduce it to account for going low due to exercise or whatever. With a pump (and ideally a CGM) you can act in advance if you’re suddenly challenged by an unanticipated exertion or missed meal (stuck on the bus, running for the train, etc etc). Or if you wake in the night with a low you have to treat. Whatever you injected, that’s what you’re stuck with. With a pump you can hit “Suspend” or (smarter) set a temp basal for an hour or two and dial it down to 0 or 50% or whatever is appropriate. I do this all the time and it’s a safety measure, not just a convenience, that you don’t have with the injectable basals.
Their line wasn’t so much “WTF” as “You’re doing fine, let’s not change anything.” A lot of this period I was in university-based health care: undergrad, then grad, then through my wife who was university-employed. So referrals to specialists were essentially not available, and for non-specialists such a change meant them learning a different treatment regimen so they could supervise me in it, with potentially scary consequences. A devil-you-know situation really. R/N was standard treatment for a long time, so insofar as generalists had any training in T1 that was what you learned. You can still run into it if you are hospitalized for an unrelated illness or surgery. You’re not allowed to administer any medications yourself and R/N is what they know so that’s what they do. I hit this about 6 yrs back when I was still on MDI and had major abdominal surgery and I gather it still prevails. I dug in my heels but it was a big struggle. I think you get out of it if you have a pump–then it’s a prosthetic device and different rules apply. Another point in favor of using a pump!
Yep you’re right - when I had my appendix out they told me since I’m on a pump they won’t touch it except during the surgery, and I’ll be in charge of my diabetes during the rest of my stay. Made sense to me and would’ve been a big argument if they had told me anything different!
My Endo is a Type 1, but, no, not the nurse:) If one has to be stuck with a disease, at least we have lots of control over our own treatment and outcomes with Diabetes. I know that hospitals generally do not allow patient control of meds in any way. I saw the disastrous results when my elderly father, a type 2 was hospitalized. The fact that they don’t mess with insulin pumps is just about sufficient reason enough to use one. However, the benefits that you have all outlined look like they outweigh the learning curve and extra accoutrements. I’m still a little scared of being attached to all the extra stuff, but definitely leaning toward doing a trial. Thanks for all of the fabulous input. This forum is amazing!
I know this is getting off topic, but what is the thinking behind suspending or a low temp basal with a low? My trainer told me that a temp basal (or any basal change) won’t really take effect for two to four hours, which is why it’s not useful for unplanned activity. Two to four hours after a low – even half an hour after a low – we don’t need reduced insulin. If you’re inclined to overtreat a low, you may even want more insulin.
I guess it depends. If I’ve had a real plunge to the point of needing to treat it, then you’re right, not much point. But I sometimes gradually drift low overnight, and if my CGM shows me I’m getting into the 70s but no down arrow I may back my basal off as a hedge against drifting lower over the next couple of hours and having to get up to eat something. Seems to work for me. At the other end of the scale I’ve found that I almost always run high on Sundays, and I finally figured out it’s because I sing in a choir, often soloing, and the adrenaline that goes with public performance pushes my BG up. I think my pump would actually let me set a separate basal program that would just kick in on Sundays but I’m too lazy to figure it out, plus I don’t necessarily want it to do that automatically. So I when I’m getting ready to leave I bump my rate up 30-50% for a couple of hours and that helps keep it reined in.
