My "P" day

I fought with insurance for about 4 months, then waited two months to see my endo, and finally my first day on the pump is Thursday.

After all that, I’m getting cold feet. I wonder if I rushed into moving to the pump too fast and if I didn’t give the shots a good enough try. I’m still learning so much about having this disease and taking care of myself. I don’t know if I need to learn a whole bunch more about living with a pump.

Any advice for someone with jitters? Is there any reason you think someone shouldn’t start on a pump?

It was like night and day for me. I was resistant to the pump for a long time but it made my life a lot easier! The delivery was so much smoother than shots (I was taking R/N before I got the pump…) that I was like ‘argh, why didn’t I do this 15 years ago!’ pretty much immediately!

Just think of it as a big syringe.

I was on shots for 36 years and was the biggest chicken in the world. I have been pumping insulin 8 years now. Just remember it is not a cure, every day is different, and it is not an exact science.

None I can think of. I resisted forever going on a pump. Worst mistake of my diabetic life I think! I started pumping January of 2008, I love it. Yep, there will be those days that you may think about chunking it in the garbage disposal, but then again, there are those days no matter what method of diabetic treatment you use. The first 2 to 3 months will probably the most difficult, trying to get all of it set. I used the book “Pumping Insulin” and it helped a lot, plus my diabetic educator is great. And lots of help on the diabetic forums. So no, I don’t think anyone who is diabetic makes a mistake by going on a pump. Good luck! Take it about 3 days at a time - chart, chart, chart everything you eat, do, times, etc. Believe me, it helps at the beginning. Make the changes slowly, and try to make one change at a time. That is what helped me figure it all out.

Like anything it takes getting use to it but after awhile you will say I wish I started sooner

Please remember that you are not stuck being on a pump once you are on one. You can always go back to shots if you decide you do not like being on a pump.

My pump made my life much easier. My pump gave me more time with my children. It gave me more flexibility in my life. It was the best thing that I ever did for myself.

You will look back and say I can’t believe that I even worried about a little thing like a pump.

Hi Kelly: A huge, huge congratulations to you! Ah, cold feet. I can tell you, now at 12+ years on a pump, I would never go back. Life is so much easier on the pump. I found control better, fewer hypos, easier to accomodate exercise or changes in schedule, easier to deal with dawn phenomenon and PMS. It is tough to get over the mental block of “I don’t want a machine strapped to my body 24/7.” But I found that that mental block was meaningless even one week into wearing the pump. I do suggest that you use “Pumping Insulin” and really do the charting–a good basal setting is everything. You do need to test a lot. But you have all the skills to be successful.

I will try to apply some irony:

a) you are expected to always like that something is pocked into your skin. For me this feels like being really ill but in reality I have only Type 1 Diabetes. Some time in the future you will experience an infection of a site. So be very diligent about site preparation.

b) you are expected to always like that your blood glucose is rising after site changes. This means every three days you will likely experience an elevated blood glucose for several hours.

Let us assume you change every 3 days and after the change your blood glucose will be elevated for 3 hours. Furthermore we assume that one month has 30 days:

30/3 = 10 days of month elevated => 10 * 3 elevated hours = 30 elevated hours. Relation of all hours of month to 30 elevated hours: 30*24 / 30 = 100 / x <=> x = 4. In other words the effects of site changes can influence 4 percent of your monthly hours negatively. I know it is a bad simplification but the point should be clear.

The benefits of the pump have to compensate these 4 percent. Furthermore you will have to develop strategies to compensate this tendency in time (one unit before site change etc).

c) you are expected to not mention anything about scar tissue. Something that is pocked into your skin for several days will need more time to heal. Combined with the fact that the pump needle can not be applied on all the places you can use a pen needle on this leads to higher reuse frequency. Even with rotation this gives your skin less time to heal and naturally scar tissue will develop (I am talking about periods of 20 years). The problem is that scar tissue will cause absorbtion problems for the insulin. You have to be very diligent with site use and correct rotation. Patch pumps like the OmniPod make the problem worse because they can only be applied to a subset of the pump sites. I am quite sure that a pumper with scar tissue will do much better with MDI.

d) you are expected to praise the flexibility of the pump for sports. Of course you have to set your temporary basal rate 1 1/2 hours or more before your activity but remember this is flexibility. Eating just before sports like I have to do is soo old school these days. Of course it contradicts weight loss but are some glucose tabs or some juice really that problematic? What if your liver dumps glucose with activity? Well then the TBR must be increased OR you could do on MDI without eating (Sorry, I could not resist).

e) you are expected to praise your new flexibility with eating, eating and eating. So you eat this and that and all the rigidity and the reproducibility of results is gone. Normally with MDI you would eat something with the intention to learn how to handle it. With the pump handling the corrections is soo easy why bother with learning? As a side effect you will likely experience weigth gain and weight makes it harder to control your blood glucose.

f) you are expected to ignore the additional costs of pumping: pump supplies et cetera.

g) whonce it has been set you are expected to never ever question your basal profile again. At least it is the best way to really spoil the benefits of pumping. I know this sounds very harsh but I have met pumpers with this ignorance.

h) you can praise that the pumps forces you to understand all the mechanics of D: I:C ratios, basal delivery, target values, injections for carbs and corrections, insulin and carb sensitivity. On the other hand all this knowledge is valuable and usable for MDI too. It is like you said: MDI has potential to be explored - different rapid and basal insulin, different application patterns, different pens.

This is not really meant to stop you from pumping. I just wanted to be critical and show side effects to be aware of. If the potential of MDI has been explored and the pump is the key to lower your A1c below 6.5 then go for it.

I’ve not run into problems w/ elevated BG after site changes nor with infections. So far the scar tissue may be challenging but, compared to the MM CGM, the pump sites are sort of insignificant? I’ve only been at it a couple of years though. For me, the correction process has made me much more inclined to study what I’m eating, or at least fit it into my matrix for guesstimation. W/ MDI, I was firing away very blindly. Which may say more about me than any sort of ‘approach’ but I found that the notion of putting the numbers into the pump makes me more interested in knowing what the numbers for the food are more precisely. I also am not sure that I agree that eating before sports is ‘old school’ as even people without diabetes can benefit from administering carbohydrates before exercise? Maybe not the 32 oz. ‘serving size’ bottles of Gatorade marketed to teenagers but keeping carbs on board is a pretty important part of distance running strategies? I change my basal and bolus profiles occasionally, not all the time but sometimes things change. I have not figured out a way to stop getting older so I blame it on that? The biggest ‘flexibility’ change for me has been the ability to utterly blow off eating if I want to or delay meals for hours? In general, I found that with the pump, I spent a lot less time working on diabetes, except maybe for hanging out on message boards?

Don’t worry too much about it Kelly. Give it a shot and an honest effert and you’ll know if pumping is for you. I was on MDI for 25 years and did quite well with it. I’ve been pumping for a little over 4 months, though, and I’m never going back to MDI.

With all due respect to Holger, I think those points he brings up aren’t “expectations for pumpers” as much as they are “the way pumpers actually feel after switching”. I do, in fact, d) praise the flexibility of pumping for sports, simply because pumping is, in fact, way more flexible for sports, for me anyway, than MDI. Why? Because I have all the flexibility of MDI in addition to the advantages of adjustable basal rates that the pump gives.

Definitely be aware that pumping brings its own set of frustrations and is in no way, shape, or form, a perfect solution to the difficulties of insulin therapy. You can do quite well on MDI if those frustrations prove to be too much.

Good luck!!!

Hi Kelly

I probably am the newest one to pumping; I started on 1/3, so I can give you the newbie’s perspective. If you were newly diagnosed and didn’t know how to carb count, keep records, consider doses, I might say that it might be too much at once. But you have been doing all that for awhile. It is definitely a big step and carries with it a learning curve and a transition period. But you have your medical personnel, your pump trainer (and they will give you someone to call if you want for a few days - I didn’t bother), and you have us. If you haven’t already join the group for your particular pump. I posted a couple questions and got quick helpful replies (I’m on the Animas Ping).

Buy yourself a pretty skin (Animas gives you one free) and/or pretty belts at spibelt or tallygear. Take extra care of yourself during the first week, take time off from work if you work, be sure and eat well and do the things that you like to do and that nurture you.

Oh and I haven’t been having the rises after changing sets that Holger mentioned, so it sounds like not everyone does. I don’t know if you paid for your pump or got it free but I got mine free and so I told myself that if I hated it I could just go back to shots. I’m at 10 days (the hardest adjustment time) and I haven’t even given that a thought. Best of luck to you and let us know how it goes.

I have to agree with Holger. Many issues arise with both the pump and MDI. Bottom line: What works for you mentally and emotionally, nothing is permanent, and the objective is to get your blood sugar in the best control possible.

If you ever do figure out a way to stop getting older, please let me know.

I must admit that the irony turned more to sarcasm and that was not my intention. Maybe it is just that I have seen many positive transitions from MDI to pumping. But then after real success stories the old habits came creeping back and then the control deteriorated…

And that does not have to be the case referring to …Holgers 's quote : " But then after real success stories the old habits came creeping back and then the control deteriorated…“
I moved forward since pumping , my choice ,determination and willingness to learn .
My reason I started pumping in 2001: …the " newer” basal insulins were unavailable .

Go for it. I was on certain meds. Then injections and meds. Then MDI for almost a year but was having a lot of hypos. I went on the pump and wouldn’t look back.

I think, Holger, that you present some very real concerns and very real issues that could arise from pumping. As a pumper, however, I think you present the potential issues in a way that sounds like they will be problems at some point. I don’t think that’s either ironic or sarcastic. I think it’s just negative and not really representative of what will happen if somebody switches over to the pump.

For me, the pump change highs were a huuuuuge concern and I think you hit the nail on the head with your calculations on what could have been a major issue had it turned out to be the case. The absolute truth is, however, that in approximately 40 pump changes, so far, I’ve had maybe 5 total pump change highs and I can attribute 4 of those to the site I chose. That doen’t even mean that I have to avoid those sites in the future. It just means that, through experience, I’m better able to anticipate and deal with potential pump change issues before they become a problem.

So, yeah, you are absolutely right in presenting potential issues but, as with all things diabetic, YMMV.

I think you do bring up a good point here, Holger, and I think that when that happens it’s based on having unrealistic expectations. The pump seems to improve management for nearly everyone, but it is not a panacea. That is why I may sound like a broken record sometimes when I react to the “I can eat anything and bolus for it with my pump” school of thought with the usual cautions.

I resisted going on the pump for years. The expense scared me, plus I hated to be “hooked to a machine” all the time. I just gave in and started this past July. It’s the best thing I ever did for myself. It has improved my control tremendously, but more than that, I feel it’s given me more freedom than I hae every had before. When I want a handful of chips or a donut midmorning at work, I just pull out the pump, give myself the appropriate bolus and go on about my business. My A1C has stayed in the upper 5’s, low 6’s since I’ve been pumping. There is a learning curve, but it’s really no big deal if you’re already used to counting carbs. Everything else just gets programmed into the pump and happens without too much intervention on your part. I also really recommend the CGM. I started that a couple of months after starting the pump and wouldn’t be without it.

Thanks everyone for their input and support. It is much-appreciated. I started on the pump yesterday afternoon and things are going more smoothly than I had expected.

I don’t believe I have high expectations for the pump and I am willing to work hard to achieve good blood sugars. My biggest problem on MDI was my dawn phenomenon. I really wanted to get my fastings under 180, which after 9 months of trying different combinations, I couldn’t achieve. Even if that problem alone is remedied, I’ll be happy.