New to insulin pumps - what do I need to know?

Type 1 and LADA
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I’ve recently had some help on this site in regards to a CGM, now I have another topic on my mind, which I came across accidentally - an insulin pump.

Although I know what an insulin pump is in very simple terms, I’ve always stayed away from using it because its a big (in my opinion) bulky device that needs to hang onto your pants or a belt (don’t even know what happens if you wearing a dress which I often do) so I’ve always stayed away from it…

but now that I’m looking into CGM’s I’ve noticed how insulin pumps works together with a CGM, and when I checked just one of the manufacturers website’s it made very some positive notes about controlling and preventing low glucose levels (which is a problem for me at the moment) and how it gives you insulin all-throughout the day, which seems to be a bit contradictory to prevent lows and that in essensce an insulin pump works like a pancreas… which sounds amazing!

so I need your help please, cause I know everyone that has or is using an insulin pump (wherever in the world you are) will have more accurate things to say about it.

(For background info - I’ve had type 1 diabetes for 22 odd years, I was diagnosed while living in USA back then but I now live in South Africa and currently I’m still using insulin injections and normal glucose meters to monitor sugar levels)

So what would be your pro’s and con’s of an insulin pump?

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It’s actually kind of the opposite. With a singe-shot-per-day basal (e.g. Lantus) you are more likely to get unwanted lows because once you’ve taken it you can’t adjust it. Lantus has a long flat effect curve that can’t perfectly match the contours of your diurnal cycle in terms of basal glucose, let alone account for unexpected events like sickness, exercise etc. Even traditional pumps allow you to program different rates to approximate that cycle. And CGM-integrated AID (Automated Insulin Delivery) pumps take that to the next level of resolution by adjusting output dynamically in real time, based on CGM readings, predictive algorithms etc.

That’s the idea, though like most things theory and practice aren’t always a perfect match. There’s still a lot of learning and user-management involved. There’s still no magic set-it-and-forget-it solution to this disease.

Cons: pumps are more complex, with more moving parts, and consequently more potential points of failure, than injections. Infusion sets can accidentally pull off or may get inserted in a spot that just doesn’t absorb very well, and there can be occlusions and other things. If you’re already doing carb-counting and have a good grasp of things like insulin-to-carb and correction ratios, that will help you get going. But you’ll still have to do a lot of testing and recalibrating—those parameters almost never transfer one-to-one from MDI to pumping, even though it seems like they should. It’s just a different beast. Having a CGM is an enormous help, but expect it to take weeks not days to get it all dialed in. Having a good trainer is a huge help. Availability of same in your locale is something you should check with your pump manufacturer. Youtube and sites like this one can be a big help, but it’s no substitute for having someone you can talk to, especially at the start. Why is it DOING this??? is a question we all find ourselves struggling with. But that’s kind of the T1 experience as a whole, isn’t it.

Good luck, keep us posted with how it’s going and feel free to ask questions—lots of experienced T1s here who are eager to help!

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I think Kimmi D. summed it up very well.
On your specific question about wearing dresses, you need substantial underpants, like our mothers’ girdles, Spanx products, on which to clip the pump. That means you have to go to the rest room to adjust pump settings.
No more nightgowns - only pajamas with the pump, so that it can clip on to the bottoms.
You can have skirts and pants specially tailored with openings for pump tubing in your pockets, but most people don’t go to this much trouble.

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I wear a spy belt to sleep and if my pants won’t hold the pump (like biking shorts) otherwise the pump lives in my pocket, with the tube under the belt.

The pump slows down the flow of insulin or stops it if I’m trending low, but it can’t counteract insulin already in my body, so I do still go low occasionally, but a snack corrects for that! The CGM is a huge help in this.

If I’ve undercounted my carbs for a meal, and glucose is trending high, the pump will increase the basal rate (after an hour, I believe) and will provide a bolus based upon where it predicts my glucose is headed. The amount of bolus depends on settings that I’ve put in: total daily dose, my weight, and, critically, insulin correction factor.

It’s not perfect. I still need to count carbs. I need to tell the pump to bolus about 20 minutes before I eat. That can be tough when traveling or eating out. But that was the same problem with multiple daily injections.

For now, CGM + pump works great for me, with usually over 80% time in range, and A1C of 6%. I’d love 100% TIR and A1C of 4.9% but I’m not prepared to make the sacrifices to achieve that. It’s a lot more work!

Have had Type 1 diabetes for 30 years with finger prick testing and injections up to six or eight times a day for the first 28 years. My control got dramatically better with the current technology of Dexcom and Tandem X2.

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so when using an insulin pump do you no longer use a long acting insulin? does it only give you short acting insulin throughout the day plus extra when you take meals? I get what you mean by one shot of long acting has the risk of lows because you can’t adjust once given and that might be adding to why i’m having so many lows at the moment (amongst other reasons) but it does still make me nervous knowing that short acting insulin is constantly pumping into my body plus additional doses for meals, but thats probably just because the way I currently inject short acting has been inbedded into my brain for the last 22 years.

and yes been doing the whole carb counting → insulin ratio from the start of my diabetes journey, so I’m good with that.

and I’ve always been told my short acting insulin especially has to be kept cold at all times… like when i go out, i carry a little pouch thats just big enough to fit my insulin pen with an ice pack… if it’s in this insulin pump device, how does the insulin stay cold then?

I appreciate all the info, thank you so much :smiling_face:

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I’m too phased about having to go to the bathroom to adjust pump settings (to give insulin for a meal… I’m guessing is what you mean) cause I already have to do that all the time for meals, cause I always get unfriendly looks with giving myself insulin injections or even just pricking my finger to check sugar levels, so i’m used to that… but i don’t like the fact that i always have to wear some type of shorts underneath for the pump to climp onto, i wonder if there’s some type of comfortable but strong enough belt that can be worn under a dress, I’ll have to check that out. Thank you for the feedback :smiling_face:

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ok so i had to look up what a spy belt was lol but yea thats kinda what i was thinking i would need if wearing a dress, so at least i have a name for it now :smiling_face:

i love the fact that it autocorrects if it see’s you going high, thats super helpful

howcome you give a bolus a whole 20mins before eating?
with injections, i give it right before i eat otherwise i go low… but curious to know if the pump just works differently that you have to give it ahead of time?

thank you for the feedback :smiling_face:

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how does everyone sleep with an insulin pump? or do you not wear it when sleeping?

cause I move around a lot in my sleep, so not sure how I would manage keeping an insulin pump safely connected to me while sleeping

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I’ve been pumping 7 years and have had a very different experience from some of the previous comments. Never once did I feel compelled to clip it to my waist, felt the need to bolus in a restroom because of where the pump was stored, went out of my way to wear pants/shorts/girdle to accommodate it, nor ever let the pump dictate my sleeping attire. Fot the most part, it lives in my cleavage. It’s my favorite spot for it! It’s convenient, accessible, I can easily see my screen when I want, it doesn’t inhibit the ability to use the restroom and dress/undress, and the tubing becomes an absolute non-issue under my clothes. I can wear anything I want, really, even dresses. Only once did I have a problem with the neckline on a gown (very rare occasion to dress up!), and I found an easy solution fixing the pump to the dress lining. It’s generally clipped to the bridge of my bra, and if I’m not wearing one of those, I just clip it to the neckline of a tank top/cami. And you if you want to carry in a pocket instead, no need for special alterations. You can clip a tiny hole in the fabric and dab a little Fray-Check (fabric glue for exactly that purpose) around the cut edges.

Sleeping is also not a problem. Usually when I go to bed, it’s still in my cleavage , but it often finds it’s way loose in the bed with me with zero issues whatsoever. If you roll over, the pump will roll with you. I do occasionally get an alert because I’m sleeping on top of it and blocking the Dexcom communication.

Seriously, the tubing is only worrisome before you start pumping. Once you’ve actually lived with it for a little while, you’ll stop noticing it.

Pumping was a simple choice for me. I’m a terrible diabetic when I have to take multiple daily injections. I’m lucky if I responsibly take all the mealtime boluses, and extra corrections are highly unlikely. 27 years of injections and it never got any easier for me. With pumping, the current technology is amazing. If really minimizes the burden of being T1 so I can live a nearly normal life, while still exceeding the ADA guidelines. I’m struggling to come up with a negative. I quite like being a cyborg.

And there’s a lot of misinformation out there about insulin and it needing to be refrigerated. You’re supposed to refrigerate the unopened vials/pens for long-term storage, but the one you’re using doesn’t need it. If you read that folded up paper they stuff in the box with your insulin, it will tell you that it’s good for 28 days at room temp. It’s actually even more heat tolerant than that. Every single time an insulin pump goes through FDA review they have to prove the safety and efficacy of the insulin inside it. I don’t know about other pumps, but Tandem’s has an alert to notify you if it does actually get too hot, so you never need to be worrying needlessly about temperature. In fact, freezing temperatures are way more damaging to insulin than warm temps.

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I never thought about using my cleavage to store it in lol that’s actually a pretty good idea and I love the frabric glue idea too

and you just taught me something new about insulin! :smiling_face: I must say I never read the leaflets in the insulin boxes, i just throw them away but I’ll definitely give it a look the next time… this will be another thing to have to re-train my brain on, because for the last 22 years of having diabetes it’s always been drilled into me that you have to keep insulin refridgerated, so this is really helpful to know now, thank you so much for your feedback

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Regarding “prebolusing” if I don’t have insulin already circulating I invariably go high. So the 20 minutes in advance works for me.

I’ve always stored my insulin in the fridge bit even when traveling I don’t worry about keeping the vials cold. There are various preservatives in my Humalog and I’ve not seen any decrease in efficacy even after several weeks of non refrigeration. Now I have a Frio pack which does help prevent the insulin from cooking I think; at least that’s the theory of evaporative cooling.

Since I don’t wear dresses or have a cleavage, I’m stuck with pockets or the belt. I sleep with the pump in the spy belt and it’s a non issue.

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oh I haven’t seen the Frio packs before, but I see I can get them here as well, looks like a much better idea than using ice packs… thanks for that :slight_smile:

the spy belt… or a running belt still looks like a good idea and I see you can get them for your thigh as well which will be helpful in some cases… for me at least :smiling_face:

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That’s correct. Pumps use short acting insulin only (Novolog, Humalog, Fiasp) and administer it in small increments ever 5 minutes according to the settings you establish, much more similar to what a functional pancreas does.

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This always seems like it’s going to be more of a big deal than it actually turns out to be. Pocket t-shirt works fine for me. Or I just leave it lying next to me on the bed. Tubing comes in two different lengths (too long and too short :slight_smile: as the joke goes). I use 42" /107cm tubing which allows plenty of slack for rolling over (which I do a lot). Sometimes it snags on things but that’s rare enough to be no big deal.

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However, anyone using pump should have insulin in pens, or syringes in case of pump malfunction. And backup supply of long acting insulin.

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thank you, that’s a good idea to keep in mind

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I put my pump under my pillow so it’s out of the way and if it alarms I’m the only one who hears it. I recently did a pump vacation for 4 days and even though I can manage fine on injections, I missed my pump. Because I’m addicted to micro bolusing. I stay in range better and most importantly, I can do intermittent fasting easily while on a pump and I was not able to manage that in injections.

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so I move around a lot in my sleep (full disclosure - I have PTSD) so my pillows and blankets often end up on the floor from all my moving around in my sleep, but someone else mentioned a spy belt or a running belt so I could use that around my waste and keep the pump in there and I think that’s going to be the best thing for me, but thank you for sharing :slightly_smiling_face:

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Ain’t necessarily so. Other than broken screens pumps(Tanden) are very reliable. I have had only one instance where I couldn’t wait for a next day delivery of a replacement pump. In that instance the pump wouldn’t charge. I got out one of my old pumps programmed it and was good thill the next day. 38 years on a pump and I have never used long acting insulin. In fact I’m currently using lumjev. I see no reason not to.

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So you have backup with retired pumps. That’s no different than having some long insulin pens and some insulin syringes to use with the rapid insulin normally used in your pump.

I have a box of Lantus pens and lots of syringes from MDI days.