New to T1D - thoughts on starting pumping?


#1

Hello! I’m about 6 weeks into MDI after begin diagnosed earlier in the year. I had a followup with my Endo this week and he was very happy with how I’m doing.
I’ve been considering an Omnipod for the the ease of bolusing without shots, particularly when dining in public, with friends, etc, and for the ability to dose more precisely. I take 1 unit for 15 g and the ratio is working pretty well, but i find myself eating more carbs than I even want at times, because I have to get to the next increment of 15, which seems counterintuative. Plus, my insulin pen doesn’t seem to work accurately at only one unit, so dosing accurately for anything under 30g of carbs is iffy.
However, given that, things are otherwise going pretty well and my doc was really happy with my dexcom data. He says he feels like it’s not worth changing what’s working, since the results on MDI have been good. However, if I decide I want to try it, he’s ok with going that route too. He wants it to be my decision but was kinda trying to talk me out of it.

What are you guys’ thoughts on pumps for someone very new to T1D? Can most people get good results with a pump? Right now I’m not having to deal with highs from equipment malfunctions and such, so I’m a little concerned I’d be creating new problems in order to fix other problems :slight_smile: I’ll also note I don’t have a lot of body fat - can pumps be uncomfortable at the insertion site? Can you feel it in you, or is it easy to forget it’s there? I have a Dexcom and don’t even notice it… does a pump feel similar to you or do you feel it?
I would love to just give it a try for a while and see, but it feels like a pretty big commitment and the decision is feeling overwhelming. Any thoughts?


#2

My advice is: go for it! It is worth it. I regret not having done it earleir in my life. You don’t even feel the pump is there and you will get much better results, more accuracy with ratios and decimal units, eating when and how much you want, etc. The improvements can be huge and in the long term you will be glad to have done it.


#3

I’ve never used a pump or a pen in the many years I’ve been doing MDI. I’ve been using the Libre sensor for several months, so I’m not against new technology. With the pump, I’ve just never seen the value. With syringes, I just draw the insulin, inject and I’m done. Seems like zero hassle and maintenance to me. Obviously others have used and loved the pump approach. Regarding eating out, I usually pre-bolus before a meal so that may happen in the parking lot. And my friends and family know I may inject at the table.

If I had very low insulin requirements as you seem to, I would check out Dr Bernstein. I believe he discusses diluting insulin in his book. It’s an extra step, but you would only need to do it occasionally.


#4

I’m a long time pump user, going back to the late '80’s. I did take one several month MDI hiatus to test out the basal insulin, Tresiba. Here’s a list of things I appreciate about the pump for me, in no particular order of value to me:

  • I have an elevated need for basal insulin in the early morning hours, often referred to as dawn phenomena. I was not able to dial in an MDI basal dose of Tresiba to satisfy this early morning basal need without driving my late afternoons into hypo territory. The pump is well-suited to meeting whatever basal profile you might need.

  • It’s socially easier to pre-meal dose with a pump than a vial and syringe or even a pen.

  • You won’t ever leave your house without your current insulin supply since it’s attached to you. You do need to remain cognizant that you have enough insulin in the reservoir to satisfy the duration of any excursion away from supplies. I almost always carry pump supplies and insulin with me, however.

  • A pump has a built-in bolus wizard, no need for a secondary app and data entry. You can easily check your current insulin on board or IOB.

  • A pump will remember when/if you took your meal dose. This is my biggest problem with MDI. You can forget if you took your insulin dose or not and then you’re faced with double dosing or missing a meal dose all together.

  • I rarely feel the cannula at the site. I’m a wimp; if it’s painful, I just install another site.

  • Pumps make available extended meal bolusing, a potent technique that can provide a lot of dose timing flexibility. This is a tactic I used to dose for protein and fat when on a low carb diet.

The biggest disadvantage to insulin pump therapy is that the short acting insulin the pump delivers is intended to perform both basal and bolus needs. If your pump becomes occluded or your site is not absorbing well, then you can be headed toward a life-threatening episode of diabetic ketoacidosis faster than you might imagine. It can happen in a matter of hours, not days. You need to monitor your blood glucose closely and regularly, be that with a CGM or frequent fingersticks.

I think CGMs perform a more important function than a pump, if I was forced to choose between the two technologies. I would give up my pump before my CGM.


#5

I’ve never been on a pump but the more traditional MDI with Humalog didn’t work for me (way too many highs and lows). I couldn’t afford to go on a pump besides some of the other issues that pumps can have so I decided to try Afrezza which was the best decision I ever made. I know you were just asking about pumping but I thought you might like to hear about an alternative if you are dissatisfied with regular MDI.


#6

If you are only interested in omnipod, and have insurance, you may want to check what is covered. UHC favors Medtronic, but with appeals, I think some have gotten Omnipod from UHC. Some plans may have preferred pump brand, and require more evidence to justify/cover non-preferred.


#7

Using a pump or MDI is a personal decision. It’s possible to have good control on both.

I’ve used both throughout the years, but I found that the pump was an ever-present reminder of diabetes. I really hated the tubing. I never tried an Omnipod, but I’d likely use this pump if I ever chose to use a pump again. I’m currently using Tresiba, Humalog, and Afrezza.

I read a thread recently on priming your insulin pen. Apparently, doctors advise ejecting a unit or two before giving a shot from a pen to ensure that you’re getting an accurate dose. Maybe you could try that and see if it helps?

Terry helpfully listed off all the benefits of a pump. I’m going to take the other side and state the benefits of MDI/drawbacks of a pump.

  1. Site failures. This was the reason I switched back to MDI. Some infusion sets are much better than others, and I’m not sure which category Omnipod’s fall into. Site failures can occur for lots of reasons, but problems with absorption are the most common. If a site fails, you need to be able to replace it or have back-up way of giving insulin on hand. I felt like I was carrying around quite a bit of supplies all the time because you can’t always easily go home to change a site. Of course, with MDI you carry supplies around too, but it’s less supplies for me.

  2. If the site fails, your basal drops off quickly. On MDI, basal runs for 12-24 hours, so once you take your basal you’re good for awhile. If a site fails on a pump, then it’s a problem that has to be addressed immediately.

  3. Scarring. Rotating sites is incredibly important with the pump or you can end up with scarring. While this scarring can also occur with injection sites, an injection is quick so the scarring is minimal whereas a pump site is over a course of several days. With more scarring, you run into more problems with absorption and lack of predictability when dosing. Rotating can help with this a lot, but some people are naturally more prone to developing scar tissue.

  4. Ever-present. As long as my basal is set correctly, I can forget about my diabetes relatively easily. With the Medtronic pump, I had to make sure the tubing didn’t catch on things or the pump was secured to my pants/shorts when I got up in the morning. The tubing can get all tangled during the night. If you accidently jostle the site or pull it out or the site fails, you can end up with really high blood sugars when you wake up. This didn’t happen often for me, but I had to always be aware of where my pump was. I don’t have to worry about that on MDI. I feel free as a bird :slight_smile:

  5. Over-complicating things. While the basal and bolus adjustments can be really helpful, they can also end up over-complicating things. You could change your basal to different levels at 6-8 times of the day, and while that’s helpful, if the absorption isn’t right anyway because you’re on the third day of the site then it seems rather pointless. One of my CDEs told me that absorption tends to be around 60% on the third day. That’s a huge difference!! All these minute changes become pointless if the sites aren’t working properly. However, basal needs can vary a little bit throughout the day, so some people truly do benefit from being able to adjust the basal rates.

These are probably the biggest drawbacks of the pump for me. I think the biggest assets of the pump are being able to have different amounts of basal throughout the day and being able to give a bolus over time.

For me, the site problems I had and carrying around this bulky device weren’t worth it. I never input my food into the pump anyway because that doesn’t track protein/fat or the glycemic index, so I don’t find it that helpful. Essentially, I found that I thought about diabetes less when I didn’t have a pump, yet I was able to maintain good control. That’s a much, much better fit for me. Others may not be bothered by thinking about it and may have fewer problems with sites, so a pump is a better fit.

It’s worth giving it a shot at some point. You may love it!


#8

I think there is a big benefit to learning the ropes with MDI before getting into a pump. I like the advantages of a pump, and I use omnipod. So I am not trying to talk you out of it. But doing MDI for a while can help you learn many things that will help you with the pump later.

A bit of a tangent, but they make some pens that can do 1/2 unit doses. What pen are you using?


#9

You make some good points. Pumps are not the perfect solution for everyone. They can be versatile and convenient but failing site absorption can be their Achilles heel. Inconsistent and frequent site absorption and air bubble problems were the main reasons I stopped using the Omnipod after a several month trial.

When I tried MDI last time, I used Tresiba, Apridra and Afrezza. If I could have fine-tuned my Tresiba (long-acting insulin) better and automated insulin dosing did not appear as an option for me, I would likely be using MDI today. I was close to what I wanted and I would have probably stayed with it except I knew I could quickly solve my dawn phenomena challenge if I switched back to the pump. So I did and it fixed my control issue.

Starting on Loop was such a game-changer for me that I could never willingly go back to simple pumping or MDI except as a temporary therapy. It’s more complex but it’s ability to make an insulin dosing decision every five minutes removes a lot of my pumping cognitive load.

I think enjoying options for insulin therapy is the key. We are all different people with different priorities and values. We’ve all suffered the setback of a fundamental metabolic failure. None of us had a choice when fate tagged us with diabetes. Being able to make treatment choices are good for many reasons.

Finally, you make a valid point about the pyschological burden that too much diabetes paraphernalia can bring to a diabetic. We each must work through this difficulty. I’ve made my peace with all the gear that needs to be within arm’s reach at any time of any day. We all have to go through that mental checklist every time we leave the house. It can be a pain and I certainly understand the “less is more” benefit that accompanies MDI over pumping.


#10

Ah, it’s our old friend YDFLNCA: “You’re doing fine, let’s not change anything.” Not to go into too much detail or fully unleash one of my longstanding rants, but this is something it’s all too easy to go along with, especially as a newly dx’d T1, and it’s wrong wrong wrong. I lived under it for 20 years, during which the medications and technologies evolved but my treatment didn’t, because I had dr’s who were schooled in the blinkered attitude that your numbers were all that mattered. Back in the day, there wasn’t any other choice but to constrict your life to fit your medication rather than adjusting your treatment to fit your life, but there IS a choice now. From a patient perspective, that’s a major point of what these newer technologies are all about. These days, “doing fine” can (and should) include quality of life, not just A1c’s. A major criterion for considering a change in treatment has to include “Will this allow me to lead a life less constricted by my disease?” not just “Will this get my A1c down a few tenths of a point?” Speaking as someone dx’d back when R/N was the only option, and was straight-jacketed into it for years past the time when I should have moved to (at least) basal-bolus MDI, because my Drs (PCPs, not specialists, b/c I couldn’t get referrals back then) adhered to the dogma of purely numbers-based YDFLNCA, I’m particularly sensitive to this very old school mind set. So I urge you to consider it from quality-of-life perspective and not just the one that physicians tend to fall into out of habit. I know people who prefer MDI to a pump because for them pumping feels like it is more complicated and occupies more of their time and awareness, but they’re deciding based on what makes their life feel more comfortable and less dominated by their disease, not just the numbers. Tthe point is we have those choices now, and it’s our right to consider them from that perspective. Yes we need to consider the quality of control as well, but it ain’t just the A1C anymore!

/rant

ETA: Or to put it another way, what @katers87 said. Hadn’t read that post before launching my response because (obviously) the OP hits a sore spot for me…


#11

Wow, you guys are so kind to give such thoughtful, detailed responses! The pluses and minuses you have pointed out are pretty much lining up with the benefits and concerns I was thinking about, so this is really interesting. I like the idea of fine tuning doses, extended boluses, and the ease of bolusing in public. I’m concerned that, like someone mentioned above, I’d find it to be an ever-present reminder and find myself spending more mental energy on it than I do now. I feel like if I was in the middle of a run, or a social event, etc., and the thing malfunctioned, I’d be VERY frustrated. I also have some fears about the idea of going very high very quickly in the event of a malfunction, but hopefully my dexcom would alert me to that happening.

I haven’t figured out how to do the quotes from previous posts :), but someone mentioned a half unit pen. I use the Humalog pen now. I think I read there’s a Humalog Jr pen with half doses. My doctor was unfamiliar with it, but I assume he’d prescribe it if told him what it was and I asked for it. Trouble is i just filled an Rx for the adult ones, so I assume my insurance won’t be wild about filling it until i’m out of the other, maybe (?)

I appreciate your “rant” DrBB, because I was thinking much the same way. Sure, my “stats” may be good with what I’m doing, but that doesn’t mean there couldn’t be quality of life benefits with trying a different route. Interestingly, my endo is actually a T1d himself who doesn’t prefer to use a pump. So while he wants to let me make my own decisions and will prescribe me one if that’s what i decide to do, I think his own experience clouds things up a little.

Part of me thinks it would be great to just give it a try, because if there’s something available that MIGHT be a benefit to me, I’d at least like to know if it’s an option. And if it works out, great, if not, at least I know. But due to insurance, expense, etc., I’m not sure what would happen if after a while I decided it wasn’t for me? If I have Omnipod look into my insurance to see if it’s even an option, will I regret it (in the form of annoying sales calls forever or something?) So much to think about! :slight_smile:


#12

The Humalog Luxura HD is their non-disposable pen. HD stands for “half-dose”.

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The Lilly KwikPen is disposable. It is smaller which is nice. But it does not have 1/2 unit doses, which sucks.
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The Lilly Humalog Junior KwikPen gives you everything you want. It is small, and has the 1/2 unit doses.

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No, not at all. Depending on the rep in your area, you might be lucky to get a single call from those people. :face_with_raised_eyebrow:


#13

If you’re interested in the Omnipod, you can go to their website and request a free demo pod. This pod isn’t functional and doesn’t have a cannula, but you can get an idea of what it’s like to wear a pod. You can also tell if the adhesive will irritate your skin (which is a problem that I’ve recently started having with infusion sets). The process was simple, although it did take several weeks for me to get one, and I only received a few calls from the company to make sure I received the demo pod and to see if I liked it. I highly recommend trying out a demo pod.


#14

I would still recommend trying a pump if you’re able to, and then decide if it’s right for you or not. It doesn’t have to be an either/or thing, I’ve gotten to a point where I pump when MDI is annoying me and vice versa. It might be easier to do this in Canada though because of the system here. I think DKA fears are overblown. Sure, it’s a risk, but I’ve had plenty of bad sites and failed pods over the years and never been close to that. It’s not something I ever even thought about before reading these forums. I stupidly used to just rip my pod off and stuff it in a drawer if it shut off and started squealing in the middle of the night, and never got in trouble. Maybe it’s luck, genes, my basal was set too high and I actually needed it off me or might’ve gone super low, no idea, but never approached DKA territory. If you’re worried about the pump failing in social situations a tubed pump is the way to go. A pod failure is catastrophic and needs to be dealt with immediately. Tubed pumps rarely fail outright, absorption might degrade in a site but sites just don’t stop working typically.


#15

I am a total fan of pumps. I like that I get the IOB (insulin on boaRD FROM PRIOR BOLUSES), MY CARB COUNT - IF i AM GOING TO EAT SOMETHING, ALL TAKEN INTO ACCOUNT. iF ALL i NEED IS 0.47 UITS OF INSULIN THAT IS ALL i GET. i DON’T HAVE TO EAT IF i DON’T WANT TO, i CAN LOWER MY BASAL RATE TO STAY IN RANGE. i AM LEAN AS WELL, AND THERE ARE DIFFERENT CANNULA LENGTHS SO i DON’T KNOW THAT AN INFUSION SITE IS THERE. i SUGGEST COMPPARING THE DIFFERENT PUMPS TO SEE WHICH ONE SUITS YOU. thERE ARE SEVERAL WWW.DIABETSNET.COM, IS ONE GOOD THIRD PARTY SITE. i ALSO STRPONGLY SUGGEST READING P(oops hit the caps key =- too lazy to redo). ANyway, get a copy of Pumping Insulin by John Walsh and Think Like a Pancreas by Gary Schneider. Both guys are CDE extraodinaires, with T1 themselves. It would take hell freezing over for me to go back to MDI. I didn’t like having to eat up to a unot (or half unot) of insulin, nor did I like waiting until my bg was 150+ to accommodate a full (or half) unit of insulin.

One word of a caution, the facebook pumping groups are grat, but often these sites are used for people with questions and/or issues, so they may look like pumping isn’t as great as it is. I have yet to have an occulsion , site issue or pump failure and I have been pumping since 2006.


#16

Wow, I’ve been pumping since 2006 too (except some short experiments on MDI more recently) and I think that is pretty rare never to have those issues.


#17

I think the lack of site issues is due to the fact that I use the 90 degree metal (very short) cannulae. Back when I first started there were the occasional bent cannula, but not since I switched to the contact detach which has the metal cannula and by design allow me to reach around my body for insertion. My pump history includes several years with a Cozmore, a few with Animas and several with Tandem.


#18

You have gotten some great pros and cons, but as many have stated, it is what will work best for you.
I have also been pumping for awhile, coming up on 27 years now! And I was not happy about it. I didn’t want that constant reminder of my disease. But I was trying to get pregnant and could get the overnight blood sugars in line. The only option was different basal rates overnight. It was a big adjustment when I first started. I thought it was going to fix everything. It didn’t. It really took about 6 months to really fine tune it, so I could try and get pregnant. And that first years was a lot of ups and downs with “issues”, like door knobs, bedtime fun issues, having sites come out etc.
But over the years, I have come to really love my pump and the flexibility it gives me.
When on injections, I ate to the peaks of the insulin, not because I was hungry. It was 5 pm, I had to eat. Now with the pump, if I don’t want to eat, I don’t have to. I also love the fact that I can turn it off or turn it down depending on my needs. Fasting for a surgery and am running low, I just turn it off for awhile. I never have to worry about eating when I should be fasting. Or if exercising, I can do a lower temp basal so I don’t crash while exercising. And I have different basal profiles for my work days and my off days. Also had a profile for pre period week. Such flexibility is harder to do with injections.
Is it better? No just different. There can be issues with bent infusion sets, but I fixed it by using metal ones and I am on the thinner side also. And before the metal infusion sets, I would get some kinks but it was just once in awhile. And I never went DKA with any of them because I tested so much early on and now use a CGM. There is a lot more to juggle but I feel the extra work is worth it.
But not everyone needs to or should be using a pump. It’s not for everyone and many, many people do a great job with injections. You just need to find what works best for you. Sorry long winded but this is a big decision. Good luck!


#19

Thanks so much everyone for the thoughtful responses! I went ahead and filled out the info to have Omnipod check my insurance. I’m not sure I’m mentally ready for a tubed pump, but I think it’s worth at least finding out if Omnipod will be an option. It sounds like it’s a love it or hate it type situation, but I figure it’s worth finding out which of those two camps I end up in! :slight_smile:


#20

Did you go directly from R/N to using a pump? This sounds like my experience going from R/N to basal-bolus MDI with Lantus/Novolog. For me the pump transition was less of a life changer (took me about 6 months to get it really dialed in too).