New to T1D - thoughts on starting pumping?


#21

No I never used NPH. I was on Lente for most of my injection treatment. When we were trying to get the blood sugars good enough to get the go ahead to try for pregnancy, I was using ultralente. I took a long time to make that switch because I was allergic to beef insulin and ultra wasn’t available in pork form for a long time. And I think because I thought the pump was going to fix everything and make it perfect for getting pregnant, there was a lot more frustration for me. And once we got the blood sugars where they needed to be and we got the ok, it of course took us a year to get pregnant. It was so very, very hard to run perfect blood sugars for almost 2 years.2 years worrying every time the sugars strayed out of target. 2 years of wondering if that hour too high was doing damage. But it was worth all the worry and headaches and pump frustrations.
I don’t think I would ever give up my pump. It gives me so much flexibility and freedom. I have had four pumps in my 27 years pumping. And am eligible for a new one right now but am holding for maybe a closed looped one in the next few years.


#22

Wow, you were truly an early-adopter of pumping!

R/N had become the standard regimen by the time I was dx’d (1983) and I was (stuck) on it until 2003, when I finally got a referral to an actual endocrinologist, at Joslin, who instantly switched me to basal-bolus MDI. By then it had been standard for years, but my less-than-expert PCPs all adhered to the principle of YDFLNCA (“you’re doing fine let’s not change anything”), so I couldn’t get access to it. I didn’t go to a pump until 2013.


#23

What’s crazy though is that MDI as we know it really didn’t exist until Lantus came out, which was only 3 years before you started it I think (and 2005 in Canada which amazes me).


#24

Been T1D for 30 years. MDI with LPH + R mixing ratios/sliding scale with syringes for years. Then a brief stint with pens. Now on my fifth insulin pump (insurance coverage allows me to get new one every 4years). Disetronic: 2; Medtronic: 3 (Current pump is the 670G with CGM, just got it less than 2 weeks ago).

I use the infusion sets that have the flexible cannula which is pretty comfortable for me. Been on Novolog and Humalog—I believe that the FDA approves only these insulins for pumps, not just standard R insulin. I could be wrong in my understanding, though. Currently being mandated to use Humalog due to my insurance. I honestly don’t have a preference between Humalog/Novolog. I’m just incredibly grateful to be alive as a result of the invention and ongoing improvement of insulin and that my insurance covers it. Just hope that they can lower the cost for everyone’s benefit. I think the cost for Novolog/Humalog is well over $500/vial. A vial of regular R insulin is a fraction of that ($75-100?). I know they have to make a profit, but I believe that affordable insulin is important. Hope that gets solved.

Good posts and feedback. By this time I’m used to all the stuff, including pump, CGM, supplies, being constantly connected to the pump. The only time I get stressed out is when I’m gathering/packing supplies for a trip. Sometimes feel like I need a separate carry-on for all my supplies! But I have a set packing list so I don’t forget something, so that helps. I do shake my head after I look at the pile of packaging (that keeps everything safe and sterile) after changing insertion set/insulin catridge, CMG sensor, etc.

The flexibility of pumping is for me more than worth any hassles. I certainly don’t regret my decision or pine for the old days—with MDI, I honestly felt like a pincushion and I often felt constrained by when/how much I could eat.

Now if we could find a way not to do fingersticks…


#25

I have a tslim. I will never go back to mdi, my bg was very unstable and there is really no way to treat bad lows safely for me. It is alot of work and there are still problems to deal with but overall it is much safer and easier. No remembering did I inject, take basal etc. It is all recorded in your pump.


#26

Depends what you mean by “as we know it.” MDI, formerly known as intensive insulin therapy, goes back at least to the 1970s, when the introduction of home glucose monitors made it practical. In fact both the DCCT (1983-1993) and the UKPDS (1977-1997) compared the effectiveness of intensive insulin therapy (either with multiple injections or by pump) against conventional therapy (one or two shots a day). Lente and ultralente were both used in intensive insulin therapy, a regimen I was on for a year or two before getting my first pump in 1980/81.


#27

I guess I was only thinking of people using NPH. Could you skip meals and carb count like you can with modern basals?


#28

Yeah, that is how I remember it. I took an intensive insulin class meeting once a week for a six week class. I was still using Lente and regular and was taking four injections a day. When ultralente (pork) was approved, I was up to five shots as I remember missing regular and ultra Lente wasn’t recommended. I was trying to get those perfect overnight blood sugars before getting pregnancy ok and the ultralente just wasn’t making it happen, which lead to pumping.
But it is so educational seeing others who went through the same old school thinking. And back than it was cutting edge. It’s where carb counting really came into my life vs the dreaded exchange diet lists. Remember those darn lists. When I was first diagnosed I thought my life was over. All my favorite foods were not listed! But my wonderful Mom made it work for the whole family. (Although my siblings were not happy about spinach and broccoli becoming a regular at the dinner table.
And I do remember like now, if the basal insulin was set correctly you could go without eating but it wasn’t recommended because Lente like NPH did have a peak just not as pronounced. And we all know how much doctors hate the risk of lows.


#29

Hi there - quick followup! I spoke with Omnipod and my insurance does cover it. Apparently normally they require you to wait 6 months, but she says they are generally successful getting them to waive that requirement.
However, my insurance requires your A1c to be greater than 7. At diagnosis this past winter it certainly was, but I get it checked again in July, and the number my endo estimated we’d see (based on dexcom data so far) was lower than 7.
So, I’m thinking I’d better give it a try ASAP, to see if they’ll waive the 6 month requirement, while my most recent A1c is still the lousy one from diagnosis? I wasn’t quite ready to take the plunge, but it sorta sounds like I’d better try while i have a chance. Does this sound logical? It’s crummy that they’ll basically deny it for taking TOO good of care of yourself!


#30

My memory is hazy, but I think when I was on early multiple injections, you had to be careful about skipping meals because lente and ultralente had peaks and dips more pronounced than with today’s long-acting insulins. Once I switched to a pump, however, I could skip meals – in fact, it was touted as one of the big advantages of being on a pump. When I started intensive therapy, variable doses (with multiple injections or pumps) were based solely on BG. I wasn’t introduced to carb counting for another 15 years (by which time it was well established; I was just out of the loop for a long time).


#31

What insurance company do you have?

A lot of these things can be overturned with appeal. They will deny it when you make the initial request, and may deny the internal appeal, but then when you do an external appeal with an independent review organization, it can be overturned for various things.

One of the things you could appeal is that a good or low A1C does not prevent you from having lows, so you could argue that not having a pump makes you more susceptible to lows.

The goal of the insurance company is to make it seem like you can’t get it and simply give up! They know you have a good chance with appeal, so they just want you to give up without trying. Do not give up!

As a reference note you can use - 1 visit to the ER for hypoglycemia will cost your insurance company more than an entire year of omnipods.

But all of that aside, definitely try to get it now. And DO NOT GET AN ENDO REQUESTED OR LAB DRAWN A1C BEFORE YOU SUBMIT TO INSURANCE!!!

You can do a home A1C and not tell anyone, but the last record of your A1C is what you can use, and is sounds like the last record was above 7, so submit that pronto!


#32

I have Blue Cross Blue Shield. I’ve found what I believe are their requirements online, and it sounds like they want you to have, while on MDI, an a1c over 7, or certain other BG numbers related to highs or lows. Since my last a1c was before i was on insulin, I’m not sure if that’ll cut it. I left a message for my endo’s office to inquire about it as well, and we’ll see if they think I have a case :slight_smile: funny, I’m stil not 100% sure I want the thing, and yet here I am getting all fussy because they might not let me have it :slight_smile:


#33

If you can afford it, do it.

The pump gives you so much more flexibility and control.

Enough said.


#34

I was approved with A1C’s of 6.8ish, but rarely over 7. But I was considered “brittle”, with lots of lows. I think that’s what got me approved with BCBS.


#35

I have found a pump is not a decision at all but is a necessity. But starting out I did manage on MDI for a few years OK. Reasons for a pump were:
1 I had lots of hypos some years it was like every day or two. The main problem was my basal needs changed over a 3 to 1 range over a few days and the changes were rapid when they occurred. I was on Levemir but it lasted way too long so I had to eat candy all day when I discovered my basal was really an overdose suddenly.

2 I had problems with glucose drops when I exercised. Again the problem was no way to turn off the Levemir. With a pump I could just turn it off when I went for a walk. Later as I progressed I needed some insulin but could set the pump to 20% of normal for exercise.

3 On MDI I was often up to 7 or 8 shots a day! I dosed for meals but often afternoons or evenings I would get a big glucose dump from my liver that raised my glucose as bad as any meal so I dosed for that. I got tired of using so many needles.

4 On a pump I found it super helpful to program a basic set of about 4 basal rates for different times of the day. I still had week to week variations but could easily adjust for those with profiles that scaled everything based on my basal rates.
Can’t do that with shots and long acting insulin.

5 Early on the pump was a big help in dosing less than 1/2 unit. That didn’t last long now that I need much more insulin but I still like having that precision for a small snack.


#36

I think it’s really important to have a thorough understanding of MDI before pumping. I know pumpers who didn’t spent much time on injections and quickly got a pump and don’t even know their ratio, correction factor etc. and leave it all to the pump. I think it’s also important to have the ability to take a pump break and be confident in your ability to jump right back into MDI with a good understanding of it all.


#37

I have a 670g pump it’s ok , it asks me for lots of blood checks get tired of that. Ran out of g3 sensors. Back to my 530g pump I still have humalog but no insurance anymore. Trying Relion R insulin in my pump but you can get a bottle at wallMart for 25 dollars. Your not supposed to do that but Iam testing it.


#38

It’s way better than DKA, at least. But it’s very different from modern analog insulins like Novolog and Humalog. I only know it from 20 years on the old R/N njection regimen, so I don’t know what it’s going to be like in a pump. What I do know is that the effect curve is much slower in onset and release, so bolusing for specific carbs is more difficult and you really have to plan ahead. And I’d be surprised if you didn’t need to make some basal adjustments.

One encouraging thing is that the original pumpers used it before the more rapid analogs came along, and there are some members here whose pumping experience goes back that far. I think @Terry4 is one, maybe he can weigh in.


#39

Hello, @motoracer and welcome to TuD! I started using an insulin pump in 1987. The only insulin formulations available back then for use in insulin pumps was Regular. Relion R is the same insulin. I used Regular insulin in pumps until 1996 when I started on Humalog, the first rapid acting analog insulin to debut.

As @DrBB said, you need to familiarize yourself with the onset, peak, and duration time of this insulin and take it into account when you decide on things like the optimal pre-bolus time for you.

The pre-bolus time is the amount of time between dosing and eating. If you eat too soon after dosing, your blood sugar is more apt to spike or go too high. This is especially important with the older insulins like R. Personal experimentation is your friend and can inform you about the best pre-bolus time for you.

Another thing to be aware of is the R will last longer than the newer insulins. Check the package insert for insulin duration and program that number into your pump. Your diabetes educator or doctor could help you with this, too. That way, your pump will know about the longer insulin duration and give you good correction recommendations.

Using Regular insulin such as Relion R in a pump is a viable way to treat diabetes. Good luck and I’d be happy to answer any more specific questions you might have.


#40

I definitely say go for it!! The omnipod is also one of the easier pumps to start, as you can stop and return it if you don’t want it anymore. You never know that you don’t like it or if pumping is not for you if you don’t give it a try.
In regards to the smaller body weight the omnipod is a bit bulky…I don’t have a lack of body fat and it sometimes is annoying for me because of its size. But what it lacks in discretion it makes up for by not having tubing. My omnipod is my 3rd pump and its by far my favorite, all because of no tubing!! I would be happy to answer any questions you may have about it!
Good luck!!