I have always used the a pen and am now wondering about the pump. Can you control your T1D as well with a pen as opposed to a pump?
Thanks.
I have much better control with the pump. You are only using the fast acting insulin with the pump so it is much easier. I like the fact that there is only one injection every three days. You fill up your pump for what you are going to use for those three days. Do what you need to do to attach your pump to your body and away you go. I would look into it. I would also check out any and all pumps available to you in your country so you can get the pump that is most suited to your lifestyle.
What about the fact that something is always attached to you?
No comparison. The pump allows for much better control. The issue of having something attached to you is a necessary evil. That said, I have become very comfortable with infusing into my legs and wearing the pump on my lower leg (Edgepark has a leg band with attached pouch for the pump to sit in. It is very comfortable if you wear a sports band type thing under the leg band.)
Better control, why? I give my self (which I don't mind at all) 1 basal at night, 1 basal at lunch and then bolus every time I eat. Why do you say you get better control?
p.s. not at all being confrontational, I really want to know why.
How about you do not have to worry about attaching a needle to the pen, the alcohol wipe, no having to find a place to give yourself a shot. You just take your glucose level, push a few buttons on the pump and you are done. You switch out the infusion set and the reservoirs every three days.
You can have it attached to your belt like a cell phone. It is about the size of a small cell phone, you can put it in your pants pocket or if you are a female you can put it in a baby sock and stick it in your bra. That is if you have a tubed one. There are also non-tubed ones.
I would start with a conversation with your doctor and see if they are pro pumps. If your doctor is not pro pump you need to find a new doctor.
Let me see if I can give this a try. I have MUCH better control. I can prevent and handle lows much better. With long acting insulin in a pen, you give it and it is absorbed over a long period of time. You can not change that absorption once you have given it. It is the same amount for the whole time period you use it for (24 hrs or how ever often you take it). If you change your activity, or your insulin need decreases for some reason, you cannot get rid of that insulin. Your only choice is to "feed it". With a pump, if you increase your activity, you can decrease your basal rate or even turn the pump off. Also, you will be amazed to see that your body needs very different basal rates at different times of the day and even on different days of the week if your routine varies. I have 9 weekday basal rates and 7 weekend basal rates. My endo and I have tried to decrease that number, but every time I try, I need to add them back. You cannot fine tune basal rates like that with a pen. You can dose in really small amounts. Much smaller than a pen. If you want a snack, it is much easier to do it with the pump than giving yourself ANOTHER INJECTION today. You don't have to think about which ICR to use at which meal, or what correction factor for this time of day. The pump does it for you. Also, it always keeps track of insulin on board when you are dosing. You cannot do that, or at least as accurately with a pen. There probably is more, but that's all I can think of right now. Try it. I imagine it is not for everyone, but you may be amazed. Good luck.
In my experience, the pump allows for much better control than the pen. Here are my thoughts as to why:
1) Sheer convenience - One of my biggest struggles with the pen was not wanting to eat something even if I was a little hungry because I didn't want to give myself another shot. I have always been someone who snacks a lot throughout the day. With the pump, if you want to have anything at all, you just have to input the carbs into your pump and it calculates your insulin output. Before I would run high if I did indulge in something, and now I can manage for any food I eat, and to a much closer degree.
2) Corrections - Whenever there was a time that I maybe underestimated my carb intake, or didn't properly estimate my food on the glycemic index, I would end up with a higher than desired reading. Instead of doing (yet again) another shot, the pump allows for a quick correction bolus. This time you enter your BS reading (bonus if your pump is linked to your meter) and zero carbs, and a dose of insulin is calculated for you.
3) More precise units of insulin: I am not familiar with all pens, but on mine I could only do 1 or a 1/2 units, that was the only breakdown. On an insulin pump, you can breakdown into .025 units if desired.
4) Quick changes to basal rates/ability to set temp rates: Basal rates can be pre-set for any length of time, and can be changed at any time. For me, I have one basal for 12am-4am, one basal for 4am-8am, and one from 8am-12am. This is great because your pump does all the work for you. These rates can literally be adjusted at any time. Also, say you were doing some extra exercise one day, you can either suspend OR set a temporary basal rate that is lower for the course of your exercise. It is unbelievable how easy it to make adjustments.
An insulin pump really is the closest thing to having an artificial pancreas. There is still work involved, but my opinion is that it is a much better means of controlling T1D. It is wonderful to do one shot in three days than 9+ shots in three days. I was very doubtful at first because of the idea of having something attached to you almost constantly. I won't lie, that is the hardest adjustment. It took me a very long time to become OK with that part of the process. Most days though, it is no longer an issue. In the end, having the convenience of the pump is worth way more than the inconvenience of having the pump attached.
I hope this is helpful. I am honestly extremely happy that I ended up with the pump. Good luck in your decision!
Thanks so much for the info.
When I take a bolus, it take about bw 30-45 minutes for it to take effect. I know everybody is different, but how long does it take for it to be efective?
I use humalog, which I believe starts working in about 15 minutes. I generally try to take it about 15 minutes prior to eating. There are times that I take it right before eating (maybe 5 mins before) and it still works well.
That's the other thing good about the pump - it's all one type of insulin, just used in different rates. I used to do humalog pens for boluses and levemir pens for basals. Now I just use humalog in my pump, and it puts out an amount of insulin per hour for the basal rate.
Well, let me weigh in with a slightly different perspective. I'm coming up on my first year on the pump after 10 years on lantus/novolog, and before that about 20 years (hard to believe it) on the old R/NPH regime. Being liberated from the old Eat Now Or Die schedule so many of us had to live with was life-changing. The pump… not quite so much.
There's a lot of pump enthusiasm around here, and my experience has been on balance positive, but being aware of some of the negatives ahead of time may help avert some frustration:
>Be prepared to spend more time, not less, focusing on your diabetes. Carb counting always seemed pretty straightforward when I was on the pen, but it's taken me a lot longer to get a handle on all the variables with the pump. You'll be doing a lot more testing and seeing the effects of things like the effects of fat in your diet, metabolic rhythms throughout the day, bubbles in the reservoir, inflammation at the insertion point, etc.
>Time frame: don't expect to have it all dialed in and predictable by the end of your first week. Expect several weeks at least, and really it's kind of inherent in the technology that you're always going to be tweaking at it. At 10 months I feel like I'm getting about where I want to be, which is good, but my expectations going into this didn't prepare me for that.
>"What about the fact that something is always attached to you?" Honestly? It's kind of annoying, sometimes more than others. I've caught the tube on door handles, I've accidentally yanked it out more than a few times because some insertion points are more vulnerable than others to sudden motions of clothes and so on. Happened to me this morning as a matter of fact--caught the patch on my jeans getting dressed and had to spend an extra ten minutes before work getting another one hooked up and pasted on. There are tubeless pumps now if this kind of thing drives you nuts.
>Bubbles in the reservoir: tap-tap-tap-tapping to get the bubbles out of the syringe was a bad memory from my R/NPH days, one I was glad to give up with the pen, but now it's back with the pump reservoir. Arrrgh. And no matter how diligently I go at it, I STILL get voids in the tube fairly often.
>my A1c actually went UP .5 on my first exam after 6 months on the pump (to 6.5). I think it's better now--about to have my next endo appt next week.
NONE of this goes against the advantages people are talking about here. It does give you much finer control, it allows you to program for your personal metabolic irregularities (I have a really hard time with "dawn phenomenon" and it's helping with that). But in general the whole presentation from my specialist and from the manufacturer reps and trainers was all smiley-face, and I think I would have experienced less aggravation at the beginning if I'd had a more realistic set of expectations around it.
Thanks so much for all the info and being straight forward. I will speak to my endo next time and see what he has to say
I've never used a pen, and have been pumping for over 4.5 years after over 25 years and 25,000 multiple daily injections. I echo the positives everyone has said on here, but I would also like to offer some negatives that I have experienced.
I used to check my blood glucose 4 times a day, now it is 9 or even more. Not necessarily a negative (it goes with the territory,) but it is an example of the fact that there really is a lot more work involved with a pump.
In terms of exercising, which I believe is essential to good control, a pump can be somewhat of a "double edged sword"- for example the convenience of adjustable basal rates can be contrasted with the inconvenience of infusion sets coming disconnected due to sweating, occasionally forgetting to switch back to the regular basal rate, and how exactly do you play contact sports?
Point being that the variability of user error is potentially much higher in my opinion with an insulin pump. Which goes back to the fact that it is a lot more work.
And forget about saying goodbye to syringes- sometimes your cartridge of insulin runs out at a really inconvenient time, say 3:30 AM or right in the middle of an important meeting or event. You always have to carry backup sets, etc. Or like me, a couple syringes and a vial, and voila! Its back to injections again. Also when a cartridge is low or an infusion site is nearing the end of its recommended 3 day life, a correction bolus does not always work, and again its back to injections. Also the pump system wastes a lot of insulin- there are over 15 units in each tube, the cartridge never fully empties, and in filling cartridges, there is a little bit of insulin at the bottom of the vial that ends up being saved for emergency or back up injections, or being thrown out. Did I mention- I HATE WASTE? lol... but seriously I really do. There is a ridculous amount of packaging and plastic in the latest infusion sets- so much so and the fact that they dont really work for me (they never inserted the cannula properly) I switched to manually insertable infusion sets. Talk about LONG NEEDLES! :D And when you consider the price of insulin, I mean "liquid gold"- what used to be 20 dollars is ten times as much... And the overall cost can be near 15 to 20 thousand dollars per year on insulin pump treatment.
Also intimacy is negatively affected while wearing a pump. It can get in the way, and disconnecting is not always a convenient, safe or advisable option for me anyway. Being tethered to something can get in the way of a lot of other activities too, and sometimes I miss the "freedom" of MDI. I do not miss the unpredictable hypoglycemia during sleep, wild mood swings, insulin shock and seizures due to my difficulties with various long acting insulins.
But, better glucose control IS better in the long run, although honestly, for me, I would like to know if Insulin Analogs of Recombinant DNA origin are really that much better than natural beef and pork insulin. We are no longer able to purchase natural insulin in the USA. Can you where you live?
Pardon me for straying off topic, if however slightly but I do often wonder if it is ok to be pumping or injecting creosote or creosole or whatever it is into my body...
In any case, to me, overall the technology of the pump is a mixed blessing with mostly favorable results. However, I do take issue with the lack of hypoglycemic or for that matter hyper glycemic awareness, and the overall cost of the treatment of the disease as it relates to insulin pump therapy.
It is truly the Cadillac plan (if I were so presumptuous,) but at last, I am forced to be- living in a country where Health Care is a product and not a human right.
That does bother some people, and they end up going back to MDI.
I would say, though, that the anticipatory "that'll bug me constantly" concern prior to trying it out is way overblown for the vast majority of people.
In my case, I was quite skeptical. I tend to be a little OCD (not in the clinical pathology sense, in the social meme sense), and was sure it would bug me. Especially the omnipod.
Got a sample dead pod from Insulet to try out, and forgot it was even on the back of my arm within a few hours. I've been pumping with the pod now since July, and haven't looked back.
It changed my life.
Many reasons. Here are a few:
- More frequent corrections. I can (and sometimes do) give myself as many as 5 or more corrections in a day, in addition to the meal and snack boluses. I'd be injecting 10+ times a day like that, and it just isn't practical.
- Flexible basal control. Basal rates can be programmed for varying profiles through the day, to head off regular times when BG goes up because the liver is misbehaving (common for most pumpers is early morning increase to head off Dawn Phenom). Also, pumps support programming different basal profiles that can be activated under different conditions, like illness, menstruation, high stress, etc.
- Convenience... can bolus anywhere, any time. You'll dose yourself to correct minor hyperglycemia because you easily can, when with shots you most likely would just let it go because it's not practical to give yourself a shot. I've glanced at my CGM and bolused a correction while walking down the street. More times than I can count.
- Much more accurate stacking management. Because the pump takes care of all my insulin accounting, I don't even think or worry about stacking. If my BG's higher than it should be, I let the pump decide if I should have some gojuice.
- Because of the above and other advantages, pumps truly facilitate having lower targets, and hitting them more often, with much less risk of hypoglycemia. I target 85, with my "stay-in" range 70-140. I also have a CGM. It was much harder to stay in that range when I was doing MDI. I just couldn't practically take the number of shots each day necessary to do it.