Pump!

Type 1 and LADA
1

So I have been type 1 for three months and on Insulin for just over 1 month. I've decided to start looking at pumps as I am a very active college student and trying to keep track of my pens and such is getting frustrating.
I'm really interested in the MiniMed Paradigm Revel Insulin Pump. HAs anyone out there used it? I've noticed that people have mentioned having a 502 or a 507, what do the numbers mean? Also has anyone used the Continuous Glucose Monitoring feature? That is definitely interesting to me but I am wondering it's real world use. Finally, Any recommended waterproof cases? And what is the procedure for showering?

Any advice, odd facts, or opinions would be great!!
Katie

2

502 and 507 are older models. The "vintage" I have has 522 and 722, w/ the 722 being bigger and holding more insulin. The Revel is 523/ 723, again with the 723 holding more juice. I find that the reservoirs are good for about 3 days, maybe 4. I've had them for 5 but the numbers get a bit more crazy after 3 days. So you figure your TDDx3 is about what size pump you need? If you are close, get the bigger one. I'm concerned that since I started on the bigger one (722...), I will be "stuck" with it when I "upgrade"? I'd rather have a smaller one.

CGM is *extremely* useful. It can be a bit finicky but still tests your BG every 5 minutes and will give you a nice head start at heading "bad guys" off at the pass. I like mine a lot. A lot of people suggest Dexcom> Minimed but the one gizmo utility of the Minimed units is very useful to me. I got my pump in April 2008, transitioning from R/NPH to the pump. My A1C was 5.8 each time with the pump. In April 2010, I got a CGM and it's been less than 5.8 ever since, one 5.6 (marathon, surgery?), a few 5.4s, a 5.0, currently 5.3 so I think I've improved my control with it?

For showering, I bolus a small amount of insulin, about what would "cover" 20 minutes or so (which might be a bit more than I need, what the hell, it's breakfast time, DP deserves no mercy...), like .3U and disconnect the pump, clipping it to MrsAcidRock's "hair towel" so it's handy and the CGM stays in range while I'm showering.

3

Are you worried about the site getting wet and the adhesive losing it's strength? I have that same concern with swimming, but I'm wondering about the effects of soap and such.

I am really excited to start my pump. I've heard it can take six weeks to get the pump is that true? Should I start with contacting the company or let my endo prescribe it? I'm glad that the GCM works so well, do you completely detach it when showering or does it stay attached?

4

Hi K ~

I am happy to post an answer to your question. Welcome (I think) to the world of diabetes. It is a lifestyle that is unique and is, and always will be, a very unique part of you.

Now, on to the pump. For me, going to a pump was life-changing. I live an active life as well, and pens were not always convenient to use, My A1-c was high and my kidneys were showing signs of wear.

I chose an Animas Ping pump. I believe the Animas is the only pump that is advertised to be totally water proof. I don't know of a waterproof case that is available for any pump. With a tubed pump, you can take it off to shower, swim, for intimacy, etc. In doing so, you will need to learn what your body does to itself without insulin, such as highs. Usually, it is not recommended that you are not off the pump for over an hour. I don't swim, but I have a friend who also has an Animas pump who regularly swims and tubes down a river with her pump in place. As for the infusion set, when the pump is disconnected, there is a cap that goes on the infusion set for protection, It is easy to put on and take off. Animas uses the Dexcom Continuous Clucose Monitor and I understand that is is very good, although I don't use one, so I can't comment on its effectiveness.

As far as I know, the MiniMed is only water resistant. The MiniMed infusion sets also have a removable lock on them and a cover for shower or swimming. MiniMed uses their own integrated CGM, and I am sorry; I don't know anything about it. I believe the numbers you ask about are pump model numbers, and are no longer made.

I liked the Animas because of its communication with the meter, its fail-safe operation, its colour screen and its computer software. Their customer service, for me, is second to none.

Best of luck in your decision, both to pump and in your choice of pumps.

Keep in touch, let us know how you are doing.

Sometimes, it is good to be diabetic! Be well.

Brian Wittman

5

I have the Minimed Paradigm Revel 523 pump. I love mine, it is very easy to use and is really user friendly I think. I use the Quickset infusion sets and after a tricky first day or two I haven't had anymore problems at all. I have had no problems with soap losening up my infusion site at all. It stays on pretty good.

I had been talking about it to my Endo but it was always we'll talk more about it next visit. I mean really you are lucky you get 15 minutes with your Dr these days lol. So I contacted Medtronic directly and let them contact my Dr's office and Insurance, I got mine in about a weeks time. Let the pump company do all the work, thats what those people get paid for and they really know how to make the process go a lot smoother.

The CGM stays attached to you while you shower. The only think you have to detach is just the pump itself, and that all comes apart at the infusion site. I love my pump. I've been diabetic for nearly 30 years and I wish I had done it MUCH sooner. My last A1C on my pump was 5.5.

6

I never worry about the site getting wet as long as the plug is inserted in the infusion set. I have never has an infusion site come out because of water or soap, and I like a very hot shower. I did tear out an infusion site once, while moving a church organ console. (I hooked it on an edge) there are skin preps that can be used if infusion sets don't regularly adhere and different kinds of infusion sets for different applications. Your CDE will work with you in finding the right one for your lifestyle.

What I did when the endo and I finally decided on a pump is that I filled out the paperwork for the pump I wanted after meeting with a CDE. the CDE sent it in to the company and they took it from there. There were certain guidelines that I had to meet before my insurance company would approve its procurement. Pumps can be had in two weeks, or in my case, it took a year.

7

Nope - I have never lost a site in the shower or while swimming. I always disconenct for showering, and for swimming as well - I usually tank my BG while swimming.

Your endo will need to fill otu paperwork for the pump "prescription." You can contact MM to start the process, but IMO it is wise to let your endo know of your intention so that the paperwork can be filled out and the process streamlined. From paperwork to pump, it was about 2 weeks for me.

8

Ok, I'll be the drip at this party. I know that a pump seems like a great idea and all, but it also involves a lot more diligence to properly use. And if you think keeping track of pens is difficult, well there is a lot more logistics. To properly use a pump, you really need to test at least 8-10 times a day, you need to accurately count your carbs and you have to press all those buttons at the right time. Having only been on insulin for a month, you are still pretty much a newbie. Before getting a pump, I would really recommend you buy the book "Pumping Insulin" by Walsh.

I'd encourage you to learn a bit more about intensive insulin therapy, establish good patterns for testing, carb counting and insulin dosing. And then move to a pump. While you might think that you can run around campus with just a little pump on your belt, you will likely still have to carry all the stuff you had before, plus even more.

That being said, everything everyone here says is true, a pump really can improve your blood sugar control and give you certain freedoms. But being unburdened by the logistics of diabetes is not really one of the features.

9

I'd say that to use MDI you would also need to test 8-10x/ day, I am more fond of "lobbying" for at least 12, w/ flurries up to 15 due to the situational nature of diabetes. This should be covered and readily accessible. It should not be *mandatory* and no PWD should be subject to penalties for not having tested but they need to be there. I sort of get what you're saying BSC however in my experience, despite 24 years of shooting R/ NPH, I was basically a "newbie" (sans honeymoon, of course...) when I got my pump and it was like a switch went on and stuff made sense almost immediately.

The delivery of pumped basal was so much smoother for me that it was amazing. People (MrsAcidRock, TKD instructors...) commented almost immediately "you look a lot better..." because I wasn't "chasing the dragon" as much. Admittedly, a lot of people are A LOT better at MDI than I was and the notion of counting carbs precisely was alien to me until I got my pump but I think that the basal "fix" was a big help?

10

Hi Katie-My experiences with my pump have also been very different than bsc's. I went in for my regular check up on a Wednesday (suspecting that something was amiss since I was eating about 3X my usual amount of calories/day and rapidly losing weight), got my Type 1 diagnosis on Thursday, and a call from a pump rep, at my MD's request, on Friday. I knew very little about Type 1 diabetes, and next to nothing about insulin pumps, but decided to try it. My pump was available in 4 weeks, but because of logistics (out of town trips which had been planned for months, taking my son out of state to college, etc.), I did not begin pumping until about 8 weeks after diagnosis. I was still somewhat honeymooning, so the small continuous doses went a long way to decreasing the number of unexpected lows I experienced during my short stint with MDI. I was diagnosed in 2008, so I was already carb counting on MDI. Being able to bolus in smaller increments made a big difference in my meal time control. It did take some time to get used to the tubing. I use the Minimed pump with Silhouette infusion sets. I am meeting with the rep tomorrrow about getting a CGM and Revel pump since I am at the end of my warranty. I have met several people who use the Animas Ping or Omnipod and Dexcom and they are also very happy. Those systems are not yet integrated. I've had excellent customer service from Medtronic, and the systems are integrated, so I have decided to stick with Medtronic. The case is not waterproof and I disconnect to swim, but if I didn't I would have to suspend my pump anyway, as I always go low with any exertion in the water. I hope this makes sense. Best of luck!

11

*disclaimer*, I got my pump in 2008 too, I just didn't pay attention to diabetes too much from 1984-2008? BSC doesn't actually have a pump, although he has one of the more intriguing cases, dxing himself in the face of resistance from his doc so I am always inclined to pay attention to him?

I agree about the customer service. Mine has been excellent all along! My pump failed on the Saturday of 4th of July weekend and, while I was *freaking*, things worked out ok and I had a new pump right after the holiday. The way that worked out makes me sort of dismiss the concerns about mechanical failure. I'm not a "camper" or "outdoorsy" so I'm not ever > maybe a couple of miles from a drugstore if it blows up.

12

And I am sorry I didn't provide further context. I am not only a drip, but an interloper. I'm a T2 and I don't even have a pump, but as many of you know, I have a wealth of opinions.

And I guess I would be of the opinion that unless you have a CGM, to properly use a pump, you really need to test at least 8-10x/day. So you still need to carry around your meter. And while Acidrock is a true swag artist, most of us have to worry more about the details. I am really a fan of the fundamentals. If you have the fundamentals right, you can do a lot better.

And I do think pump basal can not only be smoother, it can be better matched to your needs. AcidRock exercises, you can adjust your basal, not something you can do on MDI. And I suffer from a wicked case of Darn Phenomenon, it is very hard for me to handle with MDI. Many people find that the more accurate and measured delivery of insulin with a pump reduces their total daily dose, they lose weight and their control improves. All big wins. But it is not automagic and effective use of a pump is often more work than MDI.

13

I agree with Acidrock, in that everything makes sense with the pump. That is exactly my experience here. I think it is important to know how to manage diabetes with MDI (shots), but I believe it is much, much easier to manage with the pump. Counting carbs, watching food intake, thinking about foods to eat and not eat, etc. Fact: Acidrock may look better (no harm intended, Acidrock,) but I feel much better after beginning to use the pump. I am sure he does too. I find that I use less insulin as well. I know there are those who function very well with MDI and that's fine. If you want a pump, I urge you to pick one, try one and do whatever you can to make it work. Yes, it takes maintenance. So does MDI. It takes testing. So does MDI. It takes paying attention to things and being careful with choices. So does MDI. There are trade-offs, but IMHO, the pump is worth the effort.

14

Wow! I really appreciate your advice guys! Bsc you’re not being a drip :slight_smile: I’ve brought my a1c dowm from 10 to 6.5 through diet and insulin alone. My mom is a LADA diabetic do ive grown up with the carb counting and insulin control You’ll have to forgive me for sounding like an over excited child, I have done a lot of research about the pump and the supplies with it and i know its about the same amount of supplies, but it decreases my needle anxiety and increased the effectivness of my basal/bolus.

15

I currently use a MM732/CGMS.

With a pump, CGMS, and some exercise I have been able to maintain close to normal A1C's
for the last 4 years. I injected insulin for 20 years and was unable to keep my A1C under 7.0 but as soon as I switched to a pump my A1C dropped to 6.0 and it's now typically between 5.0 and 5.6. I still use my initial pump settings they have never been changed..But I do turn my basal up and down for activity and illness.

If you can get a pump and it's not a huge financial burden, get one it's simply the gold standard for insulin therapy.