Pumping and outdoor activities

Hello all -

My Endo is wanting to get me on a pump now (only recently diagnosed) and while I've heard a TON of good things about pumping and a handful of cons I haven't seen anything on my main concerns. My worries/issues/questions about pumping are -

1. I'm really active and workout a lot, usually for 1.5 - 2 hrs at a time. Do you wear the pump working out? Does it actually stay hooked on while running/lifting etc?

2. I also do a lot of outdoor activities - hiking, backpacking, canyoneering, climbing - and when I go out on trips I generally go for three or more days. MDI is a "failsafe" manual system that batteries can't die on etc. Does anyone else backpack etc on the pump in the wilderness (no towns for 50+ miles)? What equipment do you need to bring etc?

3. I'm really fricking skinny. Even with 1/2" needles and pinching hard I regularly hit muscle. Is this an issue with the infusion sites? Is it difficult to set up/insert on a skinny guy?

4. I tend to wiggle in my sleep (thrash might be a better word). Anyone have the same issue? My worry is I'd wake up in the middle of the night, tubing ripped out and a bloody, insulin infused mess everywhere....

Any help with these specific issues would be great. Everything I've read has people loving their pumps but I know there have to be bad things and I don't want to go on one just to switch back three months later.

1) I have a MM 722 it stays on working out. The only time one fell out, it was summer, I was teaching a Tae Kwon Do class and an infusion set fell out, which was annoying. I switched to the Silhouette needles and think that they stick on better than the regular ones? We had some classes where we'd work out for an hour and then do 3x 5 min rounds of sparring and I never lost a Silhouette, although I would sweat off 4 or 5 lbs.

2) I don't backpack. Mine has never blown up although I had a freaky battery meltdown (2 bars to dead) on the way to the Bears vs. Eagles game and had to replace the battery. I usually am pretty slack and figure it will work. On vacation, I bring a whole bunch of extra infusion sets, CGM sensors, etc. just in case but I have not had that many problems with reliability of the MM stuff. I stick it in and it does what it does. I think there were a few days where sensors were off and one strange pump thing, where I ordered breakfast, bolused and it crapped out after like .7U so I had to bolus about 10x (it kept track of IOB but wouldn't pump > .7U?) That was 2 years ago and it has worked great ever since then. It's also survived several bike wipeouts, one of which was a faceplant that busted up a couple of teeth. The first thing I checked was the pump. Then I looked for the bits of teeth.

3) I have used the MM Silhouette needles, that go in at an angle, pretty much exclusively. I've ripped them out like once or twice, when the pump was on my lap, b/c I was admiring my CGM or something, and forgot to clip it before I stood up. The pump hits the ground, the set gets yanked out (although not always...) and the pump is fine.

4) I've never ripped one out at night. Clipped to pajama pants waistband

Hi, Suf, I can't answer all your concerns, but if you're going to do multi-day trips into nature, you ALWAYS take syringes and extra insulin as a precaution. Wouldn't hurt to bring an extra meter and meter and pump batteries as well. Also bring more infusion sets and reservoirs than you think you'll need. Since you can get very dirty in the backcountry, alcohol swabs and hand sanitizer are a good idea, too. Infusion sets can and do come out at unexpected times. Sometimes a site is just bad. So if you're prepared with extra sets AND syringes, you shouldn't come to grief!

I toss and turn in bed, and have never had a set come out due to that (but have, due to other reasons), but I HAVE had one of my cats chew through the tubing, not once, not twice, but THREE times, LOL! When you take the infusion set out, it doesn't usually bleed, but every once in a while there will be a gusher, which will take you completely by surprise, with blood flowing or spraying copiously. Gushers are easy to stop by putting pressure on them.

I'll let other people answer your other concerns. I do hope you make a good decision about the pump -- most pumpers love them, but I do know a few that hated them. Good luck!

Since backup MDI equipment is brought along, its it possible to switch to MDI for a short period (few days to a week) then switch back? I.E. go off the pump entirely and upon returning home go back on.

Sure, if that’s what you want to do. I went on 2 different 7-day trips with my pump and had no problems. If you’re doing more exercise than usual, you can back off a pump basal, but if you’ve taken a long-acting insulin, you have no choice but to eat more snacks. Depends on what you want to do. You have to check your BG often, regardless.

1) YES. Contrary to how it seems, the pump is IDEAL for athletes. I never would have believed it but it's true! I don't do much lifting, but I run a lot and never unhook. In fact, disconnecting for more than an hour is inadvisable because without some basal insulin your bg can skyrocket.

2) I think the pump is ideal for these activities, but get a good harness. In cold weather, just make sure the tubing is kept tucked into your protective clothing. I always keep humalog and syringes in my meter case and bring Lantus for any trip > 24 hours. It doesn't matter whether you're climbing a mountain or going to the movies, you don't want to have to turn around. You can have a pump failure at any moment and you need to be prepared for it no matter where you go.

3) I'm thin, but not skinny. I use the 6mm (~1/4 in) quicksets from MM and they work perfectly, I just insert them where I have the most fat. They sell other sets for skinnier people.

4) I am also very active in my sleep and have yet to tear one out while tossing and turning. In 6 years (knock on wood) I have only accidentally torn them out when changing my clothing. The quicksets adhere very well and the tubing is quite strong.

I am also active, not insane, but outside a lot. I do suggest you really research the pumps. I chose the MiniMed, thinking the combined pump/CGMS was the ticket. Then I decided to spend the summer at the waterpark. Also getting caught on a hike when that sudden rain storm blows up. So I have to carry/wear the Aquapac when I want to be wet or to be safe. (Eventually plan on switching to Animus pump, less worry about water!) Oh, and the whole posting about MM failure related to sweat/body heat now too is something to think about.

I am not a bed tosser, but have snagged or dropped the pump and ripped out tubing. And sweated off a couple of sites. So I learned to tape the tubing to my skin just above the insertion site, solved dropping the pump ripping out site. And I have learned about Skin Tac and Mastisol, which just about superglues the site on, even when in the waterpark from 10 am to 8 pm 3 days in a row.

I tried to unhook when I wanted to play in water, pain - constantly checking sugars, calculating how much basal lost, figuring out how much to bolus, trying to not swing to low and always spiking high no matter what. So I just stay hooked up all the time now.

And no matter where I go, I always take the "medicine chest" (pump supplies) and the "pantry" (treatment for lows) along, so no change there from when I was MDI to pumping.

I resisted the change, but it is SO MUCH EASIER to pump than having to deal with MDI's, I wouldn't change it for the world.

Like others have said pumping is perfect for activities. I can't hike anymore (bad ankle) but do lift weights and sweat buckets when I work out. Sites stay on.

One advantage of a tubed pump is that you have multiple infusion sets to chose from. Angled sets tend to work well for skinny people as you can control how deep to insert. There's also short cannulas and longer ones so you should be able to find one that works.

On vacation I take more supplies than I think I'll need. My backup is usually a syringe. I can actually pull insulin from the reservoir in a pinch and for <24 hours off the pump I'd rather take Novolog shots around the clock rather than mess with Lantus/Levemir. You could always go back to shots if you wanted to for backpacking but realize that you'd be starting over in terms of getting the dosages right.

If you frequently participate in sports near water I would consider Animas or Omnipod as they are approved for use near and in water and Minimed is not. Minimed will replace a pump damaged by accidental immersion in water though. For some water sports I would find a way to secure the pump under my bathing suit or life jacket though. I wouldn't want a $6,000 pump to end up in the bottom of a river or lake. If I didn't feel like the pump was secure enough I would disconnect and go on shots rather than risk losing it.

I also toss and turn a lot at night. Pump just rolls around in bed with me not a problem. I rarely have sites accidentally pull out but when they do there's rarely any mess. The sites are subQ just like shots. I have actually found fewer gushers with pumping than I did on shots because you're using fewer sites. The volume of insulin is small even if you're taking large doses of insulin so no mess. Actually sometimes the only sign of a bad site is a high blood sugar...

Hi there,

My 10 year old daughter has been using the pump for a year and a half.

1. The only time we've unhooked our active daughter is for swimming. She can happily rock climb, cycle or hike/ski all day and keep connected. We use skintac when putting in the infusion sets and they have not ripped out yet.

2. We do lots of outdoor activities that include being away from home for days at a time. I bring extra infusion sets/tubing/cartridges and back up insulin in the form of Lantus/Novorapid just in case. Haven't had a pump failure yet, knock on wood.

3. The 6mm infusion sets work well for our thin daughter but the 9mms are too long. You can experiment with different sets to find what's best for you. Call manufacturers and ask for samples.

4. Worried about the same but so far no problems She clips pump to pajama bottoms but a friend let's his pump fly solo in bed without any problems.

Hope this info is helpful.

Best of luck.