Push for the Pump


#1

The insulin pump evangelists drive me crazy.

My A1C is 7.0? Go on the pump. I had a low this morning? Go on the pump. My big toe hurts? Go on the pump. I’m being facetious, but the evangelists are baffled why anyone would be on injections when a pump will apparently solve any diabetes issues one might encounter.

I totally understand the reasons why people would want a pump. Not liking injections, variable basal requirements, inconsistent absorption of long-acting insulins such as NPH, etc. But what the evangelists should realize is that the pump is not the best choice for everyone and it should not be a knee-jerk recommendation for all people with diabetes.

There was a good overview of the pump versus MDI debate in a recent Diabetes Care editorial, which provided an estimate that 20% of Type 1 patients in the US were using a pump. In my opinion, the most interesting part of the discussion pertained to the A1C and which patients might benefit the most from a pump. “… the best improvement [in A1C] is seen in the worst-controlled subjects (who are the likely candidates for pump therapy), a fact that was obscured in previous trials of unselected, general type 1 diabetic patients without clinical problems. When, for example, the starting A1C is 10% on MDI, the fall in A1C on switching to CSII is likely to be 2% but, in a relatively well-controlled subject with an A1C of 7%, the difference in A1C could be <0.5%.”

I’m happy that you’re thrilled with your pump. Really. But can you back off a little? Plenty of diabetics have good control without one.


#2

I totally agree. I am a former pumper myself, and returned to MDI because the great improvements I was expecting failed to materialize, and I found it was more hassle than it was worth. BTW, I like the term “pump evangelists”!


#3

It can be really frustrating. When I used to teach Sunday School, one of the other teachers brought me pamphlets and videos about pumping every week. He had lost some of his vision and had other serious complications that he managed to reverse with the pump. But because he was so pushy, it all fell on deaf ears. Like all of the treatments (low carb, nph, lantus, lente, etc.) it works well for some people and not for others.

Thanks for the link to that article.


#4

Like everything in life: there’s not a “one size fits all” solution. I love my pump and will talk wonders about it, but I recognize that it may not the best solution for everyone.


#5

I think what you’re getting from pumpers is their enthusiasm. I know many of us can’t help but think of all the ways it’s made a difference in our lives - and we’re anxious to share about that.

Regarding the A1C information - my A1C hasn’t changed much since I started pumping (6.5-6.8 to 5.6-6.0) - but my flexibility has changed, and my ability to manage difficult situations has improved vastly. It’s sort of unfair to characterize that statistical data as evidence that a pump can’t help a well-controlled diabetic achieve better, or more sane control.

Pumping isn’t for everyone. That’s for sure. And I wouldn’t try to shove it down someone else’s throat - but give people a break - they’re just being enthusiastic about something that’s helped them.


#6

I agree with Nicole. I do not think the pump is for everyone in fact, my little sister told her friend “You have to get a pump, my brother loves it.” I told her not to say that. YES I love my pump but I do not think it is perfect and definatly not for everyone.

But I will say, when I find something I really like, I tell everyone about it. I think most people are like that. Sorry you have had some bad run in’s.


#7

I understand that there are many reasons to pump and I believe I mentioned those some of those in the original post. For me, the only compelling reason for me to change would be A1C. And, unfortunately, that is the main consideration for the insurers as well. (BTW Nicole, I think a 6.8 to a 5.6 is a vast improvement!) I have no problem with enthusiasm or simple recommendations but it’s the preachiness of some users.

I think some of that might be lack of understanding from longtime pumpers about the new-ish insulins like Lantus and Levemir. When I hear things like: “the pump meant i did not have to eat at certain times anymore” or “I am no longer on a schedule”–I think–huh? Who has to do that on MDI these days?

Molly–the low-carbers are a great analogy. I totally see the logic in low-carbing, I’m just unwilling to do it.


#8

And thanks, Scott–I’ll be copyrighting the term.


#9

As both George and I pointed out pumping is not for everyone. But keep in mind, Lara, that MDI is not the SAME for everyone. I took Lantus and Novolog - and still had to eat on a set schedule or land up low and I was taking at least six injections a day - Lantus split into two - plus eating and corrections. I should have qualified that my lower A1Cs with the pump are also achieved with fewer low bloodsugars - it’s just a much smoother, less regimented ride.

Again - you have to consider that for some people pumping really works - they’re just trying to share what they feel has worked for them. I think you need to lighten up about it, that’s all.


#10

Lara

You sound a little stressed out. Maybe if you went on the pump? :slight_smile:

Seriously, I think those of us who have used them find them much better than MDI (Multiple Daily injections). Before the pump I’d have way more than 6 injections on a bad day. Since then I’ve been able to achieve much better control with much less effort.

But you are right. They’re not for everyone.


#11

LMAO Bernard.


#12

I totally agree. It’s a personal choice, and who out there likes others foisting their opinions onto us? We have enough to deal with, and this is a highly personalized disease that we control in our own individual ways. I am a former pumper myself, and returned to MDI . I actually want to go back on the pump, but I certainly understand both sides.


#13

I got yer’ pump right here! Yeah, I’ve been asked multiple times if i want to go on the pump, but my A1c’s are 5.4. How much better control can I get?

Actually, it would probably make my life easier to try a pump, but I can’t stand the idea of having this thing attached to my body all day. I’m a fairly active person and living in the desert, I don’t keep clothes on much of the day in summer. But that’s another story.

So for me, MDI’s are just fine so long as I maintain by BS’s in a great range as I do. And besides, as Amylia says, it’s really a “highly personalized disease” that it’s up to you to control. No one else can do it for you. Not even your Doc’. MIne keeps trying to get me on some kind of cholesterol lowering drugs. Go figure.

andrew