I recently started pumping for the first time. I figured writing about my experience might help others navigating the process, plus provide a nice opportunity for me to reflect on it, too.
A little background on me, this may be of interest to some, but others may prefer to skim over. I was diagnosed a dozen years ago, with late, slow-onset (long, drawn-out honeymoon) Type 1. I was briefly on a sulfonylurea, within a few months began basal insulin (Lantus) and within a year began bolus insulin (initially Humalog, later Novolog). My body has always coped with my diabetes well, I think I was diagnosed with an A1c of 5.6, it’s gradually crept upwards and these days fluctuates between 5.8 and 6.2. My fasting at diagnosis was actually at the high-end of pre-diabetic, (low 120s mg/dl, and my oral glucose tolerance was a solidly diabetic mid-200s, I’ve always had poor phase 1 post-prandial response, i.e. my blood sugars spike quickly after eating, but then my body brings them back to manageable levels within a few hours with solid phase 2 insulin release.
I’ve been using 12 units/day of Lantus, I used to split my doses and use a little more, but I found that going back to once-a-day served me better, and 0.5-12 units of bolus insulin per meal, though on the lower end of that, I had the kiddie version of the pen that let me do half-unit dosing because I’m pretty sensitive to insulin. When doing really intense exercise, like alpine climbing or trekking, I found I actually had to get off basal insulin entirely and only use bolus insulin selectively in the evenings, my body still makes enough insulin to provide sufficient basal coverage when I’m exercising intensely.
As for a meter, I’ve been a bit fan of various iterations of the Therasense Freestyle, though customer service isn’t quite what it was now that Abbott bought it out. Tiny blood sample (which translates into shallower finger pricking), ability to top up the sample if more is needed, small form factor so the whole thing stashes in my pocket nicely. My impression is accuracy is good but maybe not class-leading.
I held off on getting a pump for a long time. My control with multiple daily injections was good, and I preferred injections to being tethered to a device. I knew I’d go on a pump eventually, but I thought I might hold off until I was in a more serious long-term relationship, preferred injections over tethering while dating. The biggest factor that pushed me to finally take the plunge on the pump was fighting my basal insulin during athletic activity, while on runs or road bike rides or swimming. I’ve been consuming a lot of glucose tabs.
Initially I was pretty sure I’d get the OmniPod, the lack of infusion-set tubing was pretty appealing. But I came to realize there were some real downsides to it, at least for me. The pod is a lot bulkier than an infusion set, and unlike a pump it can’t be taken off and left behind during athletic activity or repositioned for comfort or function-related reasons. The bulky pod means that the adhesive has to be a lot more robust so it irritates the skin a lot more—seeing an OmniPod user at the pool, with his prior site visible and pretty irritated, really brought that home for me.
I really liked what I read about the new Tandem t:slim, both the whiz-bang aspect of it and the underlying functionality. Someone put it nicely, this device feels like a 21st century insulin pump. Having had it for a week now, I’m exceptionally happy with my choice. Of course there are things I’d tweak, but I’m really impressed with what the Tandem team has managed to produce, and the customer service is superb, I can’t say enough positive things about my rep.
As for infusion sets, so far I’ve tried the Inset 90-degree and the Comfort angled set. The Inset creates a tad more deeper discomfort because I’m pretty lean, but irritates the skin a lot less where the cannula enters the skin at a right angle. I thought I was going to prefer the Comfort, and it create less deeper discomfort as expected, but it irritates the skin a lot where the angled cannula enters the skin, leaving more of a mark/scar, and the adhesive seems to irritate my skin more in general. I’m going to try a few more infusion sets, I’m curious to try steel ones and just see what else is out there, but I’m pretty happy with the Inset for now.
I should also get a Dexcom G4 once my doctor’s office manages to file the proper paperwork. I previously had a Seven+, and I found it a bit too beta—too many “???” and inaccuracies, especially during exercise, which is when I needed it most. The G4, especially with the new algorithm, seems meaningfully improved, though I’m keeping my expectations in check. Regardless it’ll be a fantastic tool to fine-tune my pump settings.
So that’s where I’m at for now. Happy to engage on issues in which others might be interested and I’ll add some thoughts over time also.