Should I or shouldn’t I get a pump

Diabetes Technology
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As many of you probably know, I have been a type 1 diabetic for 61 yrs. For the past almost 20 yrs, my A1c has been between 4.6 to 5.4. I had one 5.9 during this time. Now that TIR seems to be what is looked at for good control, I am wondering if I would do a bit better on a pump. I started using a G5 last year. I have mixed feelings about it, as it often is more than 20% off. I don’t like it when it is that much off. I will start using the G6 soon and may be happier with it.

My biggest problem with the CGM is the fact that it interrupts my sleep too much. If an alert alarm goes off, I can’t get back to sleep. I have trouble sleeping anyway, so being awoken by the device is really bad for me. I always wake up naturally if my glucose level drops too low. The only place I don’t have to worry about rolling on it is if I place it around my navel. It works well there.

I have never minded giving a lot of shots, I have given myself over 100,000 and I don’t mind testing many times a day. My skin has absolutely no scaring or poor tissue.

I can’t figure out where I would wear a pump. Being very small 5’1” 105 lbs, I just don’t have a lot of body space. With my sleeping problems I can’t imagine wearing something on my arm, or wearing two devices.

When my sensor died this week, I removed my CGM and I feel like I am getting a glorious reprieve. I sleep better, and I feel free. Yes, I have to test a lot, but I have almost always had to test a lot. I stay in range quite a bit, but a low under 60 or a high over 160 will slip in once in awhile whether I wear my CGM or not.

Maybe I should wait to get a pump until the device is combined with a CGM? The implanted device sounds good, but I don’t want to have them dug out of my body.

I don’t use a lot of insulin, about 19 to 25 total units. I exercise at least an hr a day, and I eat about the same amount of carbs for my 3 meals each day. I am very strict. I followed a very low carb diet for 11 yrs, and now the Mastering Diabetes low fat vegan diet for 4 yrs. I can usually predict what my levels are, but have times when everything goes wacky.

As I reach the age of 70, I am wondering if a pump would do some of the work for me, but I just don’t know if I could tolerate wearing one. I know very little about pumps.
When I do read a post concerning pumps, I usually don’t really understand what you guys are talking about. I haven’t taken the trouble to educate myself yet.

Any comments? Thank-you.

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I’m not sure a pump would increase your control since it’s already so tight, but it might take some of the work out of it for you. I’m getting a tandem pump soon and that’s my hope for it! I’m already in range most of the time without a pump, I’m just hoping I can start dedicating some brain space to things other than diabetes with the help of a pump. Time will tell! I will try to report back once I’m up and running.

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What model do you suspect that you are open to?

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A looping system I assume, but like I said, I know nothing about pumps. It would have to be small.

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In your situation, I think the pump will be more work then what you’re doing now, and could see your A1C go up. Technically there are more steps/time required to refill every 3-4 days, change infusion sets, times infusion set doesn’t absorb well, etc.

Reasons a pump may be better is to handle odd basal requirements where Lantus, Levemir, Tresiba etc don’t meet your needs. The pump is great then for custom delivery daily to adapt on the fly, with short acting insulin in pump vs Injected long acting insulins can’t match that.

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I sighed rather loudly tonight, when my alarm sounded that it was time to change my pump. I no sooner acknowledged, yes, I know it’s time, pressing the button to stop the alarm and I put it back in my bag. Another minute went by and again the alarm sounded and my husband looked at me and I looked at my bag … lol. It was another alarm telling me I had 10 units left, I had better change my pod soon.

I can’t explain why I get frustrated when it’s time to change my pod, it’s a fact of life, every three days, 72 plus 8 hours, I need to change it. Still when the time comes, I sigh.

You’re right @MM1 I’m very happy with it for basal needs!

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I agree, I do, too. I always worry about insulin resistance with a new pod. :frowning:

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I got a tandem with g6.
My pump never alarms at night because the system makes adjustments on the fly. I stay pretty much at 95 all night.
I used to have a severe dawn phenomenon, and my pump would alarm twice once when I go high and after it recovers and goes low.
My tandem has eliminated it completely.
However you will not get a lower a1c likely.
With standard settings I got 5.8. My lowest ever.
With tweaked settings my gmi - calculated estimated a1c I’d reading 5.5 and since I know the real reading will be lower, I’m looking at 5.0.
That is with the settings tweaked though. I set my sensitivity low so I can go a little lower.
I also run sleep mode all the time because it gives me tighter control.
If you are under 5, they you are out performing a pump, however it’s nice to let the pump and algorithm take over a lot of the work.
I don’t worry going to bed at 70 because I know it will be handled. I never would do that before I had my new pump.

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@Marilyn6;

I love my G6 and I love my t:slim pump with C-IQ and it has been a game changer for me … but in my mere 48 years as a T1D, I have NEVER come close to the HIGHEST A1C that you quote.

I vote “no” on the pump in your case. What is it going to gain you?

What are the downsides: a lot of gadget fussing and tinkering. More time on the phone getting infusion sets and insulin. Even though it is probably the exact same insulin, getting it as Part B Medicare is a big pain compared to getting the exact same vials for injection.

How about scraping off an infusion set as you walk past something and you don’t have a spare with you? Or a kinked cannula … which if it takes you much time at all to notice will have you screaming above 300 mg/dL in nothing flat.

I love my pump … but, in your case, how much better are you going to do? And wouldn’t you be annoyed if at the end of the day you said: All this effort … and for what?

That’s my $0.02 as a very happy pumper.

Stay safe!

John

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I think that since you have issues with even something as small as the Dexcom that having a pump tied to you (whether tubed or tubeless) would drive you batty. Now if you were no longer able to make all of those minute by minute decisions that you currently do independently then a pump may be your saving grace, but you are doing better than a pump could do for you and unless you are willing to sacrifice some of your control and gain a few inconveniences then a pump probably won’t work well for you.

All that being said I have been on the Tandem X2 for a month and a half (my first pump in almost 30 years of having diabetes) and I am pretty pleased with the system and the Dexcom G6 has always been reliable for me. I still have nights where I am awoken by out of range BG’s but my dawn phenomenon has disappeared and replacing MDI with 1 site change every 3 days has been a pleasant change. My A1C has dropped in that month and a half from 6.9 to 6.5 as well so that’s a win for me after struggling for the past year with higher BG’s than I am comfortable with.

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The only worry is the pump losing BT connection with transmitter, or no bg reading from transmitter for extended time.

Every time I try to get to 95, with sleep on, it cuts basal and bg goes back up.
At 110 now, doing mini bolus to push lower, but basal already reduced to 50% by Mr ZZZ.

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It will do that , however you can try to lower your sensitivity setting and it will let you go lower. The pump is supposed to keep you at 112, but I get it to go lower with lower sensitivity settings.
I never lose connection w my pump, but often with the dexcom ap.
And the tandem ap loses connection all the time, but the apps are not as important as the pump.

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I am with you on a lot of these things. I was diagnosed a long time ago, before there were pumps, before there was CGM, and even long before blood testing was available at home.

How did we do it? We learned to do things by feel.

I still do that.

I was on MDI forever. Like you, maybe somewhere between 70,000 - 100,000 injections.

I started on a pump and CGM about 4 years ago. There are 2 advantages I have with them.

  1. The CGM wakes me up at night if I am low. I really don’t pay attention to it during the day. I know what my BG is, and I also test a lot. And it is not very accurate. But when I am asleep, it’s better than nothing. So I appreciate the CGM at night.

  2. I can turn my pump basal off for exercise. That is very helpful.

Those are the advantages I get from them. I don’t use any pump formulas for corrections or carbs or any of that stuff. I just dial in a number to dose on the pump. And I laugh at the CGM most of the time. But it helps me at night, so it is an okay arrangement.

So it can still work for you, if you want to use it in the old-school method.

But your A1C is stellar, and if you feel safe at night, then it might not be worth the hassle.

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Thanks to all who have answered my question. You have been very helpful. As long as I am doing as well as I am doing, I think I will put off getting a pump.

Marilyn

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I’m a technology junkie. I swear, I feed on it. I couldn’t wait to become a cyborg once I finally found a pump I was happy with the direction of. As a bonus, I got to give up shots, because I never did get used to it. I HATE needles. For 28 years I kept saying “oh, you get used to it…”, but it was never true.

If you’re doing so well without a pump, and don’t want any strings attached. Literally. Then I can’t imagine any reason why you SHOULD go on a pump. The only question that matters is do you WANT to go on a pump?

I’m a big fan of Tandem’s Control-IQ. It has massively reduced the burden of my diabetes while still helping me achieve better control. That’s a win/win for me. But that’s ME, not you.

Look how fast the technologies are evolving, though. Maybe it’s just not the right time to choose an insulin pump for you. The systems available in five years won’t look anything like what we’ve got to choose from today.

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I don’t disagree with any of the posts saying you won’t get better control with a pump. Your control as it is is outstanding, and if your eating and exercise patterns are regular and predictable, maybe the management isn’t so taxing that having a looping pump would lessen your burden.
But saying you don’t know where you would wear a pump because of your small size made me chuckle…you do realise tiny babies often use pumps?
My son started on his pump age 7, height about 4’ and weight around 50lbs. Even with him being very thin, and picky about where he likes to wear infusion sites, adequate body space good site rotation isn’t a problem.

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Dylan, I am also sensitive to the feel of tags in shirts, and have to cut them out. Like I mentioned, I don’t sleep well, so it is hard for me to imagine wearing both devices. I can’t imagine if I had started wearing a pump when first diagnosed at 8, but maybe I would have done well. Who knows. All I know is that I hated the big needles back in the 50’s. I am so glad that your son is doing well!

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The insulin was slower back then, but the longer needles often ended up going into muscle instead of fat, which made the insulin work a little faster! :grinning:

I probably did intramuscular injections more often then not back then!

I didn’t really know, I just put the needle all the way in as far as it would go.

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My wife can’t stand tags in clothes either and always cuts them off, and our youngest feels the same way. Luckily our T1 son takes after me in that respect and isn’t bothered :slight_smile:

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Marilyn, talk with your endo and fo whatever you both feel will maintain your T1 control. The pumps a good insulin delivery system and can be much more than that if you consider the latest Tandem / Dexcom software but it’s expensive and becomes another “thing” that you carry on yourself to manage your diabetes. Personally I’d rather be where you are without the pump and maintaining good control but for me it’s still somewhat of a science project to stop pump usage. Anyway I went without using a pump recently for three weeks with mixed results but really felt better not having it stuck to my waste.

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