Thinking of giving up pumping

Well as the title suggests I’m thinking of giving up pumping.

Main reasons being.

  1. Number site failures, perhaps 1 in 5 regardless of placement, technique, early changes and rotation I’m still getting welts and issues with absorption. Tried a variety of different sets, different length cannulas and have found no respite.
  2. The large majority of my serious highs (Above 13mmol for me) are a result of a site issues, so much so that I always carry about a back up MDI set up anyway.
  3. Constantly being attached to something and what looks to be the beginning of scar tissue
  4. I’m also bothered by the sheer amount of packaging, additional cost and hassle that comes with keeping an infusion system going.
  5. I always correct with a shot to the deltoid as it’as much, much quicker than a correction via the pump. I think I can spend as much time in range via MDI than I do with the pump system without all the negatives.

I’ve just been in advised in the UK that the Abbot Freestyle Libre is to be made available on the NHS from November. I am currently pumping Fiasp, so I am considering a move back to the freestyle libre and pens.

Last time I used a basal I was on Lantus, what are your thoughts on Tresiba?

I think the Freestyle (which I loved, small sensor, super accurate for me and a nice interface to analysis data, much preferable to carelink). and MDI would seem like a welcome break. Which after all the hassle I went through to the get the pump and the CGM seems a bizarre statement to be making.

I pumped for a number of years and after a while, I began having repeated occlusion issues. I was using cannula style sets. I found out about Sure-T’s, gave them a try and they saved the day for me. (I don’t do well w/o a pump). Sure-T’s are the same as Contact Detach (same set but with a luer lock connector). Scar tissue can certainly be an issue which a Sure-T can’t eliminate, but there’s a better chance it will help, as compared to cannula sets.

I don’t think any of us “love” being attached to something 24/7, but it’s what we do for better control, better health, and a longer (potentially) life, more free from DM complications. The choice is yours.

Not trying to change your mind–just mentioning some of the things that have affected me similarly, as well as my thought process about the best way to cope with DM and to look for practical solutions (such as, for me specifically, switching to Sure-T’s).

We all deal with this disease in our own way. Some are in denial, some are scared to death about their long-term prospects, some afraid of using insulin, some incorporate all of the requirements of dealing with it day and night as “a part of life”. For me, I think about what it would be like not to have to constantly think about maintaining my blood glucose–something non-diabetics never think about.

I hope you can keep up your health no matter what method you use! Good luck!

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To pump or not to pump. That is the question.

ALL good reasons to run a MI trial/give up on pumping. I go back and forth. Although, I suspect that I don’t yet have your high incidence of scar tissue complications, I believe that returning to MI has helped me understand both delivery methods better.

Just to play devils advocate, the reasons that I ‘gave up on’ MI (after several years of ‘giving up on’ pumping) were:

1.) I tend to deliver large MI bolus injection (sometimes up to 15U for a meal) and I was getting slow absorption leading to high post meal BGs (sometimes BG = 350 for several hours);

2.) I was having more difficulty during intense, sustained exercise (8 hours) that I think came (in part) from irregular absorption of my two basal MI’s.

3.) I needed to change my basal more frequently than twice a day in order to deal with my system variability.

4.) I was offered a tubeless pump, which providers promised would be better for me. It was.

I expect that the next time I ‘give up on’ pumping, it will be due the development of irregular/poor absorption at infusion site, which I anticipate will be difficult to differentiate from hardware failure. I believe that this is a side effect of long term pump use - tissue damage. But, I could be wrong. It’s something that concerns me.

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A good reason to “give up” on pumping:

You can change your mind the following week and go back on the pump.

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All very good reasons to give your pump a break and if it works for you & makes your life easier, give it a try. If it doesn’t work as well as you hoped, you still have all your supplies and pump and can just plug back in.
I have been pumping for over 25 years and I have talked with a few pumper who have gone back to MDI. Most are using Tresiba with great success. And some use Afreeza as their short acting insulin. There are some many different options now than there was before.
I also use a metal cannula due to the fact the others would bend sometimes.
I won’t beat the reasons why I pump over your head because you know them already. But my biggest reason of late has been, I can suspend the insulin delivery if needed. I have over the past year had a number of surgeries and medical tests that require fasting and I have found if the CGM has me trending down over night, I can just suspend and an hour or so without insulin, helps bring things in line. Once you take that injection, it’s there and the only thing to do for lows is more food.
Good luck with your choice. The great thing now is how many different treatment plans there are out there.

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Yes, Sally, one of the great advantages of pumping over MDI is suspending delivery of quick acting insulin. Once you inject a long acting, you are stuck (pun intended) with it for the rest of the day (or beyond).

Also, no pen is going to deliver an accurate <1 U bolus. And even when pen-bolusing well above 1U, sometimes a bit leaks out of the hole–who knows how much.

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I’ve always been on MDI, so I can’t really comment on pumping. But I recall reading in Dr. Bernstein’s book that injected insulin in high doses just sat there in a pool, thereby extending the delivery time. So, if I need to inject a larger dose, I just take multiple small shots so the delivery is not slowed down. If I recall correctly, his maximum dose in a single injection was seven units.

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It’s only available if your CCG funds it, unfortunately many have said they will not fund due to cost ie, they have no money.

How are you pumping with the Fiasp I ask because it’s a completely different kettle of fish compared to other insulin’s, I find the only way to keep numbers in range post meal is to split the bolus. I also had to reset my basals and change both carb and correction ratio.
Have you also tried an angled set this might help if you haven’t?

As others have said the best thing about taking a break is that you can always go back to your pump if MDI doesn’t work.

Hi,

Yes I have CGM funding currently so I would switch from that to the freestyle, which is considerably cheaper.

I did use the freestyle privately for a year or so, I only stopped when my CGM was approved. It’s a great little tool.

I can’t say that Fiasp has presented much differently than the novorapid I was on before hand. It has a quicker on set, seems a little less stable after 72 hours in the pump. Site irritation is definitely worse with Fiasp.

It seems to handle carb heavy meals better than the novorapid rapid, but I dual bolus for them routinely anyway. I never take a single bolus for a meal over 50g of carbs.

I made a couple of minor basal tweaks and that’s it really, I’ve not given Fiasp a full on review and compared all my data, it works and works quicker than novorapid does which is what I wanted it for.

Steel sets are better and more reliable, but site irritation is markedly worse and necessitates 24-48 hour site changes which in themselves cause issues with control.

I currently use the angled Mio set and have tried all cannula lengths they are still being pulled following occlusion alarms and come out bent at right angles.

I honestly think I can achieve the same HbA1c on MDI without all of this.

Regarding temp basal, this is only likely to impact with exercise occasionally which I’d cover with additional carbs.

It’s just a suggestion but have you tried the angled sets that you insert yourself?
I asked because the mio is the same as the animas equivalent and I found exactly the same problem as you. Since changing over to self inserting I haven’t had any problems at all.

I had a rough week with bad sites and get where you’re coming from. I tried using my rear end instead of my abdomen for a change, and it’s working really well so far. The biggest reason I wouldn’t give up pumping, even if there were no basal/extended bolus advantages, is the ability to dose discreetly as much or as little as I want at the push of a button. MDI can’t replace this. I’m often in restaurants or with other people when eating. I would not want to inject around others or run to the washroom to inject every time I want to eat something. That sounds way, way worse than having something attached to me.

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I just tried my first “pump break” and returned to the pump in just one week. I found having to give myself 6-8 injections a day, mostly corrections of course. Also lots of bruising, inconvenient. I was very disappointed because I do hate having the pump attached to my body. My plan is to try Afrezza and Tresiba next.

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Because my MM pump isn’t waterproof, I tried vacationing on MDI so that pool activities didn’t involve leaving my expensive pump unattended each time I’d get in the water. The results are so annoying! After doing that a couple of times (1 week off the pump each time), I gave up doing it that way. I switching to wearing my pump on vacation, leave it in the room safe when I went to the pool, and carried a Novolog pen in case my bgs got out of hand during the roughly 4-hour stay poolside. That worked out really well.

Another option similar to this is to use a pump in what’s called an “untethered” mode. To run untethered, one takes a long acting for most or all of the basal needs and uses the pump for meals and corrections. This makes possible disconnecting from the pump, even for hours at a time without disturbing the blood glucose levels.

It does requiring some work to get it set up well to your unique needs but being able to leave the pump in the hotel room to use the hot tub, pool, or ocean swimming is easily doable. I tried it with Tresiba as my long acting insulin. Because I need extra basal insulin to counteract dawn phenomena rises, I was able to program a small basal pump profile that rode on top of the Tresiba in the early morning hours. I was able to achieve this within a week or so of experimentation.

Some people see the untethered as the worst of both worlds but I see it as a viable way to disconnect from the pump whenever life presents opportunities, even without any advanced planning.

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As @Terry4 said, the untethered regimen works great for beach vacations. This is a blog post I wrote several years ago and it is the procedure I still use for such vacations.

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While it may work for some having a long-acting insulin in my body doesn’t work out for me because of my variation in activity levels. Im better off just putting my pump aside in a safe location while I’m poolside. If my blood sugar were to rise or I wanted to eat at a poolside restaurant I can do so with an injection from a pen that I carry

I have recently started a pump vacation. I don’t mind MDI, and although I have been on the pump for 10 years, my control didn’t improve greatly on the pump. I’m not saying I don’t like my pump, however recently I have been wanting a break! The only issue is fine tuning everything now that I’m not on the pump. That is a huge challenge. I have been running slightly high the past 2 days, each day getting more in my target numbers. I think the best advice is to look at what you need and what will keep you the healthiest. I most likely will go back on the pump after my vacation but I am sure enjoying the vacation. Good Luck!

I came across this post becuase I am so frustrated with pumping. This is the third time I have tried sing a pump and I’m starting to think my body reacts to a pump differently than other peoples.

Your not alone. It’s so inconsistent for me, especially for correction boluses. Sometimes 6 units will make it drop like a rock, other times it barely budges. When I was MDI I always knew what it would do.

I’m really jealous of people that can make it work. I am working with a great Diabetes educator whose helping me get this thing dialed in, but I’m starting to become really skeptical.

Don’t get me wrong, the pump is very useful and an excellent tool for achieving good control when used correctly.

Although I have almost had ketoacidosis a few times over the last year due to bent cannulas and the only major spikes in my blood sugar are due to pump issues.

I do get good control with the pump and spend the majority of my time within range. The temporary basal feature is useful. It allowed me to almost flat line on Sunday after attending a christening, at the post celebration I had about 300g of carbs (whoops) but managed to stay pretty flat due to a nice dual bolus and a 160 percent basal for 4 hours. I’d have injected the hell out of myself if on MDI and no doubt had a hypo… Or just sat frowning eating a salad.

I am however starting to think that I’d be able to get as good control on MDI once the basal was dialed in nicely. This would necessitate 10 injections a day or more though or a low carb diet (I’d probably back right down on the carbs, which could benefit me with weight loss etc and total daily dose). The idea of just needing two insulin vials, bag of syringes, a meter, glucose tablets and a freestyle libre does sound liberating at present.

I have to say I don’t particularly enjoy the 640g user experience either, it’s clunky, huge and I actually miss the roche pump I had before :frowning: God I do sound like a whinge bag. I’m aware that I am fortunate to have access to all this technology.

I’m a bit of masochist and I’ve not long been standing naked in front of the bathroom mirror depressing myself following a shower, my stomach, legs and the top of my buttocks are covered with bruising, red marks, irritation from adhesive, and small lumps.

Never had these issues when I wasn’t pumping and I follow the standard site rotation, site change protocol. Which again is making MDI seem more attractive.

Guess you can’t have everything though! I’ll try to remember what sent me on the path in the first place and try to focus on the benefits.

Failing that I’ll try MDI for a fortnight and see how it goes :wink:

@Terry4 I’ve been doing the untethered thing for a while, especially on holidays, when at spas and whilst exercising intensely. Definitely useful.

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Give the sure T a try if you haven’t already. I was as frustrated as you and tried MDI for a few days with Levemir and NovoRapid pens, before switching back to the pump with the sure T this morning. I was surprised how well MDI worked for the most part. Levemir works extremely well once in builds up in your system, and by splitting the dose I didn’t experience DP or noticeable problems with it tailing off. It was liberating not having to worry about site issues for a while and not being connected to anything. However, as I posted earlier and had expected, finding places to discreetly inject was really annoying and far worse than wearing a pump all the time. I wear suits for work which makes it more difficult, and hated that I couldn’t just bolus or correct without having to find a place to hide, unbutton my shirt, put the pen cap somewhere, etc. I went for a run though eating before kept me from going low, I had to keep eating the whole day to feed my Levemir dose. On the pump I could’ve just turned the basal down. Lastly, MDI is way more annoying for meals that don’t digest quickly since there is no way to extend a bolus. I had a big meal for a holiday I celebrate last night and woke up in the middle of the night with high blood sugars I had to correct with multiple injections. I’m not the greatest getting extended boluses right, but at least with the pump I could’ve just taken a correction or set a square wave bolus and gone back to sleep without even getting out of bed or turning on the light. Plus, during the dinner I had to either excuse myself to go to the washroom or unbutton my shirt to inject at the dinner table every time another course came. It was family so I didn’t care about injecting in front of them, but again this was way more annoying than just dialling a dose into the pump.

I like that there is less waste with MDI, less to carry around and less technical problems to worry about, but conclude, as I expected, that pumping is much more conducive to my lifestyle. I got great absorption with pens in my abdomen, so hoping that the sure T is the solution since the needle is so similar to a pen needle. Definitely give MDI a try and if it works stick with it, but these are all things to consider if switching!

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