Ladies, please advise me.
My new endo told me today that I should start insulin for TTC ( I’m a type 2), and that a pump was a good way to maintain control. I’ve never taken insulin before, so dont know how to make this choice. Could you please share your experience with pens/injections and pumps while trying to conceive and during pregnancy? Has anyone tried both? I’m a little scared of being tied to a device all day/night, and dont really mind giving myself multiple shots a day, but I have heard that the pump makes things much easier. Please help.
Much appreciated.
Tahira
I’ve tried both because, in the States, almost all people with type 1 are required to start with multiple daily injections. I had been trying to conceive when I was diagnosed with T1 D (just barely over a year ago). I started with pens. They were fine, honestly! Normally my insurance requires people to be on MMDI for at least 6 months before they will approve a pump (that’s typical here, and some diabetes clinics & doctors also require it). In my case, I got one in just over 3 months because my doctor and diabetes educator wrote letters to my insurance company to say that I needed to be on the pump well before I started TTC again, so I’d be stable with it during pregnancy, and that I already clearly understood intensive insulin therapy and had showed that I was responsible enough.
What I loved about the pens: They’re kind of neat, and really easy. I really had no problems with them Also, as you’ve already noted, you’re not tied to them like you are a pump. Throw one in your purse with a few pen needles and alcohol swabs, and you’re good to go.
What I love about the pump: I got realllllly tired of the injection ritual with the pens. Test, do the math to figure out how much insulin you need, swab skin with alcohol, wait for it to dry, put the needle on, set the number of insulin units on the pen, inject, hold for a few seconds, remove, then probably press on the spot for a few seconds to avoid a drop of blood getting on your clothes. I make it sound like for of a pain than it really was, but that’s how I felt toward the end (keep in mind, I was still kind of new to this and upset over how D disturbed me life). On the pump, it’s normally sooooo much faster to test, punch the number of carbs you’re about to eat into the pump, let the pump do the math, then punch a few buttons to deliver the insulin. I also think it’s a little more subtle, for when you’re doing it in public.
What I don’t love about the pump is that I’m tied to it, but it’s not as bad as it sounds. It’s pretty small. I normally just stick it in a pocket or, if I’m wearing a dress, hook it to the side of my underwear!!! I have the Animas Ping, which is waterproof, so I don’t have to worry about getting it wet. I could even take it into the shower with me, though I normally disconnect. I don’t generally “hide” it, but it’s small enough that I totally can when I dress up.
Also, having to do the infusion sets and refill it with insulin can be a pain sometimes. But I think it’s better to spend 10 minutes doing that every three days than it is to spend up to 2 to 5 minutes before every meal doing an injection. Putting the infusion sites in really doesn’t hurt more than injections, maybe just a tiny bit more, but I think it’s a little more intimidating! (Also, injections bruised me quite often. The infusion sites don’t.)
Honestly, both treatments are great. The pump has an awesome reputation for keeping people more stable, and it have fewer lows on it than I did on injections, but I know people who swear by injections, and even people who tried the pump and had such a bad experience that they switched back to injections. It’s totally your call and I think you should do what’s comfortable for you.
Merely from what you initially said, I’d say you should try injections first. If you like it and you’re stable, great, plenty of women have gone through a healthy pregnancy using injections! If you don’t like it as much as you expected or you aren’t very stable after a couple months, I would imagine there’s no reason why you couldn’t switch to a pump (though I don’t know how medical care works in New Dehli).
Either way, good luck! Either way, intensive insulin therapy takes a little getting used to… but it’s so worth it if you’ve gotten to the point where you need it!
I used a pump when TTC and before for 5 years (for a total of nearly 8 years). I went back to injections for about 10 months at the middle of last year because of insurance/cost issues and surprise, I had the second lowest A1c reading of my life at 5.8. I even had them re-check it because I thought it was a mistake.
Injections with a pen are easy and relatively comfortable and I didn’t do nearly the steps that lizzistardust described. I kept the pen needle on the pen, no alcohol swab and was just fine throughout. I did have multiple daily injections - up to 8-9 of Humalog and 2 of NPH which got to be a pain to deal with. I could have cut that down, but I am a grazer and find it hard to sit down to a proper meal.
Now, I’ve been back on the pump for 2 weeks and it feels like an old friend. My Medtronic pump is easy to work, boluses and basil rates are simple to modify and yes, it is something attached to you, but I don’t forget my insulin as I occasionally did with pens and the bolus calculators are so great when trying to figure out how much insulin to take. I do have fewer lows on the pump, which I really like.
During pregnancy, your insulin needs will vary greatly and can change pretty dramatically depending on hormones. I felt that the pump was simple to adjust and since I had used it so long before I was pregnant, I was comfortable modifying basal rates on my pump as I needed it, then adjust back down to my normal after baby was born. I maintained a 6.3 A1c all through my pregnancy.
I would think that you should try pens, if even temporarily. You learn a lot about insulin in general, how you eat and how your body reacts to injections by using pens. Then, maybe a few months from now, talk to your endo, insurance company and pump reps about getting a pump to test and compare. There are also a lot of comparisons here on the various pumps. They are all different, and all have pros and cons in my opinion.
I agree that it’s hard to make a decision to go on the pump when you’ve never been on insulin before. Good luck and let us know what you decide!
Lisa, my injection ritual definitely became a little less involved after a while! No alcohol swabs, unless I had reason to think my skin wasn’t clean. So that cut out the swabbing and drying time. My mother, who is a nurse, was horrified when she saw me do this. She was also horrified when I said I’d reuse a pen needle once or twice. I think it’s just a matter of common sense, though. She saw things from the context of a hospital environment, where people are already sick (and so have weakened immune systems) and medical staff handles their sharps (which means they could potentially stick themselves with a used needle). I, on the other hand, saw it from the perspective of living with a disease for every single day for the rest of my life. Pretty different.
Thank you both, so much! I really appreciate both of you taking the time to reply in such detail, its been extremely helpful. I think I will try MDI first, largely because the pump is waaaaay too expensive, and things here dont work on the basis of insurance.
As I understand it, MDIs arent too problematic when you have a regular routine through the day and largely eat the same foods (boring, I know, but it seems to help predict sugar levels). I’m used to testing about ten times a day anyway, and hope that adding insulin to my daily grind wont cause too much of a hassle.
On the other hand, yikes! I hope I can do this!
thank you again!
Tahira
You can totally do it! I was really intimidated when I started, but I just started by sticking to the exact, basic plan my medical staff gave me. Eventually, it becomes almost second nature and you’ll learn how to blend it with your lifestyle. Just keep in mind that you’re learning in the beginning, so just ask your doctor about difficulties you run across so you can handle them better next time.
The one practical tip I’ll give you: always have sugary candy with you! If you get a low blood sugar (which can happen even if you’re doing everything right), you’ll want to be able to treat it right away.
Good luck!!!