im about to get insulin pump (medtronic) in near future instead of injection but i got trust issue against pump which kept me away from it so far. i heard even after just 2 hours of absence from pump i might have higher than 250 because i do not have basal in my body. im especially scared of night.
so you people had any problems so far with it? also combining the long acting insulin with pump is possible?
I've been a T1D for 29 years and pumping for 26. I've never had a case of diabetic ketoacidosis. I have had many episodes of pump-related hyperglycemia (bent cannula, poor site absorption) but they've never threatened me with a trip to the emergency room.
If my BG ever exceeds 300, I use a syringe to deliver corrections. This tactic insures that I can bypass any suspected pump malfunction and get the insulin my body needs.
Yes, I wouldn't argue with the possibility of going over 250 with a two-hour absence of insulin but I believe most people have plenty of time to deal with and effectively correct hyperglycemia before it becomes an emergency.
The pump offers so many benefits, like it's ability to adapt to a highly customized basal need, that I think the attendant risk of hyperglycemia due to a pump delivery malfunction is an acceptable one.
You wouldn't want to add long acting insulin to a pump regimen since the pump delivers a slow rate basal drip that effectively covers a body's need for background insulin.
I've had a pump since 2008. I've had very few problems with the pumps I've had.
1) the first was at a restaurant, I ordered a (large) breakfast and the pump stopped and advised me the bolus didn't happen each time. It would pump a unit and a half or so (out of 8-10 the food I'd ordered needed...). I just kept "hitting" it and got the dose in and changed the gear out. No subsequent problems.
2) a few years later, I went for a run, 14 miles, on an AM when it was 87 when we started, 93 by the finish, very humid and very hot conditions. At the end of the run, I got a "Button Error" message. This was 20-30 minutes from home, so I called Medtronic from the car and the rep said "you need a new pump. We'll send you one on the next business day" which was good, however it was the Saturday of a 3 day, 4th of July weekend so not until Tuesday, I replaced it with NPH and Novolog shots (I am totally lazy about having RX for Lantus lying around, I've never used Lantus or Levemir anyway, that worked out fine as well...)
3) I had a "Motor Error" message more recently. The message came up, I swapped the reservoir, it seemed to work fine. I had another one, same thing, called Medtronic and they sent another new pump, although the old one seemed to work fine during the day I was waiting for a new one.
I've never had an elevated BG for longer than a couple of hours due to these pump problem, other than miscounting carbs, which isn't a pump problem. To me, the pump offered less work, better data tracking and, in general, more controllable diabetes. I haven't had an A1C > 5.8 since 2008 when I started and it's been under 5.3 for about 2 years now.
For 15 years I used MDI for insulin. I am now on my second pump and like the others before me never had an issue. One pumped fail but even with its failure it didn’t cause any issues at all. It was replaced by the company. It took the company 3 days to replace it, failed on a Saturday. Going back to MDI reminded how superior the pump is in managing diabetes.
The pump has been the best thing that happened to me.
Michael
I have been pumping since 1999. The concern you have is understandable since you haven't yet used the pump and shows that you are actively engaged in managing your T1D - a great attribute to have when using pump therapy.
I haven't used a long acting insulin since going on the pump, so for me, essentially zero problems.
You could use a long acting insulin for basal and bolus with the pump, but then you are giving up so much of the reason for using the pump in the first place.
Like you, I had lots and lots of concerns when I started on the pump. Sleeping, changing sets, filling reservoirs, showering, batteries, etc. They are all routine now.
I tell my sugar-normal friends that the pump changed my life in a positive way almost as much as diabetes changed it in a negative way.
It is natural to be concerned and you have identified what is to me the #1 downside to pumping because cannulas definitely can bend and block insulin. But after 8 months, I am comfortable with that risk and the upsides of pumping are very clear. For sure, you can always avoid changing sets before bedtime. For me, it more annoying than dangerous to have to change the sets and wait for the high to come down (a few hours of missed insulin isn't going to trigger DKA). After some initial trial & error, I have figured out what sets and sites work well for me, so the chances of occlusions has reduced even more. It is a comfort zone thing that will improve once you become familiar and practiced with changing out your sets.
I have the medtronic pump. No trust issues. I had an incident some time ago with the pump not being able to push insulin into my body while sleeping. I voke up as the pump alerted me by constantly vibrating.
The pump only takes fast acting insulin. You cannot have long acting in the pump.
However, if you really want to, you can take your long acting insulin from a pen and set a temporary basal rate of 0% on the pump for as long as the long acting insulin lasts. Either that or disconnect the pump entirely if you don't need any boluses for that period.