I am seriously considering the pump. I am on levimir and it doesn’t last. I inject in the morning when I wake up and in the evening before bed. I tried to split it into three doses. I tried splitting the nighttime dose by giving myself half at about 10 pm and the other half at about 2 am. That worked better but it still wasn’t perfect. And, I was sleeping through my alarm on occasion and waking up too high. Then I tried splitting it into 3 doses by injecting about 7 am, 3 pm and 11 pm. I kept forgetting the afternoon dose. I set my alarm for the 11 pm dose and slept through that once and woke up at 5 am very high. So then I went back to 2 injections. It’s not perfect, but I never forget. But, as it isn’t perfect, I am thinking of trying the pump. Who here pumps? Have you had any problems with it? Dr. B did a great job of scaring me
away from it in his book!! I am especially curious to know if who on the pump has been able to achieve an A1C of 5.0 or below, which is my goal. I haven’t been able to get there yet.
Full disclosure: I don't pump and have my own personal reasons. And, I am a Dr. B semi-fanatic. All of that being said, no one ever bats 1.000, not even him. No rule is right for everyone, and I think his pump arguments are a wee bit too dismissive.
As with advice from any expert, you take what's useful and leave the rest. If I have gotten just one thing from Dr. B, it is that experience and empirical data trump all the guidelines and theory in the world. If you think pumping might be the right answer for you, then it might be. Only one way to find out for certain, isn't there?
There are pros and cons and I agree that dr. B arguments against the pump are a bit weak and out of date. I have been “successful” using the pump and dr b food plan, etc. I use a normal bolus for carbs and then square bolus for pro. I also wear a CGM that helps deal with my gastroparisis that is an issue even with dr b mdi. To me the pump is much simpler and I have experience also with dr b mdi. However if you can’t get consistent absorption at pump sites or have scar tissue then the pump may be hard for you. I wish you well in your adventure!
Agree, Dr B's sentiments about pumping are off the mark, IMO. Change your infusion sites every 3 days and scarring will not be an issue. A pump should make maintaining a level basal much easier and allows square boluses to cover longer-digesting protein and fat.
I started on dr b in 2007. I was doing mid but I switched to a pump with cgms two years ago. I am religious about switching pump sites every three days. I too use a dual wave bolus to cover my carbs with an initial bolus and a square for proteins aNd fat using the TAG method. The biggest win for me has been the ability to totally dial in my basal since I have a pronounced dawn phenomenon and exercise quite a bit. I use mid when I travel out of country but otherwise I can’t we myself switching back. You can definitely do low carb with a pump. I also ended up getting the pump with a smaller reservoir used for kids. They questioned me about it but I told them I didn’t eat enough carbs to need that big of a reservoir. As it is, I still have to be careful to only fill my 180 unit reservoir up part way as I only use 90 to 120 units in 3 days. Good luck with your decision.
I agree with a lot of the sentiments in this thread. Pumps are brilliant for fine tuning basal rates in my opinion. I find that I need way less at night compared to the daytime - even when I've attempted completely fasting during the day. One thing that frustrates me about pumps is that even before the 3rd day sometimes, I find it start to become less effective, with raising BGs for no apparent reason. Nonetheless, there have been ways to cope with that and overall I'd say it's worth it.
I'm a patient of Dr. Bernstein's and I use both. I find the Omnipod to be very practical when I'm traveling - which I do a lot for business. It's great for tweaking basal rates, especially when dealing with things like dawn phenomenon, and also for adjusting basal rates when exercising.
I see better A1c's with MDI - sub 5% to low 5%. Pump is low 5% to mid 5%. In my case, I think it's because the pump allows me to be less disciplined. It does all the calculations for me and allows more spontaneity when eating. I find when I'm on MDI I'll usually avoid a snack due to the annoyance of all the steps of dosing and injecting vs the Omnipod which is just a push of a button.
There is no "one way." Experiment. See what suits your lifestyle and BG control goals best.
Yep, I'm a pumper and I low carb.
I'm actually quite surprised to hear there's a negativity towards pumping and low carbing.
I feel my pump has never been as useful as it has been now I've gravitated towards this method of control. Along with my CGM, I can't believe how this allows a person to map out their own perfect system. You're all but fasting nearly all of the time, and so working out your basal rates is a piece of cake suddenly, and not a giant inconvenience.
Perhaps the Dr. had issues with scarring personally, but I scar (at least to the exterior of my skin) very very easily, and have simply given up caring. Roald dahl once refered to this look as 'poachers bum' :)
The dappled white flecked look of a person who has been shot in the butt with a shotgun.
..but as far as site life and sensitivity, I have experienced no overall loss of effectiveness over the 13 years I've been pumping (I am very careful to rotate sites thoroughly).
I feel that by injecting less insulin, there is less exchange at the site, and as such they stay effective for much longer, and so to the contrary of his argument, I say that pumping and low carbing, due to the lower amounts of fluids being absorbed are far superior than regular pumpers who eat a higher carb diet.
I've been around the block a few times with my pump. I have taken the issues it throws at me in stride, and still prefer it by FAR to injecting.
I know it adds facets of complexity to the overall equation, but I believe it removes more than it adds if you're prepared to work with it, and stick to it.
The largest problematic aspect I have ever had to get over is the physical existence of the pump itself and how it generally gets in the way, but never the flexibility it allows.
So in summary, I feel that low carbing combined with pumping and also my CGM, has proved at least in my own personal case to be phenomenally effective. I have the best A1C's of my life, and because fluctuations are minimized, even the things I consider mistakes are even tiny blips on an otherwise excellent regime.
I also feel that going from low carbing, and caving in and eating higher carbs, works very very poorly.
I do it from time to time due to cravings and simply being human and making mistakes, and it seems it's more effective to try to stick with one or the other.
Reverting back to even regular amounts of carbs seems to take a while to become accustomed to, and strangeness ensues if you try to do both.
Breaddrink,
I completely agree with you about this. It's a bit unfortunate the pumps seem to get a bad rap in the low carbing diabetic community. Obviously this is probably due to Dr. Bernstein's distaste for pumps, but I think they've come along way and I agree, I think scarring can be mitigated with careful changeout of sites.
I just did one month back on injections (levemir and novolog) and all I can say is: Thank God for my pump!
The pump is a robot - it's intelligently automating my basal for me all day so that I don't have to think about it - I have other things in my life to deal with and frankly, I'm a human, not a robot - I don't do nearly as good a job as a machine that has nothing to do except give me the exact does of insulin I ask it to whether I'm awake or asleep.
Why are we making things more difficult for ourselves, adding more responsibility to "get it right" with timing, caculations, and less accurate injections (sorry - but a needle just isn't as accurate).
That's my two cents at least :)
Another low-carb pumper here!
I agree with everything that has been brought up. I've seen the best A1c's of my life as a diabetic when using the following:
Dexcom G4
OmniPod - changing site every 3 days
Dr. Bernstein's 6-12-12 plan
Symlin (have only been trying it out for a week or so)
Here are my questions for others:
-Do you get "stubborn" BGs? Like BGs that go up to 140 despite taking the right amt of insulin?
-How much more do you take for Dawn phenom? At what times?
-Does anyone use Symlin? Any success?
-Does anyone use a certain ratio to account for protein consumption?
-Does anyone track their ketones? Is it OK to have trace to small urine ketones in the morning? (When BGs are in range 70-120)
-Does anyone do intermittent fasting?
Would love to get this discussion going! I've been having some BGs in the 120-160 range after meals, and prefer to get them lower. I find that insulin WILL NOT work at times, and am wondering if my high fat intake (80% of calories) is making me insulin resistant.
Thanks!
Understand I am T2.
-Do you get "stubborn" BGs? Like BGs that go up to 140 despite taking the right amt of insulin?
Yes. Sometimes I can explain it, poor sleep, Poor digestion. Sometimes I just can't
-How much more do you take for Dawn phenom? At what times?
I take extra NPH at night right before sleep and then still need to correct upon waking up. Life is good if I wake under 140 mg/dl.
-Does anyone use Symlin? Any success?
No, but I tried Byetta and Victoza with no long term effect.
-Does anyone use a certain ratio to account for protein consumption?
I use 50% like recommended by Dr. B. Half the grams of protein are counted as carbs and I expect protein to cause a glucose surge over 3-5 hours.
-Does anyone track their ketones? Is it OK to have trace to small urine ketones in the morning? (When BGs are in range 70-120)
I don't track ketones, I don't consider them meaningful Even people on a high carb diet may have trace ketones in the morning after fasting all night.
-Does anyone do intermittent fasting?
Yes. On weekends, I will skip lunch or skip lunch and breakfast for a day or two. Sometimes I'll just have a bulletproof coffee (I use Kerrygold butter and coconut oil) for breakfast and then fast all day until dinner.
Dr. B recommends that meals be very consistent and that instead of depending on carb counting you adjust insulin to achieve postprandial targets. There are just too many variables. I don't think dietary fat is making you insulin resistant, you just need to bolus to achieve blood sugar targets rather than just doing carb counting.
I am! I'm a type 1 and I just started pumping (tandem t:slim) but have been a follower of Dr. Bernstein's methods since the mid 1980s. I refused a pump for all these years because it did seem backwards to be hooked up to something all the time when you could do it with multiple injections.
The thing that made me change my mind was not being able to be spontaneous in my outdoor life — needing to cut a hike short because I only had so many glucose tablets left and so many miles to cover. A real headache! I'm really looking forward to being able to turn down my basal rate for exercise now. It's like a dream come true!
Can only agree with your comments. I am a Type 2 that purchased my pump to have better control. (My primary care doc just kept telling me to increase my insulin shot dosage.) I cannot afford CGM or I would be there, too. But following Dr. B's low carb regimen means I have had to regularly adjust I:C ratios and basal dose that follows upon my reaching A1C in the mid five's nearly two years ago and maintaining that level.
Interesting - I can definitely see the advantage of turning down a basal rate instantaneously
I posted on this thread a few months back and was in full support of pumping and the low carb diet in tandem. Interestingly, one thing that I was having trouble with and now that I think of it, have always had trouble with, was that 3rd day effect where on the 2nd or 3rd day of a site I'd wake up with a slightly high BG (maybe 140), take a correction bolus and find that 2 hours later it would still be at 140. I'd eat breakfast or lunch, bolusing again, and be up at 200+ within an hour and finally, 6 hours later I'd finally conclude, "OK, guess my site has gone bad a bit early. Of course this isn't unexpected by day 3, but it can even happen around day 2 as well. In fact, I started to feel that on day 1 I'd be able to achieve perfect BG, day 2 was pretty good but not as perfect, then by late day 2 to day 3, there was about a 50/50 chance that it would be either pretty good or really bad.
Figuring this was probably due to overused site locations on my body, I started using completely fresh skin that was also very hard to reach to see if that made a difference - I did this over 3 months with virgin (to pumping) skin. There was a slight improvement, but the problems actually persisted. I'm not sure if this is a problem that just affects me or others but overall it's something that I guess I had gotten used to through so many years of pumping and honestly it only happened problem 1 out of every 3 or 4 site cycles so i didn't feel it was a problem.
Recently though, after a day where I spent 6-8 hours in mid to high 200s because of a bad site (not being able to get home during those hours to change my site), I got angry and decided to try Levemir for my basal rates for a while, something I'd tried before but without so much success.
This is my first week back on Levemir and I realize that one thing I LOVE about not being on a pump is that there's no 3rd day effect - it just doesn't happen. Every day is the same in terms of getting the expected result for the insulin you've injected. I'm doing 3 basal shots a day to span things out and so far, my BG average has dropped about 40 points on my meter and my BG is now staying highly consistent in the range of 90 to 110 the majority of the day. I'm still having some issues with inconsistent BGs on wake ups - either too high or too low so that's something I have to figure out still.
I'll probably update this thread in a month or so and chat more about how things are going sans pump, but so far, perhaps I'm starting to see that Dr. Bernstein has some good points about the problems with pumps?
We'll see :)
As a novice pump user, I kept my basal dosage consistent throughout the day. After a couple of years usage of my pump, frequent testing, exercise, adjustments, I noticed a pattern where during the hours from 10am until around 5pm,my blood sugar levels would rise and require bolus adjustments. I then experimented by "uping" my basal dosage, and again trial and error over a few months to where I am now able to keep consistent highs through the daytime hour in your range of 90 to 110 and bring my total daily insulin dosage approximately 10 units less than I had been using the past couple of years. (I know that we are all different in respect to what works for each diabetic, but I thought I would share my experience.)
Hey Ron,
Thanks for the input. That's definitely something to consider and try if/when I go back to the pump. For me, the first few years of the pump were pretty amazing for me, but I think after about the 6th year is when I started noticing the "3 day rule" I mentioned earlier. Since you've been on the pump only a few years now, I can't stress how important it is to keep your site in place no more than 72 hours. I failed to adhere to this rule for the first 7 or 8 years and let things go to day 4 and even 5 sometimes on a regular basis. Eventually I learned I had to simply put less insulin in to force myself off by day 3.
I think at this point I may have burned my skin out on the pump for a while and perhaps after a year or two I might be able to go back to it if I want to - nonetheless, it's nice to know that going back to injections is still an option for people who are having trouble with pump over-usage on their skin.
Nice to see a fellow Texan diabetic by the way!