Is Dexcom enough?

[Asherly]

We fitted a Dexcom to our 2 year old yesterday. Just mind blown initial thoughts are excellent.
So we have also been offered to start the ball rolling for a pump. As we were talking last night me and Daddy were wondering as we have so much visibility now would the pump help? The quarter unit measures are the major reason for the pump initially (in my head anyway ) but just wondering thoughts from the community?

 

[Inka]

None of my children have Type 1 but if they did, I’d be getting them pumps (I have one). The difference I felt in getting the right amount of basal over the 24 hours was amazing. That’s the main benefit of pumps to me - the ability to individually fine tune basal. This includes temp basal for exercise and illness. You can also do different types of boluses to deal with different meals like pasta, etc. And you get a much better night’s sleep with a great basal rate. A pump can also sort out Dawn Phenomenon.

Depending on what pump you get, there’s also the possibility of looping as you’ve already got the Dexcom.

So yes, personally I’d say go for it 🙂 My pump makes me feel normal and a big part of that is the fluctuating basal that suits my needs. No long-acting insulin can do that.

 

[Pumper_Sue]

A pump is the game changer in diabetes control.
Quality of life goes up a few notches as well.
Pumps are a lot of hard work but the pay off is being fit and healthy. 🙂
The pump enables you to increase the basal or decrease it as needed a certain points of the day as well insulin doses being worked out for you at meal times.
You can split the meal doses as well depending on the type of meal eaten. The worlds your oyster with a pump. 🙂

 

[Thebearcametoo]

Our team use pumps a lot with small kids. The control because of the tiny doses is better and it means fewer jabs. It’s worth a chat with your team as to what they suggest and how soon you’re able to get a pump. It is a different learning curve but worth the effort.

(I say that with a kid who is on MDI but because of her choice having explored a pump. We’ll revisit it in a year or so and see if she’s changed her mind.)

 

[Sally71]

Yes definitely get a pump! You can fine tune the basal by the hour, so if they are going low or high at the same time every day you can adjust just that bit and leave the rest alone. Temp basals will increase or decrease the whole basal by a percentage for a few hours to help you deal with illness or exercise (makes things like sickness bugs a lot easier to manage!). You can drip food boluses in slowly over a period of time, this helps with slow-burn foods but also if you don’t know how much your child is going to eat, then if they don’t eat enough you can cancel what’s left of the bolus afterwards. If you get a pump which links with the Dexcom it might even prevent a few hypos, as the pump will know when the child is dropping downwards and will turn the basal off until they come up again. My daughter is looking at Tandem T-Slim pump + Dexcom for her next one for this exact reason (we are just waiting to hear from the nurse to get the ball rolling).

Yes pumps are hard work but well worth it in my opinion, and the child soon gets used to wearing it and barely notices that it’s there any more.

 

[stephknits]

I would definitely get a pump if you can. My daughter doesn't want one and as she is 16 that is her choice, am hoping she will change her mind before moving to adult care.

 

[Deleted member 27171]

Hi @Asherly - pumps certainly offer a level of flexibility that is just out of reach with MDI, particularly with very small children who can be trickier to predict. Things like physical activity and and what/how much they eat can vary significantly from one day to the next and being able to apply temporary increases/decreases in basal insulin is really useful to combat highs/lows. Whereas with a long acting injection once its in its there for 12/24hrs , so if they have a really active day without planning for it, you can spend all day chasing hypos, but with pump you can reduce the basal for however long is needed. Smaller dosing is also a big advantage, it surprising how much that half unit can count!
Talk it over with his team and see what they think, may they could help you with a pros/cons list for each option. It is important that you do what is right for you and your family and there is no deadline for moving on to a pump. If MDI is suiting you all at the moment and you’re happy with it, you can always explore a pump a little further down the line.
We didn’t have the option for a pump when my son was that little, but having managed on MDI and then changing to a pump when he was older, had we be given the option to go straight to pump I definitely would’ve taken it.

 

[SB2015]

Hi @Asherly . Excellent news to hear that you were able to get the Dexcom, and that you can now all get some sleep.

A pump is a game changer. It does require quite a bit of work to get things matched to the individual needs but the flexibility and improvement in control makes it well worth it. I would definitely recommend a pump. You are then dealing with 0.1 units adjustments rather 1/4 units. So much better especially with little ones.

 

[Sally71]

Oh and the other advantage of a pump for little ones is less needles - instead of 4+ injections every day you only have one needle every 2-3 days when you change the cannula, the rest of the time you just have to push a few buttons to do your insulin doses. Makes it much more flexible, if you suddenly decide to have extra pudding that you didn't bolus for it's no problem, just do an extra bolus, no extra needle needed!

 

[trophywench]

To use one of EDUAD's excellent descriptive phrases - when you are 'impersonating a pancreas' the teeny divisions of a unit available do honestly make shedloads of difference.

 

[Sally71]

Gosh that reminds me of when my daughter was first diagnosed. She was 6, her doses then were tiny compared to now, so I imagine for a toddler they are even smaller. Especially basal! For those not on pumps - instead of long acting insulin the pump just drips in teeny tiny doses of short acting all the time. And I mean tiny - at one point my daughter was on a basal rate of 0.2 units per hour for part of the day, given that one whole unit is 1/100 of a millilitre, so 0.2 is 1/500 of a ml per hour which is split into 20 equal doses every 3 minutes so each dose is 1/10000 of a millilitre. And then we'd change it to 0.18 units per hour, so the difference to each 3 min dose is so infinitesimally small i don't know how the pump can measure such a tiny amount, but it would make all the difference between her going hypo or not each day!

 

[Asherly]

Our team use pumps a lot with small kids. The control because of the tiny doses is better and it means fewer jabs. It’s worth a chat with your team as to what they suggest and how soon you’re able to get a pump. It is a different learning curve but worth the effort.

(I say that with a kid who is on MDI but because of her choice having explored a pump. We’ll revisit it in a year or so and see if she’s changed her mind.)

Hi sorry MDI? Is that mixed dose insulin’s?
Our team are really keen for a pump although unlike Dexcom we willneed some face to face training so will have to wait forCovid to settle even if the funding is agreed.....so as a time scale I’m not sure.

 

[Bruce Stephens]

Hi sorry MDI? Is that mixed dose insulin’s?

Just means multiple daily injections.

 

[everydayupsanddowns]

Hi sorry MDI? Is that mixed dose insulin’s?
Our team are really keen for a pump although unlike Dexcom we willneed some face to face training so will have to wait forCovid to settle even if the funding is agreed.....so as a time scale I’m not sure.

Pump companies are organising remote pump starts via video-calls I think. I have certainly been offered a remote start from my existing company as they know I am up for upgrade.

I think pump and cgm are both incredibly powerful tools. The accuracy, flexibility and tweakability can offer a subtlety - particularly when it comes to basal profiles and split/extended doses.

CGM is just as much of a game changer for me.

And together, they really are the dream team - particularly if you can introduce a little semi-automation in the form of a hybrid closed loop

 

[Thebearcametoo]

Our paediatric diabetes service has restarted face to face appointments so yours may have too. You may find that there is a delay for them to do the paperwork but funding should be straightforward for a pump given his age.

 

[Asherly]

Hey all, thanks for the replies.
I spoke with my team again and we have set up My life app.
They have told me that they aregoing to try and get Jamie a ‘T slim‘. Very surprised when I was told it was the size a credit card.....
We are still unsure but have gone with it as we were unsure about Dexcom too but it has removed a big black cloud that was hanging over us.
Does anyone have any experience with a T slim? I’ve been told it’s very new and will talk to his Dexcom.
I am still absolutely flabbergasted by the technology....

 

[Sally71]

Yes pump technology is amazing! Don’t have any experience of the T-Slim yet but daughter is hoping to get that one next. Mainly because it links with the Dexcom, it should detect when you are dropping too far and switch the background insulin off automatically until you come up again, thereby hopefully preventing a lot of hypos. I believe it can’t prevent all of them, when dropping very quickly it won’t be able to react quickly enough, but should at least make them less severe in that case. Pumping in general we have been doing for 8 years, they give you so much more flexibility to eat what you want when you want. I know many people are perfectly happy with injections but I would find it very crude if we had to go back to that! Anyway if we get a T-Slim before you do I’ll let you know what we think!

 

[trophywench]

I first saw it being promoted as 'soon to come on the scene' at a DUK open day thing they had at Warwick Uni in approx 2009-ish. It could do this that and the other, so with a huge grin I asked the lady 'But tell me - will it do my ironing?' We both thought it was a shame it wouldn't and thought it would have been a very popular feature.

The overall surface size is tiny, but NB it's not that thin!

 

[everydayupsanddowns]

I believe it can’t prevent all of them, when dropping very quickly it won’t be able to react quickly enough, but should at least make them less severe in that case.

I’ve been using the Medtronic equivalent for the past 4 years, and when I looked at the sensor-augmented pump stats vs Libre ‘flying manually’ sensor stats early on, my estimate was that my time-in-hypoglycaemia fell by almost 90% - so yes... not all hypos, but a huge difference for me, once I had tweaked the settings to suit my requirements.

I am awaiting a chat next month about the TSlim myself.

 

[Asherly]

Hey all, just a quick update. Jamie won’t get a pump until his basal requirement of insulin increases. The team don’t want him on a different pump as it doesn’t talk to Dexcom. We had training initially planned to start the day after Jamie’s 3rd birthday (and I think it’s the date that set me off again )lots of tears from me this week only to find out it isn’t happening yet. Currently awake as Dexcom has a temporary error and his last reading was 2.1 so waiting for time to pass so I can see how high my fix has taken him. Happy Sunday people.