Asking clinic about a pump

[Tdm]

I had my yearly appointment today, and asked about getting a pump.
They said there were no criteria for standard pumps for t1 (is that true? I know there are criteria for hcl, and i don't meet them) but they didn't think it a good idea as have so little basal (4units of 24 hrs abasaglar is max its ever been).
Also, my control is good without, and they said why change things when all's ok.
I'm in two minds. At least with mdi i do my 24 hr basal and thats that...i'm not going to get dka for the day (i mean, provided i bolus ok) whereas with a pump one would need a back up in case it fails. Plus thete is another learning curve.
But another part of me likes the ideal of being more flexible with snacks, excercise.
Also, not sure i really trust my g6 enough to get it to control a hcl

 

[Bruce Stephens]

They said there were no criteria for standard pumps for t1 (is that true? I know there are criteria for hcl, and i don't meet them)

I don't think that's correct. I think TA151 is still active, technically. I don't think it helps because I think the criteria for TA151 are stricter than those for HCL (so if you don't qualify for TA943 you won't qualify for TA151). (Also TA151 implementation hasn't been an overwhelming success.)

 

[Tdm]

I was surrised because i'd have thought i'd have picked up if a pump was a possibility for me via guidance...but i think it may be best to stick with mdi cos it does seem to work, but it would be nice to hand over to automation from time to time and those with pumps do seem to like them...plus, you know, shiney tech...

 

[Bruce Stephens]

Yes, I feel similarly. The expectation is that TA943 will be reviewed in a couple of years and it'll be widened to everyone with Type 1 as happened with CGMs. Even now, HbA1c of 58 is pretty low, qualifying most people. (Just not all of us.)

 

[Duncan23]

I’m quite interested in this topic. I wonder about the possibility of a pump, do I need one? the benefits etc. I’m finding the posts very difficult to follow with all the abbreviations.

 

[Bruce Stephens]

I wonder about the possibility of a pump, do I need one?

I think a major driver is whether there's a basal insulin that works for you or not. I find Levemir works pretty well and I stay reasonably in range overnight and the (significantly larger) daytime dose works OK too. But some people find that's just not the case and they need something more flexible, and they can't avoid hypos with a basal/bolus regime while also getting a reasonable HbA1c.

A pump offers more flexibility, allowing various profiles to be used rather than the single flattish profile you get with most basal insulins (so it's quite practical to have a fairly flat profile but rising starting early in the morning, if that's what you need). And with a CGM you can get more automation rather than having to program everything; for a while pumps have offered some level of protection from hypos (they interrupt insulin if the CGM show you going low), and HCL offers much more than that.

I think the expectation is that all of us will be offered HCL eventually (that's where the standard of care is heading). It can automate some of the micromanagement we need to do, so if we're a bit low one night (because we did a bit more exercise) or a bit high after a meal because we miscounted a bit, HCL can just deal with it.

[I should qualify that I've never actually had (or been offered) a pump, so I'm basing this on what pump users have written and said.]

 

[helli]

I’m quite interested in this topic. I wonder about the possibility of a pump, do I need one? the benefits etc. I’m finding the posts very difficult to follow with all the abbreviations.

There are two main benefits from a pump without HCL
- variable basal. If your basal needs Gary throughout the day, a pump allows you to change them every 30 minutes. This may be due to a significant dawn phenomenon dump or a low when exercising, for example.
- small bolus. A pump can bolus 0.05 units. This gives more flexibility and accurate boluses. And helps if your insulin needs are low. It also makes split bonuses easier as you can split a bolus over a longer period.

You still need to carb count. And you need to learn how and when to use all the extra features to take advantage of them.

 

[Inka]

As above - the major benefit of a pump is the ability to fine-tune basal. Many people don’t need this. They inject their basal, whatever it might be, and they’re fine over 24hrs, but some people have a big Dawn Phenomenon/FOTF or suffer from hypos at certain times and highs at others, etc. For them, a pump works because it allows them to distribute the basal hour by hour in the amounts they need, whether that be 1 unit an hour for DP or 0.1 units per hour at night.

If MDI is working for you @Tdm I’d leave it for now. A time might come when it doesn’t work so well, and then you could reconsider.

 

[nonethewiser]

I had my yearly appointment today, and asked about getting a pump.
They said there were no criteria for standard pumps for t1 (is that true? I know there are criteria for hcl, and i don't meet them) but they didn't think it a good idea as have so little basal (4units of 24 hrs abasaglar is max its ever been).
Also, my control is good without, and they said why change things when all's ok.
I'm in two minds. At least with mdi i do my 24 hr basal and thats that...i'm not going to get dka for the day (i mean, provided i bolus ok) whereas with a pump one would need a back up in case it fails. Plus thete is another learning curve.
But another part of me likes the ideal of being more flexible with snacks, excercise.
Also, not sure i really trust my g6 enough to get it to control a hcl

Pump can trickle small increments of insulin so using only 4u isn't a problem for some pumps.

I've never had DKA, been pumping for past 12 years but always carry pen as back up if out for day or pens if away for several days.

Certainly with exercising pump come into their own as you can reduce/increase or suspend your basal depending, you'll find with most pump users that they would never want to go back to mdi once switched, although some do have occasional pump beaks for various reasons.

With @Inka in that your control is great so maybe it's something to consider in the future if things change @Tdm