Asking consultant for a pump

[runner]

Hi all, I'm currently using a CGM, but my numbers seem to hover on high, even when i've taken insulin and dropping, sometimes quite drastically when exercising, so they are very up and down, despite my efforts to control them. So thinking of asking for a pump because i understand it can help even things out a bit. Not sure what's available on NHS - is there any you'd recommend? How are the pods working out?

 

[helli]

An insulin pump does not even out levels. Insulin works at the same speed whether injected from a pump or from a pen.
Correct timing of your bolus may help to reduce the high hover. How soon before eating do you pre-bolus?

As for which pumps to recommend, I would recommend the one(s) available in your clinic. Some clinics have a wide choice on offer. My clinic has two choices - Medtronic or injections. OmniPod is not an option.

I advise talking to your DSN or consultant about your current problems. They may suggest a pump but pumps are much more expensive than injecting so most clinics want to see you have tried other options (such as pre bolusing before eating and not exercising with bolus insulin on board) before suggesting a pump.

 

[Inka]

Hi all, I'm currently using a CGM, but my numbers seem to hover on high, even when i've taken insulin and dropping, sometimes quite drastically when exercising, so they are very up and down, despite my efforts to control them. So thinking of asking for a pump because i understand it can help even things out a bit. Not sure what's available on NHS - is there any you'd recommend? How are the pods working out?

A pump is just another insulin delivery system. It needs a lot of work, and, just like injections, there are pros and cons.

If you’re going high after eating, try moving your bolus forward. Also, look at your meal ratios if you’re sure your basal is right. For exercise, I reduce my bolus for the meal before I exercise. If you can say a little more about the things you’ve tried, you’ll get more tailored suggestions.

I don’t like the pod/patch pumps but it’s a matter of preference. You’d have to see what options your clinic offers if you fulfil the NICE criteria for a pump. Some offer lots, others just one or two.

 

[SB2015]

Hi @runner

As others have said, the pump itself will not even out levels, but it gives you access to more strategies to make use of. This in itself means that there is more work involved, and a clinic is likely to assess whether you are likely to make effective use of these. So before your appointment it would be useful to list what steps you have taken so far, and have data to support this. I was refused a pump the first time I asked, then spent 6 months gathering data and addressing the issues that they raised. They are not easy to come by.

As others have said the timing of the bolus is a major factor in reducing spikes that happen after meals. Using the Libre showed me just how big my spikes were, and enabled me to find an appropriate timing of my bolus for different times during the day.

Another thing, and probably the first thing to check is whether you have the correct basal dose. Which basal insulin are you using? Are you able to split it and so make adjustments to this during the day on exercise days whilst not changing your night time dose.

Once you are sure that the basal insulin is correct, you might need to review your bolus ratios. Are these the same throughout the day, or do you need different ratios at different meals? When these are correct there are also steps to take to deal with different types of meals.

These are all also important factors in using a pump, and then there are other adjustments that also become possible. As for the choice of pumps this is set by your local clinic, so that is the first point of call. I am another person who has not used a patch pump. I prefer the idea of a tubed one and have stuck with those so far.

 

[runner]

Hi all,

Thanks for your replies and suggestions. I've been using insulin since 2008, using the basal/bolus system and DAFNE guidelines. I'm using Lantus and Humalog. I do adjust the background insulin, particularly as my lifestyle is not consistent, for e.g. when grandchildren come to stay, I often need to decrease it! Following consultant's suggestions, I split the background dose about 2 years ago and there have been times when I've had to increase the morning ratio of rapid to 1 1/2 times. However, these latest rates seem to be a new trend - maybe me getting older. I'm also on Thyroxin, but everything there seems OK medication-wise.

What are the advantages of using a pump? I've read the info on the Diabetes UK and other sites ( I think that's where I got the idea it might help to even out the highs and lows) but it's always better to hear how people actually experience their benefits.

 

[trophywench]

The major advantage for me, having already swapped Lantus to Levemir which was always designed to be used twice a day anyway and having much better success managing basal doses with that, the basal still needed a lot of fiddling with .... so I got fed up with it! I'd been offered a pump before but since I was in the throes of a mental breakdown at the time, I said straight away then, I really don't think I could cope with one right now. Hence, being fed up fiddling with Levemir and not having half unit pens even (which were only for children back then) I thought surely I could get more success with the smaller increments you can make with a pump? Yes, it's a lot of fiddling about with doses, always, to begin with and of course to a lesser degree from then on - but I would at least - hopefully? - have more chance of better BG control from the fiddling?

At that time - dunno what they do now - it was automatic to reduce your TDD basal by a third, the day you started using your pump. Well, good grief. Since it works - shows how hit and miss 'longer acting' insulins really are.

 

[runner]

Hi Jenny, nice to hear from you (I haven't been on the forum very often of late, and then usually just 'off the subject'). Thanks for that and sorry to hear about the former mental breakdown. Life can certainly be a roller-coaster! Think I'll carry on researching and ask about it at next consultation in March.