It's great to join this fantastic online community - I have been meaning to do it for ages and now I have just retired, there are no excuses! I've been type 1 Diabetic for 60 or so years now - remember Clinitest sets and boiling up metal syringes? How things have changed. I am seeing my consultant on Thursday about possibly moving to a pump as my last couple of blood tests have come out at pre-diabetic levels and I am finding increasingly difficult to control sugar levels. My Freestyle Libre monitor is going off all the time - too high... too low and its driving me crazy. I am unfamiliar with insulin pumps other than what I have read online. I would really appreciate any advice regarding pros/cons of pumps as it all seems to be a bit of a minefield.
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Hi Everyone
- Thread starter henrysuz
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Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
Welcome @henrysuz 🙂 I’ve used a pump for around 20 years. My current pump is a Dana i:
advancedtherapeutics.org.uk
In my opinion, the best thing about a pump is the ability to fine-tune your basal insulin. That makes control easier. Being able to take more precise boluses is a great help too, eg 4.25 units or whatever. It’s also simpler when you’re ill as you can do temporary basal increases as needed if your blood sugar is high.
Cons? There’s an increased risk of DKA (as we have no long-acting insulin on board); cannula sites can be a nuisance - mainly finding new/good sites; and obviously there’s more stuff to store (sets and cannulas, pump reservoirs, etc). The Pros far outweigh the Cons though.
Have you also been offered a closed loop? Do you know what pumps are on offer from your hospital?
DANA i Insulin Pump – Advanced Therapeutics (UK) Ltd
advancedtherapeutics.org.uk
In my opinion, the best thing about a pump is the ability to fine-tune your basal insulin. That makes control easier. Being able to take more precise boluses is a great help too, eg 4.25 units or whatever. It’s also simpler when you’re ill as you can do temporary basal increases as needed if your blood sugar is high.
Cons? There’s an increased risk of DKA (as we have no long-acting insulin on board); cannula sites can be a nuisance - mainly finding new/good sites; and obviously there’s more stuff to store (sets and cannulas, pump reservoirs, etc). The Pros far outweigh the Cons though.
Have you also been offered a closed loop? Do you know what pumps are on offer from your hospital?
rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
Hi and welcome from me too.
Which basal and bolus insulins are you using?
Has your diabetes become more erratic since your retirement? Just wondering if the change in routine due to retirement is impacting your basal insulin needs.
Do you adjust your basal doses yourself? When was the last time it/they was/were adjusted. Many of us find that basal doses need regular tweaking to keep the skip on an even keel. I wonder if a basal test might be helpful to assess if your basal dose is optimal.
Do you mean that your HbA1c has dropped to prediabetic levels, in which case are you suggesting you are having too many hypos..... or do you mean it has risen to those levels, which are actually really good. Anything below mid 50s is good for Type 1s and in fact with an HbA1c below mid 50s, you might struggle to make a case for a pump..... unless you have already been given the nod!
What sort of time in range are you getting on your Libre?
What do you have the high and low alarms set at? Just wondering if they could do with adjusting, so that they are less of a nuisance or is it the "signal loss" alarm which keeps going off. Many of us switch that alarm off as it is just an annoyance and unnecessary drain on the battery.
Are you aware of the limitations of Libre and other CGM. Whilst they are great bits of kit, they are not 100% reliable by any means and understanding the system's quirks and limitations can help you manage and interpret the info they give you better and kow when to double check with a finger prick. I will link to a list of their limitations below which might prove helpful to you...
forum.diabetes.org.uk
Look forward to getting to know you better and perhaps learning from your extensive experience with diabetes.
Which basal and bolus insulins are you using?
Has your diabetes become more erratic since your retirement? Just wondering if the change in routine due to retirement is impacting your basal insulin needs.
Do you adjust your basal doses yourself? When was the last time it/they was/were adjusted. Many of us find that basal doses need regular tweaking to keep the skip on an even keel. I wonder if a basal test might be helpful to assess if your basal dose is optimal.
Do you mean that your HbA1c has dropped to prediabetic levels, in which case are you suggesting you are having too many hypos..... or do you mean it has risen to those levels, which are actually really good. Anything below mid 50s is good for Type 1s and in fact with an HbA1c below mid 50s, you might struggle to make a case for a pump..... unless you have already been given the nod!
What sort of time in range are you getting on your Libre?
What do you have the high and low alarms set at? Just wondering if they could do with adjusting, so that they are less of a nuisance or is it the "signal loss" alarm which keeps going off. Many of us switch that alarm off as it is just an annoyance and unnecessary drain on the battery.
Are you aware of the limitations of Libre and other CGM. Whilst they are great bits of kit, they are not 100% reliable by any means and understanding the system's quirks and limitations can help you manage and interpret the info they give you better and kow when to double check with a finger prick. I will link to a list of their limitations below which might prove helpful to you...
CGM limitations and precautions
Moderator Note: This helpful reply was copied from another thread as it details some of the commonly experienced limitations of continuous glucose sensors. My blood sugar has been in perfect range for days now, but although I haven't changed anything, I'm starting to get very short periods of...
forum.diabetes.org.uk
Look forward to getting to know you better and perhaps learning from your extensive experience with diabetes.
Thank you for this - it is helpful. I have not been offered anything yet but I am seeing the diabetes consultant tomorrow to discuss options. I am concerned about being connected up to a pump as I also have Ehlers Danlos Syndrome which means I bruise easily and my skin is quite elastic and thin however I already use the Freestyle Libre sensors and don't have a problem with these - are the cannulas similar to these or are they thicker?Welcome @henrysuz 🙂 I’ve used a pump for around 20 years. My current pump is a Dana i:
DANA i Insulin Pump – Advanced Therapeutics (UK) Ltd
In my opinion, the best thing about a pump is the ability to fine-tune your basal insulin. That makes control easier. Being able to take more precise boluses is a great help too, eg 4.25 units or whatever. It’s also simpler when you’re ill as you can do temporary basal increases as needed if your blood sugar is high.
Cons? There’s an increased risk of DKA (as we have no long-acting insulin on board); cannula sites can be a nuisance - mainly finding new/good sites; and obviously there’s more stuff to store (sets and cannulas, pump reservoirs, etc). The Pros far outweigh the Cons though.
Have you also been offered a closed loop? Do you know what pumps are on offer from your hospital?
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
It depends on the cannula you’re using @henrysuz but they’re pretty fine. The Libre bit is more like a filament so I’d say the cannulas are slightly wider but still really narrow. The cannulas come on different lengths and in Teflon or steel, if you choose a tubed pump.
Personally, I find I get more bruises from injections than from my pump cannulas.
Personally, I find I get more bruises from injections than from my pump cannulas.
Hi Barbara. Am currently on Levimir and NovaRapid. I tried Tresiba but that did not work for me. And I adjust my insulin myself depending on what I am eating. I have been advised to raise the target levels on my monitor from 3.9 to 4.5 or even higher. My last HbA1c reading was 43 which is too low for a type 1 and as you say, it indicates alot of lows - unfortunately I have lost alot of the usual hypo signs, which is another complication. I am running at 70 - 75% in target. The signal loss alarm is off.Hi and welcome from me too.
Which basal and bolus insulins are you using?
Has your diabetes become more erratic since your retirement? Just wondering if the change in routine due to retirement is impacting your basal insulin needs.
Do you adjust your basal doses yourself? When was the last time it/they was/were adjusted. Many of us find that basal doses need regular tweaking to keep the skip on an even keel. I wonder if a basal test might be helpful to assess if your basal dose is optimal.
Do you mean that your HbA1c has dropped to prediabetic levels, in which case are you suggesting you are having too many hypos..... or do you mean it has risen to those levels, which are actually really good. Anything below mid 50s is good for Type 1s and in fact with an HbA1c below mid 50s, you might struggle to make a case for a pump..... unless you have already been given the nod!
What sort of time in range are you getting on your Libre?
What do you have the high and low alarms set at? Just wondering if they could do with adjusting, so that they are less of a nuisance or is it the "signal loss" alarm which keeps going off. Many of us switch that alarm off as it is just an annoyance and unnecessary drain on the battery.
Are you aware of the limitations of Libre and other CGM. Whilst they are great bits of kit, they are not 100% reliable by any means and understanding the system's quirks and limitations can help you manage and interpret the info they give you better and kow when to double check with a finger prick. I will link to a list of their limitations below which might prove helpful to you...
CGM limitations and precautions
Moderator Note: This helpful reply was copied from another thread as it details some of the commonly experienced limitations of continuous glucose sensors. My blood sugar has been in perfect range for days now, but although I haven't changed anything, I'm starting to get very short periods of...
Look forward to getting to know you better and perhaps learning from your extensive experience with diabetes.
It is a very complex condition as we all know and there is no doubt that as you age, the body changes and your insulin regime needs adjusting. I must admit that when I went on to the Freestyle Libre CGM I thought it was the best thing ever, but as you say, it does have its down side and you can become obsessive with trying to control the readings.
I suspect you are right and my consultant will say a pump is not the answer - we will see! And I will report back. But thank you very much for your input and the link - some interesting information which I know was not explained to me when I first started using CGM.
I do hope this message posts ok as I was half way through writing it when my computer lost its connection. The wonders of modern technology eh?!!
And does the cannula stay in place all the time and you just attach the insulin cartridge (or whatever it is called), or do you change the cannula too? What happens when you go swimming or shower? And is it a fiddly operation? I have arthritis in my hands - alot of questions but its great to be in contact with someone who can be honest about how it all works in practice rather than just the theory!
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
You change the cannula every two or three days. This is to avoid infection/skin irritation, and also to give that site a rest, a bit like with injections, where you try to avoid injecting in the same area repeatedly.
Most cannulas have inserters, a bit like the Libre inserter, but personally I find it easier to insert them manually. Basically, you remove the needle cover, push the needle into your leg, then withdraw the needle carefully, leaving behind a tiny Teflon cannula. The needle/cannula is held in the middle of a white ‘plaster’.
With tubed pumps, a very thin tube then goes from the cannula to the pump, which is roughly the size of a large matchbox. The pump holds a reservoir of insulin, which travels down the thin tubing into the cannula, according to your needs.
You can easily detach the pump for things like showering. It disconnects at the cannula site and then clicks back in, a bit like a press-stud. This takes one or two seconds. So then all you have left is the cannula in you held by the white ‘plaster’.
You’d have to try to see if your arthritis affects this, but it’s a simple process.
Most cannulas have inserters, a bit like the Libre inserter, but personally I find it easier to insert them manually. Basically, you remove the needle cover, push the needle into your leg, then withdraw the needle carefully, leaving behind a tiny Teflon cannula. The needle/cannula is held in the middle of a white ‘plaster’.
With tubed pumps, a very thin tube then goes from the cannula to the pump, which is roughly the size of a large matchbox. The pump holds a reservoir of insulin, which travels down the thin tubing into the cannula, according to your needs.
You can easily detach the pump for things like showering. It disconnects at the cannula site and then clicks back in, a bit like a press-stud. This takes one or two seconds. So then all you have left is the cannula in you held by the white ‘plaster’.
You’d have to try to see if your arthritis affects this, but it’s a simple process.
rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
Levemir is a great insulin in my opinion and really flexible, but it sounds like you don't adjust your Levemir doses, just your NR. Am I right in that assumption?
Do you take the Levemir once or twice a day and do you have even or uneven splits, if twice a day. ie x units in the morning and y units at night or do you use the same x amount of units morning and evening? The benefit of Levemir is that you can tailor it to your body's needs much more than Tresiba. Even adjusting the time of day you take it can make a difference. For instance my levels start to rise as soon as I get out of bed on a morning so I inject as soon as I wake up and before I get up. I adjust mine for exercise and illness and with the change in seasons. Some people reduce it if they have had a drink of alcohol. My night time basal needs seem to be particularly affected by exercise and I regularly have to reduce my evening dose, particularly if I have exercised or been very active on 2 or 3 consecutive days and then adjust it back up when I have been more sedentary.
Where do you have your Libre alarms set or is that what you are saying about raising your target from 3.9 to 4.5.
70% Time in Range is great, but if you are having too many hypos then that may qualify you for a pump, particularly if your awareness is a bit eroded. The advantage of a pump is that there is no basal insulin, it just used fast acting insulin like NovoRapid but it trickles tiny amounts of it into you every few minutes to cover your basal needs and you can adjust that hour by hour if necessary to match what your body needs and you can suspend that basal coverage if you are going hypo whereas, once you have injected however many units of basal insulin with injections, you can't stop that dose from continuing to release. This means that if you are having a bad hypo, that basal is continuing to drop your levels whilst you try to counteract the drop, whereas a pump can be suspended, allowing you to recover more quickly.
There are two types of pumps, tubed and tubeless. The tubed pumps consist of a cannula which enables the insulin to be deposited in the subcutaneous fat and is connected to the pump by fine tubing. The cannula needs changing every few days so that sites are rotated, to ensure good absorption of insulin. The pump is either carried in a pocket or clipped to your belt or secured in a pouch under your clothing.
The tubeless pumps are disposable and incorporate the cannula and pump in one small unit which isn't all that much bigger than a Libre but thicker and sticks to the surface of the skin in a similar way to Libre. Tubeless pumps are waterproof, so that you can swim, bath and shower with them. Tubed pumps are usually disconnected whilst you swim or shower and then reconnected straight afterwards, to the same cannula.
I think filling some of the pump reservoirs can be a bit fiddly. Some are easier than others and I believe there is one make which accepts insulin cartridges rather than needing to fill the reservoir from a vial with a needle. Some use a phone app to control the pump and some use a separate dedicated pump control unit and some can be controlled from the pump itself.
Do you take the Levemir once or twice a day and do you have even or uneven splits, if twice a day. ie x units in the morning and y units at night or do you use the same x amount of units morning and evening? The benefit of Levemir is that you can tailor it to your body's needs much more than Tresiba. Even adjusting the time of day you take it can make a difference. For instance my levels start to rise as soon as I get out of bed on a morning so I inject as soon as I wake up and before I get up. I adjust mine for exercise and illness and with the change in seasons. Some people reduce it if they have had a drink of alcohol. My night time basal needs seem to be particularly affected by exercise and I regularly have to reduce my evening dose, particularly if I have exercised or been very active on 2 or 3 consecutive days and then adjust it back up when I have been more sedentary.
Where do you have your Libre alarms set or is that what you are saying about raising your target from 3.9 to 4.5.
70% Time in Range is great, but if you are having too many hypos then that may qualify you for a pump, particularly if your awareness is a bit eroded. The advantage of a pump is that there is no basal insulin, it just used fast acting insulin like NovoRapid but it trickles tiny amounts of it into you every few minutes to cover your basal needs and you can adjust that hour by hour if necessary to match what your body needs and you can suspend that basal coverage if you are going hypo whereas, once you have injected however many units of basal insulin with injections, you can't stop that dose from continuing to release. This means that if you are having a bad hypo, that basal is continuing to drop your levels whilst you try to counteract the drop, whereas a pump can be suspended, allowing you to recover more quickly.
There are two types of pumps, tubed and tubeless. The tubed pumps consist of a cannula which enables the insulin to be deposited in the subcutaneous fat and is connected to the pump by fine tubing. The cannula needs changing every few days so that sites are rotated, to ensure good absorption of insulin. The pump is either carried in a pocket or clipped to your belt or secured in a pouch under your clothing.
The tubeless pumps are disposable and incorporate the cannula and pump in one small unit which isn't all that much bigger than a Libre but thicker and sticks to the surface of the skin in a similar way to Libre. Tubeless pumps are waterproof, so that you can swim, bath and shower with them. Tubed pumps are usually disconnected whilst you swim or shower and then reconnected straight afterwards, to the same cannula.
I think filling some of the pump reservoirs can be a bit fiddly. Some are easier than others and I believe there is one make which accepts insulin cartridges rather than needing to fill the reservoir from a vial with a needle. Some use a phone app to control the pump and some use a separate dedicated pump control unit and some can be controlled from the pump itself.
rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
Update - I spent quite a while with the consultant today and she went through the download of my Freestyle Libre readings with me. She said that she would not advise me to move to a pump because my control is so good and she also thinks that with my skin being very thin (EDS), this may cause problems with the canulas. She actually said that she was amazed at how good my control was after 60 odd years of living with the condition and that my readings were "textbook". She said that I don't have excessive hypos - it just feels like I do, and she was not concerned about my HbA1c reading! So we talked about whether moving to a pump would actually serve any purpose and whilst she could not recommend me to do so, she said it was a decision for me to make. So she has referred me to the "specialist pump nurse" (what a job title eh?!) so I can explore options in a bit more detail. But thank you both for all the information that you have provided as it did help me prepare for the consultation so I understood what she was talking about.
With regard to your point about Levimir Barbara, I take 9 units first thing (7am) and 3 units at 6pm but I have fiddled about with the dosage on occasion e.g. timings; one dose a day instead of two. I find it interesting that you adjust the doses of this as I have been told that it takes a few days for any changes in long acting insulin to take effect, hence the doses are more or less a constant and it is the short acting insulin which you adjust. Is this something you have just done yourself? It clearly works for you so I will bear that in mind for the future.
Is there a weight loss forum on this site? I got a bit of a shock when they weighed me at the clinic! Oh dear ...
With regard to your point about Levimir Barbara, I take 9 units first thing (7am) and 3 units at 6pm but I have fiddled about with the dosage on occasion e.g. timings; one dose a day instead of two. I find it interesting that you adjust the doses of this as I have been told that it takes a few days for any changes in long acting insulin to take effect, hence the doses are more or less a constant and it is the short acting insulin which you adjust. Is this something you have just done yourself? It clearly works for you so I will bear that in mind for the future.
Is there a weight loss forum on this site? I got a bit of a shock when they weighed me at the clinic! Oh dear ...
rebrascora
Well-Known Member
- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
The benefit of Levemir is that it only lasts about 16-20 hours, so aside from a slight overlap of the split doses you can adjust it independently morning and evening on an almost daily basis if you need to and see more or less real time results.
I am similar to you in that I take a lot more in the morning (usually about 22 units for me) and very little at night (anywhere from 0-5units) but if I am exercising, I have to adjust my night time dose because I am very susceptible to nocturnal hypos after exercise and even when I reduce it down to 0 on an evening, I often still hypo, sometimes between 4 and 6am when my morning dose (taken at 7am) should be pretty well all gone, but my muscles seem to suck the glucose out of my blood after exercise whilst I sleep. I can't see how I would manage without a pump if I didn't have Levemir as my basal as the others are not nearly so flexible. I absolutely love Levemir. I also find that a 12 hour split isn't ideal for me and usually I inject 7am and 11pm but occasionally I get spells where my evening levels rise for a few weeks and bringing my evening dose forward to 7pm will sort that without impacting anything else.
Yes, other basal insulins mostly need 3 days minimum between adjustments, but Libre allows me to see that I get almost immediate results with Levemir.
I am similar to you in that I take a lot more in the morning (usually about 22 units for me) and very little at night (anywhere from 0-5units) but if I am exercising, I have to adjust my night time dose because I am very susceptible to nocturnal hypos after exercise and even when I reduce it down to 0 on an evening, I often still hypo, sometimes between 4 and 6am when my morning dose (taken at 7am) should be pretty well all gone, but my muscles seem to suck the glucose out of my blood after exercise whilst I sleep. I can't see how I would manage without a pump if I didn't have Levemir as my basal as the others are not nearly so flexible. I absolutely love Levemir. I also find that a 12 hour split isn't ideal for me and usually I inject 7am and 11pm but occasionally I get spells where my evening levels rise for a few weeks and bringing my evening dose forward to 7pm will sort that without impacting anything else.
Yes, other basal insulins mostly need 3 days minimum between adjustments, but Libre allows me to see that I get almost immediate results with Levemir.
- Relationship to Diabetes
- Type 1
- Pronouns
- He/Him
Welcome to the forum @henrysuz
How do you feel after your appointment? Was it a relief to hear your Dr was not concerned about your low HbA1c?
Have you come across the International Consensus on Time In Range? That might help you interpret your Libre results in the context of international guidance.
forum.diabetes.org.uk
I don’t know if it will be interesting to you, but I wrote a blog post after about 6months into my pump experience. Having been quite averse to the idea of a pump for several years.
www.everydayupsanddowns.co.uk
How do you feel after your appointment? Was it a relief to hear your Dr was not concerned about your low HbA1c?
Have you come across the International Consensus on Time In Range? That might help you interpret your Libre results in the context of international guidance.
Time In Range - useful for Libre / CGM wearers
I've been meaning to post this for ages, but kept forgetting! At the ADA this year the international consensus paper on TIR (time in range) was published by a panel of experts with a huge amount of knowledge and expertise in supporting people to use continuous data to help manage their...
forum.diabetes.org.uk
I don’t know if it will be interesting to you, but I wrote a blog post after about 6months into my pump experience. Having been quite averse to the idea of a pump for several years.
Face-off: MDI vs Pump
Because no two days with type 1 diabetes are the same. Except when they are. The ups and downs of life with T1D.
thanks Barbara, I will bear this in mind about Levimir and see if it makes any difference to my levels.
Hi, just had a bimble through your blog - some interesting stuff especially the little video where you talk about your personal experience with pumps and the accompanying article. If I did go for the pump option I definitely would want to try the HCL. I suspect I would have to self fund and I am not sure how that would work in practice. You said in your video that you self funded the sensors - have I got that right? What about the pump itself?Welcome to the forum @henrysuz
How do you feel after your appointment? Was it a relief to hear your Dr was not concerned about your low HbA1c?
Have you come across the International Consensus on Time In Range? That might help you interpret your Libre results in the context of international guidance.
ItTime In Range - useful for Libre / CGM wearers
I've been meaning to post this for ages, but kept forgetting! At the ADA this year the international consensus paper on TIR (time in range) was published by a panel of experts with a huge amount of knowledge and expertise in supporting people to use continuous data to help manage their...
I don’t know if it will be interesting to you, but I wrote a blog post after about 6months into my pump experience. Having been quite averse to the idea of a pump for several years.
Face-off: MDI vs Pump
Because no two days with type 1 diabetes are the same. Except when they are. The ups and downs of life with T1D.
It was certainly great to have such good feedback from the consultant, but as we all know, unless you are Diabetic yourself, you cannot fully appreciate how difficult it can be living with it day in - day out. It can get you down. At the moment, I am open to trying anything new if it eases the burden of managing sugar levels. Mine may be well within the required range but oh boy do I have to work at it!
- Relationship to Diabetes
- Type 1
- Pronouns
- He/Him
Access to sensors is improving all the time, and I have just (in the past few weeks) received my first funded Dexcom G6 sensors.
I was able to get Libre for a while, but my pump can only talk with Dex G6!
Pumps are funded by the NHS in the UK for people who meet the NICE criteria. So it would certainly be worth asking your clinic about arrangements in your area as not all hospitals offer all varieties of pump.
Thanks for reading some of my ramblings!
Knowing where we live, we are always somewhat at the back end of the queue for funding! I was in one of the initial trial groups for the Freestyle Libre when that first came out, and that in itself was lifechanging in terms of diabetes management. I will keep you posted!
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