Insulin pump,for or against.

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whitty

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Type 1
Hiya everyone,i have been referred to go on a pump and cant decide if i want to or not.I would like the people who are using a pump to say if they are better now they are pumping or were they better controlled before pumping,and any advice on pumping would be helpful.I dont see DSN until 13 sep and she is going to give me all the literature then,said it was no good giving it to me unless we knew for definate i had been referred.Thanks.
 
Hi whitty im not a pumper but just wanted to say good luck with what you decide, you will get great advice in here,,, maybe have a look in the pumping section and get yourself a general idea of what everyone else is like now they pump x
 
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OK this is not personal experience as I am not yet on insulin. However I have a friend who has been type 2 for nearly 20 years and now no longer produces much in the way of insulin himself. Over the last few years he has never been over 5.5 on his hba1c a control which he himself says would be impossible on MDI. I know this is type 2 rather than type 1 however I dont see how it would be that much different.
 
Here are the last three threads on this topic on the Pumpers page (latest at the top). The positioning of these threads tends to attract us converted pumpers so you may detect a certain bias! But still there is an attempt at providing some balance. 😎
http://www.diabetessupport.co.uk/boards/showthread.php?t=10539
http://www.diabetessupport.co.uk/boards/showthread.php?t=10102
http://www.diabetessupport.co.uk/boards/showthread.php?t=10078

There are more, these are just on the current first two pages. Maybe we need a sticky on the Pumping page maintaining a list to these although it is always worthwhile kicking off fresh threads because things change - new people on MDI and pumps appear; people on MDI become pumpers and some people on pumps do return to MDI; new pens, pumps, insulins appear that may change the approach etc.

What is your starting point: How comfortable do you feel on MDI? Are you having a particular issue with MDI that has prompted them to offer you the chance to go for a pump? Do you carb count?
 
Speaking personally, I started using a pump about seven months ago after being on MDI a good few years. What initiated the change was my control becoming much more unstable, in particular too many night time hypos. A pre-requisite of the pump option at my clinic was doing the Type One course (similar to DAFNE) that the clinic staff taught. Amongst plenty of other things this improved my carb counting skills.

I was perhaps a little unusual in that I did not push a great deal initially for me to switch to a pump. My (very good) GP and DSN kept promoting the idea to me and eventually I agreed to progress it. Still I think the DSN was rather taken aback by how indifferent I appeared on the day they got me started on it but that is just my temperament.

The first few weeks on the pump were a challenge, there is a lot to learn and it is much more work than MDI. But the benefits are there to be had if you persist. It does give the opportunity of better control but perhaps more importantly it offers a more flexible approach to managing the diabetes with insulin and, I think, a more flexible lifestyle. There are ongoing drawbacks, for example carrying the pump around 24/7; continual carb counting, repeated BG testing every day; occasional carb fasting sessions to set the correct background insulin rate; not having pre-filled insulin reserviors; carrying all the replacement kit and back-ups for long trips etc. but I soon became either more accustomned or indifferent to them as the days have gone by.

Given the choice I would now be very reluctant to switch back to MDI, which is essentially the key question for me at this stage.
 
well i started the pump roughly 3 months ago , my results on it speak for themselves , hba1 before pump 10.8 and the new one taken 2 weeks ago 8.0 , it has provided me much tighter control and honestly because of the bolus calculator and corection setting i find it easier than mdi because i dont spend all my time working out the maths , obviously u are attached 24/7 but can disconnect for swimming or baths etc , in my view (and everyones will be different) it has changed my life and i cant praise them enough , i love my pump , it is ofcourse a personal desision but there is no harm in trying one, you can always change your mind and go back to mdi , but as i am aware not many give them back lol:D
 
Hi,

I have been on a pump for nearly 3 years now and I find that it is much better for me then MDI. My control is much better and I am much happier with it.

I was aprehensive at first at the thought of having it attached near enough all day and night but within 48 hours I had got used to it being there and my fears of catching it in the night, pulling on the canula, the kids catching it etc were unfounded and now I forget its there.

As pumps have become more common there are lots of ways of wearing them on your body. Being a man I don't have the same problems as women but I either wear mine round my waist under my shirt or when I feel like a change I wear it clipped to my belt like a pager.

The only problem I have had with being on the pump is that there is no back ground insulin. As I was one of the first to go on to a pump at my hospital no one had taken into account the lack of background insulin when you are ill. This led to me going DKA and being rushed into hosipital. However, now that I know this I increase the background rate when I'm feeling ill and all is ok.

It is a personal choice but hopefully the advice on the forum will help address some of the niggling concerns.

Good luck with whichever you decide.

Andy
 
I've been wrestling with this very question myself over recent months, and still find myself undecided, not as completely against as I once was, but not yet entirely convinced.

I do know that for many T1s pumps are a completely life changing experience. Most pumpers I come across say they would never go back to MDI. But I do also read accounts of the frustrations/difficulties of pumping.

Interestingly of the drawbacks rossoneri listed,

rossoneri said:
There are ongoing drawbacks... continual carb counting, repeated BG testing every day; occasional carb fasting sessions to set the correct background insulin rate;...
Click to expand...

these are part and parcel of my approach to MDI. And if they weren't I know for sure my control would be much more all over the place than it is.

I've recently blogged about my ongoing humming and haaing here if you are interested:
My Pump Problem and CGMS envy

One other thing to consider I suppose is this. There are many many T1s in the UK at the moment desparate for a pump, but unable to secure the funding and/or clinical approval. They might suggest that you go for it even if you are still a little nervous about the prospect (I'd have thought anyone would be). It would be a shame to turn one down now, then decide you want it in a year's time and end up with a battle on your hands!

Good luck with your decision.
M
 
Hi Whitty,

I've been pumping for just over a year.

I had a number of concerns when a pump was first offered to me. I wasn't convinced it would make a big difference as I was working incredibly hard on MDI and not getting anywhere. I didn't like the idea of having tubes attached all the time. I didn't want to carry it around 24/7. I was concerned about it coming off in the night & waking with ketones. I didn't fancy carb counting religiously (although I know now this is something I should have been doing on MDI anyway).

After some serious thought, I decided to give it a go. I felt I had nothing to lose - my A1c wasn't great and it didn't matter how hard I tried, it wouldn't come down.

The first couple of weeks were very stressful. Everything I had worried about seemed to become a huge concern. I felt like a walking freak show with it on my belt, I didn't sleep well for fear of becoming detached and I didn't see any immediate results with my BG. On several occasions I became quite upset and wanted to return to MDI. I had spent 17 years on MDI, and knew it inside out. The pump was new and unfamiliar territory, and I didn't like not knowing what was going to happen and having to change my thinking about my BG. For example, I'd spent 17 years snacking to keep my BG up, and now I had to take insulin for everything that went into my mouth. It took a lot of adjusting.

However, I persevered and I am SO gad I did. My A1c on MDI was 8.3% (& stuck there), and within 6 months on the pump was down to 7.1%. I was over the moon - I could only ever have dreamed of this on MDI. I feel much better because my BG isn't yo-yoing anywhere near as much as it did. I find it easier to spot patterns with my BG on the pump - on MDI it was just allover the place all the time. If I hypo and am feeling nauseous, I don't have to eat long-acting carbs after my Lucozade. Likewise if it's a hypo where I'm craving every food under the sun, I can eat as much as I want & just bolus without yet another injection. Life is much more flexible - I can have a long lie without my BG being messed up for the entire day, and can exercise without hypo-ing.

Because my control is so much better, I don't mind wearing it at all now. In fact, I'm proud to have it on my belt - I want people to ask me about it, so I can tell them how amazing it's been and how much better I feel. I've had next to no problems with the sets. They're easy to insert, once they're in they stay in for the 3 days, I never feel my basal & rarely feel my boluses. Inserting is much less painful than injections were.

I apologise for the novel. I just wanted to share my experience with you, I wish I had had contact with pumpers before I started. I'm most definitely pro pump, but I must stress that it takes a lot of hard work, especially in the beginning. I worked hard on MDI, but with the pump I work harder. I think this is mostly because the hard work actually gives me results now, but also switching to a pump gave me new enthusiasm and got rid of the bad habits I had developed with MDI.

You know your own diabetes better than anyone else, and it's entirely your decision. Best of luck with it, & keep us posted!
 
Thanks to all those who replied and left advice on pumping.I am still unsure what to do.My last 6 Hba1c have all been in what the specialist said the perfect zone 6 to 6.4.He said though this is probably due to the amount of hypos and not perfect control,this is why he wants me to start on a pump.I also dont get warnings of severe hypos.Ive got 2 weeks to decide anyway.
 
I cant add much to what has already been said, but Alex's hba1c dropped from 9.6 to 7.1 in a couple of months.:D

You have nothing to lose by giving it a go - you can always revert back to MDI if you really hate it - but I doubt you would.🙂Bev
 
I've been pumping for 6 years now, and can't recommend them highly enough. My control is vastly improved, HbA1c has gone from over 9 pre-pump, to no higher than 7.1 since I got it and as low as 5.5 when I was pregnant and pumping.

I second what Bev said - give it a try, if you don't like it you can always go back to MDI.

Good luck!
 
I won't repeat all the health benefits but there are the lifestyle benefits as well. You get so much more freedom on a pump, it is the next best thing to a working pancreas 🙂

I know with MDI you have to eat at set ish times (nothing so rigid as on mixed insulins) well on a pump you don't have to actually eat at all and certainly not at set times. The basal rates can be set so that it carries you through for 24 hours.

When you are ill you just turn the basals up or down accordingly, no more sipping coke or whatever just to keep the levels up (obviously that is not necessary every time but it worked for us a few weeks ago).

In my view and my daughter's there is no going back to injections. We both love the pump.
 
I have just spent the most extreme weekend for quite some time, marshalling on an adventure race. This involved carrying 100m climbing ropes & kit plus camping kit (rucksacks weighing around 40kg) for 8km over rough ground, ending with a scramble up very steep ground to top of rock buttress on high Lake District Fell, then descend to camp 1st night, then climb again to set up abseil, then walk down to camp near base of buttress, waiting for teams to arrive, which they did at irregular periods from about 2000 (last light) through 2nd night, very stormy dark period until 0330, when we all finally got a couple of hours of sleep before getting up to eat quickly, pack up kit, carry out same 40kg rucksacks, slightly downhill this time, but streams much fuller of water. Only enough space for my tiny little tent (fortunately a flexible hooped design, as rigid poles would have broken) among the rocks, and had to use rocks instead of pegs, as not much soil within reach. After walking out, had to drive about 1 hr to race HQ, where hot shower and a long sleep never felt so good! Had to replace one guyline back home - severed by rubbing on a rock.

I coped fine on MDI, but I'm really not sure a pump could have coped.
 
This is such a fascinating thread!
 
Hi Whitty,

I would say GO FOR IT!!! :D My consultant suggested it years ago, and boy do I wish I'd jumped at the chance then...my main concern was the idea of inserting the cannula...(it's a bit weird but fine!) Whilst pregnant I've managed previously to achieve HbA1cs of between 5.7 - 6.5%, but the only way I could do this was to take shed loads of insulin & eat up (as it were) to it - so lots of hypos & subsequent upswings. I've only been on the pump a few days, but already my control feels so much more stable, the accuracy of the dosing I can do for the carbs I eat (instead of the other way round on mdi!) is WONDERFUL! 🙂 I know I'm probably in the honeymoon stage & may possibly fall out of love with my pump in the future, but right now if anyone tried to take it off me, I'd fight them for it! I just wish I could go back in time & tell myself to go for it! Personally, I LOVE it!! 🙂
 
Copepod said:
I have just spent the most extreme weekend for quite some time, marshalling on an adventure race. This involved carrying 100m climbing ropes & kit plus camping kit (rucksacks weighing around 40kg) for 8km over rough ground, ending with a scramble up very steep ground to top of rock buttress on high Lake District Fell, then descend to camp 1st night, then climb again to set up abseil, then walk down to camp near base of buttress, waiting for teams to arrive, which they did at irregular periods from about 2000 (last light) through 2nd night, very stormy dark period until 0330, when we all finally got a couple of hours of sleep before getting up to eat quickly, pack up kit, carry out same 40kg rucksacks, slightly downhill this time, but streams much fuller of water. Only enough space for my tiny little tent (fortunately a flexible hooped design, as rigid poles would have broken) among the rocks, and had to use rocks instead of pegs, as not much soil within reach. After walking out, had to drive about 1 hr to race HQ, where hot shower and a long sleep never felt so good! Had to replace one guyline back home - severed by rubbing on a rock.

I coped fine on MDI, but I'm really not sure a pump could have coped.
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Hiya

Actually this would have been perfect for a pump user. The amount of exercise you did would be able to be controlled by the pump. I think that you have good control though but for someone who didn't on MDI, a pump would be nothing but of good benefit for them as you can turn the insulin up or down according to what you are doing (that is in basic terms by the way, pumps will know that as temp basal rates). Pumps are absolutely the best thing for all sports people. I believe that Steve Redgrave finally realised a pump would be the best thing for him.

🙂
 
I still don't think a pump would have survived the battering that my body survived - some pretty dramatic bruises on my arms, legs and trunk; finger tips and hands damaged by rock scrambling, so that adjusting buttons so often would have been a real hassle; difficult enough to find a patch of softish ground big enough on which to lie to try to sleep, without having to accommodate a lump of plastic attached to myself. I accept that pumps can cope with getting wet, but most people don't even take them into swimming pool or bath. I was in heavy rain for over 20 hours with only a tiny tent for shelter and pretty decent waterproofs for protection, but going for pee is difficult enough in salopettes, without having to deal with a tube permanently attached to some part of my anatomy.
If I couldn't manage acceptable control on MDI (and I appreciate I'm lucky I can, or perhaps it's because I work quite hard at it) and had to use a pump, it really would curtail my activities.
 
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Copepod said:
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If I couldn't manage acceptable control on MDI (and I appreciate I'm lucky I can, or perhaps it's because I work quite hard at it) and had to use a pump, it really would curtail my activities.
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I expect you work very hard at it Copepod, but just to let you know that many people do and still don't have good control, so must be a bit of luck too.
 
Copepod said:
I still don't think a pump would have survived the battering that my body suvived - some pretty dramatic bruises on my arms, legs and trunk; finger tips and hands damaged by rock scrambling, so that adjusting buttons so often would have been a real hassle; difficult enough to find a patch of softish ground big enough on which to lie to try to sleep, without having to accommodate a lump of plastic attached to myself. I accept that pumps can cope with getting wet, but most people don't even take them into swimming pool or bath. I was in heavy rain for over 20 hours with only a tiny tent for shelter and pretty decent waterproofs for protection, but going for pee is difficult enough in salopettes, without having to deal with a tube permanently attached to some part of my anatomy.
If I couldn't manage acceptable control on MDI (and I appreciate I'm lucky I can, or perhaps it's because I work quite hard at it) and had to use a pump, it really would curtail my activities.
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Just to try to 'balance' things out a bit between MDI and pumps and sports etc. Alex is extremely sporty and wearing the pump has never stopped him from doing anything. He does watersports, trampolening, swimming, football, rugby, taekwando etc etc - oh and cycling - like today I took him around the woods where its really unpredictable and full of twists and turns etc - he must have fallen off 5 or 6 times over the handle bars and neither him nor his pump came to any harm. I reduced his basals down to 50, 40 and eventually 30% for the whole afternoon and not 1 hypo or hyper. He wears the pump in a 'spibelt' and its very easy access - so button pressing is easy and quick - takes seconds, and it means he can ride for hours and hours without the worry of a hypo.🙂

When he was on MDI control just wasnt what we wanted for sports etc and we found we were forcing him to eat mars bars etc etc which somewhat defeats doing the exercise. I also used to find that injecting him was problematic if we were in the woods or on a hill somewhere - not discreet and quite awkward at times. But pressing a button is much better and not awkward or time consuming at all. Most pumps also have a remote control you can use if you dont want to waste time undoing clothing etc.

When on MDI the worst part was not being able to alter the basals - once you have injected - thats it - no going back. Whereas on the pump you can do things at short notice and alter basals accordingly or take pump off etc. I can categorically say that Alex does much more sport now he is on a pump than when he were on MDI - because it was just so difficult to get right.

I also agree with Katie that lots of people put tremendous efforts into trying to get MDI right - but it just doesnt seem to suit some people. I do think that for some it is a case of pure luck that they dont seem to suffer the highs and lows that others do - even though they try just as hard.🙂Bev
 
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