Insulin pumps

[rebrascora]

I’ll add to the list. I also find that I spike after every meal because I always inject before eating (I would forget after)

I think you might have that the wrong way around. You usually need to pre bolus earlier before a meal to prevent a spike rather than inject after eating, unless it is a tricky food like pasta or pizza when you need some up front and some after. How long do you currently pre bolus or do you inject and then eat straight away? Many people need longer pre bolus time at breakfast to prevent big spikes. For me it is 45mins in advance of breakfast but others just need 20 or 30 mins and some just 5 mins. You have to carefully experiment with it, adjusting it by 5 mins each day until the spike reduces to find out what works for you.

Libre has a facility to set an alarm, so you could try using that for when you split a dose.

I agree that your list is really well composed and you have an amazing level of maturity for someone so young.
I think it may help if you can show examples on your Libre of where particular problems arise and where you would expect a pump to improve things, so perhaps start keeping a diary of particular incidents which illustrate the problems you are having and as suggested, the things you have tried to counteract them.

 

[Lily123]

I think you might have that the wrong way around. You usually need to pre bolus earlier before a meal to prevent a spike rather than inject after eating, unless it is a tricky food like pasta or pizza when you need some up front and some after. How long do you currently pre bolus or do you inject and then eat straight away? Many people need longer pre bolus time at breakfast to prevent big spikes. For me it is 45mins in advance of breakfast but others just need 20 or 30 mins and some just 5 mins. You have to carefully experiment with it, adjusting it by 5 mins each day until the spike reduces to find out what works for you.

Libre has a facility to set an alarm, so you could try using that for when you split a dose.

I agree that your list is really well composed and you have an amazing level of maturity for someone so young.
I think it may help if you can show examples on your Libre of where particular problems arise and where you would expect a pump to improve things, so perhaps start keeping a diary of particular incidents which illustrate the problems you are having and as suggested, the things you have tried to counteract them.

I only have time to prebolus about 5 minutes before breakfast and dinner but about 10 minutes before lunch as at school it’s a walk from medical to the canteen (I have packed lunch)

 

[rebrascora]

I only have time to prebolus about 5 minutes before breakfast and dinner but about 10 minutes before lunch as at school it’s a walk from medical to the canteen (I have packed lunch)

That is why you always spike after meals then.
I can understand the constraints of prebolusing at school but why do you only have 5 mins to prebolus before breakfast and dinner? I inject my breakfast bolus as soon as I wake up, before i get out of bed and then have a routine of washing and getting dressed before I have breakfast. I tend to make my breakfast straight away so that it is ready to eat as soon as Libre shows my levels are starting to drop and the insulin is kicking in.
With a pump, you would still need to prebolus to prevent those meal spikes.

You could try a slightly faster acting bolus insulin to see if that helps like I did. I used to need 75mins prebolus time at breakfast with NovoRapid but just 45mins with Fiasp. At other times of the day it is usually about 20-30 mins. Most people would hypo with these time scales, so you do need to be careful about experimenting with the timing and do it carefully.... perhaps on non school days when you have more time.

 

[Pumper_Sue]

I only have time to prebolus about 5 minutes before breakfast and dinner but about 10 minutes before lunch as at school it’s a walk from medical to the canteen (I have packed lunch)

Ah you need at least 15 mins before you eat.
Perhaps ask if you can try Fiasp as that works quite quickly. I bolus a couple of mins before I eat.
Mind you with a pump you wouldn't have to go to the medical room as the insulin is already with you 🙂 So another pointer for a pump 🙂

 

[trophywench]

Except for lunch, your answer does not actually make sense unless you do not hold your own pens at home and they are kept away from you.

 

[Inka]

I only have time to prebolus about 5 minutes before breakfast and dinner but about 10 minutes before lunch as at school it’s a walk from medical to the canteen (I have packed lunch)

Totally unrelated but are you saying you go to a medical place to inject? Do you keep your insulin pen with you? I also think I remember you saying something about going to medical to treat a hypo? You shouldn’t have to do that. Your hypo treatments should be with you so you can treat at once and when needed.

You should also be allowed time to bolus when you need to.

 

[Lily123]

Totally unrelated but are you saying you go to a medical place to inject? Do you keep your insulin pen with you? I also think I remember you saying something about going to medical to treat a hypo? You shouldn’t have to do that. Your hypo treatments should be with you so you can treat at once and when needed.

You should also be allowed time to bolus when you need to.

My insulin pen and BG meter and hypo treatments are always with me but I prefer to do my injection and treat a hypo in medical as it just seems easier than everyone making comments even after I have explained to them what I’m doing. I leave lessons 10 minutes early to get my injection done before lunch and that means the spikes after lunch aren’t as bad. And with doing my actual injection I can answer any questions anyone has but when I’m hypo I don’t have the patience

 

[Lily123]

That is why you always spike after meals then.
I can understand the constraints of prebolusing at school but why do you only have 5 mins to prebolus before breakfast and dinner? I inject my breakfast bolus as soon as I wake up, before i get out of bed and then have a routine of washing and getting dressed before I have breakfast. I tend to make my breakfast straight away so that it is ready to eat as soon as Libre shows my levels are starting to drop and the insulin is kicking in.
With a pump, you would still need to prebolus to prevent those meal spikes.

You could try a slightly faster acting bolus insulin to see if that helps like I did. I used to need 75mins prebolus time at breakfast with NovoRapid but just 45mins with Fiasp. At other times of the day it is usually about 20-30 mins. Most people would hypo with these time scales, so you do need to be careful about experimenting with the timing and do it carefully.... perhaps on non school days when you have more time.

I’ll actually do that. I will weigh out breakfast then do my insulin then get ready for school then eat my breakfast (weighing out cereal by eye when the scales broke went wrong last time)

 

[Inka]

My insulin pen and BG meter and hypo treatments are always with me but I prefer to do my injection and treat a hypo in medical as it just seems easier than everyone making comments even after I have explained to them what I’m doing. I leave lessons 10 minutes early to get my injection done before lunch and that means the spikes after lunch aren’t as bad. And with doing my actual injection I can answer any questions anyone has but when I’m hypo I don’t have the patience

You shouldn’t feel obliged to answer anyone’s questions if you don’t want to 🙂 In fact, persistent questioning could be seen as discriminatory and bullying. I made a complaint to my work once when colleagues were being intrusive. That put a stop to it. Often people don’t realise that they’re being irritating and unnecessarily putting the focus on you for no reason. I’ve become quite fierce about it as the years have gone by. Your tutor or teachers should put a stop to it. It’s not helpful and just serves to single people out.

If you’re going to medical as your own free choice, that’s fine, of course 🙂 But you should never feel compelled to, either directly or indirectly. If you were to ever have a bad hypo, you’d need to treat it in class anyway.

 

[Lily123]

You shouldn’t feel obliged to answer anyone’s questions if you don’t want to 🙂 In fact, persistent questioning could be seen as discriminatory and bullying. I made a complaint to my work once when colleagues were being intrusive. That put a stop to it. Often people don’t realise that they’re being irritating and unnecessarily putting the focus on you for no reason. I’ve become quite fierce about it as the years have gone by. Your tutor or teachers should put a stop to it. It’s not helpful and just serves to single people out.

If you’re going to medical as your own free choice, that’s fine, of course 🙂 But you should never feel compelled to, either directly or indirectly. If you were to ever have a bad hypo, you’d need to treat it in class anyway.

It’s not so much persistent questions as it is people just looking at me oddly but i don’t mind apart from if I’m hypo then it gets to me
I choose to go to medical and the school nurses mum is T1 so she understands it better than anyone else.

 

[helli]

I agree with others that you list in great and that you need to explain why a pump would avoid the problems that you experience.

If you are not happy bolusing and treating hypos in class, a pump would not help.
Would you be willing to bolus with your pump in class? Would you be willing to adjust your basal in front of others in preparatory PE? Bear in mind that you will need to make adjustments about 30 minutes before you need them.

The advantages of a pump are
- you can take smaller doses. Are there times when you need to take less than half a unit of bolus?
- your basal is adjusted to suit different basal needs at different times of the day. Do you need more basal in the morning due to Dawn Phenomenon?
- you can adjust your basal at shorter notice. Are there times (such as PE) when you know that you will need more or less basal?
- you can adjust your basal for different “types” of day. Do you find your levels are higher or lower at the weekend or during your monthly cycle?

In your argument, you also need to be aware of the disadvantages of a pump.
- If you want to dose from the pump, it will need to be easily accessible which means it may be on display. This may be a pump under your clothing. Are you happy for this?
- setting up your pump can take a lot of trial and error. Is it the right time for you to go through the pain of this? If you are likely to take your GCSEs in the next few months, you may want to postpone pump start until afterward. Alternatively, if you are doing you GCSEs next year, now may be the time to start pumping because your basal needs may be higher when stressed.
- pumps can fail. This is rare but it can happen and if never happens at a convenient time. Are you willing to deal with the “embarrassment“ of your Libre going off because your pump has failed and your levels have gone high because you have had no basal. And then, calmly change your pump?

I hope this all makes sense and does not put you off asking for a pump. Despite the potential problems, I would fight hard if my DSN tried to take away my pump. It has made my diabetes easier to manage but is at least as much effort s injecting.

 

[Lily123]

I agree with others that you list in great and that you need to explain why a pump would avoid the problems that you experience.

If you are not happy bolusing and treating hypos in class, a pump would not help.
Would you be willing to bolus with your pump in class? Would you be willing to adjust your basal in front of others in preparatory PE? Bear in mind that you will need to make adjustments about 30 minutes before you need them.

The advantages of a pump are
- you can take smaller doses. Are there times when you need to take less than half a unit of bolus?
- your basal is adjusted to suit different basal needs at different times of the day. Do you need more basal in the morning due to Dawn Phenomenon?
- you can adjust your basal at shorter notice. Are there times (such as PE) when you know that you will need more or less basal?
- you can adjust your basal for different “types” of day. Do you find your levels are higher or lower at the weekend or during your monthly cycle?

In your argument, you also need to be aware of the disadvantages of a pump.
- If you want to dose from the pump, it will need to be easily accessible which means it may be on display. This may be a pump under your clothing. Are you happy for this?
- setting up your pump can take a lot of trial and error. Is it the right time for you to go through the pain of this? If you are likely to take your GCSEs in the next few months, you may want to postpone pump start until afterward. Alternatively, if you are doing you GCSEs next year, now may be the time to start pumping because your basal needs may be higher when stressed.
- pumps can fail. This is rare but it can happen and if never happens at a convenient time. Are you willing to deal with the “embarrassment“ of your Libre going off because your pump has failed and your levels have gone high because you have had no basal. And then, calmly change your pump?

I hope this all makes sense and does not put you off asking for a pump. Despite the potential problems, I would fight hard if my DSN tried to take away my pump. It has made my diabetes easier to manage but is at least as much effort s injecting.

I’m in Year 9 so if I get a pump it might be too close to my GCSEs in Year 11. The issue I have with bolusing in class is incase the person sat next to me can’t stand the sight of a needle and is needle phobic and with a pump I would be fine bolusing in class as there would be no needles for anyone to have a phobia about. With smaller doses it would be extremely helpful as depending on what the BG meter calculates the dose as it rounds it up or down to the nearest unit or half unit ( the meter is an Accuchek Aviva Expert)

 

[Leadinglights]

I’m in Year 9 so if I get a pump it might be too close to my GCSEs in Year 11. The issue I have with bolusing in class is incase the person sat next to me can’t stand the sight of a needle and is needle phobic and with a pump I would be fine bolusing in class as there would be no needles for anyone to have a phobia about. With smaller doses it would be extremely helpful as depending on what the BG meter calculates the dose as it rounds it up or down to the nearest unit or half unit ( the meter is an Accuchek Aviva Expert)

You would be surprised what people have phobias about, I had a meeting with some teachers about running some science activities at the Uni I worked at and one of them said one of her students had a phobia about purple. I was renowned for always wearing purple, I still do.

 

[Lily123]

You would be surprised what people have phobias about, I had a meeting with some teachers about running some science activities at the Uni I worked at and one of them said one of her students had a phobia about purple. I was renowned for always wearing purple, I still do.

I mean I suppose she must have a reason for having a phobia about purple. I have a fear of clowns because of the film It

 

[Bloden]

I mean I suppose she must have a reason for having a phobia about purple. I have a fear of clowns because of the film It

My husband can’t abide bananas - I thought he was kidding when he first told me and waved one in his face. He wasn’t a happy bunny. Who knows?

I was approved for a pump in September. I had NICE guidelines in the back of my mind and wasn’t sure I would fit the profile, except for my A1c which has been stuck at 8% for 10 years. The consultant said yes because 1. I need very small amounts of insulin, and 2. I’m very active and tend to go low really easily when I exercise (or just nip down the shops for milk...v annoying).

Good luck @Lily123!

 

[Lily123]

My husband can’t abide bananas - I thought he was kidding when he first told me and waved one in his face. He wasn’t a happy bunny. Who knows?

I was approved for a pump in September. I had NICE guidelines in the back of my mind and wasn’t sure I would fit the profile, except for my A1c which has been stuck at 8% for 10 years. The consultant said yes because 1. I need very small amounts of insulin, and 2. I’m very active and tend to go low really easily when I exercise (or just nip down the shops for milk...v annoying).

Good luck @Lily123!

A fear of bananas seem fairly unique - I feel sorry for your husband as many people will think he’s kidding if he tells them

 

[sg295]

Hi all,

Can I just ask, is it imperative to meet the NICE criteria in order to get a pump or if you have other good reasons can they count as well?

I have heaps of reasons why I think a pump could benefit me, mainly to do with quality of life issues but not sure if these reasons in themselves would be good enough?

Other issue is being fairly new to this, I’m not sure if I will be taken very seriously but things have changed since being diagnosed, most notably my career and the immense (and I mean immense!) difficulties surrounding that r.e diabetes management, as well as many other things so I’m not sure if that’s good enough or not?

Thank you!

 

[Lily123]

I just asked my mum about insulin pumps and I showed her the list I put together - she told me that when I was first diagnosed they asked about insulin pumps and was denied one because I had too good control over my numbers. But 6 years on there’s no harm in asking again right?

 

[Lily123]

Hi all,

Can I just ask, is it imperative to meet the NICE criteria in order to get a pump or if you have other good reasons can they count as well?

I have heaps of reasons why I think a pump could benefit me, mainly to do with quality of life issues but not sure if these reasons in themselves would be good enough?

Other issue is being fairly new to this, I’m not sure if I will be taken very seriously but things have changed since being diagnosed, most notably my career and the immense (and I mean immense!) difficulties surrounding that r.e diabetes management, as well as many other things so I’m not sure if that’s good enough or not?

Thank you!

You don’t have to meet the NiCE guidelines but if you meet the guidelines then you should get funding but if you don’t meet the guidelines then you have to have extremely good reasons to get a pump

 

[sg295]

You don’t have to meet the NiCE guidelines but if you meet the guidelines then you should get funding but if you don’t meet the guidelines then you have to have extremely good reasons to get a pump

Ok great, thank you!

I’m not sure I meet the NICE guidelines that’s the issue but I do have a list of about 13 reasons why a pump could benefit me!

Guess I’d just have to present my list and hope for the best!