More pump questions

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fencesitter

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Hello all
I hijacked another thread just now about lypohypertrophy, so thought I'd start a new one ...
I posted recently that my son William has been offered a pump because he has lymphoedema in his legs, and it limits his injection sites. You responded very helpfully over my question re. infection risk from cannulas, so I think we've knocked that worry on the head!
William is chewing over the idea but will take some persuasion I think. I'm hoping he might work up to it slowly and perhaps give it a trial over the Xmas hols or the summer after next (he has some intensive treatment for his legs lined up this summer, so I think taking on a pump too would be a bit much.
Everydayupsanddowns has replied v.reassuringly about being hooked up 24/7 which is one of my son's concerns.
Right now, he is doing well on MDI and likes being able to inject and then just forget about it. He perceives that he'll have to engage with his diabetes a lot more when on a pump and isn't sure he wants to!
For me, one concern is around having basal as a continuous supply of rapid acting insulin. There have been a few stories of really grim problems associated with kinked cannulas, pump failure and so on. Two deaths quite recently in fact :(
Did those poor people not understand something essential (eg. use pens to correct when in doubt)? In the case of the child I'm thinking of most recently, it looks like his parents continued to use the pump when in fact the cannula was blocked. It is so tragic and very scary that something like this could happen. I also wondered whether there a any risk that with a large reservoir of insulin attached you could make a mistake and overdose?
Some people say lypohypertrophy is less likely on new insulins and with tiny needles. I wonder what the evidence is about this?
This has turned into an essay. Thanks v.much to anyone who manages to get to the end and reply 😱
Catherine
 
Hi Catherine,
my bad so humble apologies, I checked with the lass who has the lymphoedema. Pump has caused no problems at all with her and she loves it 🙂

Being attached 24/7 ....... it took me less than half a day to get used to that idea even after 42 years on insulin.
Yes pumping is hard work to start with. But it then just becomes routine, as long as you stick to the basics ie test and count carbs properly.
Takes a few seconds to bolus for a meal cannula changes take a little while to start with but once used to it can get it down to a couple of mins including the cartridge change. Or less than a minute if just changing the cannula.

Deaths whilst on pumps! In all honesty there are deaths every day related to diabetes. Reading the reports about the pump deaths I have to say it was either very bad reporting or something very badly wrong with the childs care.
Pumps alarm if there is a blockage it's to do with pressure build up.
But then the basic rule is test your blood sugars. If you are high for no reason at all then disconnect and prime the pump just to check all is well in the 1st instance.
Depending on the how high the high is either inject to bring it down or bolus a correction via the pump. If still going up then change the cannula.
It's very rare to have a pump failure without any warnings from the pump as in alarms.
Cannulas coming off can be a problem as obviously no alarms for that, but simple solution is to put some tape over the cannula so it can not be yanked out 🙂

I also wondered whether there a any risk that with a large reservoir of insulin attached you could make a mistake and overdose?
Click to expand...
Nope because you have to work through a sequence to deliver the dose and ok it. The pump is also set up to each persons needs. IE, as in you set it to not exceed x amount of units in 1 bolus.

Hope some of that helps 🙂
 
Hi WillsMum

I am not a teenager but had some of the same reservations as your son - I like the idea of injecting and forgetting about it and did not like the idea of being attached to something all the time. I was pretty well controlled on my pens (Novarapid and lantus - HbA1c low 6s) so felt they would do.

I have to say though that going on the pump about a month ago has been a revelation. It has really stabilised my BGs and meant that any massive highs and lows have largely gone.

I don't know about the deaths but it sounds like you and your son know what you are doing so any highs would be addressed with a pen and a move of canula site, rather than assuming the pump is doing what it should.

I don't know qyute how (after being so long used to lantus) but the small drip drip of novarapid does the trick! You could in theory OD but you could on a pen to - it is the same process of self administering. Also it doesn't let you set massive basal rates, as I recently found out when trying to set my 0.350 and 3.50 - it was clever and said no!

It is a big step I think, so you and yoru son are right to mull it over fully, but I am now seeing it as the next, positive step in diabetes management. Also if he says yes and then decides no he can just go back to his pens. The nurses were keen to stress that to me. 🙂
 
Your son will have to be okay in testing frequently, I probably test 8 or 9 times a day...you probably need to..to get great the best control. It does become second nature after a short time. In my 11 months of pumping I have had far fewer highs and lows than my 15 years on MDI.....and I certainly wouldn't go back to 'finger in the air' MDI! 🙂
 
Just a quickie,

It is incredibly sad and anxiety provoking when you hear of deaths and we never get the whole story, one boy had other complicating health factors, I know nothing of the other. However, there are rules to follow with the pump if you get a high reading, and the pump reminds you so it mustn't be overlooked. Basically a reading over 13.9 needs addressing and checking after an hour, if after that second check the reading is high and climbing then the rules for us are to correct with pen and change cannula, no messing around.

To address your overdose concern, I agree no different with a pen when self administering. However, there is a default setting -a maximum bolus (which can be over-ridden but it does make you stop and consider etc) similarly there is a max basal setting.

🙂
 
I was far more likely to overdose on insulin whilst on MDI, knowingly did this once and ended up in an ambulance (the one and only time) I double injected without realising....I wonder how many times I have actually done that before! Thankfully this is not a problem with my pump. 🙂
 
Thanks so much everyone
These replies are all very helpful! I will drop some of these tips/ideas during conversations! I think if we continue to take a softly softly no pressure approach and address his concerns over time, he'll want to give it a whirl. And as you say, he can always go back to MDI if a pump doesn't suit him. I will keep you posted on progress! We had a letter from the consultant today summarising William's latest visit, which mentions the pump offer so it's good to have that in writing.
Bye for now and thanks again 🙂
 
Willsmum said:
Thanks so much everyone
These replies are all very helpful! I will drop some of these tips/ideas during conversations! I think if we continue to take a softly softly no pressure approach and address his concerns over time, he'll want to give it a whirl. And as you say, he can always go back to MDI if a pump doesn't suit him. I will keep you posted on progress! We had a letter from the consultant today summarising William's latest visit, which mentions the pump offer so it's good to have that in writing.
Bye for now and thanks again 🙂
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ha,ha.....if he gets a pump....i guarantee he won't give it back! 🙂
 
Snap, Phil !

But of course - you CAN can't you? - so it's not like you have burned all your bridges?

And I nearly put miune in the dustbin early on - after about 3 or 4 weeks - but two weeks later and I was hooked !

Nearly 12 months on, No, I wouldn't be parted!
 
I have a 15year old daughter on a pump she won't give it up for anything. Doesn't mind beign hooked up took her a day to get used to it, easy to hide lots of people don't even relise she's got one ot think its a mobile or MP3 player. Had much better control now and if things go wrong there is always a pen and new pumpsoften take less than 24 hours to come. I know she would say if offerd one go for it
 
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