Pump advise

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bagillions1

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Type 1
Hey, just wondering if anyone could offer any advice on pumps.

I currently use a G6 and Tslim and have just received a email saying my pump is running out of warranty and to basically renew.

2 questions/concerns if possible for any advice, as Im struggling to find the answers

1) I use a high amount of insulin a day roughly between 200-300 units a day resulting in having to change my cartridge every day / day and a half. Are there any options for pump that store more than 300 units? to reduce the need to change so often
2) your locked into the pump for 4 years, Im concerned in that time that another pump may offer better functionality etc and I will miss out on this, is there anything amazing that any other pumps are offering now or planing in near future to have?

Thanks all for any input, it is much appreciated 🙂
 
Welcome @bagillions1 🙂 As far as I know, no pump in the U.K. offers a reservoir that holds more than 300 units. There used to be the T Flex that held 480 units but I’ve never seen that in the U.K. Presumably you have a fair amount of insulin resistance to be using that much insulin a day? Have you/are you trying to reduce that?

The only option I can think of is to use more concentrated insulin in a normal pump (eg U200 or U500) but you’d have to be very careful programming your pump to do so.

The only thing I’ve read about some pumps offering in the near future is integration with Dexcom G7 so it can be used to loop. I find the 4 years go fast (I’ve had a pump for almost 20 years) and at no point have I wanted a new pump before my 4 years is up. If you choose wisely, you should be happy with your pump for the four years.

Edited to add another thought: you could use a kind of untethered regime and take all/a percentage of your basal insulin via injection. This would reduce the frequency of reservoir changes.
 
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I cannot comment on the option for pumps with more than 300 units per cartridge beyond the suggestions form @Inka.
Regarding "missing out" for 4 years, my attitude has always been that I would be missing out even more if I did not take a pump. In my experience 4 years has gone quickly enough for me to familiarise myself with a pump and get used it its quirks before moving on to the next one.
I think there are a few options though
- patch pumps such as OmniPod are replaced after each use so may have a shorter "tie in period". However, they do not have large reservoirs for the insulin.
- I thought T-Slim was able to do software upgrades on the pump to offer new capabilities.
- A combination of these two is the Medtrum approach (again not a large reservoir). This is another patch pump but the "brains" are reused for about 6 months. I don't believe you are tied in for the full 4 years and each "brains replacement" comes with an upgrade.

Regardless of these thoughts, they are irrelevant if these pumps are not available at your clinic. Your best bet is to talk to your DSN to find out what pumps are on offer to you and what suggestions she has regarding your specific requirements.
 
I’m now wondering if @bagillions1 is in the U.K. due to posting time and the fact that he doesn’t seem to have been helped to manage his high insulin use. Either way, the answers are pretty much the same.
 
I too would ask if you have considered options to reduce your insulin usage. At such a young age that is a lot and may well impact sites significantly over your lifetime. I appreciate there may be other issues/conditions which mean this is challenging for you.

The only other thing that occurred to me reading your post was that the Ypsomed pump uses cartridges as a pump reservoir rather than having to fill the fitted reservoir in the pump, so that might make life a little easier for you, when you are having to change so frequently..... assuming your clinic offer the Ypsomed pump.

I imagine with that amount of insulin, cannulas are going to be a big issue, so if you are finding the T/slim cannulas that you are using now, work well for you with those doses, then you might find that a change to a different pump manufacturer with different cannulas could cause you significant issues, so there may be a good case for sticking with what works for you now.

All that said, I am not a pump user myself, but those are just points that I have picked up in reading other people's posts, so I could be talking nonsense, in which case, hopefully others will correct me.
 
rebrascora said:
The only other thing that occurred to me reading your post was that the Ypsomed pump uses cartridges as a pump reservoir rather than having to fill the fitted reservoir in the pump, so that might make life a little easier for you, when you are having to change so frequently.
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Most pumps have cartridges rather than internal reservoirs. The only difference with Yposmed cartridges is that they are pre-filled.
I think it is only the smaller patch pumps which have internal reservoirs.
With tubed pumps, you can change the cartridge without the need to change the tube and the cannula.
 
Thank you all for your responses, I am in the UK but work shifts so was up late last night. The Diabetes team have never really spoke to me around reducing the amount of insulin or using a different insulin. Since I was 8 nearly 20 years ago I have always used Novarapid (and levimir when using pens). for the past 16 years really poor control (over 110 on my hba1c) until I received my pump and G6 and now constantly at around 45 for the past 3-3.5 years. So quality of life has massively improved however can be painful and frustrating with the amount of times having to change the insertion site. Thank you all again 🙂
 
I’m sure that can be sorted @bagillions1 You have options 🙂 You might want to think about which option you’d prefer before you talk to your team. On paper (ie looking at it objectively), the best option would be a stronger insulin as this would reduce the volume you’re taking. It would mean your pump needing adjusting though and I don’t know how keen your team would be to do that. If they won’t, you could look at an untethered regime - that is, injecting all or a percentage of your basal in an injection (you might need to use a once daily insulin rather than Levemir but it’s not an uncommon thing to do).

If you’re not on Metformin, you might also want to ask about that as it can help insulin resistance.
 
I think if your pump has revolutionized your diabetes management by such a massive amount, I would be inclined to stick with what is working as regards the pump sensor combo you have. 45 is a really great result but a reduction from 110 is massive and amazing that the technology can make such a huge difference and improve your quality of life so much. I would ask your consultant or nurse about options to help you reduce your insulin resistance a bit as larger doses are more likely to affect your cannula sites over time. Exercise would normally help and it doesn't have to be anything too strenuous. A daily walk is ideal although I appreciate it can be difficult to fit in with shifts. Medication like Metformin can also reduce insulin resistance. Using a higher strength insulin would mean you were injecting less volume each time, so that would be better for your sites and less cartridge filling, but you do have to be more careful with higher strength insulins (at least until you get used to it and they do seem to be a bit reluctant to prescribe them, but they certainly are available, so worth asking about that option.
 
rebrascora said:
Exercise would normally help and it doesn't have to be anything too strenuous. A daily walk is ideal although I appreciate it can be difficult to fit in with shifts.
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Take care if exercising with high BG. It can push levels even. higher.
However, exercising with BG under about 10mmol/l certainly helps with my insulin sensitivity (opposite of insulin resistance).
It doesn't have to be a marathon a day. As you mentioned, a walk will help.
 
Thank you very much, I think that has hit home well, why change something that clearly is working. I will speak to the team around a different insulin and metformin so thank you all 🙂
 
helli said:
Take care if exercising with high BG. It can push levels even. higher.
However, exercising with BG under about 10mmol/l certainly helps with my insulin sensitivity (opposite of insulin resistance).
It doesn't have to be a marathon a day. As you mentioned, a walk will help.
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A daily walk should not be too strenuous even for mid teens levels and in reality no more strenuous than routine activities like housework but as the OP has an HbA1c of 45 there is nothing to indicate that levels are persistently high and their pump is clearly managing levels really well, so I am not sure why you mentioned high levels being an issue with exercise in this scenario unless you are somehow associating insulin resistance with high BG levels.
 
Your switch to a pump has had a very positive impact, so sticking with a pump would be good. The different cannulas for pumps use different adhesives, so take care to check before you switch over to a different one.

I have not tried this, but I think the biggest advantage of pumping is the variable basal, whether by using your own profiles or by looping and having auto adjustments. I was wondering what would happen if you did your meal boluses using a pen, making sure that you let your pump know that you have done this (there is a way of doing that and the different manufacturers call it different things ) you could then use legs for boluses, whilst using abdomen for cannulas for basal. This would reduce the amount of insulin needed in your reservoirs. The Medtronic 780 has cartridges that can be filled with up to 300 ml. Would that be enough for your basal requirements For 2/3 days? Might this be worth discussing at your next appointment?
Let us know how you get on.
 
YSOMED PUMPS IN MIND THE BEST SO FAR REF INSULIN CARTRIDGE VIAL CHANGE
all the rest have gone backwards in insulin fill system s mile ahead in techs
also nobody is say about the COST OF SMART PHONE OR BROADBAND in my case another £35 per month from the old suffolk boy vic
 
VICTOR HILL said:
YSOMED PUMPS IN MIND THE BEST SO FAR REF INSULIN CARTRIDGE VIAL CHANGE
all the rest have gone backwards in insulin fill system s mile ahead in techs
also nobody is say about the COST OF SMART PHONE OR BROADBAND in my case another £35 per month from the old suffolk boy vic
Click to expand...
I guess this is another example of the best pump is the best pump for you.
I have no trouble filing cartridges and would rather do so than waste half a pre filled one because my insulin dose is too low to use a full cartridge in a day.
And I would never be without my smartphone. I use it for emails, for banking, for podcasts, for navigation, and for my diabetes management. If I was not able to use my phone to manage my pump and CGM, I would feel it was taking a mile backwards.
 
HELLI
not yet have this pump till next month .
so will be trial and error agree what suits some and not others
point of view on phones magic . but pam not a user of them like yourself .
my ACC-CHEK DOES all of my service every min and hour but like your good self you mange phones as part of life .
64 years on insulin first jabs in 1957 and control well you soon learn
and i admire your low dose well done i used to have PENFILL INSULIN PEN WHICH WAS SUPER
I also like to keep active at 78 so keep well and safe vic
 
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