Pump and injections?

[Emmakeets]

Bit of a complicated one so bare with me..

I’ve been struggling a lot with my diabetes in recent years and am currently under the eating disorder team receiving treatment. Something I feel would really benefit me is a pump for a number of reasons mental health related.

I have an appointment soon with the pump consultant to discuss this but already know some of the issues that will be raised as the DSN has already mentioned them.

Obviously as my biggest issue is not taking my insulin at all their concern is that if I stop taking it on the pump the risk of DKA is faster due to their being no basal insulin. My psychiatrist has mentioned that he is aware of some people on the pump still taking basal and I wondered if anyone here does that? And if they do what it’s like/how it works.

They’ve also said that due to the issues around ‘non-compliance’ they are only likely to offer the omnipod as the others are tied into longer contracts. I’m aware that omnipod only has 200u and I take around 90-100 units a day currently so this has been raised as an issue. Again taking the basal or some of it separately could help with this? I have tried metformin and a number of other meds to help with insulin resistance but unfortunately cannot tolerate them at all.

Any other suggestions welcome! I just want to go to the appointment as prepared as I can be to keep the conversation moving.

 

[Finn]

I’m aware that omnipod only has 200u and I take around 90-100 units a day currently so this has been raised as an issue.

Is 90-100 units a day your TDD (basal and bolus) or just your average daily bolus? If you were giving basal manually, then only the bolus should be factored in when considering the pump's capacity.

 

[helli]

When reading about people combining pumping and injections 8t has been the other way around - pumping for basal not bolus.
As you would still need to "dial up" your bolus, 8 am not sure how this would help with non-compliance. Plus you have to be willing to change the pump at least every 3 days (or more frequently if your tdd is so high).
Pumping is something to consider but, 8n my experience, it comes with the need for more thought than injections. It was like learning how to manage diabetes all over again.

 

[Inka]

Hi @Emma Lowery @Emmakeets Yes, I’ve heard of a number of people using both pump and injections for basal. The regime is sometimes called Untethered. Sometimes the split is 50/50 but other times it’s different percentages. I’ve never done it myself. The split would depend on your aims and your personal situation.

I’d go to the appointment with a list of reasons and examples of why you think the pump will help your MH. By examples, I mean actual hypothetical situations that you could describe and how the pump would help in those circumstances in a way that injections couldn’t.

Look after yourself x

 

[Flower]

Hi @Emmakeets

I started to use a pump in 1998 as I was struggling so much with a diabetes eating disorder/diabulimia/insulin manipulation & omission.

I don't have any experience of using a pen as well as a pump but wanted to say how much changing to a pump helped me out of a long and dangerous period of my life. My consultant went through the pros and cons and there were quite a few, there was only one type of pump availible in 98 and there is obviously a big risk removing long acting insulin from the situation. However starting on a pump saved my life from insulin omission and dangerous hypos where I overreacted to try and prevent DKA.

The pump removed a lot of conflicting thoughts from giving myself insulin. I didn't have to get my pen, dial up what I needed/what I was going to take and physically inject it. It cut out so many steps that I was battling with and as it turned out it helped me move on and start to feel so much better.

I was worried sick either way before starting on a pump, could I use it, would it remove decisions from me, did I actually want to use one. After I got used to how it worked it removed and reduced a whole lot of mental turmoil I was in.

I hope your appointment goes well and you can work out a method to use a pump alongside injections.
Wishing you well x

 

[Emmakeets]

@Finn sorry 100 units is tdd including the basal so would be less if I took that separately

@helli I don’t think that injecting my bolus would help me but I think if it was basal and just the one a day I could find that manageable. I’m aware there’s a lot of work to put in to get the pump up and running and the doses correct but I still think I would find this easier.

@Flower i could have written your 3rd paragraph myself! That’s exactly why I think it will help. I’m quite a tech person so I like that side of it and I just feel like it removed a step to be able to just insert an amount on a screen rather than physically injecting. I put a lot of barriers in my way to taking my insulin and find if someone gives me my insulin in my hand I won’t outright refuse.

 

[helli]

@helli I don’t think that injecting my bolus would help me but I think if it was basal and just the one a day I could find that manageable. I’m aware there’s a lot of work to put in to get the pump up and running and the doses correct but I still think I would find this easier.

Sadly, pumps do not take over the job of calculating and thinking about bolus doses.
Even with closed loop, pumps cannot predict what and when you are going to eat and injected insulins are not fast enough to react to a rise from a CGM.

Thinking of an alternative, I wonder if it would help to try out mixed insulin.
This would only require two injections a day but your meals would have to be regular and around the same amount of carbs.

 

[Emmakeets]

@helli no I know it doesn’t calculate it for me I just meant it takes time to get ratios etc right. I have no issues with calculating doses it’s more with the taking it.

I don’t think mixed insulin would work for me. I have an 18 month old so trying to eat regularly and the same amount would be challenging to say the least!