Questions about pumps

[soupdragon]

My clinic have just placed me on the list for a pump.
Trying not to get too excited because I've been told it's quite a long list but I have an appointment coming up soon to discuss things.

I have a few questions about pumping generally which I'm hoping for some help with.

How soon in advance of (aerobic) exercise would you typically need to reduce insulin?

If you have a tethered pump do you remove it for exercise or just reduce the rate?

Also, is the prebolus time before meals similar with a pump to injections?

Thanks in advance for any responses.

 

[Inka]

I’ve had a tubed pump for almost 20 years. Here are my answers:

Usually about an hour before exercise would be when you put a temp basal on but it varies depending on the insulin and the exercise’s effect on the individual. Sometimes I don’t bother and just reduce my bolus if I’ve eaten recently.

I just keep my pump on. I’d only take it off for high contact sports. You can suspend insulin delivery or put a temp basal on.

Yes, the pre-bolus time is similar to injections.

P.S - I hate the word ‘tethered’. A tubed pump is no more ‘tethered’ than a patch pump. They both have the pump and cannula linked. I prefer tubed pumps because you can put them where you want and can remove them in seconds and reconnect them in a second too.

 

[soupdragon]

I’ve had a tubed pump for almost 20 years. Here are my answers:

Usually about an hour before exercise would be when you put a temp basal on but it varies depending on the insulin and the exercise’s effect on the individual. Sometimes I don’t bother and just reduce my bolus if I’ve eaten recently.

I just keep my pump on. I’d only take it off for high contact sports. You can suspend insulin delivery or put a temp basal on.

Yes, the pre-bolus time is similar to injections.

Thanks @Inka.
The reason I was wondering about removing the pump was that I met someone with a pump at an exercise class (she spotted my Libre) who said she removed hers for the class. I haven't really seen it being mentioned on here so wondered if it was something that a lot of people did.

 

[Inka]

Thanks @Inka.
The reason I was wondering about removing the pump was that I met someone with a pump at an exercise class (she spotted my Libre) who said she removed hers for the class. I haven't really seen it being mentioned on here so wondered if it was something that a lot of people did.

Personal preference, I’d guess. I only remove mine for ice-skating - because I crash into things and fall over I’m hoping to take up a martial arts class and I’d probably remove it for that too.

 

[soupdragon]

I’ve had a tubed pump for almost 20 years. Here are my answers:

Usually about an hour before exercise would be when you put a temp basal on but it varies depending on the insulin and the exercise’s effect on the individual. Sometimes I don’t bother and just reduce my bolus if I’ve eaten recently.

I just keep my pump on. I’d only take it off for high contact sports. You can suspend insulin delivery or put a temp basal on.

Yes, the pre-bolus time is similar to injections.

P.S - I hate the word ‘tethered’. A tubed pump is no more ‘tethered’ than a patch pump. They both have the pump and cannula linked. I prefer tubed pumps because you can put them where you want and can remove them in seconds and reconnect them in a second too.

Good point about the "tethered" pump. Can't remember now where I saw it described that way.

 

[helli]

Thanks @Inka.
The reason I was wondering about removing the pump was that I met someone with a pump at an exercise class (she spotted my Libre) who said she removed hers for the class. I haven't really seen it being mentioned on here so wondered if it was something that a lot of people did.

When I had a tethered pump (yes, I did feel tethered to it but, as you say, it is personal preference), I often removed my pump for exercise because it would get in the way. I got fed up with moving it around for a gym workout - clipped on my side waist band for cardio but that got in the way or bicep curls so moved it to the front but then that got in the way of lat pull down so I moved it to the back but that was in the way when I was lying on the floor for an workout.
I also found that it would bounce around when I did some cardio. I know some people use a pump belt but to stop the pump “jigging” I needed to tighten the belt too much and found it restrictive.
I agree with Inka that the advantage of a tubed pump is that it is easier to detach. However, I find a patch pump does not suffer from “bounce” and mine is so small I do not need to move it around for 3 days. And I don’t have to find somewhere to clip it.
Obviously, with a patch pump, I cannot remove it for exercise but, for cardio, I usually suspend my basal 30 minutes before I start (I use Fiasp which is very fast acting) and set the time to finish 30 minutes before I finish. For resistance exercise, such as climbing, I need to increase my basal. The timing is about the same 30 minutes before until 30 minutes prior to completion.

 

[soupdragon]

When I had a tethered pump (yes, I did feel tethered to it but, as you say, it is personal preference), I often removed my pump for exercise because it would get in the way. I got fed up with moving it around for a gym workout - clipped on my side waist band for cardio but that got in the way or bicep curls so moved it to the front but then that got in the way of lat pull down so I moved it to the back but that was in the way when I was lying on the floor for an workout.
I also found that it would bounce around when I did some cardio. I know some people use a pump belt but to stop the pump “jigging” I needed to tighten the belt too much and found it restrictive.
I agree with Inka that the advantage of a tubed pump is that it is easier to detach. However, I find a patch pump does not suffer from “bounce” and mine is so small I do not need to move it around for 3 days. And I don’t have to find somewhere to clip it.
Obviously, with a patch pump, I cannot remove it for exercise but, for cardio, I usually suspend my basal 30 minutes before I start (I use Fiasp which is very fast acting) and set the time to finish 30 minutes before I finish. For resistance exercise, such as climbing, I need to increase my basal. The timing is about the same 30 minutes before until 30 minutes prior to completion.

Thanks for that information @helli
Really useful things to think about.

 

[SB2015]

I am another one who prefers a tubed pump, but I have never tried a patch pump. I know how often I dislodged a Libre by coming in contact with a door frame. I like being able to move my pump around and I find that that enables me to keep it attached during exercise, apart from swimming.

An important consideration for you is which pumps are available at your clinic. Each of them offers specific pumps, which they are able to support. Once you know, post the list, and people will be able to tell you the pros and cons for ones they use.

 

[soupdragon]

I am another one who prefers a tubed pump, but I have never tried a patch pump. I know how often I dislodged a Libre by coming in contact with a door frame. I like being able to move my pump around and I find that that enables me to keep it attached during exercise, apart from swimming.

An important consideration for you is which pumps are available at your clinic. Each of them offers specific pumps, which they are able to support. Once you know, post the list, and people will be able to tell you the pros and cons for ones they use.

Thanks for this @SB2015
I've had a quick look at the list for my clinic and it seems as if Omnipod and some tubed pumps are available but I'm waiting for the appointment to check the list.
My first thought was that I'd prefer a patch pump but I'm trying to work out what might be best for me with different types of exercise.

 

[Saoirse]

I have been pumping now since July. before choosing a pump I was given some excellent pieces of advice on this forum including that there is no *best* pump, just the one best for you. I find preblous time now a bit shorter but my dsn says this is due to my levels being more in range. Some suggestions for questions to take to your appointment:
1) what pumps are available from your clinic (key)
2) how much insulin do you use every 2-3 days ( pumps have different reservoir capacity)
3) how do you want to bolus( from app or from pump directly)
4) what are your preference about size and weight of pump (ask at the appointment if you can see and feel sample pumps) btw omnipod will send you a dummy patch pod that you can wear for a couple of days if you ask them- I dont think you can wear libre and pod close to each other so think about site preference too

Good luck!

 

[soupdragon]

I have been pumping now since July. before choosing a pump I was given some excellent pieces of advice on this forum including that there is no *best* pump, just the one best for you. I find preblous time now a bit shorter but my dsn says this is due to my levels being more in range. Some suggestions for questions to take to your appointment:
1) what pumps are available from your clinic (key)
2) how much insulin do you use every 2-3 days ( pumps have different reservoir capacity)
3) how do you want to bolus( from app or from pump directly)
4) what are your preference about size and weight of pump (ask at the appointment if you can see and feel sample pumps) btw omnipod will send you a dummy patch pod that you can wear for a couple of days if you ask them- I dont think you can wear libre and pod close to each other so think about site preference too

Good luck!

Thanks @Saoise
Lots to think about!
Interesting point about Libre and pod location which I hadn't thought about.

 

[nonethewiser]

Thanks for this @SB2015
I've had a quick look at the list for my clinic and it seems as if Omnipod and some tubed pumps are available but I'm waiting for the appointment to check the list.
My first thought was that I'd prefer a patch pump but I'm trying to work out what might be best for me with different types of exercise.

Have patch pump which is Omnipod Dash, next year hoping to switch to Omnipod 5 which will be paired with Dexcom D6.

Not had any issues exercising with Omnipod although don't do any contact sports.

 

[soupdragon]

Have patch pump which is Omnipod Dash, next year hoping to switch to Omnipod 5 which will be paired with Dexcom D6.

Not had any issues exercising with Omnipod although don't do any contact sports.

Thanks @nonethewiser

 

[everydayupsanddowns]

How exciting @soupdragon!!

My clinic have just placed me on the list for a pump.
Trying not to get too excited because I've been told it's quite a long list but I have an appointment coming up soon to discuss things.

I have a few questions about pumping generally which I'm hoping for some help with.

How soon in advance of (aerobic) exercise would you typically need to reduce insulin?

For when I went to the gym I used to aim for giving the TBR about 30mins head start, but I’ve also just lazily started the TBR as I start a run. I tend to also top-up with fast carbs during exercise, so I am not expecting the TBR to do everything.

If you have a tethered pump do you remove it for exercise or just reduce the rate?

I’ve done both. Gym visits it was easier to simply disconnect and leave it in the locker (the TBR would have reduced basal to nearly nothing anyway!). For longer distance runs I kept the pump attached for safety, but turned down low. Then if I got delayed I still had it with me.

Also, is the prebolus time before meals similar with a pump to injections?.

Yes it was for me. Plus there’s the extra option of dual-wave / combo boluses, where you can give a small downpayment well upfront, and deliver the rest over a short or long time. Quite like a split dose, but automated.

 

[soupdragon]

How exciting @soupdragon!!


For when I went to the gym I used to aim for giving the TBR about 30mins head start, but I’ve also just lazily started the TBR as I start a run. I tend to also top-up with fast carbs during exercise, so I am not expecting the TBR to do everything.

I’ve done both. Gym visits it was easier to simply disconnect and leave it in the locker (the TBR would have reduced basal to nearly nothing anyway!). For longer distance runs I kept the pump attached for safety, but turned down low. Then if I got delayed I still had it with me.

Yes it was for me. Plus there’s the extra option of dual-wave / combo boluses, where you can give a small downpayment well upfront, and deliver the rest over a short or long time. Quite like a split dose, but automated.

Thanks, Mike. It's so useful to see the different approaches that people use.

I'd thought that I'd been on the route to a pump a couple of times before so hoping that it goes smoothly this time!

 

[everydayupsanddowns]

Thanks, Mike. It's so useful to see the different approaches that people use.

I'd thought that I'd been on the route to a pump a couple of times before so hoping that it goes smoothly this time!

Fingers crossed there won’t be too many unnecessary hoops to jump through this time!