Matt Cycle
Well-Known Member
- Relationship to Diabetes
- Type 1
I started pumping nearly 2 months ago and thought I'd put down my experiences on the process of actually getting it and then starting on it for anyone who may be thinking about it. Be warned - a bit of a ramble coming up. 😉
So, in terms of getting it I'd been under GP care for my diabetes for a number of years but having issues in recent years with hypos and hypo awareness and liking the idea of temporary basals for exercise amongst other things I started researching and warmed to the idea of a pump having been put off originally by the whole 'attached to me all the time' thing. After speaking to my DN at the surgery she was fine with it and I therefore had to be referred back to the hospital clinic. I started back at the hospital clinic within a couple of months and completed the DAFNE style carb counting course (very useful in itself but an essential requirement if going for a pump in my area) and things seemed to be moving along nicely. However, the slowly grinding gears of the local NHS meant months and months would pass. If you find yourself in a similar position don't despair as things may move more quickly in your area.
However (bit of a rant coming up) I do sometimes feel those diagnosed in more recent times receive better care and advice than older hands who are just expected to know everything. Diabetes management is changing quickly nowadays so whether it's DAFNE courses or information and access to the latest technology, everyone, regardless of how long they have been diagnosed, should have access to these resources. I feel strongly about this and the so-called postcode lottery as the whole provision of Type 1 care across the country is uneven and unfair to say the least. My time on the forum has shown this has led to some people (possibly not even confirmed Type 1) receiving any number of things and other Type 1's who may have been diagnosed for a long time missing out. It often appears to be a case of luck as to who gets what or of those who shout the loudest. 🙄
Back to the pump then and from a choice of five I chose the Medtronic 640G because as well as being a decent and well proven pump from all the reviews I read, there is always the possibility of getting the CGM sensors as well. Once it was all approved, ordered and arrived at the clinic the start was dependent on the availability of the rep. One thing I'd recommend is being well prepared before starting as I'd got myself a copy of Pumping Insulin by John Walsh and Ruth Roberts and had done a fair bit of reading and researching - the forums very own Mike (Everydayupsanddowns) has done some excellent instructional videos on the 640G on youtube. My clinic would normally do 2 sessions with the rep. The first (morning or an afternoon) involves the basic mechanics of it, going through setting it up - looking at the functions, creating initial basal profiles etc, loading the reservoir with insulin and inserting the cannula - and it's off you go. The follow up appointment 2 days later would go through the first set change. The rep wasn't available for the second session so I only had the one session and did the first set change on my own at home. It was fairly straightforward - the pump itself guides you through it, the information booklet has step by step instructions and as mentioned there are online videos if you need them. Just remember to remove the needle guard from the cannula applicator. 🙄
How does it work? The pump only uses rapid insulin for both bolus and basal with the basal being drip fed in very small increments. The 640G requires a reservoir to be filled every 2-3 days from an insulin vial. Those who remember using syringes just think of that on a bigger scale. Tubing is attached to the reservoir and then loaded into the pump. The other ending of the tubing is attached to a cannula contained inside an applicator (a bit like the Libre applicator) . The applicator fires a needle in and leaves a plastic cannula held in place by an adhesive pad. This part has a plastic clip where you can detach the pump if you want to when having a shower etc. Every 2-3 days the reservoir, cannula and tubing is all disposed of and you start again. It sounds complicated but it's all straightforward once you do it. The consumables i.e. reservoirs, cannula/tubing and batteries are despatched directly from Medtronic via courier and you can order 3 months worth at a time.
What's it like actually using it? Well, after so long injecting with syringes and pens I won't lie and admit it did feel strange at first having the tubing and pump attached. I was concerned about taking my jumper off and yanking out the tubing but it's pretty secure and fastened well at either end. The tubing I use is 60cm long but it still feels slightly awkward getting dressed and undressed with the possibility of catching the tubing. The pump has a clip which I use on my belt and I bought myself a lycra pouch belt for when I'm on the bike and at night in bed. I've not gone down the Great Escape route of cutting holes in pockets and feeding tubing through gaps in clothing that some people mention. Yes, it took a bit of getting used to after injecting and I am aware it's there all the time. For me personally it didn't take a big rethink in managing my diabetes when starting to use it as I see it as just another method of injecting insulin albeit with more options available. If you can cope with that then the pump will not be an issue. The initial settings regarding basal rates, ratios etc for the pump were put in at the first meeting with the Medtronic rep based on TDD and weight and used software with an algorithm but as with all things T1 diabetes related they required tweaking and adjustment. Basal testing can then be done to firm things up. I'd got into the habit over the years of travelling light with my diabetes related stuff - just a pen, meter and dextrosol tablets and I now found myself having a bit more 'equipment' to carry around. Yes, the pump is bigger than a pen (about the size of a fat mobile phone) but it's not a massive deal really and is fairly discreet. I still carry a pen around in case something goes wrong and sometimes a spare cannula in case of any problems with that. Set changes - reservoir filling, cannula and tubing - are done every 2-3 days and although they don't take long (3-4 minutes) are a bit of a palaver compared to simply getting a pen from the fridge every couple of weeks or so and screwing a needle on.
In terms of pump operation anyone who uses a mobile, computer etc (pretty much the whole population then) would have no problems going through the button pressing. Even if you aren't 100% comfortable with technology it's straightforward stuff. One of the issues I had with myself at first was the complete reliance on technology and something I couldn't see happening keeping me alive. With syringes and pens being mechanical you simply dial up, stick the needle in yourself and press the plunger and know it has gone in. With the pump you can't see it but you soon know if something has gone wrong as your blood glucose quickly heads skywards but it just needed a slightly different mindset to begin with and the technology is well proven as the drip, drip, drip quietly does its stuff.
Is it worth it? It's still early days but for me yes, absolutely. Time will tell in terms of the figures but the finer adjustments, dual waves, multiple basal patterns and especially the TBR's have, I feel, given me greater control of my diabetes although of course it is possible to manage your diabetes successfully on pens for most people. I had managed what I thought was 'okay' on syringes and pens for over 30 years but (with a fair bit of work) for me personally I feel this has made it easier (that's easier definitely not easy 😉) to manage. I still get hypos and still go high but I think that's part and parcel of typical T1 however you manage it, but so far the highs and lows have been reduced. If you work, are active in work or outside of work, doing different things on different days then you would probably notice the benefits more than someone whose only activity is pottering around the shops occasionally and going for a coffee with Ethel. 🙄 I know T1's can be reluctant to change things but my DSN said she sees a number of people on pumps who don't even use TBR's which seems a bit of a waste of the technology to me. It's certainly not a panacea for all T1 issues, it takes a bit of effort and I realise they're not available to all but if you are eligible and are thinking about it then I would certainly recommend giving it a go. 🙂
After that little lot time for a coffee!
So, in terms of getting it I'd been under GP care for my diabetes for a number of years but having issues in recent years with hypos and hypo awareness and liking the idea of temporary basals for exercise amongst other things I started researching and warmed to the idea of a pump having been put off originally by the whole 'attached to me all the time' thing. After speaking to my DN at the surgery she was fine with it and I therefore had to be referred back to the hospital clinic. I started back at the hospital clinic within a couple of months and completed the DAFNE style carb counting course (very useful in itself but an essential requirement if going for a pump in my area) and things seemed to be moving along nicely. However, the slowly grinding gears of the local NHS meant months and months would pass. If you find yourself in a similar position don't despair as things may move more quickly in your area.
However (bit of a rant coming up) I do sometimes feel those diagnosed in more recent times receive better care and advice than older hands who are just expected to know everything. Diabetes management is changing quickly nowadays so whether it's DAFNE courses or information and access to the latest technology, everyone, regardless of how long they have been diagnosed, should have access to these resources. I feel strongly about this and the so-called postcode lottery as the whole provision of Type 1 care across the country is uneven and unfair to say the least. My time on the forum has shown this has led to some people (possibly not even confirmed Type 1) receiving any number of things and other Type 1's who may have been diagnosed for a long time missing out. It often appears to be a case of luck as to who gets what or of those who shout the loudest. 🙄
Back to the pump then and from a choice of five I chose the Medtronic 640G because as well as being a decent and well proven pump from all the reviews I read, there is always the possibility of getting the CGM sensors as well. Once it was all approved, ordered and arrived at the clinic the start was dependent on the availability of the rep. One thing I'd recommend is being well prepared before starting as I'd got myself a copy of Pumping Insulin by John Walsh and Ruth Roberts and had done a fair bit of reading and researching - the forums very own Mike (Everydayupsanddowns) has done some excellent instructional videos on the 640G on youtube. My clinic would normally do 2 sessions with the rep. The first (morning or an afternoon) involves the basic mechanics of it, going through setting it up - looking at the functions, creating initial basal profiles etc, loading the reservoir with insulin and inserting the cannula - and it's off you go. The follow up appointment 2 days later would go through the first set change. The rep wasn't available for the second session so I only had the one session and did the first set change on my own at home. It was fairly straightforward - the pump itself guides you through it, the information booklet has step by step instructions and as mentioned there are online videos if you need them. Just remember to remove the needle guard from the cannula applicator. 🙄
How does it work? The pump only uses rapid insulin for both bolus and basal with the basal being drip fed in very small increments. The 640G requires a reservoir to be filled every 2-3 days from an insulin vial. Those who remember using syringes just think of that on a bigger scale. Tubing is attached to the reservoir and then loaded into the pump. The other ending of the tubing is attached to a cannula contained inside an applicator (a bit like the Libre applicator) . The applicator fires a needle in and leaves a plastic cannula held in place by an adhesive pad. This part has a plastic clip where you can detach the pump if you want to when having a shower etc. Every 2-3 days the reservoir, cannula and tubing is all disposed of and you start again. It sounds complicated but it's all straightforward once you do it. The consumables i.e. reservoirs, cannula/tubing and batteries are despatched directly from Medtronic via courier and you can order 3 months worth at a time.
What's it like actually using it? Well, after so long injecting with syringes and pens I won't lie and admit it did feel strange at first having the tubing and pump attached. I was concerned about taking my jumper off and yanking out the tubing but it's pretty secure and fastened well at either end. The tubing I use is 60cm long but it still feels slightly awkward getting dressed and undressed with the possibility of catching the tubing. The pump has a clip which I use on my belt and I bought myself a lycra pouch belt for when I'm on the bike and at night in bed. I've not gone down the Great Escape route of cutting holes in pockets and feeding tubing through gaps in clothing that some people mention. Yes, it took a bit of getting used to after injecting and I am aware it's there all the time. For me personally it didn't take a big rethink in managing my diabetes when starting to use it as I see it as just another method of injecting insulin albeit with more options available. If you can cope with that then the pump will not be an issue. The initial settings regarding basal rates, ratios etc for the pump were put in at the first meeting with the Medtronic rep based on TDD and weight and used software with an algorithm but as with all things T1 diabetes related they required tweaking and adjustment. Basal testing can then be done to firm things up. I'd got into the habit over the years of travelling light with my diabetes related stuff - just a pen, meter and dextrosol tablets and I now found myself having a bit more 'equipment' to carry around. Yes, the pump is bigger than a pen (about the size of a fat mobile phone) but it's not a massive deal really and is fairly discreet. I still carry a pen around in case something goes wrong and sometimes a spare cannula in case of any problems with that. Set changes - reservoir filling, cannula and tubing - are done every 2-3 days and although they don't take long (3-4 minutes) are a bit of a palaver compared to simply getting a pen from the fridge every couple of weeks or so and screwing a needle on.
In terms of pump operation anyone who uses a mobile, computer etc (pretty much the whole population then) would have no problems going through the button pressing. Even if you aren't 100% comfortable with technology it's straightforward stuff. One of the issues I had with myself at first was the complete reliance on technology and something I couldn't see happening keeping me alive. With syringes and pens being mechanical you simply dial up, stick the needle in yourself and press the plunger and know it has gone in. With the pump you can't see it but you soon know if something has gone wrong as your blood glucose quickly heads skywards but it just needed a slightly different mindset to begin with and the technology is well proven as the drip, drip, drip quietly does its stuff.
Is it worth it? It's still early days but for me yes, absolutely. Time will tell in terms of the figures but the finer adjustments, dual waves, multiple basal patterns and especially the TBR's have, I feel, given me greater control of my diabetes although of course it is possible to manage your diabetes successfully on pens for most people. I had managed what I thought was 'okay' on syringes and pens for over 30 years but (with a fair bit of work) for me personally I feel this has made it easier (that's easier definitely not easy 😉) to manage. I still get hypos and still go high but I think that's part and parcel of typical T1 however you manage it, but so far the highs and lows have been reduced. If you work, are active in work or outside of work, doing different things on different days then you would probably notice the benefits more than someone whose only activity is pottering around the shops occasionally and going for a coffee with Ethel. 🙄
I know T1's can be reluctant to change things but my DSN said she sees a number of people on pumps who don't even use TBR's which seems a bit of a waste of the technology to me. It's certainly not a panacea for all T1 issues, it takes a bit of effort and I realise they're not available to all but if you are eligible and are thinking about it then I would certainly recommend giving it a go. 🙂After that little lot time for a coffee!
