To pump or not to pump, please help. Heavy exercise...

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Adam Hardy

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Hey guys,

Can I just say I have what I would consider great diabetes control. I have been type one for 15 years. My last 2 yearly A1C results were 38 and 39, and the diabetic nurse said it was one of the lowest she has ever witnessed for a type 1.

I have in the last year started some serious exercise (mostly medium to high intensity cardio), but find myself glugging lucozade to cover the lows and it's a pain. I'm also consdering working towards running a marathon.

I have adjusted my Levirmir quite a lot lower, and also heavily reduce my novorapid. With me trying to tone up and build muscle i'd rather not have to drink the lucozade as it's so high in sugar content.

My diabetic consultant said that a pump could be ideal for me. I've never really considered one before as they seem a little tricky.

Now i'm a glutton for sweet things, whilst I do have the occassional thing a good 3 times a week I in effect allow my blood sugars to drop to around 3, and then eat something sweet to keep it below a set level. I've been doing this for over 10 years with no hypo glycemic attacks etc. And I know the hospital do not like you doing this.

Another thing I occasssionally have is takeaway food - Pizza express, chinese and indian foods. I find all of these foods are tricky to deal with. I find the best way to handle them is to give a lower novorapid dose when eating the foods, Then with pizzas in particular give the rest of the novorapid dose 3 hours later to balance in out (due to the slow absortion of the carbs from fat content).
I also treat high protein meals the same way as they seem to turn into a carb about 6 hours later.

Could a pump handle these anomolies with the way I control my blood sugars.
I know you normally program the pump to tell it how many grams of carbs you have, but given the GI range of some carbs obviously eating a cake would have far more irractic effect on sugars than eating the same measure of brown rice.

Thanks in advance guys,
Adam
 
Two things here:
1.For things like pizza,takeaways etc where you already split your dose, a pump can be set to give your insulin in one go, over a set period of time that you tell it (eg an hour,3 hours, etc) or a combination (1/2 upfront, rest over 2hours, for example). Pumps will probably help you. But dont be misled-they do require as much work as MDI. Maybe more. Tricky can at times be an understatement.
2.I would say that allowing your bg to drop to 3 so that you can eat sweet stuff is dangerous in the long term as you risk losing hypo signs. And your statement about not having hypoglycemic attacks is false as your bg being below 4 means you are having regular hypo attacks, you just dont see them as that. That is why your HBAC1 is so low. But I think you know that. And you may think your hospital is wrong not liking you putting yourself at risk (which is what you are doing) but they are just doing their job. If you choose to do that, its your choice.
 
Yeah I like to run my sugars relatively low. Most morning they are no more than 6. I do a lot of driving £15000 miles plus a year and I am constantly testing my blood sugars (10 times a day or more) and wake up at least twice a night (like clockwork) to test them.
I also always wake up and I am very aware if my blood sugars drop below 4. I think in my lifetime I have had two diabetic fits - but these were down to me mis-using drugs and not taking care of my blood sugars.

So with a pump I can tell the meter to deliver my evening injection over say a set period? Hmm this sounds good and sounds even better than what I am doing.

I'd consider myself a little technically minded so I wouldn't mind the challenge of mastering one of these, Going to push it further and give it a go I think!
 
With a pump you can also tell it to reduce your basal rate by a % for a period of time (up to 24 hrs) which should stop you going hypo during exercise. Although it takes quite a lot of trial and error to work out how much to reduce it by, how far in advance of the exercise to start the reduction, and how long afterwards to wait before you cancel it again!
 
I would get my name on one ASAP ! I have been T1 for over 50yrs now & from the age of 3 been injecting up to 4 times a day ? When I hear a member of the public say "I don't like Needles" I could knock them out :D. I have had a couple of pumps now & a big bloke would not be able to pinch it off me 🙂 Good luck
 
I would also recommend that you try a pump.

I found life became much more flexible, through the use of the extended bolus deliveryfrom fatty meals like pizza, multiwave Bolus for a mixed meal and porridge. I used to try splitting my injections but often forgot the second half so this is a lot easier.

For exercise it is great. As Sally assays it takes a while to work out how much to drop the basal amount for and for how long before and after, but if you look at patterns it becomes clear.

You do need to be willing to check your rates and adjust them regularly but I would definitely not go back to multiple daily injections now.
 
Hi Adam - just wanted to add, that the critical BG is actually 3.3. Below that - it definitely affects your brain whether you like it - or can recognise it - or not. That's why they say '4 is the floor' - it gives us room to manoeuvre, before we lose co-ordination etc.
 
You do often get some choice but sometimes your diabetic clinic only normally deal with one make or a few. Have you discussed it with your diabetes consultant, cos it is he who has to recommend you for a pump, which means the NHS will pay for it. It would be an expensive business to self-fund - I change my cannulas every 2 days (some people get 3 days but I have absorption issues no doubt from over 35 years of jabbing beforehand) and they cost about £7 each, plus £9 for the things that need changing every 5 or 6 days, plus the original cost of the pump and matching meter and or handset to begin with.

Then of course - few of us get the opportunity to self-test various different kinds. There is a thread on here somewhere - this year! - to narrow it down LOL - where each of us gave what we saw as the pros and cons of our own pumps to try and assist someone else just like you.

You could start though by buying the 'Pumpers Bible' - a book that rejoices in the whacky and innovative name of 'Pumping Insulin' by John Walsh - which is what it says. If it doesn't put you off completely before you start, LOL - proceed and discuss with your clinic.
 
And I'd just like to add that I think you'd find a Freestyle Libre the perfect adjunct to a pump (and it'd save you doing those night time tests). I've found it invaluable for getting the basals right, and great also for exercise. You cannot use it to replace the finger tests when driving though as the DVLA do not recognise the validity of the Libre results (yet).

All the available pumps have the same basic functions, but they differ in minor ways which comes down to a matter of lifestyle or personal preference. For example, the Roche pumps have a remote control which means that you don't have to fiddle with the pump itself. On the other hand, they are not fully waterproof so you have to disconnect the pump when swimming or showering (unlike with the Animas and Medtronic pumps).
 
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