Please Explain The Pump To Me

[Staceyy]

I've asked several questions on this forum regarding the pump trying to get a better understanding of what it is and how it controls blood sugar. I realize I'm still ignorant as on a previous thread, I read it can be disconnected. I thought the pump was something that was implanted in the body. Please forgive my ignorance and enlighten me. Exactly what is a pump, what does it look like, when is it used, and is it attached to the body? Is it apparent to an onlooker that this is what you have? Thanks.

[xMenace]

It looks like a large pager that I attach to my belt next to my cell phone. Many options for wearing them exist.

From it runs a 43" thin tube to a "set". Some tubing is shorter. Preference.

The set is a port with a plastic hose or canula that sticks in your body. The other is where the tubing attaches/detaches. There is an inserter needle that slides inside the canula. The whole thing is shoved in and the inserter removed. We do this about every three days. There are devices to inject for you. No more pain than regular injections.

The pump contains a reservoir that holds up to either 180 or 300 ml of insulin, about three days worth.

The pump has buttons that do fancy things. Two basic operations are boluses and basals. Boluses or meal insulin can be given in a straight up shot, over time, or a bit of each. The second is a basal pattern. Basal covers your background sugar releases. These follow waves unique to each person. We can spend much time matching this release to our waves as they are not easy to figure out.

That's about it with a few more bells and whistles such as utilities and wizards.

Insulin pump - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Insulin_pump)

[JediSkipdogg]

This is a pump...

http://upload.wikimedia.org/wikipedia/commons/thumb/8/89/Insulin_pump_with_infusion_set.jpg/300px-Insulin_pump_with_infusion_set.jpg

That above is the Deltec-Smith Cozmo, one of about a half dozen pump models to choose from (all can be found in the Resource Directory on the right hand side here.) The user wears one of a few different types of infusion sets that are connected to the body and changed every 3 days to prevent the build up of scar tissue.

The infusion set is either a plastic canula (that is inserted with a removale needle) or a metal needle that goes into the skin to allow the insulin to flow out the end into the subcutaneous tissue (aka generally fat.) The lenght of the needle or canula that stays in the skin is anywhere from 1/4-1/2 an inch and should be un-noticable during wear.

The connected to the infusion set is a tubing that goes between the infusion set and the pump. I think all infusion sets have some sort of disconnect feature on them so the pump may be taken off in times of need (sex, shower, sports) as long as proper care is taken before removing the pump.

Then there is the pump. Like I said there are a few different versions of a pump with different features. There is even one pump that doesn't have the tubing and everything is sorta in one. It's called the Omnipod. However, a traditional pump will have the tubing between the two and then it has a cartridge to hold either 200 or 300 units of insulin and a battery. Then you control everything via a few button pushes.

If you truely want to consider a pump, I cannot stress enough to try them all out or at least ones that you think you'd like. Ask them for a saline trial where they will hook you up, give you some basics, and then let you act like you are pumping so you can get the feel of it. Nothing like having your insurance buy you a $6000 pump and then you find out it's not for you.

Good luck and if you have anymroe questions, just ask.

[shabbie6247]

and in 'for dummies' format...

a needle is inserted into the skin and held in place by a sticking plaster.

a tube is attached to this that connects to a pager sized device called an insulin pump.

the job of the pump is to trickle feed you with insulin to provide 24/7/365 cover.

when you eat a meal you can ask the pump to deliver more insulin to cover the carbs in a meal.

thats it in a nut shell. theres loads more besides, like all the different programming to achieve best coverage from your insulin.

it is possible to detach the tubing from the needle bit so that you can take a shower or go swimming etc this is possible for a short time

[Jill-O]

But with a pump, do you have to tell the pump how much insulin to give you? Or does it have sensors and know your glucose level and automatically give you the insulin you should have?

If not, what is the major convenience of the pump? Not having to do mulitple injections?

(I've been wondering exactly what they "do" and what makes them preferable over the 2 shots I do right now. Thanks!)

[shabbie6247]

But with a pump, do you have to tell the pump how much insulin to give you? Or does it have sensors and know your glucose level and automatically give you the insulin you should have?

If not, what is the major convenience of the pump? Not having to do mulitple injections?

(I've been wondering exactly what they "do" and what makes them preferable over the 2 shots I do right now. Thanks!)

you do have to tell the pump how much insulin you want it to deliver and over what period of time.

you still have to test your finger sticks, some individuals have a second machine which is called a CGMS, thats a Continuous Glucose Monitoring System, it dose what is described in the name, but these are seperate to the pump.

the convienience of having a pump is different for everyone, but personally (3 weeks in so far) its improved my control because the long acting part is more consistent as its a gradual release every 3 minutes.

pre-pump days i would have had to take 7 or 8 shots a day to achieve the same kind of cover from my insulin. thats the beauty of the pump, you only change the needle bit once every 2 or 3 days. so now i dont look like a dart board!

i like the flexibilty of being able to eat more often if i want to without having to give a shot everytime i eat a piece of friut or a biscuit.

i love my pump :T

[JediSkipdogg]

But with a pump, do you have to tell the pump how much insulin to give you? Or does it have sensors and know your glucose level and automatically give you the insulin you should have?

You still tell it what to give. Currently the JDRF is huge in what they are calling the artificial pancreas. I think over 50% of their money goes towards that now. Which is research into a device that will find out what your BG is and then predict how much insulin to give you. In my opinion, we are at least a decade away from that due to so many variabilities in each person and how food reacts to that person. Then add to the fact the delay in current methods of getting a BG (CGMS delay is estimated 10-15 minutes) and then delay in insulin action, and you have too much delay to be anything accurate over what we have now.

If not, what is the major convenience of the pump? Not having to do mulitple injections?

There are two huge main advantages. The basal option is one. A pump can more accurately fine tune their basal (long acting insulin) since it's given every 3 minutes instead of all at once in a 24 hour period. For someone like me, my insulin usage in the morning is low, and then doubles in the evening with a faster increase near 5:00 pm. Then about 5 hours later it goes back down.

The second main advantage is one needle poke every 3 days instead of 3-5 a day. For me, wearing a uniform to work, it would take 5 minutes to give a shot if I used that method. I'd then also have to always excuse myself from the office to either take my pants down or take my shirt uniform off, which is a huge inconvenience since who knows what could happen then in a police department. The other advantage along with this is you can eat when you want and eat extra. For example, those on shots, if you eat dinner and give the shot before the meal, you either have to know then if you are having dessert or give a second shot when you decide to have some. My brother is in that situation many times. Where for me, I jsut push a few more buttons and don't have to worry about another injection.

[Staceyy]

Wow... Thanks everyone! It seems pretty intimidating. I had a completly different idea of what it was. In my mind, I was envisioning something that was implanted in the body that would do all the work for me. I guess diabetes is something we have to take responsibility for ourselves in all cases. I guess I thought it was an easy way out of responsibility. Shame on me! Thanks for the wakeup call.

[Lloyd]

If you have dawn phenomenon, which is high blood glucose in the morning before you have had breakfast, an insulin pump is the only sure way to treat this, because the problem starts while you are sleeping.

-Lloyd

[Jill-O]

Thanks, folks.

Reading it, I was thinking at this time, it's not for me since I only take two shots (and am not bothered by them). THEN I read the above about the dawn phenomenon, which is without a doubt my most frustrating situation with this disease... I go to bed with good numbers, and if I wake up to 140, THAT is "good" for me. Anywhere from 160-190 is typical for me and can be 210 when I'm feeling a little sick :(

[xMenace]

If you have dawn phenomenon, which is high blood glucose in the morning before you have had breakfast, an insulin pump is the only sure way to treat this, because the problem starts while you are sleeping.

-Lloyd

It's not the only way, but with mdi it takes a lot of testing, trial and error, and creative uses of insulin to match not only the DP but all the hills and valleys. Many of us drop low in the nights before the DP kicks in. Lantus is very difficult on us as it does not let up during this time. Many also drop in the middle of the day when they are active. This is easily treated by MDI but rarely understood. Then the evenings can behave like a mini DP, some of us call this a dusk phenomenon. Again we can add fast acting to our basals. What we end up with is a 24hr roller coaster. For those who do split doses, it's only a partial fix. Two doses of flat still add up to one big flat. The two ramp-up times have minor impacts for extremies like me. One can always wake at 5am and give a shot of *alog. It treats the DP, but it's inconvenient.

Pumping allows us to match our needs very closely. Here's my basals. Yellow is the release and blue is the 'effect' per my weighting. Just look at the yellow one;)
http://www.diabetesforums.com/forum/attachments/diabetes/2337d1185295996-basal-questions-xbasals.jpg

[shabbie6247]

staceyy,
if anything you have to be a whole lot more responsible with a pump, but even with all that in mind i still much prefer the pump to MDI. for me the same amount of work goes into it but its so much more flexible ....for me :)

[deansreef]

I was a humulin 70/30 user for 19 years- recently endo switched me to Lantis 1 time a day and humalog with each meal- morning numbers are 200+ most days with a reading around 65 to 80 before bed- most frustrating... I am starting a minimed 522 this friday hopefully control will be better- A1C is between 5.5 and 6.0

[xMenace]

I was a humulin 70/30 user for 19 years- recently endo switched me to Lantis 1 time a day and humalog with each meal- morning numbers are 200+ most days with a reading around 65 to 80 before bed- most frustrating... I am starting a minimed 522 this friday hopefully control will be better- A1C is between 5.5 and 6.0

Welcome.

You'll need to basal test to effectively treat that DP. I'll PM you some links when I get to my laptop.

[BlueSky]

.... I go to bed with good numbers, and if I wake up to 140, THAT is "good" for me. ...
Have you considered switching your evening Lantus with NPH? NPH taken before bed gets going in the early hours of the morning when your DP kicks in. So you would wake up to better numbers. You would also find that you don't spike as easily after breakfast. If I were to go back onto shots, I would cover the basal with two shots of NPH - one before bed and a smaller one probably at lunch time. They would sort of cover both the dawn phenomenon and the dusk phenomenon. If your early-evening numbers are ok, you could probably get away with Lantus in the morning and NPH before bed.