Considering a Pump.

[BrianM]

Hi, I'm new, I've introduced myself in the introductions forum.

If you read my intro, you'd already know that my doctor has strongly reccomended that I get a pump.

I had been referred to another doctor to talk about that, but he can't see me for like three weeks and I can't simply wait for my doctor to refer me to someone else, I'm far too curious and I want to get my mind made up and on a course of action ASAP. I am impatient. :)

Anyways, I've been browsing this forum (I think I've almost read every single thread) and I still have questions/concerns. If its something thats been asked dozens of times before, I apologize for the repetitive nature of my questions.

So, here are my questions, in no particular order of importance :)

What all is involved in getting the pump? Does it involve a hospital stay?

It's my understanding the pump provides a baseline of humalog/novalog fast acting insulin whenever it is hooked up. When you eat, or as other times arise, you can also use the pump to give you an additional dose. What method (sliding scale, counting calories, etc..) do you use in order to determine that amount?

It seems like everyone's major complaint is changing the injection sites (am I even saying that right?). This has me confused, I'm not sure what all that entails and I hope someone can clarify that.

Does anyone play any sports? I am an avid softball player. I jump, slide and dive and by the time I get home I'm pretty dirty. In that instance, what risk would I run in either damaging the pump, or if i take the pump off for my games, what risk do I run of wounding the injection site?

I'm assuming you leave the pump hooked up even at night when you're in bed. How often does that get in the way? I can't imagine ever being comfy if i wore my cellphone on my boxers when i went to bed. I toss and turn alot at night. Do any of you other restless sleepers have problems with the pump at night?

And finally, what kind of success have the rest of you had with getting your insurance to cover the pump? Cost is a major concern of mine right now, and I'd just like to get a general impression of the luck everyone else has had.

Anyways, thanks for taking the time to read this novella. I am sure there are more questions to come in the future.

[MarkMunday]

I have also been considering a pump but have decided against it, simply because of cost. I can see how it could get in the way if you play sport. An alternative is to use the pump and Lantus together. That allows you to take the pump off when you are doing sport. See this article (I have also been considering a pump but have decided against it, simply because of cost. I can see how it could in the way if you play sport. An alternative is to use the pump and Lantus together. See
[URL=http://www.diabetes123.com/clinic/untethered.htm) for details.

Mark

[MarkMunday]

I cant seem to get that link to work. So here goes again :Article (http://www.diabetes123.com/clinic/untethered.htm)

[am1977]

I was on the Paradigm Insulin Pump for about a year, before I started having some problems and have switched back to MDI of Lantus and Humalog. Anyway, I'll try to be brief and to the point and answer your questions.

I did not have to go to a hospital during my pump training. In fact, my pump trainer came to my apartment. She briefly went over everything and helped me connect to the pump. I think it's important to state that I had done some research on the pump prior to this appointment so I was well prepared. Minimed sent me a video and a whole work book and info. to look over as well. All in all, things went very smoothly getting set up and actually starting on the pump.

You are correct, you only use short acting insulin in the pump. The pump realease little spurts each hour and to cover meals you bolus an extra amount of insulin to cover what you eat. Generally withthe pump you use carb counting. If you are seriously considering the pump, you should definitely learn how to do this. A CDE or dietician can help you with this. The dietician/CDE can help determine your carb to insulin ratio. For most people, they start off at 1 to 15 grams of carb...meaning you give yourself 1 unit for each 15 grams of carb. This is something you definitely want to review with your doctor, CDE, or dietician. It can be a very individual thing.

I don't know about most people, but for me changing the sites was the worst, I hated that part of having the pump. I think mostly b/c sometimes I was unsure of whether the set was in correctly, sometimes it hurt a bit, and to be honest sometimes it was just a pain to have to change the site. There is work involved in having the pump, you have to plan out when you need to change sites, have supplies on hand, and test even more often.

I don't play sports per say, but I work out in the gym and the pump has hardly caused a problem with my working out. Perhaps someone who plays sports can give you their take on this.

I think you get use to sleeping with the pump. It might be a little uncomfortable at first, but then you forget you even have it on.

I was lucky in that my insurance covered my pump 100%. I think it really depends on what insurance plan you have.

I hope I was able to provide some good info for you.

Good luck! :)

[Dobson]

i've been thinking about the pump also, but with my current lifestyle (im 16) i dont think it would work so well. but im going to definetly consider it more earnestly later down the road.

[Dewey]

Hi Brian,

I have been on pump therapy for 8 years, and am very pleased with it. I didn't have to stay in the hospital, and now Doctors no longer commonly do that with patients unless they are working with children (this may not be true for all).

When I began pump therapy, I went to the doctor's office and met with the rep. It was fast, simple and I left the office with insulin in my pump that day. Now, they offer the option to use a trial run of saline in the pump, and this is beneficial for new pumpers who want to try before they commit.

I use Humalog in my pump, but there are other insulins available as well (i.e. Novolog, Buffered Regular <a.k.a. Velosulin>, etc.). For bolusing, I initially used a sliding scale, but later found that counting carbs worked better. If you're unsure about the amounts of carbs in certain foods, there are "mini" books that offer information on a multitude of foods, their carb content and other helpful info. Your doctor can work with you to find the best method suited for your needs.

Though some pumpers may be sensitive to site changes, I've never really experienced issues. Occasionally, if I hit a sore spot or the set is not seated properly, it will sting or hurt. I use the needle type sets as the needles tend to be a smaller gauge and work better with my body type. Many users balk at this idea, but some are allergic to cannulas and I've found that my absorption is far better with needle sets. They do not hurt as much as people would think. In fact, when I used the angled cannula sets, it hurt much worse to insert them.

Playing sports shouldn't pose much of a threat if you disconnect, or wear a "sportguard" arcrylic safety case (to protect the pump). If you are sliding a lot on the ground, it may be better to disconnect, but you'd want to ensure that your set is in an area where you don't usually slide, and that you check blood sugars consistently to avoid high numbers.

I sleep with my pump every night and it has never become dislodged or got in the way. You can wear a pocketed t-shirt to put the pump in, or as Deager explained, make your own "waist band" to wear the pump on. I've been wearing a pump to bed for 8 years without trouble. :)

In the area of insurance, it depends on the type and the coverage you have. Often, with a letter of medical necessity and other information, insurance companies will cover the pump up to 100% (but not all ins. companies will do this, it depends on your personal coverage plan). There are many pump companies (i.e. Animas, Deltec...etc.) that will do the insurance "leg work" for you. Although some insurances may be reluctant to pay, they usually do come through.

A useful website to compare pump companies and products is:

Pump Comparisons (http://www.diabetesnet.com/diabetes_technology/insulin_pump_models.php)

I also am throwing Animas into the mix, as they offer interest free payment plans (for out of pocket expenses) and 90 day trials to new pumpers.

Animas (http://www.animascorp.com/index2.shtml)

I hope this information is helpful to you. Sorry for the long reply, but I wanted to ensure that I "covered all the bases" (no pun intended - lol). If you have any questions, ]
you can PM me through this site. I've been on the (following pumps) Minimed 506,7,8,11, 512, Deltec Cozmo and the Animas IR-1200(currently), so feel free to ask with confidence, and I'll gladly help. :D I cannot stress enough to research and ask as many questions as possible. It will help you to decide which pump is best for you, and enable you to make an informed choice (so there will be no regrets later). Hope this helps :)

[David]

Hi Brian, I've been using a pump for almost 4 years, after more than 30 years injecting. I think am1977 did a good job describing her experiences and I'll try to do a good job too.

I didn't have to stay in the hospital, although I've heard of a few who have. I started out by gathering as much info as possible: from my doc, from the pump companies. I had to show my doc that I was able to handle the frequent testing, counting carbs and making on the spot dosing decisions. My carb counting was shaky, so I had to take a carb counting class. I was also able to borrow two different loaner pumps from my endo for a few days each (pumping saline) to give me an idea what dragging around a pump was like and help me decide which pump I preferred. I had another class to learn how to use the pump I got.

You're correct, you only pump short-acting insulin (great explanation of this from am1977) The pump provides a baseline, called a basal, which takes takes the place of longer acting insulin. You take a bolus when you eat or need to correct. That's usually determined by how many carbs you eat (carb/insulin ratio is figured by your CDE, doc and you). A correction bolus is a sliding scale type of thing also figured by your CDE, doc and you.

I've used many different sets. Some pumpers prefer one, others like another better. try as many as you can. Yeah, they can be a hassle, but I think of them this way: Once shot every three days or 4 shots every day.

I sometimes play softball and a few other sports. I usually keep it connected when I play, but yeah it could be damaged. A slide could pull the set out, but I'd just replace it after I shower. Jason Johnson pitches for the Detroit Tigers and keeps his connected when he plays. He clips it in back, you can see it if you look close. You could disconnect if you're concerned, especially since your basal needs may be very reduced when exercising.

Sleeping took a while for me to get used to. I tried clipping it to the sheet, to the pillow, wearing clothes to clip it to. I finally just set it beside me and when I roll over, it comes along if it wants to. I wake up once in a while if I roll on top of it. No damage done.

Check your insurance policy. In the US, the pump and supplies should be covered under the Durable Medical Equipment clause of your policy. My DME pays 85% of pump and supplies. You should provide records of your testing, history of lows and highs, ambulance rides, ER visits, anything to show your insurance company that covering a pump is to their as well as your benefit. The pump company you choose have staff that know how to deal with insurance companies and will help you get their pump approved. Your doc should sign a letter of medical necessity that will be in the info packs from the pump companies.
David

***Edited to remove link. TAutry***

[BrianM]

Thank you for all the information.

To clarify, I was always under the impression that a pump required outpatient surgery and a tube was "installed" (for lack of a better word) in order to hook up to the pump

As I understand it, I was incorrect in that impression, now the injection site is something you install on your own. I assume, it basically means there's a needle in you at all times?

[rzrbks]

BrianM,

Yes, it's what I would call a "Type" of needle. Whicvh, to be honest is the major reason I haven't gone that route. My control is just fine on MDI ( Multiple Daily Injections), worst A1c was 5.7 and I feel better knowing that I aresn't ( Yankee, for Ain't) hooked up all the time to insulin so I am able to pretnd, at times, that I'm "normal.

The CDE wanted me on the pump when I was first diagnosed, I fended her off (she too is Type 1 Diabetic and believed that the pump was the way to go) but since I've been Happy AND successful with MDI they don't push the pump any more and let go about my merry way.

Just my $.O2

[statdeac]

For the record, my experience is similar to RZR, except that my endo was not pushing it. Since then, I have a new endo who suggested it and I resisted because I didn't see the benefit for me.

That said, this is my experience and my situation doesn't necessarily apply to you. You have to consider how well you do on your current regimen, your tolerance for shots, your money/insurance situation, etc.

Good luck! :)

[Shalyndria]

Hi Brian.

No, there is no needle left in your body after insertion (unless one uses a needle set, but that's less common nowadays). There is a miniscule cannula, made of teflon, which is flexible and less invasive than steel needles. There is a needle that is used to introduce the cannula when inserting a site, but it is removed after insertion. For the most part one cannot feel the cannula at all, it's as though it's not there.

To add my response to your initial question, I sleep in the buff and while it was a trying adjustment initially I now just throw the pump somewhere on the bed and sleep (this on the advice of one of the wonderful members here :) ). I've woken up tangled in tubing, with it wrapped around my waist, or sleeping right on top of my pump.
It's become an extension of my body, and when I'm not wearing it I always feel as though something's missing. Quite simply, one just becomes used to having it while sleeping, working, exercising, etc etc.

Everyone has done a wonderful job of answering all your questions, so I'll refrain from parroting any answers.

Good luck to you and keep us updated!
Shy

[SunniD]

There are official sites and sites with good reputations to get your info from Brian. It's best to learn good proper pumping techniques rather than bad habits some pumpers have.

***Edited to remove content that was rendered irrelevant by earlier edit. TAutry***

[Dewey]

To find any good and useful info., I either come here, go to ChildrenWith Diabetes, or other sites to find the latest and greatest. Hope this is helpful and if you have any questions, please feel free to ask, PM, or e-mail me. Good luck and we're here to help! :)

***Edited to remove content which, again, was rendered irrelevant. TAutry***

[TonyAlmeida]

As I found out - a hospital stay for New Pump User orientation is not called for. It's just a way for an Endo to make more money off you (on of my local endos used to get kick-backs from our local hospital for filling beds). Keep in mind - we Diabetics are a cash cow for both the medical community and medical industry. My pump training was 2 hours in the endo's office with a nurse practitioner and the pump company trainer.

When you're on the pump - forget the Exchange List B.S. You count Carbs (a lot easier) and make sure the Carbs you take in give you enough Calories. I found the software at CalorieKing.Com for my PDA the best $20 odd investment I ever made - makes it easier counting up Carbs/Calories for meals.

The pump while sleeping - I just clip it to my waistband below my navel. I use my abdomen - so sleeping on my stomach is a thing of the past. You'll sleep on either your back or the side you don't have the infusion set in. Don't worry - in your sleep, your body won't let you roll on it. After the first night, you forget it's there.

Site changes are probably the most undesirable part. At max, you have to change every 3 days. Some people can do 4 days - but 5 days is just begging for a nasty infection or for your skin to heal *around* the cannula (which is bad). The longer you keep it in, the longer it takes to heal that puncture wound. There's no one method to how you put the site in or take it out.

[koblenz]

Hey Brian,

I am in the same boat as you. I am currently researching pumps and have found the cats here to be very helpful. While I have not made my final decision on a model, I will add a few bits of information I have learned...

1. When you contact the pump companies for more information, find out if they have a rep in your local area, and set up a meeting with them. I have had meetings with 2 reps at my house ( I have 2 more to go ) and it was very valuable. Both reps I spoke with:

- brought the actual pump and let me play with it.
- brought actual infusion sets so I could see what they look like and how they are inserted
- had all kinds of obligitory marketing material and videos to watch.

Having a pump in my hands, being shown it's features, buttons, etc. and reading the experiences of others here have really put my mind at ease.

However, most of these reps are SALESMEN. Take what they tell you with a grain of salt, and do your research. I have found several things I was told by a rep to be "partially" true. Afterall, it is their job to talk you into buying THEIR product. Several posts in this forum have some great sample questions to ask the reps (sorry, I don't remember which ones, I printed them out).

2. Read and research as much as possible. My Endo and CDE recommended a book "Pumping Insulin". That answered a lot of my questions and gave me a very good idea of the knowledge and skills you will need to have a sucessful pumping experience (at least that is what I hope).

3. I called my insurance company before I started this journey and asked about coverage. I didn't want to get my hopes up and find out I would have to pay a huge sum of money. I had to keep calling until I got a "supervisor", but was informed that they do cover 100% of the pump and the on going supplies will be a prescription type co-pay. When I spoke to the sales reps, they were quite familiar with my Insurance and confirmed that they did cover 100% as long as it was deemed "medically necessary". WHEW! I also found out that once you submit all required paperwork, it can sometimes take upto 2 months for approval and delivery.

OK, that is all for now. Feel free to Yahoo IM or PM me and I can pass on other things I have learned thus far; not that I am as informed as many others here...

Good luck!

[Dewey]

Here’s a List of Questions to Ask:

1. What kind of infusion sets will I be able to use with this pump
(Luer lock or Proprietary)?
2. How many boxes of supplies come with my new pump?
3. What types of features does this pump offer?
4. Is the pump waterproof?
5. What batteries are used in this pump, and are they easy to
obtain?
6. Would it be possible to use the pump on a trial basis?
7. Are payment plans available for out of pocket fees (if
applicable)?
8. If my pump needs to be serviced or upgraded, will I receive a
backup?
9. Would a backup pump be provided for travel, trips or
vacations?
10. Can I have my pump returned to me when it has been
upgraded or repaired?
11. Does the pump come with software enabling it to
communicate with the computer? Do I have to buy anything
extra? (I.e. Ir cables)


Another member (Chuck) added some good questions to also ask:

Training, performed by sales rep or an R.N. or certified trainer ?
Is a CDE available to help me solve "little" problems,
preferably, a company employee ?
(or a hospital based R.N., CED, who the pump company has checked out)
What training will I provided with initially, and by whom ?
Carb Courting review, very important
How long with the in-hospital (outpatient) training be ?

Hope this helps! :)