To pump or not to pump...?

[qtrchicken]

I have been a Type 1 diabetic for almost 19 years. Like most of you, I've had ups and downs. For the last 3+ years, my endo has been suggesting that I switch to a pump. I have researched and weighed all the pros/cons and am still not sure if it's right for me. I'm currently on Humalog/Lantus combo. It works ok for me and my A1C's are usually good.

I'm very active and that's what's giving me some pause. I play basketball 3 times a week, work out 3x a week and race a motorcycle during the warm months. I check my blood often, but am considering the Medtronic pump with the CBGM wireless piece. It seems like it would make life simpler for me. I'm concerned about the activities and the pump interfering with each other.

The cost is a factor for me, but my health is worth whatever I can pay. If anyone else has made the switch or has relevant experience, please let me know your thought/suggestions/etc.

Thanks!!

[solox316]

Your sports and activities seem non-invasive enough... meaning I don't think the pump will get in the way too much.

Many many people are very successful and very happy with MDI. I wouldn't be, so I am very pro-pump.

I would say, if you are happy and you have good readings, no reason to switch. But if you want tighter control that you can't seem to reach, and more control over variables (particularly large amount of exercise) a switch might be good.

The CGMS won't really make life simpler, it takes a lot of work/tweaking to get it accurate. It doesn't save on fingersticks for the most part. The CGMS can help you tweak your control...

[xMenace]

Flexibility and control.

Flexability: I can sleep in till noon. I can skip any meal. I can eat whenever I want to. Grazing is not only possible, but it's evil! :evil:

Control: I went from a 7.3 to 6.5 in 6 months. Since deciding to not consult with my health team on tweeking it, I've dropped to 6.0% far many fewer hypos and far less serious. You will lose awareness eventually.

Activities: If Toby can do it, I don't know why you couldn't.
YouTube - Toby Petersen (http://youtube.com/watch?v=nxlIf3pusKM)

[RobiJo]

There are plenty of folks out there that wear pumps and are very active. Watch the youtube link in xmenace's post. There are sports harness' you could wear or just disconnect. One of my best buds has beat the living daylights out of his pump and it still works fine. He regularly jumps off cliffs, skydives, bungee jumps the list could go on.

The biggest change for me when I switched: the freedom. I could sleep in and and eat when I was hungry; rather than when my insulin said I had too. The CGMS is pretty cool too though not perfect yet.

[BlueSky]

Get one on loan from a pump company and see if you like it.

[Subby]

If it's just the activities that gives you pause, I think you should go for the pump. Variable basal rates and the ease with which you can cater for activity far outstrips MDI. With the lack of long acting insulin in you, you can completely change your basal profile within the next few hours, for as long as you want, easily.

So, going to play basketball in an hour? Dial up a temporary basal of 80% for 4 hours (or whatever works for you with a bit of trial and error), and after you have experimented a little and gottne a handle on the best variables, you will find it minimises the impact of excercise on your BG.

After 15 years MDI, (although it has to be said I found it a lot more tricky than you seem to find it), it was a revelation to be able to be so flexible with insulin delivery and I hope never to have to go back. At the same time, it does take some effort to work with the pump, so if you feel "eh, who cares about it, MDI's good enough" at all, keep thinking twice about it.

The loan Bluesky mentioned would be good, if it's possible.

One last thing... researching and thinking about pumping simply doesn't give you any kind of feel for how it really is (for better or worse). So at some stage if you do want to try it, you will simply need to stop thinking about it, and just take the plunge.

[fgummett]

Even if you can't work out a loaner, I recall I had a 30 day money back guarantee when I bought my first MM... so you can try it out without risk :)

It may be an oversimplification, but I compare Pumping to MDI in this way: Imagine a truck that makes a daily trip down a twisting, gravel, potholed, mountain road with steep drops off to either side of the road. Now imagine that you get to set the speed once before the trip starts (basal rate) and only get to alter the steering once before each major bend in the road (meal bolus). Wouldn't you rather have more access to the accelerator, brake and steering wheel... that would be the pump:) You can set multiple automatic basal rates for different times of the day and than change them on-the-fly for example, when exercising. Because you are only using fast-acting insulin your control is much greater both for increasing the amount of active insulin AND for decreasing it. You can set a bolus that is spread over time for example when grazing at a wedding buffet. But it does require more work, is expensive and of the infusion fails for whatever reason (many safeguards built in) you can quickly lose you basal insulin.

[qtrchicken]

I wasn't expecting any responses this quick, but thank you to all who have responded. I will watch the video today.

Here's my endo's theory. I am an engineer that designs and develops software. So, he thinks it would be not only easy, but also very interesting for me to use and tweak. He keeps telling me that I could get my A1Cs in the 5's consistently and not have to worry as much with nighttime lows and lows while participating in high stress activities.

I attended a pump-info class at the hospital facility last month and there were a lot of choices. I've had my mind set on the Mini-Med from Medtronic, but have no experience to rely on besides the features. Does anyone have any reason I shouldn't go with the Mini-med? Otherwise, I'm calling next week to give my approval.

[fgummett]

Well that settles it... I also write software and if you are even a fraction of the geek I am, then you are going to want all the latest hi-tech toys :D

But seriously, your background should make it easy for you to adapt to the pump, if you do decide to go that way. Best of Luck!

[qtrchicken]

I'm probably more than just a fraction of a geek, but refuse to admit it. :-) I have 4 running pcs within arms reach with Linux, XP, etc.

fgummett - I'm not that experienced with Type 2, but why would you be on a pump with type 2? I guess it must be a serious Type 2. Several extended family members have type 2 in my family, but I've never been able to connect that to my type 1. I'm sure genetically there is a connection, but research doesn't seem to suggest that connection.

Anyway, the more I've thought about it over the last few months, I'm getting frustrated with sneaking away for shots at every meal, etc. And the nightly falling asleep on the couch - only to have to get up, test and take Lantus has grown really tiring.

I think in the beginning, I will end up taking more "pump holidays" until I get it completely running precisely.

[fgummett]

I'm probably more than just a fraction of a geek, but refuse to admit it. :-) I have 4 running pcs within arms reach with Linux, XP, etc.

fgummett - I'm not that experienced with Type 2, but why would you be on a pump with type 2? I guess it must be a serious Type 2. Several extended family members have type 2 in my family, but I've never been able to connect that to my type 1. I'm sure genetically there is a connection, but research doesn't seem to suggest that connection.

Sounds like a geek to me :D

My specialist started me on insulin within my first year as we both felt it would give me the best control for a long and healthy life. I started on MDI but not too long after (being a geek myself) learned about the pump... I have not looked back yet and have great control :)

As for being the "serious Type 2" there is a whole other thread (http://www.diabetesforums.com/forum/diabetes/28261-so-so-has-diabetes.html) about that discussion :)

[shades9323]

Flexibility and control.

Flexability: I can sleep in till noon. I can skip any meal. I can eat whenever I want to. Grazing is not only possible, but it's evil! :evil:

Control: I went from a 7.3 to 6.5 in 6 months. Since deciding to not consult with my health team on tweeking it, I've dropped to 6.0% far many fewer hypos and far less serious. You will lose awareness eventually.

Activities: If Toby can do it, I don't know why you couldn't.
YouTube - Toby Petersen (http://youtube.com/watch?v=nxlIf3pusKM)


You can do all those things on MDI too!;)

[qtrchicken]

So, one person is in favor of MDI. I can respect that, but what are the arguments to stay on MDI?

I've been talking to the rep at Medtronic and she has me a bit worried about the CGM system. Not that it doesn't work, but I may not necessarily qualify for it. First you must prove that you check your blood with a monitor at least 6 times/day on average. I'm close to that, but can't guarantee it. I'm definitely not buying it outright. It's rather pricey at the street price. Not to mention that the monthly costs outside of insurance are just ridiculous.

I've looked at the Dexcom too, but that's a completely different system. They demo-ed it for me at the info session. The guy had the dexcom along with the Medtronic mini pump. I like the Dexcom CGM system as it has a ton of checks/measurements and very good alarms. That's what I really find the most appealing about any pump. The ability to be notified if things are out of my set boundaries, seems like an excellent tool.

[fgummett]

some MDI advantages:

* much cheaper
* not tied to a pump 24/7/365
* less chance of DKA [so long as you remember to give your long acting basal]
* possibly don't need to test quite so often
* don't need a degree in computer science to program it
* supplies are more likely to be available Worldwide
* no annoying beeps or alarms going off at odd moments
* as a man I would not need to shave patches of my belly every three days
* ... I'm sure there are many more...

[qtrchicken]

fgummet - are you changing your allegiance? I thought you were in favor of the pump vs MDI?

[shades9323]

I am in favor of using what works for you. I am an MDI user, more due to cost. I would love to try a pump. I like gadgets! But my insurance sucks for DME.:( Both methods do the same job. To combat any exercise lows from having a not variable basal, I just eat extra carbs. I like to eat.:T

[fgummett]

fgummet - are you changing your allegiance? I thought you were in favor of the pump vs MDI?
Not at all... along with just about everyone who has tried a pump you would have to, "pry it out of my cold dead hands". Just trying to be helpful. The cost is certainly a big consideration especially if you don't have insurance $7-8,000 just for the pump and then around $250 per month for supplies. Even more if you also go with CGMS. You need to test probably in the order of 8 - 10 times a day or more, especially when first starting out on the pump and by all accounts it is more work than MDI... although it really doesn't feel like it :)
I'm hoping you'll get some other feedback here but if not please search and read around on the forum as I know there are different opinions on this. For example I understand that some do not feel that the extra effort and cost are justified for what may be a small improvement in control.

To be Frank (hah!) I can list the advantages of MDI and still know I am better off on the pump... my insurance did not cover the replacement pump I just got so I am out of pocket nearly $7,000 what does that tell you?!

[rzrbks]

My CDE has been after me to switch to pump for 5 years now. I haven't because:

1) Worst A1c has been 5.9

2) Cost, Cost, Cost and Cost

3) I don't want to be tied down 24/7

4) Cost

5) I bolus much like pumpers which is why I keep A1cs in 5.5--5.7 range

The most important thing, however, is that you have to do what's best for you.

Unless and until my control goes to $%#%^$, I'll stick with my MDI.

I have to let you know that I'm still using my InDuo even though the non-replaceable batteries died a year or more ago. The injector works just fine without the batteries.

If I was only able to use a regular pen, I MIGHT think more seriously about about switching except for COST.

[shiftzor]

To be Frank (hah!) I can list the advantages of MDI and still know I am better off on the pump... my insurance did not cover the replacement pump I just got so I am out of pocket nearly $7,000 what does that tell you?!

Lol, that you are now extremely poor, living under a rock in a cave, somewhere remote, growing a beard and wondering where it all went wrong. :D

I am asking the same question (as an MDIer) and currently I am pro pumping. Getting one might be harder said than done. I have yet to properly research it but I will do ;). Good luck with your quest.

[qtrchicken]

My insurance provider does cover the cost of the pump, supplies, CGM and accessories. I couldn't justify it, if I had to pay out of pocket. It will run me about $700 to get the pump with my insurance. Not sure about monthly costs, but they won't be too much more than what I'm paying now. (that's all relative)

In the end, if I don't like it, I can always switch back without too much drama. I see my biggest hurdle as the bolus calculation. I've never really figured out my Insulin to Carb ratio. I guess it's time to start counting and get a baseline.

[xMenace]

In the end, if I don't like it, I can always switch back without too much drama. I see my biggest hurdle as the bolus calculation. I've never really figured out my Insulin to Carb ratio. I guess it's time to start counting and get a baseline.

Generally it's incorrect basals that make things difficult. Focus more on basals first. Once they are set accurately, bolus ratios pretty much fall into place.

[shades9323]

My insurance provider does cover the cost of the pump, supplies, CGM and accessories. I couldn't justify it, if I had to pay out of pocket. It will run me about $700 to get the pump with my insurance. Not sure about monthly costs, but they won't be too much more than what I'm paying now. (that's all relative)

In the end, if I don't like it, I can always switch back without too much drama. I see my biggest hurdle as the bolus calculation. I've never really figured out my Insulin to Carb ratio. I guess it's time to start counting and get a baseline.

You should have yout I:C ratio worked out if you are on a pump or mdi. It is very important to have these right no matter which method you prefer.

[Subby]

You should have yout I:C ratio worked out if you are on a pump or mdi. It is very important to have these right no matter which method you prefer.

True, but at the same time, as control sounds pretty tight already, if going for the pump, the transition onto the pump would be a fine time to work all that stuff out - it's really not that complex anyway. I found its a lot easier to tinker with getting I:C ratio right, armed with a pump. For a start you can experiment with smaller sized carb amounts and multiple extra boluses through the day, without having to resort to a lot of injections, and with a much bigger chance of very similar absorption, at least while on the same set (usually 3 days).

[Blibbit784]

I am going with Minimed, starting Monday. The trainer is helping with my ratios as I am brittle and have poor control on injections. She also tells me the pump has only a 3% margin of insulin that may not be absorbed or used properly, but with injections you may not get up to 50% since it is subcutaneous.

[Subby]

I am going with Minimed, starting Monday. The trainer is helping with my ratios as I am brittle and have poor control on injections. She also tells me the pump has only a 3% margin of insulin that may not be absorbed or used properly, but with injections you may not get up to 50% since it is subcutaneous.

That 3% may be true in some clinical study, but be aware that there are quite a few factors that might significantly affect absorption, including: set type, area of body used (for example I have a few cm circle on my belly that doesn't work well, or it may be large areas), how well the cannula is "seated" in the hole etc etc. Many of these issues may not crop up at all, and if they are present they can be dealt with, for example by trying a different set, or keeping track of where you get good results on your body. But, being aware of them is the first step, so keep it in the back of your head if you find absorption does vary a lot more than you would expect.

Congratulations on the move, I predict you'll feel a whole lot better soon like me, and your health will improve the more you synch with the pump. Took me a good 6 weeks to feel I had a real handle on it, and thats kind of time frame seems to happen for other people, so take it easy and hang in there. Don't forget the pump forum here, we're all here learning together and there's lots of experienced pumpers around. :)

[MJM]

I have friends who are triathletes and pump users. They have the pump because it facilitates greater control. If you start to go low you can reduce your basal instantly or even stop it, if necessary. It allows for night-time basal adjustments to meet your needs. In other words, greater control and greater flexiblilty.

[Gary_W]

I am going with Minimed, starting Monday. The trainer is helping with my ratios as I am brittle and have poor control on injections. She also tells me the pump has only a 3% margin of insulin that may not be absorbed or used properly, but with injections you may not get up to 50% since it is subcutaneous.

Excuse me for being dense, but can you explain this to me a little more in depth please?

I used to whack an 8mm long needle into me. Now I have a 6mm teflon tube sticking in. Are you saying that the 6mm tube is not subcutaneous? I know that you use less insulin on a pump, but further details on this would be welcome :)

So as not to pinch the thread totally, I'm a 100% pumping convert. Just over 3 weeks in and you would have to threaten violence to get me back to MDI. And even that might not work...

[solox316]

Are you saying that the 6mm tube is not subcutaneous?

I am curious about this too... I was always under the impression that infusion sets are sub-q...

[Lloyd]

fgummett - I'm not that experienced with Type 2, but why would you be on a pump with type 2?

For one thing, if you have Dawn Phenomenon, it is far and away the best method to manage it.

I have 9 different basal rates, ranging from 2.8 U/hr at 2 AM to .65 units/ hr at 2 PM.

The ability do do this has dropped my fasting readings from 180 - 220 down to the current 80 -110.

It took effort and trial and error to get this all set up, but you can see the results below. 90 average glucose, and also a 90 average fasting glucose.

-Lloyd

[Blibbit784]

Folks, I am sorry about the confusion here, wrong choice of words. I spoke with the trainer and she said that the pump allows insulin infusion in small amounts between the cells (interstitially) Def.
2 a: situated within but not restricted to or characteristic of a particular organ or tissue —used especially of fibrous tissue b: affecting the interstitial tissues of an organ or part

Yes it is also subcutaneous, injected into the fluid between the cells.
She said when you put a large amount of insulin, say, your twelve hour dose by injection it pools in your system. The amount actually used can be lower because of pooling. A basal rate allows small doses just like the pancreas so it is absorbed better. She said there were other factors like hormones that could affect your insulin absorbtion, and that insulin injections are mostly guesswork because you don't really know how much you absorb.

[Funnygrl]

It's funny, but the way my insurance is set up, it's far cheeper to pump than do MDI.

MDI was:
$10 Lantus
$10 Novolog
$25 strips
$10 syringes
per month
=$165/three months

Pumping:
$15 for strips, cartridges, sets, wipes, lancets, and IV 3000 for 3 months
$10 for insulin per month

=$45 for three months

[Scratch]

Yes it is also subcutaneous, injected into the fluid between the cells.
She said when you put a large amount of insulin, say, your twelve hour dose by injection it pools in your system. The amount actually used can be lower because of pooling. A basal rate allows small doses just like the pancreas so it is absorbed better. She said there were other factors like hormones that could affect your insulin absorbtion, and that insulin injections are mostly guesswork because you don't really know how much you absorb.

I think she's a bit full of it. I didn't guesswork my way to 5.6 and 5.7 on my last 2 A1cs.

[Blibbit784]

That's possible, but I have to say that in my case I have issues with absorbtion anyway, I never really now what I'm getting. I can take a large dose, not have my sugar change much, then a couple hours later all of the sudden that insulin hits me.

[BlueSky]

.... She said when you put a large amount of insulin, say, your twelve hour dose by injection it pools in your system. The amount actually used can be lower because of pooling. ... She said ... that insulin injections are mostly guesswork because you don't really know how much you absorb.
I think that first bit is true enough. The bigger the injection, the more unpredictable absorption becomes. But it works pretty well if injection sizes are kept below 10 units. It is another good reason to spilt the Lantus dose between 2 or more shots.

[Alice]

I currently prefer MDI...but not for any reasons against the pump. In my eyes, they are near identical insulin treatments...just with a different delivery method and the pump is based on using fast-acting insulin 24/7.

I've never understood why people think eating on a pump is more "flexible" such as for grazing. The bolus is still the same. I split boluses...although I guess a "square-wave" is something a pump can do. I rarely hear people talking about those options.

I just don't like dealing with the pump. I like the freedom of taking my bolus, putting my pen away in my purse and I'm done with it. Same with my once a day Lantus pen.

I like the knowledge that my Lantus is working (very well, in my case) at all times. I can adjust that dose up or down every 24 hours....although not hourly as some people choose. Personally, I don't know that working out those frequent bolus changes would be accurate for me...as they change all the time anyway. So, whether you are changing them hourly or daily...the important thing is that you monitor your basal changes overall. Yes, it can be argued that a pump is more precise here...but you'd have to test constantly to know if a basal is truely that accurate.

One question I have for pump users that I've always forgotten to ask...since you are trickling droplets of 3-4 hour insulin...is there a slight delay in changing basal amounts anyway? Or, is it such a constant trickle that it becomes a stable number...

One day, I expect a realtime insulin to be formulated which is great for pumps. But currently, a meal-based insulin is used. This never comes up in discussions, so I'm probably curious about a non-issue. I'm not against pumps...they are wonderful. I just don't see one side pitted against the other. I think both options are great. But, I do think MDI can be just as successful. They both take work and frequent testing.

[BlueSky]

The key advantage of a pump, IMO, is the ability to to customise the basal rate. If you have a flat basal rate, you don't really need a pump. Lantus will do the job. But if the basal requirement is highly variable over the 24 hour cycle, you can't easily do what the pump does with shots. NPH and/or Regular can be added into the mix, but it is far from ideal.
.... One question I have for pump users that I've always forgotten to ask...since you are trickling droplets of 3-4 hour insulin...is there a slight delay in changing basal amounts anyway? Or, is it such a constant trickle that it becomes a stable number.......
There is lag effect of about an hour - the time it takes for rapid acting insulin to peak. So if the basal requirement increases from , say, 0.4 units an hour to 0.7 units an hour between 4am and 5am, the pump would be programed to increase the basal rate at 3am.

[firoz]

I am just as active, if not slightly more and that is why I haven't gone the way of the pump. I noticed some people said that it doesn't get in the way because you can get harnesses or disconnect it, but I think that kind of defeats the point of having it in the first place no? I windsurf so if I hit the water really hard and had a pump, something bad would probably happen.

If you're playing basketball and someone rushes you or it gets caught or if you eat it on your motorcycle...it's probably going to cause trouble yeah?

I try to stay as close to natural as possible so I say if you're healthy and don't mind the slight inconveniences that come with injections, then stay off the pump. The alternative is of course to do a trial period thing like someone suggested and see how it fits your lifestyle.

Personally, I don't like the idea of having anything inside my body that could be ripped out, but I'm irrationally paranoid and haven't really researched the pumps because I'm quite content as is.

Let us know what you do though eh? ^_^