Contemplating a pump

[MagsRM23]

Hello! My name is Maggie, and I'm an 18 year old freshman at Indiana University studying vocal performance, theatre, and dance. I was diagnosed with type I diabetes when I was 6 and have been taking injections ever since. I have never had any complications or hospitalizations in twelve years, but my control is not as tight as it should be. My A1C's have never been under 8.0, and I just switched to an adult endocrinologist who wants to change that to prevent future complications. I take a split Lantus dose and numerous Humalog injections throughout the day, and I do correction rates for high blood sugars and carb:insulin ratios for corrections at meal times, so what I do already is very similar to the pump therapy. My pediatric endocrinologist always wanted me to go on a pump, but because of my dancing and performing I just don't see it as working out. I am constantly wearing leotards, sweating, and being touched for partnering exercises and lifts. I don't see how a pump would fit into all of that. I know you can disconnect for an hour or two, but I feel like I would have to do that so often that it wouldn't be worth it to even be on the pump. I know there are special tapes and rigging devices to make thenmdiscrete, but I was hoping that there was another dancer on this board who uses a pump that I could talk to. I know that my overall health would greatly improve if I went on a pump, but I'm just not convinced it is right for me. I plan to be performing on Broadway one day, so my lifestyle won't be changing any time soon, but then again, neither will my diabetes. Anyone who thinks they have useful information is welcome to respond to this post. Thank you so much, and talk to you soon!

Sincerely,
Maggie

[Shalyndria]

Hi Maggie :)
First off, welcome to the forums! Everyone here is very friendly and informative, so feel free to post any questions or comments you may have to the group.

I'm not a dancer (with the exception of my car, bars, and my house lol ;) ) but I am a pumper, so I'll do my best to answer some of your concerns.
As you've said, it is possible to disconnect the pump for those times when it's just not practical to wear it. In that case, it is possible for one to take a bolus to cover any basal requirements that will not be met while one isn't hooked up. There are also different types of 'holsters' that can be worn to make the pump less noticeable; the sport pump harness comes to mind. Something like a sports bra but without the bra; the pump is on the harness mid-back. As for infusion sites, most hubs are very discreet, and the sites can be worn anywhere one injects so that you wouldn't have to worry about it being bumped during lifts and such.
I can certainly appreciate how difficult this decision must be for you; I'm racking my brain here and not coming up with much! :p I'm sure one of the other pumpers here will have some creative ideas for you though.

The pump is not the be-all-and-end-all to control; optimum results can be achieved with MDI's, as many members here (who've eschewed the pump) can attest. You can only decide what works best for you, and then do the best you can with that :)

Good luck and please keep us posted as to your decision!
Shy

[Brent44a]

Hi Maggie,

I just ordered my pump on Thursday. A couple of the reasons I ordered mine might work for you.

1. The morning BG readings are always high, the "Dawn Phenomena" I think it is called. The pump will allow me to increase my basal in the early morning before I wake, lower it while active during the day and then a different setting in the evening. At least I hope that works out.

2. I had always been able to eat just about anything I wanted. I know that has changed forever, but I would like to be able to eat a snack without having to take an injection.

3. My family has history of cardio-vascular disease and I know my best chance of dealing with that is to take care of myself. I think the pump will help in that effort.

Since I don have the pump yet, I'm not sure of discreet locations and that seems to be you foremost concern. I'll go through a couple of days of training when I receive the pump so I may have at least an idea then.

Good luck with Broadway. Its one of my favorite places in the world and my wife & I really enjoy the shows. Friday we went to a local theater and saw the comedy "Das Barbeque." We laughed our heads off.

Brent

[am1977]

I use a Minimed Paradigm 511 Pump and also Lantus. To be quite honest , I've had some ups and downs with the pump. For a while, I decided to take a short break from the pump (which happened after my A1c climbed higher than I have ever seen it). So I can't tell you, that the pump is error free. There are problems that can happen with the infusion set or site among other things. When that happens, it's easy to slip into DKA if you aren' t careful. However, I have gone back to the pump and am using it in combination with Lantus, which I won't go into too much detail about. I wanted to give the pump a fair chance and I also thought that part of the problems I was having could have been partly my fault. So far, so good. I haven't had any major problems since returning to it :) .

What I would suggest to you is to do a little research on the pump. You could go to some of the manufacture's websites, talk to your doctor about it, and also check out the "pumping" seciton of this forum. It might be something that really works for you and you might see some great results. It's a unique experience for each person.

I wish you luck with your decision.

[Dewey]

Hi Maggie,

I go back and forth between the Cozmo and the Animas IR-1200. From the sounds of your control issues on multiple injections, pump therapy would definitely be helpful to you. As Shy stated, there are various clips and things (including ones for bras) to keep a pump well hidden. Another factor when considering a pump (for a Dancer) is size (the smaller, the better).
Another consideration is the Untethered Regimen, where the pump can be removed for weekend activities (such as shows, dances, etc..) and you take injections just for the time (Lantus and Humalog or whatever your doctor and you decide) that you aren't connected to the pump. I truly hope these suggestions help, as it sounds like pump therapy would be better than just shots. I will post again as I can conjure up some pics and more details (or sites) on the various items which can aid in making your pump more discreet. :)

[MagsRM23]

Thanks to everyone who has posted here with helpful information. My doctor game me information on the Cozmo and Animas 1200 pumps that I've been looking over. I guess my real concern is with the insertion site. I saw all the fun bra/garter holders for the pump, but in partnering and lifts, there is a lot of middle body contact from your partner. I'm just worried about insertion sites that won't be disrupted in all of this contact and won't "come out" or be painful while dancing. I see a pump as possible in my personal dancing, but partner dancing complicates matters because of the physicality. Any suggestions? Thanks again!

-Maggie

[MarkMunday]

Maggie,

As Dewey mentioned, the untethered regimen could be the way to go for you. It gives people involved in demanding activities the best of both worlds. Basically, you inject one shot of Lantus daily to take care of your basal insulin requirement. And your pump deals with meals and snacks. It means that you can disconnect your pump without depriving your system of basal insulin.

Read this article about it : http://www.diabetes123.com/clinic/untethered.htm

Cheers,

Mark

[Dewey]

In a case where a lot of middle body contact is happening (i.e. partner is holding you up by the tummy, etc.) it may be wise to either use your hips or rear-end for sites. Those areas do work, and you would then not have as much worry about your site being brushed or dislodged (as easily). In light of that, you'd also want to get infusion sets with longer tubing, depending on where you plan to attach the pump. This way, no matter how you twist or turn, your tubing will be long enough to keep your site intact. A friend of mine, who dances in Steamboat Springs, uses the Minimed 508 and usually disconnects right before going out on stage. This way, she doesn't have to worry about it getting in the way or dislodged. I still also think the untethered regimen would be helpful at those times, as you wouldn't have to worry about keeping track of where the pump went. My friend has, on occasion, forgotten to re-connect after shows, and one time, even left her pump at a school in which they performed. She had to wait till the school re-opened to get her pump! :eek: In light of those incidents, using the untethered regimen around showtimes may be most beneficial for you. Again, hope this helps. :)

[HeatherP]

Hi Maggie,

I just wanted to say welcome, I'm not currently a pumper. I'd encourage you to seriously consider a pump. They're quite small and you might just be amazed at how much control it will give you. You'll get great advice from the other pumpers here. I've heard many companies will give you a loaner to try out w/ just saline solution. You might want to give it a try!

Nice to meet you,
HeatherP

[Shalyndria]

Originally posted by MagsRM23
Thanks to everyone who has posted here with helpful information. My doctor game me information on the Cozmo and Animas 1200 pumps that I've been looking over. I guess my real concern is with the insertion site. I saw all the fun bra/garter holders for the pump, but in partnering and lifts, there is a lot of middle body contact from your partner. I'm just worried about insertion sites that won't be disrupted in all of this contact and won't "come out" or be painful while dancing. I see a pump as possible in my personal dancing, but partner dancing complicates matters because of the physicality. Any suggestions? Thanks again!

-Maggie
Well, there are several places to put an insertion site. I use all of them (unless there's some I don't know about lol), including:

- My arms (back, upper)
- Breasts (don't gasp, it's one of the best places IMO to put the thing and hardly hurts - apparently one doesn't need much up top either)
- Hips
- Upper and lower abdomen, including the sides of the abdomen
- Upper buttock
- Upper thighs

Some of these sites might not be appropriate for the physical aspect of dancing, but I'm sure that there are a few there that might be workable.
Andrea (am1677) and Dewey mentioned the Untethered Regimen; I don't use this myself but I'm sure Andrea could explain it to us. And you can search the forums for past posts on it and gather some useful information.

Shy

[MagsRM23]

Thanks for the site suggestions. I think I could probably finnagle some of those to work out depending on the kind of dancing I'm doing. I don't quite understand, even after reading the articel, the un-tethered regimen. Could someone explain that to me again? Do you always take Lantus? Or only when you need to disconnect for a long time? If you do always take Lantus, then what is the point of the pump? Thank you all so much for all of your information!

-Maggie :)

[Dewey]

While I personally haven't used the un-tethered regimen, my understanding of it is as follows:

The un-tethered regimen can be used in a number of ways. The most common was as described in the article, with an injection of Lantus (long-acting) to cover any extended disconnects from the pump. The pump only delivers short acting insulin (i.e. Humalog or Novolog), and if you are disconnected without the coverage Lantus provides, your blood sugars can rapidly rise. In Dr. Edelman's case, he disconnects from the pump on weekends, and uses Lantus and a short acting insulin pen (i.e. Novolog) to cover meals. On Monday through Friday, he's connected to the pump, but still takes a 75% (15 unit) Lantus injection. This injection would cover any extended disconnects from his pump, without the concern for hyperglycemia or DKA. The remaining 25% of his daily insulin intake is via the pump (at approximately .2 units per hour which equals the remaining 5 units), as he said his daily intake is 20 units. Add the two together, and you get the 20 unit total (or 100%). :) This would be beneficial for you, in that anytime you're onstage, you wouldn't need to worry about hyperglycemias or DKA. However, your insulin intake will need to be setup with your Endo.

[jazzy1]

Hi Maggie!!

I've been on the pump for about a week now. It took me 18 years to go with it for some of the same reasons. I thought for me, it wouldn't be best because I would always be tied to a machine! It really isn't nearly as bad as I thought it would be. I hardly ever use the clip...but intead opt to put in in my bra. The site where it's inserted doesn't bother me...it isn't sensitive to the touch...and as a matter of fact, it takes a little elbow grease to remove it. I use (I forget what it's called) a patch to cover it up (just incase). It's a patch of sticky, clear, plastic-ish tape. The hospitals use it on kids to cover up IVs to make sure they stay in place...I'm REALLY sorry that I can't remember what it's called!! UUUGGGHHH

Anyway...like you've seen, there are all sorts of options available to you. I decided to take on pump therapy after a trial run. As some one else mentioned, my insurance allowed me to try it out using a saline solution. I wore it for about a week. You might want to talk to your endo to see if that would be an option for you. If you decide the pump will be too much of a hinderance to you, at least you know that you've tried.

Good luck!

[archimeech]

lol, Jazzy. the patch that you are refering to is the IV3000 bandage. Also, Maggie if you're worried about sweating and the possiblity of the site coming off, I posted my method of attaching my infusion set. Believe me, I have lived in the hot sweaty south all my life and there are times that I have gone over the recommended 3 day use of an infusion set, try more like 1-1/2 to 2 weeks. The sight was stuck to my skin so well I still had to pry it off with quite a bit of pulling and the use of some rubbing alchohol to break the adhesive bond. Check in the post that I have linked below named,"I'm a little nervous." I give the method in some detail as to how I laminate my dressings and infusion set onto my skin. alternative sites sound like a good way to go also. I find whenever my site is pushed, rubbed, or otherwise bumped hard that it does hurt and sometimes needs immediate changing. Good luck.
p.s. and remember if it doesn't work, at least you tried. I say give it a few months at the least and if it doesn't work out switch back.

http://www.diabetesforums.com/showthread.php?s=&threadid=3217

[MagsRM23]

Thanks again for all the helpful hints. Jazzy, where is your insertion site? Are you a dancer too or just very active? I think putting it in my bra would work too, I just would have to pick a fairly "safe" insertion sight to go along with it. I guess another concern of mine that I would like to think wouldn't be a problem is the fact that I don't want to be blackballed, so to speak, for being diabetic. I know it sounds silly, but it's hard enough in the performing arts to make shows and get cast in things. If a director should ask me about my pump, I'm worried he or she may think I'll be unreliable or a medical hassle (when clearly I wouldn't be). I still wait to tell directors/choreographers that I'm diabetic until after auditions and casting results. Obviously I want them to know in case something should happen, but I want to be cast based on my ability. If I do try the pump it won't be until probably May so that I won't have to figure it out all by myself at school. My parents would be able to help over the summer and I would be able to really get it down over the summer without having school stresses. I'm just so undecided!

-Maggie

[am1977]

"I don't quite understand, even after reading the articel, the un-tethered regimen. Could someone explain that to me again? Do you always take Lantus? Or only when you need to disconnect for a long time? If you do always take Lantus, then what is the point of the pump? "

I can speak from first hand experience about the "Untethered Regimen". I have been using it since mid September and, al in all, am doing well on it. :)

Everyday, I take a morning shot of Lantus (in my case-20 units) and then I take my meal dosages(boluses) of Humalog with the pump. The Lantus I take in the morning makes up about 75% of my daily dose of long acting insulin, then you would program the pump to deliver the other 25%, which is known as your basal rate. The reason why I do this is b/c if your pump fails to deliver the insulin properly, and you are just relying solely on the pump and no Long acting insulin, you could be at risk of developing DKA relatively quickly. To me, it's a comfort knowing that I have that 20 units working as a background insulin and I am far less likely to develop DKA. I think the article also mentioned that for some who are very active, disconnecting from the pump very frequently can wreck havoc on blood sugar. However, when there is Lantus working, active people, like yourself, can disconnect from the pump w/o too much worry.

To me, it's the best of both worlds. Yes, I have to take one shot a day in addition to the injection you make when changing infusion sites, but that's so much better than the constantly taking an injection everytime you eat something. All i have to do now, is press a button when I want to eat to cover whatever it is. I don't have to worry too much about DKA and pumping, b/c the Lantus is working, I get to use all of the pump's cool features..such as square wave or dual wave boluses, and best of all my blood sugar has improved a great deal

I hope this helped you out somewhat and answered your questions. It is something I think all pumpers should consider.

Good luck.

Andrea :D

[jazzy1]

Maggie
Although I probably don't perform nearly as much as you do, I am a dancer. I volunteer and sponser a local high school drill team. I am also very active and LOVE to play contact sports...I know...not a very girlie thing to do...LOL! If I know that my schedule holds a lot of activity for the next few days, my "safe insertions sites" are usually like around the lower part of my stomach. Are you sitting? put your left hand right were your left thigh meets the bottom of your torso. That's where mine is now...no problems with it! You'll know your own safe spots since you know the type of moves and positions you'll need to be in.

You can disconnect the pump it's self during auditions. The only thing that will be left is the infusion set. Even in leotards, it's barely noticable (especialy black ones!) I can understand not wanting to be singled out or "black balled" just as you hide it now until after the auditions, you can do the same with the pump.

archimeech
Thank you!! That was really bothering me! What would I do without you??