What are the pros and cons of switching to an insulin pump?

[raulsecajr]

I'm a type 1 diabetic and I've been injecting my insulin three times a day for five years now. A lot of friends that I know are on the pump and a lot tell me it's a drag and others tell me it's life saving. The thing is I don't have medical insurance and I probably won't be able to get on the pump anyway, but I was wondering what will the pros and cons be if I just switch into the pump? Thanks for the help. :)

[Subby]

Hi raul, in an nutshell I find the pump gives me better control than I can get on injections alone. Some reasons are slow released boluses, variable basal rates, and temp basals. This means my insulin can be better tailored to my personal needs, and to substantially better cope with such things as exercise, stress, activity, types of food. It's not all the pump, it's probably less automatic than one as first thinks. There needs to be a partnership, some functions are there to be set up, many need to be used and interacted with by the user.

A1c wise it led to a definite improvement. More obviously and immediately for me, the better BG control led to feeling a lot more healthy day to day and having more energy and vitality.

There is no doubt some people might benefit more than others with a pump vs injections. This is for both concrete, biological reasons like having the need for differing basal rates through the day, compared to relatively flat long acting insulin, or for less tangible reasons such as it suiting their personality or lifestyle to wear and use the pump.

As for friends who find it a drag, you should ask them why they still use it. They can always return to shots, and really, if it's a drag as in worse control - they should. That said, it can be quite the process to get the settings on a pump correct and to best effect. You need to be positive and motivated to get the best out of a pump.

[alrock]

I just started on my pump about a month ago. Everyone kept telling me how great the pump is, blah, blah, blah. Hopefully it will get better ~ but frankly I hate it as of right now! Yes it is better for control and I see that and that's why I'm sticking with it.

But ...
it is a MAJOR drag to have something connected to you at all times imo.

And it's a drag to get used to keeping an eye out on how much insulin is left in your pump. Will I run out in the middle of a workday and have to ask for special treatment to go home early and fill my pump? I am JUST waiting for that day to come because i know it will. I'm just not that organized.

And for me - it is REALLY REALLY hard to sleep at night. I still haven't found a comfortable way to wear it at night. i just toss and turn too much and it gets in my way and wakes me up several times a night.

[Subby]

I just started on my pump about a month ago. Everyone kept telling me how great the pump is, blah, blah, blah. Hopefully it will get better ~ but frankly I hate it as of right now! Yes it is better for control and I see that and that's why I'm sticking with it.

How are you finding it better for control? Some people can get just as, or close to, as good control, with careful use of injections.

The reason I ask is that, especially if you feel negative about it, you should get very clear in your mind the exact benefits it gives you! Otherwise, you should consider that it's not for you. Seriously, I and many people I have talked to just do not find it is particularly inconvenient or a problem. That is not to say that we are "right" and you are "wrong" - that is to say that it is different for everyone and you should listen to yourself. If it's a major hassle for you, it's important to know that not everyone else puts up with it being a hassle - it's that you have your own experience, and need to bear that in mind when deciding whether to keep trying new things or whether to give it away.

Sometimes I wonder if having years of difficulty on injections, leads me to be overly naturally positive about the pump come what may. I could definitely understand having more issues with the pump, if one hasn't had the inconvenience of trouble with injections for a long time like I did. There's no doubt that it's at least a little inconvenient having a device attached - given great, close to "normal" control on injections, I'd chose injections any day.


And it's a drag to get used to keeping an eye out on how much insulin is left in your pump. Will I run out in the middle of a workday and have to ask for special treatment to go home early and fill my pump? I am JUST waiting for that day to come because i know it will. I'm just not that organized.


First, even if you are on injections, you need insulin on you at all times. This doesn't change with the pump, in fact it's a good idea to have insulin and pen/syringe on you at all times. I personally carry a small case, like a half pencil case size, with a few syringes, a penfill, and a couple of "bits" so that I can refill a reservoir at any time, plus a spare battery. This still comes out as less to carry than pens, nibs, etc.

Second, you can customise your low reservoir alarm to whatever suits you. What is your typical daily dosage needs? Check that out, then set your low reservoir alarm to go off to give you at least half a day's warning.


And for me - it is REALLY REALLY hard to sleep at night. I still haven't found a comfortable way to wear it at night. i just toss and turn too much and it gets in my way and wakes me up several times a night.

How do you wear it? I leave it free floating. Sometimes I wake up a bit tangled, but strangely I don't find it too bad (strange, because I am very fussy with sleeping without clothes). I'm not doubting you are having issues, at all, and I wish you luck in finding solutions that work for you, whether you keep the pump or not.

[raulsecajr]

Sometimes I wonder if having years of difficulty on injections, leads me to be overly naturally positive about the pump come what may. I could definitely understand having more issues with the pump, if one hasn't had the inconvenience of trouble with injections for a long time like I did. There's no doubt that it's at least a little inconvenient having a device attached - given great, close to "normal" control on injections, I'd chose injections any day.

The thing is, I'm very interested in how the pump works. I understand the hassles, but I don't feel it. I really wish I could get one, but I don't have insurance and I'm not amazingly wealthy. So for now I want to know as much information about it as I can. I see people with it and I guess it makes everything about insulin relatively easier. It just needs getting used to right? Do you need to switch where the needle goes often?

[inkvisitor]

My NP reintroduced pump talk to me recently so I had similar questions and had to evaluate some things.

I think it is helpful for those that aren't getting the control they want from MDI - not saying the pump solves it, but it's another option. It also seems easier to dose and just push a button for (or pre-program?) dosages. Also, with MDI, I sometimes experience insulin not fully staying in so that would be another plus I assume.

I ultimately declined to do it - partially because I am comfortable with MDI and really dislike the thought of being "connected" to something all of the time, and also because I have been able to get better control through other means (carb counting and limiting, more testing, and so on).

[Subby]

The thing is, I'm very interested in how the pump works. I understand the hassles, but I don't feel it. I really wish I could get one, but I don't have insurance and I'm not amazingly wealthy. So for now I want to know as much information about it as I can. I see people with it and I guess it makes everything about insulin relatively easier. It just needs getting used to right? Do you need to switch where the needle goes often?

I really wish that more people had access to the pump if they wanted it. I consider myself very lucky to get access, I'm not particularly wealthy, and the way it is set up in this country if you have pretty much any decent private insurance (which anyone can pay a half-reasonable amount for) you get the pump covered, and covered well. Consumables are heavily subsidized for all. So I consider it a lot of luck. I hope your circumstances change one way or the other at some stage, so you can at least try it.

There can be various attributes of a pump that makes it really useful for particular people. Here's my own biggest reason (though there are more that are almost as big). I get terrible hold ups to any instant delivery of insulin over about 2 units, it can be from 40 min to a couple of hours. This is whether it be by injection or by default instant bolus by pump. I have high insulin needs, so just looking at a cup of tea could almost be 2 units: back on MDI set doses my typical meal dose was 15 units. When I worked this issue out by trial and error (that this was a big reason my control sucked so bad over the years) I was able to switch to slow release boluses, where it releases a bolus over 30 minutes or more, for every bolus. By using a slow release, I get a consistent action where my bolus starts working in 20 - 30 min every time. This had been a remarkable change in how easy and how well insulin works for me.

So you can see this is a very specific, vital benefit the pump gives me. I just can't get a slow release bolus from injection, for obvious reasons.

What I think would be interesting for you to consider is how basal is delivered, compared to long acting. This is one of the biggest across the board differences between pump and MDI.

Yes, I think there is definitely a transition of at least a few weeks getting used to the pump. More importantly, is getting the settings right, so that when you dial in your food in the way of carbs, it has the right I:C ratio to produce the best bolus prediction. Or learning that in the case of this or that food, you need to tweak those predictions a bit. Setting up your basal rates can take some time. It took me a few months to get it all working correctly, and I had to work way out of the box from what my docs told me, to get it working well. But, I am a bit of an unusual case, such as those bolus holdups.

[butterflykisses]

What I find the biggest benefit using a pump is basal delivery options that can be changed almost instantly. With injections if I did something different than the norm..say played with grand kids...exerting more energy than normal, I would be chancing lows. There's no way to turn off injected basals. With a pump I can just set a lower basal rate and not worry about going low.

The biggest con is definitely cost. Even with insurance co-pays and deductibles add up. I have a friend who is also diabetic and uses a pump. Having diabetes as a preexisting condition made finding insurance next to impossible. If you don't have a job that provides good group insurance, at least right now, its close to impossible to get it. Her only option is high risk insurance with a high deductible. By the time she meets her deductible its a new year and resets.

[Richard157]

I have been Type 1 for 64 years and I injected my insulin for 61.5 years. In june, 2007, I started pumping. It is wonderful to be able to program different basals throughout the day and night for more even control. My basal rates are programmed to increase as the night progresses so I do not have high blood sugar when I get up in the morning. No more days with 6 injections. I place the small 6mm (about a quarter inch) needle in my skin and I don't even feel it. I need to do that once every three days. Then I push buttons to deliver my insulin before each meal and snack. There are so many wonderful features with an insulin pump. I could go on and on. Do you have any particular questions?

[Gordonm]

I'm with Richard on this. I injected for 32 years before making the switch to a pump. I was dead against it for years and had great control on MDI. The pump has been a dream for me. No more carrying around all the stuff and when I eat I just push a few buttons. Far easier than getting out the syringe and bottle. I enjoy theease of programming basal rates and being able to change dosage anytime I need to. Sleeping with it? I don't even notice it. Being hooked up is absolutly not an issue and I am at the beach all summer and very active. You get used to it very quickly. The only con is the cost. I refill mine at 5 days and don't even think about filling it until about the 4th day and then keep track of it. I have never run out. If you are coming close just pack another full resevoir and put it in. No need to run home to get it. I have carried full resevoirs with me many times and switched on the fly.

[rkicklighter]

My personal experience. I've been a T2 for years and had to go full MDI with insulin a few years ago when my Pancreas finally stopped all together.

My control with MDI was good, but not great (50%+ readings inside my target range). Complicating this was my work schedule. I travel 85% of the time for work and it's not a regular job either. Different time zones, countries, eating habits and work hours. Today may be a 4 hour day, tomorrow a 14 hour day and I never know this in advance.

Add to this, many of these job sites are ones where any food is provided or must be obtained from what is available onsite. Nothing can be brought in from the outside. Or, the site is in the middle of nowhere with the closest food establishment 40+ miles away. When its 3 am and a piece of machinery is losing thousands of dollars a minute in production costs, you don't stop to eat. At best you may get a Diet Coke and crackers or a sandwich from the vending machine.

These are my primary reasons for going to a pump. It doesn't matter how long the day is or what I may have to eat, with the pump I can easily cover any carbs I may have to and I can do it without carrying a sackful of supplies with me. I do always have a backup infusion set, cartridge and insulin in my laptop case. Along with the easier working environment, my control is much better, averaging 82% of my readings within target and the highest outlier for the past 2 months was only 49 points, plus only 1 low since going on the pump.

YMMV, but for me the pump has made my life much easier.

RK

[GeishaGirl]

Well, I was only on MDI for 6 weeks before I decided that injections (insert favorite negative crude phrase here). I hated them. I have really sensitive skin, and I tended to bleed and bruise with at least one injection a day -- it looked like my husband was beating me!

Pros of pump:
- SO much better control! My basal needs vary wildly throughout the day, and this is the only way I can avoid "feeding the insulin" or going stupid high for no reason.
- Insulin is always with you -- no need to carry pens, or wind up in a tight spot if you decide to suddenly go out to lunch with a friend.
- With the above: easier for a spontanous life.
- No more calculating your I:C on your own!
- No more injecting for every single correction.
- The ability to stop delivery of insulin if you decide you don't like your lunch and you won't eat it (I'm REALLY picky, this happens to me a lot!)
- The ability to truly help regulate DP
- Personally, I feel it provides a much higher "quality of life" (whatever that truly means) than MDI, at least for me.

Cons of pump:
- Being the bionic wo/man. (Frankly, *I* don't find this a con, but many do. I got used to it within days, and find it to be a great conversation piece, and a great way to educate non-Ds. My students also find it fascinating and LOVE watching me use it!)
- Getting the tubing caught on things (doorknobs, someone else's grocery cart -- OUCH!)
- Having people say, "What kind of cell phone is that?" (again, I take it as a teaching opportunity, but it bugs some people)
- Sex -- not gonna lie, my husband, even after a year, is still a little weirded. I've been trying to integrate the removal of the pump into foreplay, but he's terrified of touching it, because he thinks he'll wind up killing me. No joke. Kinda ruins the moment when the other half says, "Okay, can you take of the pump now?"
- Pets. My dog gets tangled in the tubing and then tries to jump off the couch.
- Pump errors - I've actually only had two in the entire year I've had the pump, but I've heard horror stories.
- Clothing limitations - at least for women, it becomes hard/impossible to wear a dress.
- Weight gain - I've put on 20 lbs since being on the pump and can't seem to get it off.

Frankly, I still adore my pump. I much prefer having it to not having it. But, as always, YMMV :)

[Rob43]

I'm thinking about the pump also. Do you test your BG before the pump give you the insulin? Can eat anything you want on the pump?

Thanks, Rob

[Subby]

Yes, you still test, 4 - 8 times is what is usually considered needs to be maintained. Not only to verify that things are on track, but you also tell the pump your BG through the day so that it can give you the correct insulin to help control your BG. Whether at a meal or between.

As for eating anything, I guess you can eat anything ever, right? If there are consequences to be paid, you pay them for example, excessive carbs, excessive insulin, may lead to weight gain and trig increase. If the food, whether type or amount, spikes you faster than the insulin can work, your control and health will suffer too. Blood sugar wise, generally people find that insulin from a pump can work a bit more effectively, and you can have different types of boluses that may cater more effectively for different types of foods.

As compared to older more rigid insulin therapy (set dose, set time etc) the pump gives an incredible jump up in freedom as far as eating when you want, what you want, while likely maintaining control better in comparison. However, it's not all that different to modern multiple injections based on carb counting, as far as dealing with food goes. With obviously, a lot less injections involved.

[lark 27]

Pros:
Flexibility with Basal Rates for different times of day leads to greater control.
Easier to determine both basal and bolus needs.
The pump has really allowed me to exercise (flexibility of basal rates) without slamming carbs. This along with committment, etc. has led to me losing 19 pounds thus far. (232 at a max down to 213 today). I can't stress enough how important the pump has been in this regard.
I've also got a continuous glucose monitor system with mine (Minimed Paradigm) and being able to track my BG levels has been amazing.
The CGMS also provides another level of safety as it alerts me to hypos/hypers. This is especially nice for peace of mind when sleeping. Mind you the CGMS is behind in alarming me when my BG drops to a set level so the few times it's happened I wake up anyway prior to the alrm going off, but it's a nice peace of mind feature especially for my wife. (Years back I did have a seizure while sleeping due to hypo unawareness).
Accountability (follow me for a second on this one). You know how studies always show that people do much better with diets/exercise/etc. when they keep a log. I've never been a great food log/exercise log person for very long, but I do know that when I do log for a week or so I am better for that week than I normally would be. With my pump I have a log of carbs consumes and insulin delivered that I upload to the computer every couple weeks. Now there are days when my insulin needs are high for some odd reason, but as a general rule I know I can't lie to myself when I look back and see a day where I had 60 units of insulin instead of the average of 45, I know I made some bad choices that day. This also enters my mind when I'm contemplating bad choices!

Cons:
Connection to a machine. this kept me from going on a pump for years. It's not as bad as I anticipated it being but it's sometimes annoying. Of course I can disconnect when needed: any activity that I might typically do naked (such as bowling and crossword puzzles).
Sleep: Sometimes I roll over and wake up from lying on the pump. Other times I wake up because it's buzzing at me for a low reservoir or because of a low/high BG alarm (this is a good problem to have sometimes but often the CGMS is just not calibrated perfectly so it tells me I'm below 70 when I'm actually perfect at 90.)

All in all, you can see Pros far outweigh the cons.

[xMenace]

Pumping has done so much for me. I have tamed my wonky brittleness nearly completely. Once you learn how to separate testing of and administration of basal and bolus insulins, managing your sugars really does become almost trivial. The main cause of highs now are bad sets which do happen to everyone, and you do need to learn how to recognize and deal with them promptly.

Convenience is a tradeoff. When I go out to lunch with whomever, bolusing is a non-issue. Before I'd dissapear to the boys room, do my business, and come back. Going to parties and grazing is a real treat! Changing sets and reservoirs can be a chore, but really it only takes a few minutes. I do them separately, so I rarely do both at once. Wearing it 24/7 sure does sound like a ball and chain, but it's not. Sleeping is probably the worst. It constantly tries to sleep under me. You do get used to it. I wear mine in the shower, during most exercise activities (hockey excluded most of the time), and intimate times. After three years it's become a non-issue. Door knobs suck.

For a sub-6 A1C and a chance to save my vision and hopefully avoid a premature death, it's worth much more inconvenience than I put up with.