Contemplating the Pump

[drewgolden]

So I am mad about the whole Lilly dumping Humulin L on me.

And I hate that I have to take yet another insulin to take care of night time. I am always worrying about problems with insulin rejection, etc. It's a real concern especially when vendors keep introducting new products and then dump the old ones.

And then I am also shocked, SHOCKED, that I am in the 2% that Lilly claim use the antiquated L.

So I surf around and I can not figure out what everyone ELSE is doing.

Now here's the thing. I manage to a gHb of a 6 consistently, year over year, it's always a 6.

And my norms are managed a tad lower than normal: I like to keep myself between 70 and 110. Yes, I am happy at 70. SO maybe it's the keeping myself lower and ultamitly lower gHbs that have resulted in the perception that my present therapy has been 'good'.

But according to those people at lilly; I am not the norm and they are dumping my L. This is a huge deal. I have to mess with something that has been worked towards for 20 years.

SO as I read up, perhaps the pump is not so differnet to what I do today.

I take 5 or 6 shots a day. I test frequently. I mean like 5 or more times a day - it is PAINFULLY expensive.

And I have forever relied on L to 'cover me' when I am not eating.

So the pump is like the L. It's always slowly releasing what the L did. So I could set the pump to deliver over 24 hours what I did with the L and then I figure I could bolus (um, new pump term, but I mean to say give myself the shot of insulin I would give at meal time by pressing a button on the pump.)

Sounds okay. If everyone says it's better I am good to try it out.

Seems like you have to wear a pager 24x7 and swap it out/perform maintence every 3 days.

Swimming pool? Shower? Sleeping? Questions......

And one would think with a pump there would be less to carry. But I am thinking you have to carry an emergency replacement line and a emergency vial and syringe in case things go wrong.

So what do I gain if I am already hitting a 6 regularly?

Should I just go from L to Lantus (sheesh, their web site sounds like it is for people who hate to inject, or are having problems with the whole insulin thing!)

Can I really achieve better control with a pump?

I am pissed off about my sudden dependence on something that is going away. I wonder if life would be a whole lot simpler if I only had one kind of insulin and a pump to deal with it.

drew

[duck]

You just disconnect your insertion set when you shower, and if certain "intimate activities" do not allow you to remain connected. Some people leave their pump connected to the waist of whatever they sleep in, others let it "roam free" beside them on the bed. I do whatever is easier at the time (I have a two-year-old who likes to jump in bed with us occasionally, so...).

Drew, you sound like a good "candidate" for a pump. But if I were you, I would give Lantus a shot (pun intended) first. You sound like you are in remarkable control on MDI, so I'm less inclined to think you "need" a pump. Lantus' profile is much more subtle than the L, so you'd have some "getting used to" to perform, but most Lantus users seem to like it's predictability. Lantus *just* came out when I started pumping, so it was never really an option for me. I can tell you I'd sooner shoot myself than start taking NPH again.

I think you'll be fine whichever direction you take.

BTW, I do not carry a spare reservoir/insertion set/insulin with me...I carry a Novolog pen and about a dozen pen-needles in my work bag (which is almost always in my car which is almost always less than ten minutes from me), so if my pump were to go haywire, my backup is close by and not all that cumbersome. I have some needles and a pen stashed at my parents and inlaws places since right now those are the two places I would most likely spend the night/have a layover, so no need to carry that stuff there either. I have found both pumps that I have had to be remarkably consistent and reliable (knock on wood). You'll figure out what type of "safety net" you need to feel comfortable with your pump if you decide to go that route.

[MarkMunday]

Drew,

I am not a pumper. But I have thought carefully about switching to a pump. Cost is the main reason for not doing it. Here in New Zealand no financial assistance is available for it. Here, for what they are worth my my thoughts on the subject.

A pump provides a far superior control mechanism. The reality is that basal insulin requirements are not constant throughout the day. We tend to need more insulin in the mornings. And the pattern is a bit different for all of us. With a pump, you can program your basal rate so that it matches your physiological insulin needs. This is a big plus.

Having said that, you have obviously been ably to approximate your basal requirements pretty well with Lente. Switching to a pump may enable you to reduce your HBA1cs marginally. But it wouldn't be worth going out of your way to make this happen. Your HBa1c doesn't need to be lower than 6. If you were trying to clear up complications through improved control, it would be a different story. But this is obviously not the case.

Lilly is pulling L from the market because of falling demand. And demand is falling because better alternatives have become available - Lantus and Levimir. They are almost peakless in their action. And variability in absorption and action is a lot lower. So I have no doubt that you would do just as well, if not better, on on the newer insulins as you did on Lente. And switching to Lantus seems like the next logical step.

Like you, I have tried various ideas without waiting for the doctor to suggest them. And I have ended up on an interesting coktail of insulin. My basal comprises 8 units of Lantus in the morning and 8 units of NPH before bed. The NPH deals with the Dawn Phenomenon, which Lantus (because of its flat action profile) can't handle. I inject 8 units of Actrapid (which is like Humulin R) before breakfast, whic is usually low carb. And I inject Novolog before lunc and dinner.

I may still get a pump. I have minimal retinopathy that I want to clear up. So I want to get my HBA1c below 6. I am testing another idea at the moment - using Metformin as an adjunct to insulin. Initial indications are good. And if it brings my HBA1c below 6, I will stick with MDI.

Cheers,

Mark:smile:

[kk5483]

I am thinking about going to the pump but my line of work may make it hard. I am a deputy sheriff and i only have a 32 inch waist and my belt is full w/ a gun, taser, asp, pager, chemical agent, handcuffs, magazines, radio and glove pouch. Anyone have any ideas can the pump go anywhere else?????

[jeggeman31]

You just disconnect your insertion set when you shower, and if certain "intimate activities" do not allow you to remain connected.

So I can stop throwing the dang thing over my wife's shoulder:questionm :flute:

[JediSkipdogg]

I know your feeling as I work in a police department (Dispatcher now) and use to work 3 years of campus security with a pretty full duty belt. You can maybe try to get a larger pouch for one item (like the glove pouch) and stick it in the back of it or you can just put it in your pants pocket. I pretty much kept it in my pants pocket most of the time. My biggest fear always was though if I got into a scuffle with someone that I could possibly damage it. But I think the glove pouch idea would be best, and to think I just thought of that.

[jeggeman31]

I am thinking about going to the pump but my line of work may make it hard. I am a deputy sheriff and i only have a 32 inch waist and my belt is full w/ a gun, taser, asp, pager, chemical agent, handcuffs, magazines, radio and glove pouch. Anyone have any ideas can the pump go anywhere else?????

I was talking to a pump wearing officer about a month or 2 ago. I don't remember if it was via a board like this or if it was at work (also work for a PD) Anyway he somehow had a small pocket made inside his vest and put his pump inside his vest. He said he always went back to the station or home to eat so he could be in a safer place when he had to get to his pump for meal bolus.

[kk5483]

After Looking Around I Thought Of Like A Pouch On My Vest Like I Carry My Back Up In My Vest Since I Have Easy Access To It Thanks For The Input!!

[someone]

Lantus is quite good. I had no problem achieveing a 5.4 hba1c with it. I just switched to the pump, and the only reason I did so was so that I could eliminate those highs during the day and not be low at night, and so that I could have a much greater flexibility. With the pump, I can control my basal by creating windows which automatically change my rate throughout the course of the day. The pump is really not a nuisance, and can be easily disconnected at any time, however, you will find that there usually is no need to disconnect. Many of the newer pumps can be worn in the shower and swimming pool.

I would strongly suggest that you try Lantus first and see how that goes.. Lantus offers about the same flexibility of the pump, however, you have to take many shots. Before I got on the pump, I was taking 7-9 a day which gets very tiring after a while. The main reason the pump would help with control itself is because of the fact that you can alter the basal rate according to your cicumstances. Other than just control, it adds conveninces as you mentioned, hit a button and drink a regular soda. :)

Whatever you decide to do, I would definately not go back to the old dreaded NPH.

[rzrbks]

With NO apologies to Will S.

To PUmp or Not to PUmp, that is the question. To suffer the stings and needles of outrageous fortune, or to take arms against a sea of MDI, and thus by opposing, end them.To pump, to pump, perchance to control.

[rzrbks]

Too late to edit:

I'm on MDI.

Lantus = Basal. Novolog/NovoRapid for Bolus. Since I carry an InDuo http://www.diabetesforums.com/diabetes/3519-accu-check-compact.html

it's sort of like having a pump but not being connected 24/7............worst A1c has been 5.7