Re-Examining your regime

[drewgolden]

Questions for pumpers!

I'm a needle-er and give myself quite a few pokes each day. I'm on a sliding scale and mix (horror) Humalog + Humilin R during the day and I have a great big basal shot of the soon to be discontinued Humulin L at bedtime.

I have just read "Think Like a Pancreas " by David Mendosa http://www.diabetesmonitor.com/e00204.htm .

First off, after reading the book, I am convinced that I need to switch to the pump.

Secondly, I am horrified that the regime I thought was bleeding edge is horrifically outdated. Humalog L is being discontinued, and R is apparently very very passe.

So my questions to the pumbers out there are as follows:

1.) I have only used a General Practicioner all of these years (usually picking Internal Medicine Specialists) should I have him refer me to an Endorcrinologist? Are they that much more helpful?

2.) On switching to the pump. I have come up with my own sliding scale regime after years of practice. I can easily eyeball meals and determine (almost without thought) what the insulin requirements of the meal will be. With that math change much when moving to the pump? Should I worry about exchange rates and so fourth? Is it really all that hard?

3.) Wearing the little guy. I sleep in my undies and am worried about my bed time options. Is it hard getting used to sleeping with the pump?

4.) Mimimed 515. I am thinking about taking the leap onto that pump. It seems as a company they are reachning out to help me through the process. Are they a good company? Have others managed a good switch with them? For beginner pumpers, are they a good place to start (I consume less than 45 units a day.)

5.) Setting basal levels, how many throughout the day? It seems through my own experience I could easily have three basal levels. How long does it take to establish what works best, or is that always a work in progress?

6.) On the pump.... do you wish you lept to it sooner? Should I be hesitent or do I jump ahead?

I am seeing my GP tomorrow and I think we are going to ask for the pump.

I appreciate all of your help. I want to keep on the latest technology and be doing all that I can to better manage the situation.

Cheers,
drew

[MarkMunday]

..... 1.) I have only used a General Practicioner all of these years (usually picking Internal Medicine Specialists) should I have him refer me to an Endorcrinologist? Are they that much more helpful? .....
Drew,

If you had seen an endocrinologist, you most probably would have switched to a more modern insulin regimen many years ago. But you seem to have made the decision to switch to the pump without seeing an endo. If cost is not an issue, pumping is definitely the way to go. But seeing an endo now won't make you a better pumper. And, as long as you are in reasonably good shape, there is no need to see an endocrinologist. He/she won't be able to tell you anything a GP hasn't told you already.

Learning how to use a pump properly is a trial-and-error process. And it is very personal. When I was considering getting a pump, I read Pumping Insulin by John Walsh, which is very good. All you need is the relevant knowledge, lots of testing-and-measuring, and someone to write the prescriptions. Endos, INMHO, are an overpriced and and over-rated luxury.

As I don't use a pump, I can't comment on your other questions. But I am sure you will quicjkly get used to using a pump and making the most of what it can do for you. I am very envious. Good luck !

Mark

[JediSkipdogg]

I can help you out as much as possible....

1.) I have only used a General Practicioner all of these years (usually picking Internal Medicine Specialists) should I have him refer me to an Endorcrinologist? Are they that much more helpful?

A doctor is only as helpful as the patient and his knowledge along with how much he loves his job is. I've been to two endo's my entire life, and my juvenile endo was stuck in the 1980s method of insulin control and really didn't teach anyone about counting carbs. Now my new one does nothing but stress that. So it's a tough decision to say which is better.

2.) On switching to the pump. I have come up with my own sliding scale regime after years of practice. I can easily eyeball meals and determine (almost without thought) what the insulin requirements of the meal will be. With that math change much when moving to the pump? Should I worry about exchange rates and so fourth? Is it really all that hard?

On the pump you will only use one kind of insulin. Therefore you will need to have some adjustments at first to figure out your numbers for that insulin. If you were on a more modern regime, you wouldn't have to do many changes, if any, at all.

3.) Wearing the little guy. I sleep in my undies and am worried about my bed time options. Is it hard getting used to sleeping with the pump?

I've had my pump for 4 years and some nights I sleep like a baby with it and others I want to throw it out the window. It depends if the cord gets tangled around me or not. Personally, I'm thinking of going back to how I was in college with it and buy some shorts and stick it in the short pocket. It seems like that is what worked best for me.

4.) Mimimed 515. I am thinking about taking the leap onto that pump. It seems as a company they are reachning out to help me through the process. Are they a good company? Have others managed a good switch with them? For beginner pumpers, are they a good place to start (I consume less than 45 units a day.)

Choosing the right pump is a tough one. There are many threads on here about it. Some people love and swear by Minimed while there are quite a few that have had nothing but horror stories with them. I think it can be that way with any company you choose though. So you have to find what you like best, then choose it, and if you don't like it in 3-5 years when you are eligible for a new one, then make the switch to a different company. I for one have had no problems with Animas.

5.) Setting basal levels, how many throughout the day? It seems through my own experience I could easily have three basal levels. How long does it take to establish what works best, or is that always a work in progress?

I currently have 6 different changes throughout the day, but I'm about to redo my entire basal regime. And yes, it's always a work in progress because your body is always changing how it reacts to food and insulin. It won't be a weekly change, but it could be a slight change over the years.

6.) On the pump.... do you wish you lept to it sooner? Should I be hesitent or do I jump ahead?

I'm 23 now, and started the pump when I was 19. I think I made the right move at the right time as I was in college and it allowed a much easier way for me to enjoy my job and college. I personally don't think there is a too late, but there can be a too soon. If you are highly active in contact sports or something where your pump could get damaged alot, then I would wait till you either stop playing that sport or analyze how to take care of it better. Like don't start on it if you are on a college football team and will be off it in 2 years, wait the 2 years to start it then.

I wish you luck in your decision and I hope I helped answer your questions.

[David]

1.) I have only used a General Practicioner all of these years (usually picking Internal Medicine Specialists) should I have him refer me to an Endorcrinologist? Are they that much more helpful?

Since your present GP seems to have been satisfied with the Lente/Regular regimin, I'd consider someone changing to someone who's specialty demands keeping up on the most current treatments. That would be an Endo.

2.) On switching to the pump. I have come up with my own sliding scale regime after years of practice. I can easily eyeball meals and determine (almost without thought) what the insulin requirements of the meal will be. With that math change much when moving to the pump? Should I worry about exchange rates and so fourth? Is it really all that hard?

You being already able to eyeball will be a great help. Your new Endo's staff should be able to build on that and give you hints to make it even more accurate. The math may change some and you may be given another perspective, but it should come easily with the knowledge you already have. Exchanges will probably be tossed out and carb-counting used unless you want to continue with the exchanges. Remember, each carb group exchange (Starch, Fruit, Milk, Other Carbohydrates, and Vegetable) equals 15g of carbs, so it's easy to convert between the two .

3.) Wearing the little guy. I sleep in my undies and am worried about my bed time options. Is it hard getting used to sleeping with the pump?

It took me about two weeks to get used to. You could try sleeping with a deck of cards with a 23 or 43 inch string taped to it and your belly. Maybe try putting the deck in a cell phone pouch with a clip to try clipping it to your undies, sheet or pillow. Personally, I don't clip mine to anything, I just let it roam tethered to me. Me or my wife occasionally roll over it, but we just push it out of the way when we do.

4.) Mimimed 515. I am thinking about taking the leap onto that pump. It seems as a company they are reachning out to help me through the process. Are they a good company? Have others managed a good switch with them? For beginner pumpers, are they a good place to start (I consume less than 45 units a day.)

I started with a Minimed, I now have the Cozmo. I didn't personally have problems with Medtronic/Minimed's billing, proprietary set connection, Quickset plus reservoir size or BD Link meters, but had heard enough to take them into consideration when it was time for me to upgrade. I'm sure that the problems brought on by the Medtronic take-over have been dealt with.

5.) Setting basal levels, how many throughout the day? It seems through my own experience I could easily have three basal levels. How long does it take to establish what works best, or is that always a work in progress?

That varies person to person. There's no "one size fits all". I have two basal profiles, a work day and a weekend, and each of those have 5 or 6 rates thru the day. Other pumpers I know just need one profile and rate. I took a while to determine that I needed two profiles and I occasionally need to tweak them when I notice my levels have creeped up or down.

6.) On the pump.... do you wish you lept to it sooner? Should I be hesitent or do I jump ahead?

YES! I should have lept years ago. Waiting so long is my biggest pumping regret. I mentioned above about my various basal profiles and rates. While they may seem complicated, I could never have used them while injecting, and as a result, I had many highs and lows. I've greatly reduced (almost eliminated) those swings by using a pump. Hesitate only to get educated and decide whether it's what you want to do. Another book you might want to read is Insulin Pump Therapy Demystified: an Essential Guide for Everyone Pumping Insulin by Gabrielle Kaplan-Mayer

Edited to add, I notice that you're in Plano. There's a Dallas/Ft Worth pumper group that meets at Baylor Irving Hospital. Their websites here: http://dfw-iug.org/home.htm

Good luck.

David