[klpants]

Hi All

Curious, if a diabetic already maintians good control on insulin shots is there really any need to go onto a pump with the added costs, risk of infection to sites, being "attached" to a pump etc?

[birds_eye]

Hey kplants, I also asked myself that same question, last year about this time in fact... I met with pump reps and spoke to pump users, and after a weighing up the pros and cons thoroughly, I decided against going onto the pump. I'm on Lantus and Humalog at the moment, or what is also known as the "Poor man's pump" which provides the similar effect as a pump - a basal rate and a bolus when needed.

Also the users I spoke to achieved a 30 day average of more or less what I was achieving at the time, so that affected my decision. The pump I know is great for achieving good HbA1c levels, and tight control, but if you really pay attention to your body and learn how it works in diffrent circumstances, there is no reason why good control cannot be achieved with "the poor man's pump".

I think not being on the pump is alot more effort, but then being on the pump means you constatnly have this "pager" attched, high risk of infusion infections, risk of it falling off, and so on and so forth...

This topic will forever be debated hotly i know, people for and against, and I would also like to hear what all of you say.

[klpants]

Hey Birds_eye, thanks for that, my thoughts exactly. I'm on Humalog and Lantus too, never heard it called the "poor man's pump" though, good one!!

[duck]

It really becomes a personal decision; I would be loathe to ever go back to MDI, but it is an option if I get tired of the pump. And obviously, it is possible to get very good control without pumping, as members like Deusxm will point out and are testament to.

I'm not quite sure why "risk of infection sites" is listed here as a drawback to a pump? I had more issues with sites being sore/bleeding when I was on MDI, and I chalk that up to taking no less than two shots (and toward the end, up to eight) shots a day, therefore increasing my risk of infection...

[archimeech]

Originally Posted by klpants

Hi All

Curious, if a diabetic already maintians good control on insulin shots is there really any need to go onto a pump with the added costs, risk of infection to sites, being "attached" to a pump etc?

Simple answer is, no.

If it works, don't mess with it.

[Cinnabon]

The advantages I have had since starting on a pump is NO more Dawn Phenomenon!, I reduced my amount of daily insulin totals by 50%, and don't have to stick to any type of schedule or any type of food. I was on MDI and achieved perfect control. I was so fed up with the insulin peaking, HYPOS, and having to follow a schedule.

[archimeech]

The benefit I've received is also with the Dawn Phenomena and a reduced amount of insulin. but, it's a lot of work so it's not an easy decision, nor should it be taken lightly. I now check my sugars about 10 times a day. my fingers are so sore, but I have a problem getting a decent sample from other places. I'm hoping for a cure, but in the meantime, I'd love a non-invasive glucometer to go with my pump.

[klpants]

I guess I was referring to this kind of thing:

Source : http://www.insulinpumpcenter.com/intro/101.htm

Skin Problems - One of the most common problems associated with insulin pump use involves skin irritation. Today's infusion sets feature hypo-allergenic adhesives that truly minimize skin irritation, but those with very sensitive skin may still experience itching, rashes or inflammation. A variety of alternative tapes are available for those who need them. Skin infections are another potential problem. Typically, skin infections will not occur as long as the skin is cleansed well prior to needle insertion and the infusion set is changed on a regular basis.

But then reading the above, you're right sticking needles in yourself has just the same risk of infection. I just assumed the infusion sites were bigger holes in the skin, talking from no experience of course!



I'm not quite sure why "risk of infection sites" is listed here as a drawback to a pump? I had more issues with sites being sore/bleeding when I was on MDI, and I chalk that up to taking no less than two shots (and toward the end, up to eight) shots a day, therefore increasing my risk of infection...[/quote]

[archimeech]

The reason for it being listed is that, while you only have a syringe sticking in you for a couple of seconds the canula although small stays in you 24/7. It leaves you open for infection if you're not careful.

[am1977]

Before I went on the pump...I was doing quite well . I had A1c's mostly in the 6 range, and one that was 5.6 which I was very happy with . However, I hated taking injections and I was taking up to 5-6 injections a day . The pump offered me flexibility and freedom and that's why I decided to go for it. Saying that, my A1cs have mostly stayed the same, though I did have 2 which were higher than I was hoping for. My control has not improved. My Endo actually told me not to expect better control before I started pumping, but I didn't believe him ...I thought it has to improve at least slightly. I think,although I love the flexibility and freedom,I was taking advantage of it too much and let my control slip. So it turns out my doctor was right.

I think it's a totally personal decision whether you want to pump or not. It's not for everyone. So if you are comfortable with MDI for right now...then I say stick with it, especially if your control is where you want it to be . That doesn't mean that down the line, you can't give the pump a try. It's always an option .

[JasonSmithMT]

Originally Posted by klpants

Hi All

Curious, if a diabetic already maintians good control on insulin shots is there really any need to go onto a pump with the added costs, risk of infection to sites, being "attached" to a pump etc?

The answer to the question "is there really any need" then the answer is without doubt no.

I'll start off by saying I'm a strong advocate for pump therapy. That being said if you look at the studies many show, based on HbA1c levels, that just as tight control is possible on MDI insulin therapy as compared to CSII (pump) therapy. If you dig around long enough you will find several studies that say CSII is better as well as finding some that say better HbA1c levels where achieved in the MDI group. So I think the take home message is that, yes, MDI insulin therapy can be just as effective as CSII. What I think is also notable in these studies is that most people after the study is over choose to stay on pump therapy if giving a choice.

What no one can argue with is that insulin pump therapy is the most flexible insulin therapy method that is currently available. This is due to the fact that in CSII you are using only one kind of insulin that has a far more predictable and faster pharmacokinetic profile. Because you are using only a rapid acting insulin in the pump that is infused continuously through out the day you can adjust rates moment-to-moment as needed to more closely mimic how a healthy pancreas releases insulin. The long acting insulins that are used in MDI therapy, Lantus included, are far less predictable. They have to sit in a pool under the skin and slowly release into the blood stream to have its effect. This process by the nature of it leads to its unpredictability. For lack of a better way to say it once a long acting insulin is injected you get what you get. If something unexpected where to happen it is impossible to change you basal rate at that point. If at the last minute you decide to go for a hike for example many people on MDI would have to compensate by eating some carbs or plan ahead by taking less rapid acting insulin at mealtime. With CSII therapy you can temporarily turn down the basal rate.

Of course this pharmacokinetic advantage also becomes a big disadvantage in that case of insulin flow getting interrupting you run the risk of DKA much easier than MDI therapy.

Jason

[klpants]

Originally Posted by archimeech

The reason for it being listed is that, while you only have a syringe sticking in you for a couple of seconds the canula although small stays in you 24/7. It leaves you open for infection if you're not careful.

Thanks Archmeech, this is what I was trying to say.

[gettingby]

I have to agree with Meech and the old saying:" If it ain't broke, don't fix it !!"
If you are comfortable with all the injections and are maintaining tight control, then stay with what works. I've researched pumps but have decided for the moment to stay with MDI. It's all about personal preference.