[fgummett]

Originally Posted by qtrchicken

This decision just doesn't get any easier.

I like your approach and suspect that trying it out should help you to make up your mind one way or the other.

[qtrchicken]

Yeah, I'm going to call the annoying medtronic rep and see if I can do that. She's been pressing me since January to sign the insurance forms. I just want to be sure.

You guys have been good with the info and personal feelings on pumping. Sounds like those that pump love it, those that do MDI and have good A1Cs, see no reason to switch. I can respect that.

I asked the local rep, that came out to demo it, if there were any new versions on the way. She said they were working on integrating the CBGM with the pump. That would be nice. One connection that delivers and reads and alerts the user would be exactly what I'd want. Unless of course there is an actual cure.

[viranth]

Originally Posted by qtrchicken

I asked the local rep, that came out to demo it, if there were any new versions on the way. She said they were working on integrating the CBGM with the pump. That would be nice. One connection that delivers and reads and alerts the user would be exactly what I'd want. Unless of course there is an actual cure.

I'll definately get the pump when it has the glucose monitor built in.

Right now I'm doing fine without a pump, I can see that it's very handy, but I'm just waiting for the new generation of pumps to come out.

[qtrchicken]

I did get some info that they (Medtronic) would probably never offer a unit that was closed loop. I mean one that monitors and reacts to the detected BG. It was stated that the liability involved with that would not be worth the risk. If it malfunctioned, the lawsuits would swamp the company.

However, having the 2 features in an open - alert/response type system could be very lucrative. They are a business after all, so I could see their thinking.

[Subby]

Some good points made in the posts, and you seem to be on the ball with the main ones qtrchicken. Here's some more thinking on the pump, don't take me to be "this camp or that camp", but as a current pumper with 15 years MDI as well, I do have some perspective to share.

On activity, do you need to eat snacks/energy, to stay level, currently? Do you need to manage activity? Because a temp basal can seriously reduce the need to "manage" around activity. Just wanted to make that clearer, as some points seem to be that a pump is a negative with activity (ie, fragility, getting in the way). Temp basals are a huge bonus in managing activity and sport compared to having long acting in the system, in my experience at least.

As far as being in the way etc, of course in the case of windsurfing etc, I could see why the pump would be at risk. In the case of many sports I think there are many solutions to keep the pump safe enough and out of the way. These things are very tough. Of course there would be a select range of activities where a pump would be a real pain or untenable. You need to judge whether you'd be doing those to a degree you can't "get around" it.

By the way, removing is a cinch and I find that it's no problem to get by for up to an hour, with maybe a small catch up bolus to get basal back on track. So if I was to play basketball for example, I would probably not wear it, and if I was playing more than an hour I would connect, pump an hour's bolus (or something equivalent), disconnect for another hour. These kind of pumping techniques can be developed.

None of this changes whether you personally don't like it attached. I think you can only work that one out by actually trying it. Bit like wearing a watch: some people love it, some are so so, some hate it. Me, I hate any watch, any jewelry etc, I hate wearing anything at all when sleeping, yet I have very little problem with my pump, forget it physically most of the time.

I think what bluesky said was very true... variable basal requirements are a huge benefit of a pump. For those like me, with a variation of about 60% in basal reqs through the day, you might be able to imagine what a nightmare MDI and Lantus was. You don't sound in that boat. Then again you might find some improvements. Has the educator/rep suggested specific ways it will help YOUR situation? (eg, times of hypos, events you come across?)

I don't think that's the only real advantage though, temp basals really have many great applications, and bolusing with a few buttons rather than an injection has to be considered a pretty good bonus... Today, a long day and lots of waiting around airports being bored etc, I bolused 9 times: meals, snacks, a couple corrections. No way I would have injected that many times. Not only painful and unpleasant, also a recipe for site problems (which became a real problem from about year 10 on, in my 15 years MDI). Also, I am assured of the same even absorption rate, being the same site per 3 days. THAT is a huge benefit for me, again probably less so for many others.

Seeing your ambivalence (which I mostly share) about CGMS, I think you should just stick that issue firmly in the background for the moment. Minimed are trying to encourage jumping on board with kit and kaboodle, I do think it's a convergence that will occur more and more, I don't think the current "packaging" is necessarily sinister (although of course it makes business sense), but at the same time I think there is really very little compelling reason to get both at the same time, unless you were to be really keen/sure about it. Pumping is enough to adjust to/assess suitablity of, without worrying about the possibly problematic ins and outs of CGMS at the same time.

[qtrchicken]

Subby, thanks for the post. A lot of good info in there that I was looking for.

My activities (at least in recent years) seem to be revolving around my acting Lantus and left over Humalog insulin. I mean to say that during an all day event, my levels tend to go up/down without any real consistency. The mornings will be high, then low later, then high, etc. Some of my activities can be stressful (but that's part of why I like them), and that usually causes my BG to drop sharply.

Here's my big issue lately. Morning highs. It seems like lately my morning levels are high, even after it being @100 at 10:30pm. Then in the AM it's over 200. I've tried to adjust my nightly Lantus, but then I suffer with strange daytime lows for seemingly no reason. I am thinking that a 24hour basal would help me stay in line and not yo-yo so much.

My wife really wants the CGMS to help stop me from having a scary hypo during a night that she's out of town. We have a little one, so it's extremely important that nothing happens. I think inevitably I will go with the pump, but I just want to be aware of what I might be in for. According to Medtronic, they are issuing a free OneTouch Ultralink with all new MiniMed pumps, so that would afford me some finger time to get the pump sorted out. After that, I could get the CGMS and go from there - I guess.

[Subby]

You difficulties with Lantus sound typical. I found that I would have 6 hours it covered well, then massive lows, or with other dosages, 6 hours pushing low, then spiralling highs... and terible problems with activities, I'd suddenly "soak" up the Lantus in the system. This is just the limitation of MDI, if your basal profile is quite variable through the day. One can fiddle with timings and split doses of long acting, etc, (and for some people this works) but otherwise, variable basals is a whole other level, for many a godsend. I predict you would really benefit from the pump to improve these issues.

I understand your take on CGMS, it's a fair enough point (although I'm not sure it's trustworthy enough yet as a "backup warning system"), but bear in mind that you can make great progress with just the pump and variable basals alone, (with some work put in to "get it right") to the degree than hypos and hypers from basal fluctuations are far less likely and much less severe. With careful testing periods you could probably virtually eliminate your overnight problems. But do remember, at the least 6 BG tests through the day are desirable, none of this (or CGMS) gets rid of the annoyance of testing.