Honestly, I don’t see what the big deal is using a pump to deliver the insulin. Granted, I’ve never used a pump but if I did I’d just go for it. I don’t know what an endo would add.
When I started pumping I already had several years of experience with MDI. And I had a CGM to alert me if my BG was getting too low or high. And if anyone had ever asked me: “Do you ever find out that you took too much insulin or not enough insulin?” I would have laughed and said, yeah, most every time I eat and bolus, plus whenever my basal requirements are changing (which is a few times per year.)
So of course I started pumping on insulin rather than saline. I divided my daily basal dose by 24, and that was my hourly basal rate to start, except I reduced it a little for safety, and set it to be a little more overnight because I knew my BG tended to rise overnight on Lantus, and a little less during the day. Then I just watched what happened and made tiny adjustments every third day until I got it dialed in. Then I started gradually adjusting my insulin:carb ratio so that meal bolusing worked right (not too big a spike after eating, not too big a drop 3 or 4 hours later.) After that was all set I tweaked my correction ratio until corrections generally caused my BG to do the right thing. It probably took 3 weeks to get it all running well, but there was no big issue. Just step by step, small adjustments to get it dialed in.
If the CGM keeps someone safe on MDI, why would it be any more risky on a pump? I guess the main new things that can go wrong on the pump are (1) occlusion problems, so if the BG keeps rising steadily despite 3 corrections via the pump, take a good correction by syringe and change the infusion site; and (2) making too big a change to the pump settings all at once can make the control get worse and worse, so just take small steps to first fix the basal, then fix the meal boluses, then fix the corrections to hone in on the right pump settings.
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In which case, 10 minutes would be more than enough time. One bolus. One extended bolus. One temp basal. Done. Changing settings and ratios doesn’t involve delivery of insulin, so heck, you could have cyanide in it for all it matters.
Could just as easily practice all three with insulin. Which is what I did during my one hour of training. Seems Joslin is being exceedingly cautious, but I guess they have their reasons. I wouldn’t have the patience, myself, to go a whole week with saline.
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6 months. The medical team wanted him to start at 3 months, but he didn’t feel ready. He now doesn’t blink when he takes a pump vacation.
We were one year. The Endo team wanted to be sure we had good experience with MDI before switching to a pump.
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They made me wait 44 years until they thought I was ready…
In all seriousness though, doing MDI for a while does help with understanding everything!
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Yeah. It takes the “magic box” away from the pump and shows it just doing the same thing that you already were doing with MDI.
With a few tweaks.
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BBKThat makes a lot of sense and if the apt. Monday goes, not go the way I want it I’ll be doing what you did. It makes total sense and sounds pretty straightforward. Thanks for the input.