Pumping while also taking Afrezza?

I’ve been thinking about pumping a lot lately, and have a few questions as I prepare for an upcoming doc visit. I have been dealing with an increased need for insulin for at least 3/4 of the month, and my doctor isn’t willing to prescribe a basal insulin (at least, not in our discussions over messaging - I see her Monday and will present my argument for it again then). She wants me to try an oral first, one with a lot of potential side effects. No, thanks…I’m wondering if she’d be more willing to let me try pumping, because you have a lot more control over basal doses than with MDI.

My main question is, I use Afrezza a lot. 2/3 meals per day, most days, sometimes for corrections or a last minute treat. Is it even worth pumping if I’m only using Novolog for 1 meal and a couple snacks a day? Granted, during that bothersome 3/4 of the month, I’m sometimes injecting corrections throughout the day, so the basal dose would eliminate the need for all of those extra sticks.

Other question is…is it worthwhile to try to get a pump if I may need to suspend my basal dose for up to a week each month? Does anyone deal with something that on a regular basis?

And from a financial perspective :slightly_smiling_face: I was denied coverage (again and again and again…and again) for a Dexcom last year. I’m planning to follow up with insurance again now that we’ve met our deductible for this year and try to pin down why, which I never was able to figure out last year despite 6 months of asking…anyway, I’m hoping they won’t deny coverage for a pump…? But also had me thinking, are the extra costs associated with pump/pump supplies worth it in my case, or should I just keep pushing for a prescription for basal insulin?

I know this post is long; sorry. :blush:

Great post. Great questions.

I love your problem solving and researching.

I’m likely on higher quantities of insulin than you currently need, but I love pumping for basal and corrections while injecting for meals. If you can cover all of your needs w pumping, it could simplify your self-care. I wish I could bolus though my sites but it seems my skin won’t tolerate it. But if you can get insurance coverage, it seems worthwhile to try!

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A basal dose doesn’t really eliminate the need for any sticks… it just prevents your bg from rising outside of meals… if you don’t need it at this point I don’t think a pump has much to offer you…

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I do need think I need it 3/4 of the month…just a small dose - I’m hovering around 110-120 most of that time (not eating), unless I dose corrections throughout the day. I used to be around 70-90 when not eating. The advantage I see with a pump would be the ability to dose small amounts and adjust it more quickly as hormonal changes affect my insulin needs, rather than, for example, doing a once/day dose during the higher period until I started going low and then having to feed the basal til it wore off…

And just to clarify - I meant sticks as in injections, as I’m doing extra injections throughout the day to correct the higher numbers.

ETA - and yes, I know, fasting in 110-120 is not bad, but when I add food, I can go up to 180 from that dosing “normally,” so I either have to be really aggressive with meal boluses (which leads to more lows than usual) or, more often than not, when I’m not aggressive enough, then I have to do extra corrections to bring it back down. I don’t want to have to deal with that just because my doc wants me on orals rather than what I need - insulin.

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So you consider the advantages of pumping over basal injections worth the added cost of supplies despite still doing MDI for boluses?

  1. I’m fortunate to have very good health insurance. My copays are manageable.
  2. Yes. With my personal daily basal fluctuations (about 8.5 units to 12.5 units fluctuation through each cycle), I now consider it a must. And honestly, my meal spikes are SO much improved since going back to shots for meals…but that’s probably a quirk specific to my body.

I don’t know exactly what your current situation is and where your prognosis is headed for future insulin dependence, but maybe you won’t need all of the fluctuating basal control that I need. If it is going to be expensive for you, I’d personally try long-acting insulin shots first. Your needs seem to be coming on far more gradually than mine did, so you may be able to anticipate and fine-tune faster than I did.

I use Afrezza with pump, but Afrezza is OOP. And cost has increased even with the discount card. So I use pump basal, bolus and eat mostly lower carb meals, and Afrezza less often.

The pump is best for the basal patterns that can be adjusted as your needs change. So seems you need to first convince Dr you need basal, and pump would be great. Or 2nd choice being basal injection.
Maybe you agree on basal injection to start, then switch to pump, particularly if the timeline of injected basal activity does not match when your body needs it.

That’s what I’m hoping she agrees to. I have a plan, even, to try to avoid the lows I’m sure she’s concerned about, so I’m hoping with my (hopefully sound) argument, she’ll agree. If not, I’m trying to think of other alternatives to talk over with her.