Really can't imagine going back to an insulin pump

Hey there,

first, a little bit of introduction: I’m Luke, 31 years old and having T1 Diabetes since 2002.

I have had been using an insulin pump (Accu Check Insight) for quite some time, when a couple of weeks ago, I woke up in the middle of the night to an error code alarm ringing (something that is apparently very common in Accu Check/Roche pumps and relates to the electronics -E7 error code-, anybody with this problem, too?).
At first, I was really annoyed obviousley, bc. something like that really s***cks, to be honest. Anyway, I did what the protocol tells you to do in those situations: Monitor your blood glucose levels tightly, try to mimic the insulin pump with little insulin shots every other hour and then at some point start using your emergency rations of basal insulin, which you have stored in your fridge for exactly those kinde of situations. In my case, this was Protaphane. For bolus shots, I use NovoRapid.
And here’s my problem in a way: At first, I thought this would just be a short transition until I receive my new insulin pump after a couple of days. The new pump then indeed arrived really quickly, however, by then I had realized how comfortable life can be without a pump. During the first days without the pump, I became aware of all the things that have had annoyed me with the pump the whole time: Always wearing this little “thing” with you, the permanent connection to the body via tube, the problems that this entails for example when you get undressed. The sometimes uncomfortabe sleeping positions, and so on.

Now I really can’t imagine going back to the pump. However, my head tells me the that this would be the “sensible” thing to do, in particuar with a lifestyle such as mine. I have quite a stressful high-intensity job. I do a lot of exercise. Then I always had this problem with high fasting blood glucose levels in the morning, a problem, which probably many T1 Diabetics know, and which brought me to the pump in the first place. All of this can be better accomodated with a pump, I know that.
On the other hand: Even before the pump, my blood glucose levels were always quite good (apart from this fasting blood glucose problem), so it would probably not a catastrophe either going back to insulin pens altogether.

So, does anybody has experiences with going back to pens and shots after years of pump therapy? What kind of basal insulin do you use and how do tackle the problems with high fasting blood glucose levels without a pump? How do you feel with shots again?

Sorry for my lengthy post here, I have just written down all the things on my mind.

Before I forget: Before starting with a pump, I used Lantus (then Toujeo) as basal insulin and Humalog (Insulin Lispro) for bolus shots. I sometimes thought of switching to other basal insulins, such as Levemir/Determir or Tresiba before.

All the best
Luke

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Hi @Luke. Welcome to FUD.

Might be worth looking at the OmniPod, since it is tubeless. You still have to wear the pod, but it is similar to wearing a Dexcom. You kind of get used to it. The lack of tubes means you don’t really need to worry about it too much when getting dressed or undressed.

If you want to work on this with injections, there are things you can do that make it better. You have to find the right basal, and work on dosing and timing and possibly splitting the doses and maybe taking it more than once per day.

And if you have a consistent issue with morning BG being high, you can do things to address it.

Do you have access to any other basal insulin’s? Are you using anything for basal now besides NPH? What time do you take it?

If you want to share what your current dosing regimen is, we can discuss some options.

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Not wanting to have a pump is a pretty common feeling in my experience being around a bunch of T1’s. Nothing wrong there. Life can be very good without a pump, especially if your control is great. I would say the thing my son would miss the most without the pump would be for exercise and ease of grazing type eating. The good part of my son’s pump (Tandem) is that it does a pretty good job of controlling his blood sugar with his Dexcom as part of the system. Does your pump offer any type of integration with a sensor?

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Me too. Good way to describe it.

:smiley::smiley::smiley::smiley:

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It sounds like you may have a bit of pump burnout and it might help to take a break from pumping for a week or three. Lots of people take a “pump holiday” from time to time. Remember that mental health is one of the most important aspects of diabetes care!

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I understand the feeling, but not the lack of imagination.

I’m intolerant of equipment that fails, support services that are hard to contact or don’t respond in a timely manner. When a problem happess, my first reaction is anger, the second is to want something simpler that can’t have that problem. It takes me a while to cool down and remember why I had that equipment .

I had a similar feelings to yours when I chose to give up using computers that required constant updates and repairs. They were a lot of work, constant aggravation, and expensive. Then I started missing the few things that I needed/wanted a computer to do for me. I found something else that could do them with fewer of the problems that PCs had. I’ve used a Chromebook computer for 4 years and while it has some bugs and limtations, it has been a net win.

Whe I have a tough choice to make I look for an analogy to put things in perspective.

Like cars, pumps have been around for a pretty long time. While they have become more complicated, expensive, and harder to fix, they have become easier to use when they are working. I’d never go back to driving a 1976 stick shift Corolla even though I have fond memories of it. Fuel efficiency was great. It was cheap. It was also cramped, steering and shifting required muscle, the AC wasn’t good, after a few hours driving I’d be tired, and it rusted.

Every tech has benefits and costs.

The questions you need to answer is this: Why did you decide to use a pump? Did it do what you wanted it to do? Did the costs in time and effort, the inconvenences and annoyances of using a pump outweigh the advantages for you?

I’ve been asking those same questions from the opposite end, because I use only old tech today. GM with MDI using Humulins looks antique, but I’ve seached and never found any clinical evidence that insulin analogs or newer hardware guaranteed better outcomes. The statistical evidence was slightly positive for outcomes for persons with poorly controlled diabetes. When I was younger and easily accomplished good control, QOL near EOL wasn’t a consideration.

Being a very self-sufficient person I don’t like someone or something controlling me. I’m a lousy car passenger, I want to drive. I don’t delegate what I can do. I don’t trust without verification. I’m frugal.

I’ve used MDI and GM for 40 years. When I care my numbers are better than good. The “tech” is cheap, simple, reliable predictable. But as I’ve got older, MDI has become tougher to use to maintain tight control. I’m making more mistakes, being more easily distracted, forgetting what I’ve done, having more hypo experiences. I’m tired of dealing with consequeces of what I recognise is an old technology.

My cons for a pump + CGM
Wearing and changing an infusion set.
Spending $$$ to replace syringes
Wearing a CGM
Trusting a pump and CGM
Replacing 50 GM sticks I can get for $10 with disposible electronics for $$$.
Dealing with multiple suppliers instead of just one.
Medicare approvals for DME.
Mandated doctors visits
Needing to retain a GM, “old” insulin, syringes and supplies as a check and backup.

My pros for a loop system:
Could reduce my errors, minimize hypo events
Could match my insulin intake to my food intake and activity level better,
Could give a clear simple picture of where I am and what’s been happening
Newer software can stop insulin delivery to prevent a low and warn me when I’m going out of contol.

I decided that the pros of becming a “looper” outweighted the cons. Your answers will vary from mine, and the value you place on each will also.

Either way, good fortune.

Striving for the serenity to accept the things I cannot change,
the courage to change the things I can,
and the wisdom to know the difference,
living one day at a time;
enjoying one moment at a time;
taking this world as it is and not as I would have it,
while I can.

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