I am new to this site. I have type 2 diabetes and am insulin dependent. I am in the process of transitioning from three to four daily injections to a pump. I was wondering what anyone, with type 2 experience with a pump has been? I am hoping to be approved for a Tandem Tslim X2.
Any input is greatly appreciated!
@dr.intrepid, so sorry not to have direct experience. I did gather some interesting literature on the subject in the past couple of years, which I am sure you are aware of. Just in case, the two papers I think are most interesting are:
(also at ADA) http://care.diabetesjournals.org/content/36/Supplement_2/S219
Pump therapy is a promising approach for insulin therapy intensification in type 2 diabetes. Despite limited data from randomized control studies, longitudinal data in actual use settings suggest that CSII may be preferred to MDI in type 2 diabetic patients with severe insulin resistance and poor glycemic control despite sufficient insulin titration and adherence to recommendations on diet and exercise.
The use of insulin pumps in patients with difficult-to-treat type 2 diabetes is safe and effective for up to 5 years
And, of course, the very generic 2012 ADA position statement is almost useless (the 2015 update is not relevant, I think):
http://care.diabetesjournals.org/content/35/6/1364
Ultimately, many patients will require insulin therapy alone or in combination with other agents to maintain glucose control.
@dr.intrepid Not sure if it helps, but a large percentage of my Endo’s patients are T2 on a pump. My insurance carriers (plural) state the therapuetic need for T2 pump therapy is:
Medically Necessary:
External insulin pumps (with or without wireless communication capability) are considered medically necessary for individuals with diabetes in any of the following groups:
I. Individuals with documented diabetes mellitus meeting all the following criteria (a-e):
A. Completed a comprehensive diabetes education program within the past 2 years; and
B. Follows a program of multiple daily injections of insulin; and
C. Has frequent self-adjustments of insulin doses for the past 6 months; and
D. Has documented frequency of glucose self-testing an average of at least 4 times per day during the past month; and
E. Has documentation of any of the following while on a multiple daily injection regimen:
They are very quick to point out that Closed Loop pumps are considered medically necessary ONLY for T1s. That said, the Tandem TSlimX2 is slated to get 2 upgrades (free to in warranty customers) this year that will in effect make it a closed loop pump.
@dr.intrepid I don’t have experience in the type 2 realm, but both myself and @Thomas have lots of experience with the X2. So if you have any pump questions just ask.
I’m T2 ,my experience with a pump has been positive. The reason to pump are basically the same in T2 as T1. The strongest positive is the ability to vary basal rates. Convenience is also a big plus.
Pump therapy for a T2 really looks no different except for the amount of insulin infused, insulin resistance often means higher basal and bolus rates. Reservoir size is something to be considered, how much insulin will it take to last for three days. When I started my pump my doctor set my initial rates as he would a T1, this was totally inadequate.
@SLEE, could you expand some on what you’ve seen?
Like what many T1 have experienced, I experienced a decrease in my TDD. This is not a guarantee but it did happen for me. Having a pump allows for more freedom, it is great having your insulin right there on your belt. An infusion is much more discreet that an injection. The bolus calculator is an excellent tool. I am good at math but tracking IOB is impossible without a pump. I feel much safer with a bolus calculation when I know IOB is considered. The biggest advantage to a pump is variable basal rates, especially when fighting dawn phenomenon.
There are disadvantages, the possibility of site failures is real and the fact that you are connected to something 24/s disturbs some people.
Everyone,
Thank you for your input. I just got word that I was approved for a Tandem slim x2. I should be receiving it in the next two weeks. I will try to post updates on my experience with the pump. I have been using a Dexcom 5 for the past two years.
Yes, I have been using the pump for about three weeks. It has not been as easy of a transition as I thought! It really takes lots of patience and trial and error. When I first started the pump, I started having post postprandial highs that I had not seen before (250-300, which is very high for me). These highs were very concerning. The Tandem people and my doctor were very helpful. They counseled patience and helped me fine tune the pump settings.
This past week, my doctor suggested I raise my hourly basal level from 1.25/hour to 1.375. That last change made all the difference. Since raising the hourly basal level, my postprandial levels have returned to levels that I had when using injections. I have had some highs into the 200 range, but that was due to my underestimating my carbs and/or eating more than I should have.
The one thing that I really like about the pump is that I do not have as many lows as i did while on long acting insulin.
Since the start of this week, I have really began to see benefits of the pump. If it was not for the Tandem team and my doctor, I think that I would have given up. However, as of right now, I am very happy with the Tandem pump and Tandem itself.
Regard!
@dr.intrepid Glad it is working well for you. Like you I went through a rocky period of basal adjustments, but once the basal testing/tuning is finished things really made huge improvements in my daily BGs. Stick with it if you can, for me the first 3 months were a period of mistakes (my own) and vastly improved BGs. Personally I was too hesitant on numerous times to change my infusion set when it had problems because i thought the problem was something I had done. I have read on this forum and others many many great tips which have allowed me to troubleshoot almost any problem I have run across (even those of my doing).
After using my Tandem for +6 months now, I honestly wonder why I waited so long to start on a pump. I hope your experience is and will be as good or better than my own.
@dr.intrepid, such great news!
When we started pumping in August, it took us quite a while to get dialed in! At firs, we were a bit shy about making changes. But now we have no qualms setting up new profiles and responding to changes in BG profile as needed. It quickly becomes second nature.
I would love to know how things change in the next few weeks and months! Hopefully you can keep on sharing both problems and resolutions 
I am pleased to report that this past week has been awesome with my new pump. My glucose numbers are now within the ranges I was experiencing with insulin injections. I am having fewer postprandial highs as well. The few i have had are usually in the low 200’s and fall within an hour. What is really nice is that I no longer have the late morning lows I used to experience with long acting insulin.
I did have to raise my insulin to carb ratio. Is it possible that my body is becoming less resistant to insulin?
Glad to hear it’s working well for you!
What type of insulin are you using in your pump?
Anything is possible, but the most likely answer is that your body is reacting to a different basal amount delivered in a different way. When we switch from pump back to MDI for our pump vacations the basal amounts don’t work out to be exactly the same. Anytime we change basals, we usually have to recalculate meal ratios.
Novolog
I would guess that you are getting better absorption of your bolus insulin. A needle injection happens rather quickly while a pump delivery happens over a longer period. Slower delivery can result in better absorption.
