FUDiabetes

Why Use a Pump?

Serious question as I consider using a Pump for the first time.

I read story after story of pump occlusions, infusion set problems, skin infections, tube kinks, etc., etc. with pumps. I’ve never had any such problems on MDI, and my Bg has been very well controlled for the past twenty or so years ( we won’t talk about the first thirty).

So, what is the big allure with a pump? I’m not being snarky, I really want to know from the horse’s mouth. Is it something I should consider at this point?

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Personally, the #1 reason is simply the fact I can turn off basal for runs. That really is the big draw for me.

It really is just that simple for me. Not much else.

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This may not be a big deal to you, but for us, the ability for my son to eat what he wants and not give shot after shot as he adds to the food total is awesome.

Also on MDI, we may have had our basal set a bit too high, but skipping meals resulted in lows, and now when things pop up and meals get skipped we are able to adjust things and do that effortlessly.

Finally, the ability to deliver insulin in tenth of units has made a difference in not having to eat so many extra calories, rather than being boxed in to 1/2 units.

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@Chris I hear you. But often times I don’t eat until dinner. My basal works just like basal should. And like I had told @Eric , I take so much insulin because of insulin resistance that my Bg would probably go up if I took 1/2u.

Taking multiple doses of bolus insulin as I added food to my meal would be much more convenient with a pump.

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i have been D for 30 yrs and have been on my pump(s) for the past 18 or so yrs. it has made an incredible diference in my life and i would never consider going back to MDI (i have tried to take what is called a “pump vacation.,” where i have gone back to MDI for a couple of weeks, and it was just too complicated to bother)

on MDI i was giving myself about 10 shots a day. i was using Lente, NPH and R, and then, ultimately Humolog for meals instead of R.(which was wonderful) however, i did not like being on long acting insulin as i had to eat according to the peaks; i had a lot of highs and lows, and could not reel it in to keep me as stable as i have been on the pump. also, i did not care for having to take so many shots, mixing insulin in my syringes, etc.

also, i did not have the same tight control over my basal profile as i do on the pump. that is one of the features that i LOVE about the pump. i also like that i only change my pump every 2 days, so no needles except the rare need for a correction. i love that i can control temp basals when i need to, i love that i can do lowered or higher basals for exercise or illness. i love how easy it is to change my basal profiles with absolute ease when needed. i can set my ICRs for the entire day, and set them for every possible hour of each day from 12am to 12am. i also love that i can disconnect whenever i feel like it.

there are many more reasons, i am certain, but cannot think of them right now. but i hope you get the gist of my preference and why. and, btw, i have never had 1 infection since i have been on the pump. YDMV, but for me, as long as i keep everything sterile i have been ok. the only problem i have ever had has been a pump malfunction or a “bad” infusion site. but both of these problems are so easy to correct that it doesnt bother me in the least.

hope this help some. and btw (again), on MDI my A1c was in the 8%. on the pump i am down to 4.9% (of course my swimming has been a strong contributor for that low # )

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In my 20+ years of pumping, I had maybe 5 issues related to pump. With most failures, they are identified more quickly with CGMS since there is earlier visibility that something isn’t quite right. Having more precise control of basal at different times of the day was huge benefit for me.

But if MDI works for you, no reason to change.

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I think Insulet is currently in clinical trials for a U-500 version.

If you are going to do it, I think it would help you to have a pump made for U-200 or U-500. Doing a 20 unit bolus on a pump might suck. But doing the same thing as 10 units might make it more manageable.

Generally the only time I take 10 units is when I have dinner with @daisymae.
:grinning:

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It’s true that injection by syringe is quite reliable. But pumping is pretty good too. In a decade I’ve had one occlusion, no infections, no other set or tube problems. I think the troubles are generally rare enough that they can be ignored as a decision factor. (Except maybe with Omnipods?)

Here’s what I got from the pump.

  1. I fixed the fact that on MDI I had to eat repeatedly during the day to avoid going low while having to wake up at night to correct a high. It turns out that during the middle of the day my body needs about 1/4 the basal that I need in the wee hours of the morning, and it’s straightforward to accommodate this with the pump. Some would say “dawn phenomenon” but for me the pattern is more complicated than that.

  2. With the pump I naturally have insulin with me at all times without having to carry it separately. It’s trivial to take a correction whenever I want. Or to handle an unexpected eating opportunity.

  3. I can specify an insulin dose to a much finer granularity than the 1/4 u that I could do with a syringe.

  4. It’s easy to reduce or halt basal at any time this would be useful, which helps when fasting, or exercising. Similarly, it’s easy to increase the basal for a few hours, such as for stress, a stubborn high, illness, or unusual sloth.

  5. Adjustments to insulin dosing (bolus or basal) can be done at any time of day, they don’t need preplanning.

Before pumping I thought that I would hate the tube and having something tethered to my body. The CDE said that after a day or two I wouldn’t even notice it, and she proved that by giving me a sample infusion set. I inserted it and taped the end to a small box to simulate a pump. It turned out that I didn’t snag the tube, and I didn’t notice the box in bed or during the day. For me it just wasn’t a problem, even though I was pretty sure that it would be.

I’m on on old Medtronic pump now because of LOOP. If I weren’t looping I’d be on the t:slim X2 which I liked somewhat better. Maybe in a year or two if Tandem’s closed loop system is good enough I’ll go back. Or maybe I’ll keep looping and get the open-protocol Sooil Dana RS if that’s approved in the US. (They say they intend to submit their application to the FDA “soon”.)

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you’re too kind :wink:

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Doc, I was really nervous about making the switch last year from MDIs to a pump (Omnipod)…and I am HUGELY happy that I did! I don’t look and feel like a pincushion anymore!! And I can deal so much more easily with irregular meal and activity schedules. I have only had one occlusion and one dubious pump bump during this time. And when I do need to make a correction, I can do so more precisely.

I say…Go For It! :grinning:

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It’s a tool that can be a huge difference-maker for some and for others it’s merely a marginal improvement. I don’t recall having any trouble on MDI when I started pumping and my control is about the same. However, when I am on MDI I often have to take 10+ shots a day, including a split dose of Levemir, and use Regular along with Novolog for protein/fat digestion. For a lot of people this would be a complicated nightmare and the pump makes it much simpler to just adjust basal at different hours and on different days and extend boluses for hours after eating. Tresiba works well for you, but there are many including myself who cannot get it come anywhere close to matching their basal needs. I also find I always have carbs that spike me hours after eating, and so an extended bolus or Regular insulin is a must before I go to sleep most of the time to maintain good control, as well as adjusting basal rates or taking more Levemir.
I wouldn’t expect it would affect your control much. It would be useful for you if you’re interested in being able to adjust basal at certain times, bolus by just pushing a button (which is more discreet than shots as well), using extended boluses and the carb calculator/logging software.

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Asjustable basal rate was the big on for me. I need very little basal in the late afternoon and lots on the morning. The morning shot of levemkr was either too much for the afternoon or not enough for the morning.

Also convenience of not needed to time/remember basal shots.

I have had one occlusion when I started. After I figured things out I had no big issues. I think the issues either are person specific or overblown.

So I pump. But I use MDI on my son…

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Why are you considering a change if what you’re doing is working for you? If you think about the problems you’re having with MDI, it might highlight the ways a pump might help. When I switched to a pump over eleven years ago, it was primarily because I hated getting up every morning at 3:00 AM to give a shot of Humalog because of the dawn phenomenon. That, and my control was just not where I wanted it, although it ultimately took a CGM and pump combo to solve that problem.

I find the ability to have a basal profile with different basal rates over the course of a day very helpful, as there are definitely times of day I need more insulin and times I need less. I also need the ability to rapidly adjust basal rates up and down based on things like activity levels and hormones.

The ability to micro-dose comes in handy when I want to bump a BG down slightly but when half a unit would be too much.

I also like the ability to micro-dose anywhere without anyone even knowing. I really miss that on MDI. Like others, on MDI I average about ten shots a day. On a pump I still do about ten boluses a day, but I can do it anywhere andy everywhere without even taking my pump out of my pocket, which I love.

I also love that I can download my pump and CGM data to look at without having to keep a manual logbook.

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I think it can be useful to try different things, just to see if it is better. No harm in trying it.

@docslotnick, I have some spare PDM’s and pods. So I can let you try it for nothing, if you want. And you can always go back to MDI if you think it was better.

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I’ve often thought the same thing, but I didn’t know what I was missing. It would be a major move for me, possibly unnecessary. I probably would not have the support of my wife, she is of the opinion that I should leave well enough alone. That alone might probably make up my mind.

I honestly do not know what to do, and I thank you all for your glowing evaluations. I think I’ll see what my doctor says when I see him next week.

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@Eric That’s very kind of you. I’m not the least bit intimidated by the technology or the Omnipod system. None of it looks too complicated.

I just have to make up my mind.

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Sure. But try it and then make up your mind. :grinning:

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Over two years on the pump and we’ve never had an occlusion.

We do it to spare 8 - 10 shots per day.

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Pros and Cons

Pros: Convenient bolusing, control over dynamic basals, no shots. Ease of giving a micro bolus.

Cons: Bad sites (sometimes), Not bad site–but not sure if it maybe a bad site, so you give a manual shot to try to rule it out before trying to replace a pod–that old story. More equipment to carry (possibly).

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My biggest problem, pre-670G, was having the adhesive that was holding my infusion set loosen. Once I discovered Skin Tac, I have only had maybe an incident or two. That was prior to the 670G though… so IF you do decide to try a pump, choose wisely. :neutral_face:

Agreed.

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