# Insulin pumps



## FM001 (Dec 20, 2010)

It seems that switching to pump therapy is becoming more and more common in treating type 1 diabetes, sometimes I feel that I'm missing out on something!

What are the main benefits of pump therapy over MDI, I know it vastly improves control in people who previously struggled with MDI, but are there any other benefits which may pursued me to consider this route myself?


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## Andy HB (Dec 20, 2010)

Hi toby, I think I'll move this into the pumping section. Hopefully, it won't get lost amongst the other threads then. If you still don't get any replies, then feel free to 'bump' it.

Andy


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## Freddie99 (Dec 20, 2010)

Hi Toby, 

I do love my pump. The best thing for me is that you can tailor the basal rates to suit you. That makes them really precise and you don't get things like your levemir running out after about twenty hours. The basals can be made to suit a variety of situations and you can alter them instantly. 
I can choose a variety of options for my bolusing. This makes dealing with certain food much easier than it would otherwise be. They are much more precise. For example I can give 0.025 of a unit should I need it. 
I find that the pump is much more flexible for me and the clock doesn't really rule my life like I used to find MDI did. 

Tom


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## Ellie Jones (Dec 20, 2010)

It's so much more flexible than MDI..

How well we control our diabetes totally relies apon the basal line, everything is worked off the point, the flater the basal profile is the easier it is to calculate or the other aspects of our control, ratio's, exercise effects etc...

Problem with MDI is all what can be hoped for with 1 or 2 injections a day, it to even out the peaks and trough's to creat a subtle wave that doesn't deviate +/- 2mmol/l from axis.. Most diabetics will use ratio's in there quick acting insulin in helping to compensate..

With the pump you can get a pretty good even basal rate, over coming DP, night time hypo's ect..

Pumps have 3 kinds of balous deliveries, so you can deliver the exact amount of insulin to suit the foods you are eating and at a pace to match it's asorbtion..  

You've also got the back up of TBR (temp basal rate) which you can use to adjust the basal, handy for high fat content foods, illness or when changes in routine happen..

So you take charge of your diabetes in a pro-active and reactive manner..

Some that isn't easily done with MDI


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## Jennywren (Dec 20, 2010)

My pump is great i have been diabetic for 30 years and pumping since september , my control has never been so good


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## purpleshadez (Dec 20, 2010)

I love my pump,

I think it's very important to point out that it's not a miracle cure, it takes a lot of work to get right. Some more than others but it is so worth it! I only mention this as shortly after starting on the pump I had a massive high due to a problem with the canula and for a short while I felt a bit conned for want of a better word.

I quickly realised that it wasn't a cure, just a smarter approach to insulin delivery. Some people also worry about being attached 24/7 (me again) but it really isn't that bad I honestly forget its there until I need it  There are the odd snags where my youngest daughter tries to run off with it when I'm not paying attention or I get hooked on a door handle, but it's really not the end of the world. Another bonus for me is that I now NEVER forget my insulin! Not once! Also, you can take it off for short periods (bath/shower/swimming etc...)

I'm glad I fought for a pump, it gave me the motivation I needed to be more proactive which is another benefit. this time last year I would have been happy with a BG of 9-10. Now i'm horrified!


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## FM001 (Dec 20, 2010)

Thanks all for taking the time to reply with your encouraging posts!  It would appear that once the hard work of calculating ratios is finished the rest is plain sailing, does anyone know what %  pump therapy improves hba1c on average?


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## bev (Dec 20, 2010)

Hi Toby,
I just wanted to add to this that it isnt a 'last resort' if you cant manage MDI or you cant get good control on MDI. It is also for people who have a great hba1c too - it is just a much more accurate way of delivering the *right* amount of insulin at the right time. MDI is allright - but once you have injected it is anyones guess whether it has been absorbed sometimes - especially with tiny amounts.Bev


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## shiv (Dec 20, 2010)

toby said:


> Thanks all for taking the time to reply with your encouraging posts!  It would appear that once the hard work of calculating ratios is finished the rest is plain sailing, does anyone know what %  pump therapy improves hba1c on average?



Hi toby, I basically agree with everything everyone has said. Thing is though - it's about as far from plain sailing as you can get. You work out your ratios...and then something happens, and they need changing again (see: cold weather, for eg). Pumping is incredibly hard work and you really need to have the desire to do it. That said, the hard work is worth it in terms of the flexibility it can give and the problems it can iron out, such as dawn phenomenon.


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## sofaraway (Dec 21, 2010)

I am not pumping yet but am in the process of getting one. I actually don't mind if my A1c goes up when i start on the pump and the consultant even said he would like it to go up slightly. My A1c doesn't really give a true reflection of my control, it's dragged down by the amount of hypos I have. 
The main problem I feel a pump will help me is with the basal rates, particulary with exercise. 

If your control is good and you are happy with injections then i wouldn't worry that you are missing out on something. It might be worth talking to your DSN to see what the situation is like in your area.


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## fruitloaf (Dec 23, 2010)

A really interesting thread. I had been wondering the same thing Toby. I can see how there are advantages for people who have difficulty maintaining good control despite good compliance. What about adults who start using pumps having had diabetes for many years? at what point did your diabetes team suggest that a pump might be necessary and was your control previously poor or was it to make your control even better and allow you more flexibility? How does a diabetes team differentiate between someone with poor control despite a huge effort to improve and someone with poor control because of lack of compliance/motivation. This could be the difference between a pump being really effective and being a complete waste of time and money. I think it's safe to assume that the majority if not all of the people posting on this forum come into the 'compliant and motivated group' but it still presents a dilema to the HCP making the decision about who gets a pump and who doesn't. 

I'm not in anyway being critical of people using pumps I think they sound brilliant and although clearly need alot of work to get it right are much closer to mimicking pancreatic function than MDI. I'm just generally interested because it seems they are being used much more at the moment and the NICE guidelines are open to interpretation to some extent.


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## novorapidboi26 (Dec 23, 2010)

Its simple really, if the patients is testing all the time, suffering from dawn phenomonon, suffering from lows due to higher sensitivity and just cant get there blood sugars stable.............any good diabetic team and pct will know if the effort is being made...........

But again it all depends on where you are , some areas may hand them out willy nilly regardless of control where as some may drag you through a long tiring process to even be considered.........

The proof should all be down in paper, so getting recording folks........


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## Northerner (Dec 23, 2010)

Actually, my consultant said that he thought people shouldn't be denied pumps just because they have good control, which appears to be the main reasoning (which I do appreciate, with limited funds available). It means that, for someone like myself who has had pretty good numbers - all HbA1c for the past 2 years at 5.x% - it's unlikely that I will ever be considered for a pump even though I think I would regain much of the quality of life I had before diagnosis in terms of flexibility and sponteneity. Trouble is, he doesn't have funding for pumps and he says if I was referred to a pump-friendly clinic then I would be turned down on the NICE criteria.


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## Northerner (Dec 23, 2010)

fruitloaf said:


> ...I'm just generally interested because it seems they are being used much more at the moment and the NICE guidelines are open to interpretation to some extent.



I'm not sure that's true, to be honest - the UK is way down the rankings when it comes to pump use, something like 4% of T1.


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## novorapidboi26 (Dec 23, 2010)

I am hoping when I discuss pumps that the NICE criteria can be bent a wee bit...........I dont think every point needs to be met..........

I have dawn phenomonon and cant get below 8.0-8.5% despite contant focus on my blood sugars.....

I think for you Northener a pump would just be a burden to......


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## tracey w (Dec 23, 2010)

novorapidboi26 said:


> I am hoping when I discuss pumps that the NICE criteria can be bent a wee bit...........I dont think every point needs to be met..........
> 
> I have dawn phenomonon and cant get below 8.0-8.5% despite contant focus on my blood sugars.....
> 
> I think for you Northener a pump would just be a burden to......



Then you fit the criteria on both counts nrb.


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## novorapidboi26 (Dec 23, 2010)

But then I think they want to see it effect your quality of life as well do they not.....(or at least at my pump centre)....I have to say that apart from being a bit tired in the morning I am ok.....but I am sure it will smack me in the bum later on in life.......


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## shiv (Dec 23, 2010)

fruitloaf said:


> What about adults who start using pumps having had diabetes for many years? at what point did your diabetes team suggest that a pump might be necessary and was your control previously poor or was it to make your control even better and allow you more flexibility?



I've had type 1 for almost 20 years and have just switched over to pumping. My team thought that all my problems with dawn phenom. could be solved on MDI, which they could not. I had to fight for over a year to get someone to listen to me and for the consultant to agree to it. I'm waiting for funding to come through at the moment.



fruitloaf said:


> How does a diabetes team differentiate between someone with poor control despite a huge effort to improve and someone with poor control because of lack of compliance/motivation. This could be the difference between a pump being really effective and being a complete waste of time and money.



If a person is lacking compliance or motivation, it's unlikely they will want a pump - and obviously a team can't force a pump on anyone! I know what you mean though - if they did want a pump but were lacking that motivation, hopefully their team would pull out all stops and support them to get their motivation back.

Only 4% of people with type 1 use pumps. They are being talked about a lot more now but there are still thousands and thousands of people out there who don't know about them or have a team who aren't pump friendly and thus don't get very far.

Northe - remember the law - if your consultant agrees you would benefit from a pump, by law the PCT has to provide one. His funding, or the PCT's, doesn't come into it - by law they have to provide it. If you really feel that pumping would give you your life back, can I suggest getting in touch with INPUT? They know their way around all things pump concerned so would definitely be able to help you. Sounds like my consultant - PCT putting pressure on him to keep people off pumps, or perhaps he doesn't know that the law says they have to provide it - so he is taking their word when they say there is no funding.


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## novorapidboi26 (Dec 23, 2010)

shiv said:


> I've had type 1 for almost 20 years and have just *switched over to pumping*. My team thought that all my problems with dawn phenom. could be solved on MDI, which they could not. I had to fight for over a year to get someone to listen to me and for the consultant to agree to it. I'm *waiting for funding *to come through at the moment.




So you have a pump and your waiting for funding........I dont understand.....


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## shiv (Dec 23, 2010)

I have a loaned pump from my hospital. Waiting for funding so I can buy one of my own. Or rather, the hospital can buy it for me.


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## novorapidboi26 (Dec 23, 2010)

shiv said:


> I have a loaned pump from my hospital. Waiting for funding so I can buy one of my own. Or rather, the hospital can buy it for me.



Ahh............I see, not heard of that before.............I assume the funding is guaranteed...........


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## shiv (Dec 23, 2010)

Now that my consultant has written to them to request funding it is. As I said to Northe, if your consultant says he recommends one for you, the PCT by law have to provide the money to fund it. They might kick and scream about it but that's the law.


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## novorapidboi26 (Dec 23, 2010)

I agree with that the law, if the professional specialist doctor wants something, they have to be trusted to make the right decision, not someone dealing with money........

I hope you get your own one soon so you can name it.......


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## Liz! (Jan 6, 2011)

Remember it's not just highs that can be a pain in the btm, if you can't stop lows at certain times of the day then it might be, like me, that you have a very low insulin asal requirement then and no long-acting insulin can cope with that.

I still have problems as my night time requirements are about 0.025u per hour between 12 and 3 in the morning, but my pump doesn't go down that far, so I do fel ill in the mornings quite often, and also often have to eat before bed (when I really do not want to) and half way through the night when it's almost impossible.

However the pump revolutionised my life, that and animal insulin. i had problems with bending my fingers, pain in joints, and very, very severe hypos - as soon as I wen ton animal insulin the pains went, my fingers freed up and my hypos, while still reading the same don't feel so terrible. Human and analog insulin just seems too - strong or something for me.


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## Northerner (Jan 6, 2011)

I've heard that a lot from people who have been diagnosed a long time - that the animal insulin is better and the synthetic causes side effects. I wonder why?


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