# Oedema risk with insulin pumps



## Northerner (Jul 11, 2013)

Diabetes patients may be at risk of oedema and neuropathy if they have rapid improvements in glycaemic control, endocrinologists warn.
Sudden intensification of insulin therapy and glycaemic control as seen with commencement of insulin pump therapy may result in oedema and neuropathic pain, according to specialists from Sir Charles Gairdner Hospital in Perth.

http://www.endocrinologyupdate.com.au/latest-news/oedema-risk-with-insulin-pumps


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## Pumper_Sue (Jul 11, 2013)

It doesn't matter whether it's by pump or injection, the warning has always been there.......... rapid improvement leads to problems esp with eyes.


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## Northerner (Jul 11, 2013)

Pumper_Sue said:


> It doesn't matter whether it's by pump or injection, the warning has always been there.......... rapid improvement leads to problems esp with eyes.



Indeed. It's unfortunate that, often, healthcare professionals are either ignorant of this possibility or fail to pass the information on


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## everydayupsanddowns (Jul 11, 2013)

I also believe that 'insulin induced neuritis' (and retinopathy too?) that follows rapid improvement tend to be more short-lived and recoverable than the damage that was being done *before* the improvement.

It isn't safe to stay unimproved either is it?!


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## Pumper_Sue (Jul 11, 2013)

Northerner said:


> Indeed. It's unfortunate that, often, healthcare professionals are either ignorant of this possibility or fail to pass the information on



What worries me is this endo has only just found out this information


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## Phil65 (Jul 11, 2013)

everydayupsanddowns said:


> I also believe that 'insulin induced neuritis' (and retinopathy too?) that follows rapid improvement tend to be more short-lived and recoverable than the damage that was being done *before* the improvement.
> 
> It isn't safe to stay unimproved either is it?!



Good point Mike.


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## chandler (Jul 11, 2013)

I've only started to use my pump with saline, will move on to insulin in a couple of weeks.  I sat down with the clinic people last week and calculated my initial pump settings.  

Does that article explain why I am starting the pump at only 75% of my total daily insuling when using pens?


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## Northerner (Jul 11, 2013)

chandler said:


> I've only started to use my pump with saline, will move on to insulin in a couple of weeks.  I sat down with the clinic people last week and calculated my initial pump settings.
> 
> Does that article explain why I am starting the pump at only 75% of my total daily insuling when using pens?



No, I think this is due to the way you use insulin from a pump more efficiently. With injected doses a proportion is 'wasted'/becomes inert due to the size and duration of the injection doses. With a pump you are trickling tiny amounts of insulin in as your basal and may be using less for bolus, particularly if you extend the bolus so it's effectively a small dose delivered over a longer period.

Or at least I think that's the reason, I'm sure I will be corrected if hopelessly wrong!  Good luck with the pump!


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## everydayupsanddowns (Jul 11, 2013)

Northerner said:


> No, I think this is due to the way you use insulin from a pump more efficiently. With injected doses a proportion is 'wasted'/becomes inert due to the size and duration of the injection doses. With a pump you are trickling tiny amounts of insulin in as your basal and may be using less for bolus, particularly if you extend the bolus so it's effectively a small dose delivered over a longer period.
> 
> Or at least I think that's the reason, I'm sure I will be corrected if hopelessly wrong!  Good luck with the pump!



That's pretty much exactly what I was told. Most people get started on a reduced Total Daily Dose and then adjust from there. It may be that you end up on a similar total to your injections eventually, but the split between basal and bolus may well be different.

I think part of the idea is to avoid lots of crashing hypos in the early weeks, but the reduction is based on averages and 'what seems to happen for most people' so it's likely that it won't be far off.

You should be in quite close contact with your pump clinic in the early days anyway so can consult them if you think your BGs are going completely haywire.


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## chandler (Jul 11, 2013)

Thanks to you both for that. Makes sense.


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## Lauren (Jul 12, 2013)

What do they mean by 'rapid improvement' and how does this affect your eyes?


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## bex123 (Jul 12, 2013)

I was told when i started the pump course that my blood sugars would be reduced gradually , but the reality was that what they suggested my basal should be was pretty much spot on and my hba1 crashed from 11 to 7.5 in a couple of months. I was really pleased .... BUT i started feeling off and saw the pump doc and after tests he said i had transient autonomic neuropathy, my blood pressure plummeted and i have had low blood pressure ever since starting the pump. While the risk of me developing any further complications is now greatly reduced i seem to be stuck with the low BP and am now going for tests to see if i am stuck with autonomic neuropathy ( i have issues other than just low bp ) i have been stuck in a situation where i am damned if i do and damned if i don't. and it has been hard and probably why i have a love hate relationship with my pump. It IS a great bit of kit and does a fantastic job of controlling my blood sugars. but for me it has been a double edged sword. I cannot stress enough that blood sugar needs to be reduced gradually over a few months , our bodys just can't cope with such an instant change and i would advise anyone starting the pump to really make a point of agreeing a plan with the pump team to reduce it gradually and not end up in a situation like mine.


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## AJLang (Jul 12, 2013)

Hi Bex

I just wanted to sympathise. Although going on the pump hasn't caused me any problems I also have CFS/ME, autonomic neuropathy (stomach and suspected in my feet) etc etc.  Ihope that your neuropathy issues do prove to be transient x


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## LaughingHyena (Jul 17, 2013)

Interesting, I'll be starting pumping in September so I'll have to watch out for this. I had similar issues after being diagnosed so I hope it doesn't happen again.

When I was first diagnosed and started on insulin, started with swollen ankles but by the end of the first week I was swollen all over couldn't wear a watch or shoes or even half my trousers  The DSN didn't seem to know why, nor did the doctor who saw me, lots of tests found nothing wrong and after a couple of weeks all settled down and we stopped worrying about it. 

Then I started with pains in my feet, this time I was told it may be as a result of stabilising the BGs and would hopefully pass. It took nearly a year but did go away.


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## megga (Aug 3, 2013)

Although i was on the pump for years my HBA1C has allways been above 10, but this year i have got it right down but have got numb toes and calf, the doc said it could be down to rapid improvment.
Bex123, i echo you, i have been feeling quite porley for a while now, so it may be down to the sudden drop in HBA1C.


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## trophywench (Aug 3, 2013)

Well I had one spot of retinopathy in one eye from the mid 1990's.  Some time after that, the other eye joined in.

Got my pump in April 2011.  A1c reduced from high 7's low 8's to 6.5.  WOW !  Feb 2012 retinal photography revealed lots more spots in both eyes, deep sigh.  No treatment as still nowhere near my eyesight.  Well that's a blessing.

Feb 2013 - no sign of it in either eye.

Lots of pregnant T1s have terrible probs with it, simply because of having such stringent control before and during preg, or that could be exacerbated by BP issues at the same time.

Our clinic reduce TDD by 30% when starting on a pump.  I seem to recall that's what it suggests in 'Pumping Insulin' ?


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