# Pump coming up !!



## Nada (Nov 16, 2017)

Hello everyone,
I am hopefully coming on a pump soon, I was given the choice of Animas Vibe, Medtronic 640G or Accucheck insight.
I have been a Type 1 since the age of 7, almost for 20 years now, so although I don't mind having a pump as I have been experiencing severe fluctuations and spikes for the past 9 months without any improvement, I am a bit perplexed.
I have a libre now and was thinking that I do not want to lose the continuous monitoring bit, so that made me exclude the Accucheck insight as as far as I am aware you need to finger prick to bolus for accurate calculations. I am currently thinking about the Medtronic 640G and buy the Elite sensors myself.
Please let me know your experiences and any advice.
I am reading different threads on the blog and ordered pumping insulin book.
Any thing else you advise me to do meanwhile ?
And what kind of accessories or hacks that you found made your life easier?
Thank you all in advance.


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## Ljc (Nov 16, 2017)

Hi Nada welcome to the forum.  I can’t help with the pump , others here can and should be along soon.


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## HOBIE (Nov 16, 2017)

Welcome Nada. I love my Pump ! After years of sticking pins in they are like having a new life. I have been T1 since being 3yrs old in 1963. I once worked it out how many injections I have had but give up. I know which pump I would pick but you do your homework & good luck.


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## Nada (Nov 16, 2017)

HOBIE said:


> Welcome Nada. I love my Pump ! After years of sticking pins in they are like having a new life. I have been T1 since being 3yrs old in 1963. I once worked it out how many injections I have had but give up. I know which pump I would pick but you do your homework & good luck.


Thank you for your reply. 
I am trying to do my homework but end up feeling overwhelmed, confused and in tears.
if you can give me any tips that would be great.


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## Nada (Nov 16, 2017)

Ljc said:


> Hi Nada welcome to the forum.  I can’t help with the pump , others here can and should be along soon.


Thank you


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## grainger (Nov 16, 2017)

Hi Nada

I’ve had a pump for 1 year now. They are fab, hard work at times but I absolutely love mine and they’ll be in for a fight if they ever want it back!
I have the Medtronic 640g and it’s fine for me but I have no comparison to make as its all I have ever had. I don’t have a cgm with mine.

Good luck. Hope you love whatever you choose as much as I love mine


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## Radders (Nov 16, 2017)

Hi Nada

I don’t use the bolus calculator because my first pump didn’t have one so I got used to doing the sums myself. I love my pump but like Grainger says it’s hard to compare if you’ve only used one type.

I find the Libre really useful for seeing what’s happening overnight and finding out how different foods spike me especially in combination with exercise. 

I am racking my brain to think of a tip to give but if you have any specific questions I’m happy to try and answer!


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## Flower (Nov 16, 2017)

Hello Nada and welcome 

I've used a pump for the past 18 years and am currently using a Medtronic 640g with Enlite sensors. Using a pump has been the best thing for my control and I feel so much safer without long acting insulin in my life.

Whichever make of pump you go for will be just fine for you, they all do the same thing in delivering insulin just with different menu arrangements, whether or not you want a remote handset etc. If you're finding the Libre system a great addition to your control then you can carry on using that with any pump unless you specifically want the features of the Enlite sensors with insulin suspension and alarms for low and high blood sugar.

I always finger prick test for boluses regardless of the cgm as that is what I've been told to do due to the difference between interstitial and blood glucose. 

Can you ask your diabetes team for a look at the different pumps and see which one you prefer? If it's your first pump once your basal rates, ratios etc are set correctly- which does take some time to achieve -then I'm sure you'll get on fine.

Please don't feel overwhelmed by it all,  pumps offer great flexibility with tiny insulin increments, temporary basal rates and a host of other ways to get good control . It's just a different way of delivering insulin around the clock. Good luck deciding


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## Northerner (Nov 16, 2017)

Hi Nada, if you haven't already seen it, there is a lot of good information on the INPUT website:

http://www.inputdiabetes.org.uk/


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## Nada (Nov 17, 2017)

Northerner said:


> Hi Nada, if you haven't already seen it, there is a lot of good information on the INPUT website:
> 
> http://www.inputdiabetes.org.uk/


Thank you that is really useful


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## Nada (Nov 17, 2017)

Flower said:


> Hello Nada and welcome
> 
> I've used a pump for the past 18 years and am currently using a Medtronic 640g with Enlite sensors. Using a pump has been the best thing for my control and I feel so much safer without long acting insulin in my life.
> 
> ...



Thank you for your reply 
I just knew about the Enlite sensors last week  but the insulin suspension property seems great. Just a question that may be daft, if you need to check your level do you need to check the pump or their is a meter/receiver kinda thing ? 
Just went on medtronic website they are saying that they won't be supplying cgms for new patients, was wondering what does that mean ?
I had a look with the DSN, she did not want to be biased and left me to do my research, hopefully I will let her know my decision by next week so I can have my pump around the new year.
Thank you again for your help.


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## Nada (Nov 17, 2017)

Radders said:


> Hi Nada
> 
> I don’t use the bolus calculator because my first pump didn’t have one so I got used to doing the sums myself. I love my pump but like Grainger says it’s hard to compare if you’ve only used one type.
> 
> ...



Thank you for your reply, any tips about having the pump around with exercise, how do u keep it safe and in place ?


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## everydayupsanddowns (Nov 17, 2017)

Nada said:


> Thank you for your reply
> I just knew about the Enlite sensors last week  but the insulin suspension property seems great. Just a question that may be daft, if you need to check your level do you need to check the pump or their is a meter/receiver kinda thing ?
> Just went on medtronic website they are saying that they won't be supplying cgms for new patients, was wondering what does that mean ?
> I had a look with the DSN, she did not want to be biased and left me to do my research, hopefully I will let her know my decision by next week so I can have my pump around the new year.
> Thank you again for your help.



Medtronic have been having slight supply issues recently (in part down to a hurricane hitting one of their factories!) and have also been taking on lots of new customers in the US where the pump market is changing (Animas and Roche have stopped supplying pumps there). This meant that they had to take the unusual decision to not accept new sensor customers for a short while so that they could guarantee supply to people already using them.

I would imagine they will start accepting new customers very soon, maybe early in the new year?

Good luck with your choice. I am another MM640G user and I really like it.


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## everydayupsanddowns (Nov 17, 2017)

Nada said:


> Thank you for your reply, any tips about having the pump around with exercise, how do u keep it safe and in place ?



Pumps are great for exercise because you can turn the basal down to nothing or very little to allow for the extra insulin sensitivity from the activity. For distance running I've always just clipped the pump to my shorts pocket. For short-ish gym sessions (30-45 minutes) I just disconnected entirely and left it in the locker. 

You can use elasticated tubi-grip type things if you need to keep it attached but are doing lots of rapid moving.

For swimming people disconnect and then just re-connect and micro-bolus every hour or so to cover a small proportion of the missed basal.

Really depends on what you are doing and how your BGs behave. 

You can also set a temporary basal rate (TBR) after exercise to avoid the risk of hypos after activity is that's something you struggle with.


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## trophywench (Nov 17, 2017)

Well this is exactly it with a pump - any make or model of pump - we have to test more, not less and especially as no CGM actually measures blood glucose but uses interstitial fluid, which lags behind blood glucose, you also have to be constantly aware of that and always take it into account before making any dose changes.

Every single person's actual body reacts differently to exactly the same exercise or food or whatever so there's no way of knowing that upfront - though eventually being diligent and logical with testing reviewing and adjusting it should be possible to get it about right a lot more of the time.

We have to work to reap the rewards - they are NOT automatic!


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## HOBIE (Nov 17, 2017)

I am a Medtronic 640G user too. I think Medtronic are world leaders & wait the waiting list for there new toy in a few years ?


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## Flower (Nov 17, 2017)

Nada said:


> if you need to check your level do you need to check the pump or their is a meter/receiver



If you are using the Enlite sensors there is a glucose value  showing on the pump screen all the while plus the graph of where your levels have been over the past 3 hours. You can look back over the past 6/12/24 hours on the same screen by pressing a  few buttons. The glucose value can have 1, 2 or 3 arrows up or down depending on the rate of rise or fall of your glucose or no arrows at all if things are stable.

The Contour 2.4 Link glucose meter sends any finger blood glucose results wirelessly to the pump and the value appears on the pump screen. It then asks if you want to calibrate the sensor with that reading and/or use it for a bolus. You can use any other glucose meter you want to but have to input the results manually .


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## Radders (Nov 17, 2017)

Nada said:


> Thank you for your reply, any tips about having the pump around with exercise, how do u keep it safe and in place ?


It does depend on the exercise. Most of the time I have my pump on my waist band on a fairly strong clip and as long as the waistband is robust enough that’s fine. I have a Velcro belt that came with the first pump and I use that for sleeping but could also use it if wearing Jogging bottoms or leggings with a flimsy elastic waistband. When I used to do more vigorous exercise such as skipping I used to disconnect briefly but my skipping days are over! For swimming I have to disconnect and this is never a problem except on the very rare occasions when I’ve swum for longer than half an hour followed by washing my hair. That doesn’t work so I now restrict swimming to half an hour and to be honest that’s plenty!


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## m1dnc (Nov 18, 2017)

I'm a 640G user too, with Enlite sensors. My second pump after a Roche Combo. I went for the Medtronic because of the CGM and because it's waterproof. I don't have to disconnect when swimming - just slip it in my cossie pocket. I do take it off in the shower though - only for convenience as the tubing starts to get a bit of a nuisance when I twist and turn. I like to walk a lot and I have a pre-set temporary basal rate that I switch to when I go for a ramble. It takes a week or three to get used to all the intricacies of what the pump can do, but it's well worth the trouble and I wouldn't go back to MDI. There's no need to stress about the changeover; you will get lots of training from your DSN and the manufacturer's rep. At the end of the day, most models of pump do much the same and the choice between them is mostly down to personal circumstances and whether their particular features are important to you (like waterproofing for me).


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## Pigeon (Nov 18, 2017)

Hi Nada, I started with a 640G last week! If you search I had an earlier post about the same thing. I got to see pumps in person at the clinic, which was helpful. I looked at the Input website and searched through people's blogs and reviews and wrote a big list of pros and cons. In the end I decided that the 640G seemed to have the least complaints about it, and I liked the fact that it has some (limited) remote bolus options, through the BG meter. The Accucheck Insight is smaller and has full remote access, but it's a touch screen and very slow and a lot of people complain about it. Animas has no remote, and also they've pulled out of pumps in the USA, which rang a few alarm bells about if they'll go the same way here. As people say, I'm sure you'll find any pump good, and after a while you'll find out how you lived without it.

I started off with a morning with a nurse and the Medtronic rep, who was great and very knowledgable and down to earth. I'm going back to see the nurse on Monday (10 days in) and I've done lots of testing in the mean time. I thought changing the cartridge and doing the cannula was very confusing the first time they showed me, but when I did it myself with the instructions it was fine, and now a week in I can do it quite quickly. 

So far I have mainly worn the pump in pockets (cut little holes inside to pass the tubing through) but I have bought some lycra pouches (TK Maxx do one by a company called Cover Girl that was £6, Decathlon was good as well) for doing sport. I bought a Christmas party dress this week and I think I'll wear the pump in my bra and use the remote function that night- yes I did try putting it there in the changing rooms!

My results have not been amazing so far but I feel like they're getting better. We set up a basal profile with the rep for a starting point, then I had a terrible first 36 hours where I kept doing corrections, increasing basal and nothing would bring BG below 16! I used my pen to do a correction, changed the tubing and got it down to 14, then it went back up to 16. Finally 36 hours in I realised my basal rate was 130% of 0 units/hour! So we had set up a lovely basal profile but not selected it, and the default rate was 0! eek. I felt rubbish having had nothing but bolus and correction doses for over a day! Once I sorted that felt a whole lot better! I still haven't had a day in single figures but I'm keeping lots of notes and tweaking things- I think the starting doses set up were quite conservative. I've got a Freestyle Libre sensor at the mo to help with observing overnight trends.

I got the pump on the grounds of not needing much insulin and having a lot of night time hypos. One benefit I hadn't really expected was I feel a lot happier not doing injections! 11 years in and I never thought they bothered me, but I've found it's a different mindset to be able to do a bolus where I am if someone comes round with biccies at work, or to be able to top up after a meal if I want pudding. the rep even recommended a setting for popcorn or drinking a cappucino, thngs I wouldn't normally do with injections! So there is lots of potential, I just need to keep testing and tweaking to get my doses right. Hope that helps - it is a big decision but you love the flexibility you get with it!


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## trophywench (Nov 18, 2017)

... and I discovered how much I hated and despised filling syringes even when they are shedloads bigger and called pump reservoirs - that was a very nasty shock to me.

It made the choice of pump replacement fairly obvious though!  LOL


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## HOBIE (Nov 19, 2017)

everydayupsanddowns said:


> Pumps are great for exercise because you can turn the basal down to nothing or very little to allow for the extra insulin sensitivity from the activity. For distance running I've always just clipped the pump to my shorts pocket. For short-ish gym sessions (30-45 minutes) I just disconnected entirely and left it in the locker.
> 
> You can use elasticated tubi-grip type things if you need to keep it attached but are doing lots of rapid moving.
> 
> ...


When I am busy at work or relaxing I like the "Temp Basal" feature of my pump. I like to miss meals & its good for that too


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## everydayupsanddowns (Nov 20, 2017)

HOBIE said:


> When I am busy at work or relaxing I like the "Temp Basal" feature of my pump. I like to miss meals & its good for that too



I wouldn’t apply a temp basal for missing a meal Hobie. I would adjust my basal pattern so that I could miss a meal and still stay level - that way if I don’t eat or meal timings vary it shouldn’t make too much difference. Same principle applied on MDI, but pump basal pattern can be adjusted with more precision. 

Of course the nuisance is having to repeatedly tweak it to keep it up to date with changes in season/body’s insulin needs


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## HOBIE (Nov 21, 2017)

everydayupsanddowns said:


> I wouldn’t apply a temp basal for missing a meal Hobie. I would adjust my basal pattern so that I could miss a meal and still stay level - that way if I don’t eat or meal timings vary it shouldn’t make too much difference. Same principle applied on MDI, but pump basal pattern can be adjusted with more precision.
> 
> Of course the nuisance is having to repeatedly tweak it to keep it up to date with changes in season/body’s insulin needs


I never know what I am doing at work. I could be doing a Re-Wire or up & down ladders all day, or sitting connecting a Fuseboard. Chasing boxes out who knows. A pump is a great toy & very adaptable to what you are doing Everyday


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## everydayupsanddowns (Nov 21, 2017)

HOBIE said:


> I never know what I am doing at work. I could be doing a Re-Wire or up & down ladders all day, or sitting connecting a Fuseboard. Chasing boxes out who knows. A pump is a great toy & very adaptable to what you are doing Everyday



Yes I use TBRs for increased activity every day. Even if it’s just a gentle walk with the dog. For more significant activity/DIY/Gardening I generally need a strong TBR (50% or less) and top-up carbs too.


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## trophywench (Nov 21, 2017)

LOL - I am not anywhere near active at the moment - gentle walking even without a dog and a Sherpa  carrying the Handbag (I wrote that using Edith Evans' voice) is more like walking up Snowdon at the moment!

However I too am using 24 hour TBRs delivering however much extra insulin I appear to need that particular day, to try and counteract the ruddy inflammation round my knee.


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## Maryanne29 (Dec 1, 2017)

I use TBRs a lot, depending on whether I’m on my feet at work rushing around or sat at the computer all,day. It’s so easy to set a temporary rate and works for me.


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## Ally beetle (Dec 1, 2017)

Nada said:


> Hello everyone,
> I am hopefully coming on a pump soon, I was given the choice of Animas Vibe, Medtronic 640G or Accucheck insight.
> I have been a Type 1 since the age of 7, almost for 20 years now, so although I don't mind having a pump as I have been experiencing severe fluctuations and spikes for the past 9 months without any improvement, I am a bit perplexed.
> I have a libre now and was thinking that I do not want to lose the continuous monitoring bit, so that made me exclude the Accucheck insight as as far as I am aware you need to finger prick to bolus for accurate calculations. I am currently thinking about the Medtronic 640G and buy the Elite sensors myself.
> ...


I have the accucheck insight which I love for the handset and the bolus adviser but I think out of the group you have to choose from I would choose the Medtronic 640g for the cgm feature with insulin suspend which would give me more confidence with hypo avoidance but if you can't get or afford the CGM it is not as useful.


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## HOBIE (Dec 2, 2017)

Can you imagine going up Scar-Fell ? (in my 50th year of T1) Temp bolus on.  Down to 2% on my Medtronic. ! had a Libre on too with perfect bg


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