# Info Please



## Akasha (May 12, 2010)

As it says, can i have any info on pumps please? 
Preferbly in lameans terms, no big words that are hard to pronounce. 

My hospital have never really said about them, other then mention them in passing at my carb counting course. 
My OH was put forward for one, but decided that he didnt like the idea of it, and mainly only tells me stuff to put me off. 

Thanks in advance!


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## Red Pumper (May 12, 2010)

Hi Akasha,

what sort of information are you looking for?

Are you wanting a brief description of what a pump does and how it is managed or are you looking for more detailed information than that?

Keith.


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## Akasha (May 12, 2010)

Erm, well,
I did wander about the canular. (is that what it is called?)
how do you know when its empty? or anything needs changing on it. 
Does it also tell you what your blood levels are, orr do you need to still use a meter? 
If i had one, would i need to see the DSN more often? (Hope not  )
How long do they last for? 

My basic knowledge is its like having a insulin pen (nearly) permanently attached, delivering a continual amout of insulin untill you eat then you press a button to give an extra shot. 

So in answer to your question keith, Both please!


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## Freddie99 (May 12, 2010)

Hi Akasha,

There's lots to know. I've only just started on one (a month ago today) and it's really helping. What it really is is just a little machine that pumps in insulin. Quite literally. You have a basal rate which is always present. It carries out much the same function as your basal insulin such as Levemir/Lantus. You then bolus at meal times or whenever you take on carbs. There are a variety of options for boluses such as an extended bolus which means that it trickles in over a period of time that you specify. You can fiddle with your basal at the touch of a button for things like exercise and that.

I know comparatively little about pumps but there are those who know alot more than I do. For want of a better phrase, just pump them for information!

Tom


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## Red Pumper (May 12, 2010)

Hi Akasha,

to add to Tom's response and to try to answer your questions:

As Tom says, the pump (about the size of the old style pagers) delivers a constant supply of  short acting insulin, this is the basal dosage and replaces your levemir or lantus injections and can be programmed to deliver at different rates during the day according to your body's needs. This can also be adjusted temporarily to take account of exercise etc.
When you eat any food containing carbs, you press a few buttons on the pump so that it delivers a bolus dose based on your insulin to carbs ratio, this replaces the short acting insulin (humalog, actrapid etc.) that you would normally inject before each meal.

The pump has a reservoir (or cartridge) that you fill with short acting insulin. Depending on the pump this hold anything from 180 units to 300 units of insulin and will last three to six days depending on your insulin requirements. When it gets empty, you will need to replace the cartridge.

The pump delivers the insulin through a cannula to which it is connected by a very thin felxible tube. The cannula is a small metal or teflon needle (usually about 8 or 9mm long) inserted into the skin in either the abdomen, buttocks, thighs etc. (basically it can be inserted in any site that you currently inject into. The cannula needs to be replaced and re-sited every two or three days. You need to rotate the sites as you currently roatate you current injection sites.

You still need to test you BG levels (possibly more than you do now) so that you can do any corrections to bolus doses etc. and to check that BGs are withn the correct range and to make sure that there are no problems with the pump delivery (sometimes cannulas get blocked or air bubbles appear in the lines).

You need to be connected to the pump 24 hours a day but can disconnect for up to an hour for a shower, swimming, etc (or as my DSN put it, if you want to 'get intimate' ). I thought being connected 24 hours would be a big issue for me but it's not been a problem at all. it's amazing how quickly you get used to it.

You need to carry an emergency kit with you at all times in case of any issues. This will contain a spare filled reservoir, a spare cannula and tube, a spare battery, ketostix and finally a syringe and insulin vial in case of total pump failure. Sounds a lot but it's suprising hpw small it can be packed down.

The theory with a pump is that the basal rate takes care of your backkground needs and that you shouldn't need to snack. You can then eat when you want to not because you have to to. You just need to deliver a bolus dose each time you eat any carbs. That's the theory anyway. You will still have the odd hypo that needs correcting but these should be less often and less severe that those that you experience with MDI.

Phew, I think that's about it. If the above raises any questions, then just shout.


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## Akasha (May 12, 2010)

I tend to carry around 2 insulin pens, spare strips, more needles then i need anyway, so carrying supplys wouldnt be a prob. 
Are the cartridge the same ones that fit in the pens? 

When would the pump sit if its connected to say your thigh? (i wouldnt want it in my bum, as sitting down may be uncomfortable)


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## Red Pumper (May 12, 2010)

The cartridges or reservoirs (different pump manufacturers use different terminology for the same thing) are not the same as the ones that fit in the pens. The cartridges are empty and you need to fill them yourself from an insulin vial. It's a simple procedure once you get used to it.

The pump connects to the cannula via a tube which can be upto to a metre in length. so it doesn't really matter where the cannula is inserted, the pump can be carried out of the way in a trouser pocket, clipped to a belt (some women clip it to their bra strap) or wherever is comfortable.
If the cannula is inserted in the bum, then it tends to be towards the upper part, so there is little or no pressure on it when you sit down.


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## Freddie99 (May 12, 2010)

I use my (expansive) beer gut to put my cannulas in. I have tried my lower back but I seem to find that the insulin doesn't absorb as well there as it does in my belly. 
I keep my pump in my pocket or sometimes clip it to my belt. I don't really use the clip much as I just find it makes the pump bigger than it needs to be. I'm still learning alot but a month in I've picked up some rather good hints. 
Pumps are really a wonderful tool but as with anything you get out what you put in. Nothing ventured nothing gained and all that.


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## Akasha (May 12, 2010)

Ohh, like filling a sringe to refill another vial. gotcha! 

I ment to ask if you can get the smaller cannulas? as i am not very big, and only use 6mm needles... 8mm make me bleed 

The reason im considering is i got to work and had an extra Breakfast in effect (1 crumpet) and did insulin for it. I had a thought of, a pump would make my eating habbits easier.. 

I do seem to go from one extreame to another with my blood levels, but my HBa1C is 7.6 atm. Would i be considered?


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## Freddie99 (May 12, 2010)

Akasha said:


> I do seem to go from one extreame to another with my blood levels, but my HBa1C is 7.6 atm. Would i be considered?



Depends on your consultant. Mine was exceptionally good. Even though my HbA1C would have precluded me from getting one I still got one! Just brow beat your consultant into it. The swinging form high to low should also help alot.

Tom


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## Akasha (May 12, 2010)

My previous nurse (i think she was aiming to steer me towards a pump) left last July, and i havent seen the same one since. 
(may be sorting that out, as i got told if i go at 3.30 on a friday there is only one nurse there) 
And my consultant is, well, He knows alot about nothing. If your lifestyle doesnt match that in the text book then he is out of his depth. 
I also got told last year that i couldnt transfer to a female consultant unless i was planning a pregnancy. 

I had a good week last week, all readings below 9 and only one hypo. then since sunday ive been like a yoyo.


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## johnellis (May 12, 2010)

Just to back up what Tom says I got my pump due to erratic control and having a lot of hypos.  I had a good HbA1c but I know what you mean about a yoyo effect.  I know that it can be a bit of a postcode lottery but there is guidance for doctors from NICE about who can get funding for pumps so may be worth discussing with your nurse or consultant.


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