# Pros and Cons of Pumping



## Splats13 (May 20, 2014)

Hi All,

I've recently been having some problems with my control after my DSN made some changes to my insulin regime. I had CGM done recently and from this we can't really find any real rhyme or reason for all of the crazy highs, but we're working on it slowly.

During our discussions the DSN asked if anyone had ever mentioned a pump, which they haven't thus far. I'm in the process of researching this now, in case we can't get control through insulin and consider a pump as an option for the future. Therefore, as much as I can read the Diabetes UK and manufacturers blurb (which is useful), I thought it would be good to get some real life low down on pumps.

So to all you pump users.... what are the good bits and bad bits about using a pump? Be honest, i'd rather hear about it warts and all so I can make a really educated choice on future treatment if I have to!

Thanks in advance


----------



## Sally71 (May 20, 2014)

Hi Splats
We love our pump and would never go back to MDI!  Mainly because of the greater flexibility and fine tuning possibilities it gives you that you just could not do with pens!

Pros:
Only one needle every 2 or 3 days instead of several a day.  Once cannula is in you can have as many snacks and do as many corrections as you like, don't need a needle each time

Instead of one or two jabs per day of long acting (basal) insulin, the pump carries short acting only and slowly drip feeds you with teeny tiny doses every few minutes.  This is called the basal rate and can be adjusted by the hour to your exact requirements, so you get more insulin when you need it and less when you don't.  Which should result in more stable BGs.  You can't do that with Lantus and Levemir!

With meal boluses you have several options: Standard, which zaps the whole dose in at once the same as a pen, Extended, which drips the dose in slowly over whatever time period you specify (anything from 15 mins to 12 hours on the Roche one) or Multiwave which is a combination of the previous two, i.e. it zaps a portion of the dose in straight away and the rest goes in slowly over a period of time.  You get to choose how much up front and how long the rest will take.  This is useful for dealing with foods which digest very slowly, and you may also find them handy for other things, although it takes a fair bit of experimentation to find out what works for you!

You can also do temporary basal rates which will increase or decrease your basal rate by a % for a period of time, useful for dealing with illness (usually more required) and exercise (usually less required).  

You can also set several permanent basal patterns if you like, e.g. If you work shifts. We have one for school days and another for holidays as activity levels tend to be much higher at school. 

Basically all of this fine tuning means that you can have much tighter control over your BGs and with the cannula in all the time you can basically eat what you like when you like, just bolus as and when you need to, 10 times a day if you like!

Cons:

You have to wear it all the time, although I think most people get used to it fairly quickly.

It can take a VERY long time and lots of hard work to get basal rates, ratios etc set up to exactly what works for you, I think it's quite common for new pumpers to go through a phase of wanting to chuck it out of the window!

And then D being D never stays the same for long so you just get everything set up nicely, it all runs smoothly for a week or two and then it all changes and you have to start tweaking everything again, sometimes it seems to be endless! And you still get those mad days when it all goes wrong and you can't work out why, no pump can prevent that.

Occasionally you can have cannula failures etc which are a bit of a faff, especially if you are out and about.  You have to test more often just to check that everything is working,  the pump should alarm to tell you if something is wrong but there are some things which it cannot detect.  If it stops working or if cannula site goes off, you have no long acting insulin on board and therefore BGs can rise rapidly and then DKA beckons if you don't notice it soon enough!

The Animas Vibe is the only completely waterproof pump, if you have any of the others you have to take them off for things like swimming, you are then on a time limit of an hour before it has to go back on again.  Don't have to worry about that with jabs!  (although you could cheat, plug pump back in temporarily after an hour, do a test, do a correction if high, then take pump off again for another hour)

I have to say, on balance I think the pros far outweigh the cons!
The Roche Combo comes with blood test kit which acts a as remote control for the pump, so that you don't have to fish the pump itself out from under your clothes every time you want to do a bolus.  Just test, enter carbs, handset will work out how many units required for carbs + correction if necessary, the it's two more button pushes to deliver bolus and the only time you need to touch the pump itself is when you refill it.  We've got that one and it's fab! Downside is that it won't fully integrate with a CGM. I've never yet tried a CGM though so can't comment on that.

Can't think of anything else to add at the moment, hope that helps


----------



## Redkite (May 20, 2014)

Hi Splats,

Sally's covered all the points so I won't repeat everything . Just to say, we would NEVER go back to injections - pumping is the closest approximation to a working pancreas, and it's overwhelmingly positive.  That said, I have to admit that it's much harder work, simply because you have so many more tools at your disposal (ways to get creative with your insulin delivery/timing).

The negatives for me are:

* another layer of problem solving when investigating highs (e.g. could be a cannula problem, not a need for more insulin)
* impossible to travel light, as have to take all your pump consumables as well as back up injection equipment
* a nuisance and a worry when it comes to watersports (except the Animas, which is waterproof) - there is a need for planning when going to a waterpark or kayaking, surfing, etc. to make sure pump is safe and secure (not £3k device left lying on beach towel!) and not disconnected for too long, as you have no other insulin in your body.  This is not an insurmountable obstacle, but doing these activities when on injections seemed relatively carefree in comparison, whereas sometimes they now seem more hassle than they're worth....


----------



## trophywench (May 20, 2014)

Both the answers are correct, but from parents of T1 children so they do not know what it's like for an adult.

Dunno how long you've been Diabetic or how old you were, but I was diagnosed aged 22 and I had my pump when I was 61.

Lovely for the first 3 weeks, then the euphoria wore off, I realised I was on my own, things were no longer instinctive, it was a learning curve, it was just like being newly diagnosed again, I hated it and if you'd said it doesn't matter, bin it - I might quite easily have done it.

But a pump is much like D itself really.  You have to control D or else D wins.  You have to control the pump - cos I WILL NOT be beaten by a small heap of plastic and electronic junk!

So I gritted my teeth, and I won !  LOL


----------



## Splats13 (May 21, 2014)

Thanks for all of your comments. They are really helpful.
It'd be great to get some info from adults who use the pump themselves too- just to see if there are differences in opinions due to lifestyle differences.

it does sound like a real positive option though. After 25years with injections perhaps this might be a good move!!


----------



## Pumper_Sue (May 21, 2014)

Hi Splats,
Having a pump is a lot of hard work, if you put in the work you reap the benefit  There will days when things go t*ts up and you wish the pump on another planet 
Lots of sleepless nights whilst you sort your basal out. Think you have it sorted then it needs tweaking again.
It's a very steep learning curve to start with as many say it's almost like starting again with your diabetes career.
End result though is a better quality of life 

Invest in the book pumping insulin by John Walsh. (Amazon) It's worth it's weight in gold and known as the pumpers Bible.
I've had a pump for about 7 years now and to say it's life changing would be the understatement of the year.


----------



## HOBIE (May 21, 2014)

Its the best tool so far for Diabetic control. Full stop.    T1 for over 47yrs & know a little bit about the condition.  Would go wild if I had to back to Mdi.  Have been pumping for more than 7yrs now & cant say I love the dam thing but is so much easier when set for the individual. First few weeks can be a test but the benefits are great.  I didn't really test as much as I should have but the pump encourages you to do so. If you get the chance TRY one


----------



## Maryanne29 (May 21, 2014)

I agree with everything the others with pumps say. It was the best thing ever to happen to me diabetes-wise. After being on many MDI regimes since age 4, getting my pump aged 59 was completely life changing. I did go through the phase of wanting to chuck it away as others have said too, but now nothing would make me give it back. It helps me feel better than I've done for many years. Get one if you have the chance!


----------



## Splats13 (May 21, 2014)

Thanks all for your comments. They are really helpful. I will bear them all in mind if/when I consider the option of changing to pump.
I do really like the sound of having greater control, despite some of the teething problems and frustrations, so it's definitely something I will look at in more depth and consider raising next time I see the DSN.

thanks again


----------



## Flower (May 21, 2014)

Like the others have said I wouldn't swap my pump for anything. 

The removal of Lantus/other long acting insulin from my life has made the world of difference, I couldn't control my night time readings and was going unconscious and having fits from hypos. With a pump you use only quick acting and have a visible active insulin onboard read out. You do have to be aware of a very rapid increase in blood sugar and the possibility of ketones if for whatever reason insulin delivery is interrupted.

The flexibility is great compared to injecting 4 or 5 reservoirs of insulin per day. The minute amounts mean less severe hypos and it encourages you to keep tweaking to get better control as you start to see results. I feel so much safer knowing I have only got tiny amounts of insulin floating around in me.

I'm not really aware that my pump is attached to me unless I get the tubing caught around a door handle etc and yank the cannula out but that's a rare occurrence and a only small inconvenience.


----------



## trophywench (May 21, 2014)

I do hope you didn't mean that literally!    

You made me laugh ....

My reservoirs hold 315ml, x 4.5 that would be 45 or more days worth of insulin in one go, were I still on MDI amounts.  On the pump it's even longer!


----------



## Flower (May 22, 2014)

Oops, better clarify that, I was using the word reservoir in the non pump way to describe a bigger pool of insulin in one delivery. That would be extreme insulin usage otherwise


----------



## Pumper_Sue (May 22, 2014)

Flower said:


> Oops, better clarify that, I was using the word reservoir in the non pump way to describe a bigger pool of insulin in one delivery. That would be extreme insulin usage otherwise



Lol was thinking we had an insulin junkie in our midst


----------



## megga (May 22, 2014)

Hi, i have been on the pump for around 6 years, yes it has its pros and cons, and it all comes down to preference. like mdi's they take a bit of work, so there's no easy option.
I hate mine, i don't like that its on me 24/7. this to me is the worst thing about them, its a constant reminder to me of my condition, and i'm the kind of person that just gets on with life, and i feel it don't let me.
But for the past 3 weeks i have gone back on to mdi's, and i have found a system that works for me.

This site has taught me that D is not only about carbs, but fats affect me as much, and with me they can affect my B/S for up to 24 hours.
My D nurse is a very nice caring person, but i do think after we have carb's in the bag, we should have more course's, on other affects, it may save the NHS £1000,s on the pump.


----------



## Maryanne29 (May 22, 2014)

That's an interesting view Megga. Having been on MDI for over 54 years and on a pump for six months, I find I can "forget" about my condition with the pump, whereas with five or six injections every day it was always with me.
But it's good you've found a way that suits you.


----------

