# Joining 'team pump'



## everydayupsanddowns (Oct 12, 2011)

Hello to all you happy pumpers....

Just had an email from my DSN to say that my application has been supported and I'll be switching to pump therapy over the next month.

Due to go on saline from 31st October and insulin from early November.

Still a few 'intro/set-up' chapters of Pumping Insulin to get read before then


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## novorapidboi26 (Oct 12, 2011)

Congratulations, I didn't know you were waiting for a pump............

How long?

Exciting times, I am sure you will settle in quickly........


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## everydayupsanddowns (Oct 12, 2011)

Have been moving toward it for 2 years I think (I had significant pump-aversion). While I realise they are still not perfect, I've come to the point where I recognise that pumping is the most subtle/tweakable system available and that whatever I try on MDI I will still have problems, but that these might be severely reduced/eliminated by pumping.

We shall see.

If all goes to plan I'll be pumping insulin around 8th November


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## Hanmillmum (Oct 12, 2011)

everydayupsanddowns said:


> Hello to all you happy pumpers....
> 
> Just had an email from my DSN to say that my application has been supported and I'll be switching to pump therapy over the next month.
> 
> ...



Good news! Must say you are already off to a good start with the "Pumping Insulin" book, wish we had found it earlier, it wasn't until 6 months in we came across this and things really made sense from then on.
Millie was on the saline too but I asked after 2 days if we could just get on with it, (the insulin) which we did - the practical aspects were straight forward enough. Its the fine tuning which takes the effort.
Best of luck with it all


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## Northerner (Oct 12, 2011)

Terrific news Mike! I hope/am sure it will be of great benefit to you, given the knowledge you have aquired and the work you put in  Do you know which pump you will be getting?


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## everydayupsanddowns (Oct 12, 2011)

Northerner said:


> Do you know which pump you will be getting?



I've gone for a Medtronic Veo. Mostly because it allows me to access the inbuilt CGM from time to time (whenever I can afford it!)

M


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## Phil65 (Oct 12, 2011)

Great news Mike...you will be really pleased with it, I'm sure! Saline....paa! I got my pump and played golf the same day!


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## Steff (Oct 12, 2011)

Excellent news Mike,happy pumping x


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## Robster65 (Oct 12, 2011)

Glad to hear it Mike. It's been a long timecoming, I know. I'm amazed how quickly they've approved it. Way better than I expected.

Will be watching with great interest.

Rob


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## FM001 (Oct 12, 2011)

Great news regarding the pump although I'll admit that I didn't know you were looking to switch from MDI.  I always understood that the criteria for a pump was if someone was struggling on injections and had hba1c's of 8 and above, have they now relaxed the rules or have I got this totally wrong?


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## everydayupsanddowns (Oct 13, 2011)

toby said:


> Great news regarding the pump although I'll admit that I didn't know you were looking to switch from MDI.  I always understood that the criteria for a pump was if someone was struggling on injections and had hba1c's of 8 and above, have they now relaxed the rules or have I got this totally wrong?



That is one of the criteria under which you can be considered (and you're right, that does not apply to me). 

Where I do qualify is 'excessive hypos/hypo unawareness, fear of which affects quality of life...' 

I've done a lot of work on hypos over the last few years and I have far fewer and less serious ones than I used to, but still far too many. My awareness is improving, but it's still a constant nagging doubt. I've not needed help from Mrs EDU&D from crushing overnight hypos for over a year having changed timing of Lantus, but my basal needs fluctuate quite often and the fixed/flat profile of a basal analogue is always going to struggle. Just a tiny overshoot of Lantus can leave me chugging upwards of 60g CHO in Lucozade trying to firefight relentless lows (or whacking in 6-8u of seemingly water-like corrections of Humalog to pull BGs down). I rarely drive for fear of dropping into an unexpected hypo, and when I do I tend to try to run around 7-10 just to be on the safe side.

My hope is that the more flexible/accurate/responsive basal profiles that a pump offers will help keep me in that tiny target range with fewer 'wobbly weeks' while I test and adjust Lantus and wait for it to wake up to the new dose.

I'm not without a degree of lingering pump-aversion, but I'll never know without trying it. I'm pretty sure I'm doing about as well as I can on MDI, but it's still not good enough. I'm lucky enough to be in quite a pro-pump area (postcode lottery again), and have been able to make a successful case despite a pretty good A1c.


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## novorapidboi26 (Oct 13, 2011)

I look forward to seeing how your results compare and to your subsequent blogs on the topic....................


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## everydayupsanddowns (Oct 13, 2011)

Preparing myself for a lot of work at the start. Seems to take a good few months of 'Argh!' and relearning how everything works before you begin to get more reliable results.


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## Monica (Oct 13, 2011)

That's brilliant news.

Toby - Carol's HbA1Cs have never been above 8, only for the first 3-6 months after diagnosis. Carol got hers because of swinging levels and too many hypos under 3, which she didn't feel. Carol was first offered her pump at the clinic visit where her HbA1C was 6.9. I thought that was a brilliant result, but the consultant wasn't happy.


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## FM001 (Oct 13, 2011)

everydayupsanddowns said:


> That is one of the criteria under which you can be considered (and you're right, that does not apply to me).
> 
> Where I do qualify is 'excessive hypos/hypo unawareness, fear of which affects quality of life...'
> 
> ...





That explains a lot and can well understand why you feel the need to switch.  Never really heard of anyone changing to a pump and regretting it afterwards so hope this is the case with you too and all goes well. Good luck


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## FM001 (Oct 13, 2011)

Monica said:


> That's brilliant news.
> 
> Toby - Carol's HbA1Cs have never been above 8, only for the first 3-6 months after diagnosis. Carol got hers because of swinging levels and too many hypos under 3, which she didn't feel. Carol was first offered her pump at the clinic visit where her HbA1C was 6.9. I thought that was a brilliant result, but the consultant wasn't happy.




It would seem that hypos are a major influence in persuading clinics to change you from mdi to pump therapy, hope others who are experiencing these difficulties read this thread and learn from Carol's and Mike's experience.  Thanks Monica


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## Ellie Jones (Oct 13, 2011)

Welcome to the club Mike

Some of your problems are very similar to ones I had before I started pumping and I think that you will be taken aback when you find out what the pump can do for your basal profile..  I had all sorts going on with mine, from DP and EP with a large range flucuation to top it off..  The pump copes and flattens it off to a good working platform..  And it's a case of pressing a few buttons to go from the basal needs of a work day or very active day to an lazy day off..

I used to have to do some real high end intensive management daily to keep my BG's in a reasonable range and keep hypo's down to 2-4 mild ones a day and avoid as many highs as possible, so adveraged out around 6-8 jabs a day in this effort..

Don't be surprised if you feel a bit emotional after a week or so, it's pretty natural...  I sobbed my heart out with tears of joy after the first week purely because I hadn't had one hypo for 7 days...


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## shiv (Oct 13, 2011)

Fab news Mike


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## rachelha (Oct 13, 2011)

That's great.  The first couple of weeks have been tough, but I have had only two night time hypos in the last three weeks, which is wonderful.


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## Phil65 (Oct 14, 2011)

everydayupsanddowns said:


> Preparing myself for a lot of work at the start. Seems to take a good few months of 'Argh!' and relearning how everything works before you begin to get more reliable results.



Hi Mike,

Like you I was on MDI for a fairly long time and I too was 'pretty well controlled' although not without hypos and feeling that I could do better but not on the insulin regime that was available.  My main problem on MDI was my Basal (Lantus) I was never confident about the dose, time of dose, whether to split the dose and how long it was working in my body for (consistently).  I did get complacement with my diabetes for several years i.e not testing often enough and carb counting was only introduced after 10 years of living with diabetes (it was never mentioned to me before! ) 
I have been on my pump for 6 months now and although not a perfect cure it is much,much better than being on MDI, I never really minded taking injections it was the sometimes inconsistent readings I would get that frustrated me so much. You are right that starting pump therapy is like being diagnosed again, however your diabetes education is such that I expect you will adjust to it with few problems.  The differences or problems I faced were:

1.  Getting the basal rates right....and even when you think you have, you may need to change them again! (Lots of tiring fasting testing). My basal rates are massively different per hour eg 3 units per hour early morning (to combat DP) v 1 unit per hour in the afternoon, plus many other rates in between for the rest of the 24 hour period! So much better than MDI!

2.  I had problems with the type and length of cannula and transfusion sets to use, I was getting high readings due to 'tunneling' with teflon so changed to metal cannulas.  Also I have to pay close attention to the siting area, sometimes the absorbtion rate may not be perfect (high readings will confirm this) If I find an area that is a bit lumpy it is almost as if no insulin is working at all....at first you think that your pump is broken or you have air bubbles in your cannula or all manner of 'reasons' why you are high, instead of going back to basics.

3.  Finding the right Temporary Basal rates for periods of activity/inactivity or illness...this takes time also and is really trial and error, for example when I play golf I give myself a TBR of 10% and if I'm on a long journey (plane etc) I up it to 200%.  I haven't been really ill yet, just recovering from a heavy cold which didn't really affect my levels.  

4.  I change my cannula every 2 days, I don't leave it for 3 days as recommended because for me after 2 days the insulin doesn't deliver as well and my levels start to climb.

To think I've already missed 930 injections during my 6 month pump therapy makes me smile!   

Good luck when you get it, I'm sure you will adjust with few problems.


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## everydayupsanddowns (Oct 14, 2011)

Thanks All

Phil - did you find much reduction in TDD? Was your proportion of TDD as basal:bolus roughly the same on MDI as it is now? How about insulin:carb ratios and correction factors - does *everything* change or have some things stayed the same?

M


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## Phil65 (Oct 14, 2011)

everydayupsanddowns said:


> Thanks All
> 
> Phil - did you find much reduction in TDD? Was your proportion of TDD as basal:bolus roughly the same on MDI as it is now? How about insulin:carb ratios and correction factors - does *everything* change or have some things stayed the same?
> 
> M



Hi Mike,

My TDD didn't reduce if anything it has increased, I know that is unusual but maybe my TDD wasn't correct on MDI.

The proportion of basal:bolus ratio is about the same as MDI at the moment mine is 40:60, I need to look at this in a lot more detail and suspect I will probably move to a 50:50 ratio (it is just so time consuming and....hard work!)

My correction factor is 1 unit will lower my bs by 1 mmol....obviously personal to me but the same as MDI.

My carb/insulin ratio however is now very different on the pump compared to MDI....FOR THE BETTER! 

Morning  2.7 units per 10g carb (higher than MDI)
Lunch 2 units per 10g carb (Same as MDI)
Evening 2.5 units per 10g carb (higher than MDI)

Also Multi wave bolus is excellent for Pizza, Pasta, Takeaway, high carb and high fat meals.....better than splitting with two jabs!  

Starting on the pump also made me really concentrate on getting things right, I was almost certainly getting slightly complacement on MDI with a 'that will do' attitude.


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## everydayupsanddowns (Oct 14, 2011)

Thanks Phil - that's very helpful. From what I've read 40% TDD as basal is not unusual - so that might just be what you need.

I'm currently on approx 45% TDD as basal, and it seems like it's easier to make an estimate of starting pump TDD/basal/ratios if you have an idea of that.

Suck it and see I guess!


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## Phil65 (Oct 14, 2011)

everydayupsanddowns said:


> Thanks Phil - that's very helpful. From what I've read 40% TDD as basal is not unusual - so that might just be what you need.
> 
> I'm currently on approx 45% TDD as basal, and it seems like it's easier to make an estimate of starting pump TDD/basal/ratios if you have an idea of that.
> 
> Suck it and see I guess!



Yep, absolutely.........get ready for night time fasting testing!!


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## heasandford (Oct 14, 2011)

Oh eduad, you're finally going for it, I will watch your progress with great interest as I am still considering (none of my diabetes team are though...) In particular I am interested that you are still up fpr the CGM, life's dream as far as I am concerned! 

You might want to give a quick report on the general message board when you've had it awhile, sometimes think some of us (who, me??) don't look at the pumpers because we're not doing it, so aren't persuaded how much beter it could be (although I accept that it might not always be so, and there's a lot of work to do)

Best of luck!!


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## Jojo26 (Oct 16, 2011)

*Medtronic veo*

Hi mike

I'm also starting the medtronic veo tomorrow after 25 yrs of mdi so will be very strange for me to switch over lol but very much looking forward to it.  I'm starting on saline tomorrow then insulin on the 31st oct as it's my week off work so can get used to it at home, hope all goes well with urs il keep u updated how I'm getting on  

Jo


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## Ellie Jones (Oct 16, 2011)

Strangley you don't take much notice not inject the bolus injections when you eat, I suspect this is because you are taking a BG and pressing buttons, so doing something with your hands..

It was my two basal injections that took a week or so to adjust to, every 11.30am and 11pm I would looking to inject...  Getting use to wearing the pump took only days..

I was lucky I went straight onto insulin, handed my pump at 11am by 12 I was pumping...  Had a 2 day training session where when we played with the controls we just detached the pump..

Then told by the DSN not to be afraid of detaching the pump for 30 minutes or so and just play with the controls..


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## Unicornz (Oct 19, 2011)

everydayupsanddowns said:


> Have been moving toward it for 2 years I think (I had significant pump-aversion). While I realise they are still not perfect, I've come to the point where I recognise that pumping is the most subtle/tweakable system available and that whatever I try on MDI I will still have problems, but that these might be severely reduced/eliminated by pumping.
> 
> We shall see.
> 
> If all goes to plan I'll be pumping insulin around 8th November



I'm a bit late I see but I wanted to say congratulations that's great news! I recognise what you are saying above so much, I used to be the same. Didn't even want to think about a pump, but after years and years of trying everything on MDI I realised that it was getting to the point where it was the only option left. Been on it since March now and things are going so much better, I really can't believe I never wanted to try it earlier. 

Best of luck with everything, the first few weeks/months are going to be challenging but it's definitely worth it!


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## grandma (Oct 26, 2011)

great news about the pump hope it all goes well for you.
I think I must be very lookey as I only went on the Dafne 1 year gone Sep.And had never been told about the pump but now I am getting one.
Was to get it on18th Aug but something about bloods not back and Doctor going on holiday, managed to get anothe appointment and I now have to go on 3rd Nov. so hope that its the day for the pump.
Im a but confused about it all and I gess I will need a lot of help from you lot on hear. The only thing they did in  Aug. was show me how it went on ,all the bits and not mutch else just said it was pink and that was that come back in 2 week and nothing else.
Ill let you know what happens in Nov. so if I do get one as I think then its been quick havent had to wate like you lot.


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## Northerner (Oct 30, 2011)

Good luck tomorrow Mike!  See how long it takes before you forget you have it on!


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## Robster65 (Oct 30, 2011)

Yep, best of luck with it. Will be watching it all with great interest. Even the bits where you shout and scream at it and wish it was a pen. 

Rob


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## Steff (Oct 30, 2011)

Best of British from tomorrow onwards Mike


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## trophywench (Oct 31, 2011)

Ooops - I'd forgotten it was tomorrow!

And tomorrow we can all start betting how long it will take him to do his first set change, can't we?


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## Jennywren (Oct 31, 2011)

Good Luck , hope all goes well for you .I went straight onto insulin on the first day but i know a lot of places like to to get use to a pump with saline first .


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## Pumper_Sue (Oct 31, 2011)

Good luck Mike. I'm sure you wont need it though as suspect you will take to pumping like a duck to water.


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## everydayupsanddowns (Oct 31, 2011)

Thanks all 

Surprised how 'significant' it has felt over the last 24 hours or so. Have been willing the days to pass for the last month and now it's all a bit 

Yes 'first set change' will be an interesting one... I'd guess at an hour from what others have said!

Depending on how many goodies I get to experiment with on my saline week I'm hoping to do a few changes in the first 7 days though, so that I have a chance to see what various different sites are like to live with.... sit on.... sleep alongside...

I should be a dab-hand at changes by Friday!


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## teapot8910 (Oct 31, 2011)

Best of luck Mike!


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## Pumper_Sue (Oct 31, 2011)

everydayupsanddowns said:


> Thanks all
> 
> Surprised how 'significant' it has felt over the last 24 hours or so. Have been willing the days to pass for the last month and now it's all a bit
> Yes 'first set change' will be an interesting one... I'd guess at an hour from what others have said!
> ...



Hi Mike, those cannula's cost ?10 a time so you won't be to popular doing un- needed changes. 
Just do as would be expected whilst on a pump. Stick to your belly for the time being as it's easier. Take your time with the changes etc there is no prize for the shortest change over lol.


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## everydayupsanddowns (Oct 31, 2011)

Pumper_Sue said:


> Hi Mike, those cannula's cost ?10 a time so you won't be to popular doing un- needed changes.
> Just do as would be expected whilst on a pump. Stick to your belly for the time being as it's easier. Take your time with the changes etc there is no prize for the shortest change over lol.



Good point... I will try to behave myself


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## trophywench (Oct 31, 2011)

Mike!! - don't care how much they are.  They won't give you ever so many anyway but if they do give you different types, then they expect you to play in any case.  Not like you are likely to use a million, just for the hell of it!

At the first sign of it hurting even if it's only just gone in, watch it like a hawk and in any event, if you see any blood - always remove it and start again.

I thought you had said your tummy has quite a few 'iffy' areas? - in which case you certainly will need to experiment with thighs, bum etc, won't you? 

You want to make sure you are comfy with it before you go live - and that is precisely what this week is for .......


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## Phil65 (Oct 31, 2011)

Good luck Mike.....you will soon forget you are wearing it.  The weirdest feeling is getting used to not having to inject!


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## everydayupsanddowns (Oct 31, 2011)

trophywench said:


> Mike!! - don't care how much they are.  They won't give you ever so many anyway but if they do give you different types, then they expect you to play in any case.  Not like you are likely to use a million, just for the hell of it!
> 
> At the first sign of it hurting even if it's only just gone in, watch it like a hawk and in any event, if you see any blood - always remove it and start again.
> 
> ...



Thanks TW 

Yes I do have one whole side of my abdomen that's still got a bit of hypertrophy which I don't really trust.

Did want to investigate variety... I'll see what the DSN/rep suggests as an approach for getting the most out of the week.

M


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## Steff (Nov 2, 2011)

Mike hows it going so far? you adapting ok


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## grandma (Nov 11, 2011)

*pump on hold*

well I got the appointment for to go back to the hoapital 5th Jan.
I think this is for the CBM but I will give them a ring to see so dont think Ill get the pump before Feb March now but will keep hopeing.
Dont know what else to say as I have been let down twice now, but still havent been on this long road for very long like a lot of you trying to get a pump. Well its been ordered anyway went for the Combo


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## HOBIE (Nov 11, 2011)

Keep at them "grandma" & good luck.  What made u go for combo ?


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## everydayupsanddowns (Nov 11, 2011)

Steff said:


> Mike hows it going so far? you adapting ok



First few days on insulin so early days yet but I already love it.

Push-button doses and very subtle delivery options available. 

Initial set up was bound t be a bit wrong, but I've cut myself some slack for a few weeks while I do some observe/tweak/observe/tweak 

I've already had some very successful overnights (which were rare as hen's teeth on Lantus for me)


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## Robster65 (Nov 11, 2011)

Brilliant news mike. Not jealous or anything 

I'm eagerly watching on twitter. All looking really positive.

Rob


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