# What are the pros and cons?



## Reeceeey (Apr 24, 2016)

Hello Everyone,

I am a recently diagnosed Type 1 Diabetic and am yet to go on the DAFNE Course come the 11th of May. At the moment I'm in two minds as I'm doing injections but my doctors have said about the pump just in case I wanted to have the pump in the future and I just wanted to know what the pros and cons of a pump is?

I want to make sure I know exactly what I could be getting into if I chose to go on the pump in the future as at the moment the looks and stares I get off strangers is making me really uncomfortable to do my injections in public.

Any suggestions or help or advice is greatly appreciated


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## Milsey moo (Apr 24, 2016)

Hi, I'm type one have been for six yrs been on a pump for four and a half yrs. It's so much more flexible. U have to change it every three days so that's one needle in every three days instead of like 12+. Cons would be some times the canulars bend then u have to change it . It links to your bg monitor . I wouldn't go back to the pens.


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## Reeceeey (Apr 24, 2016)

Milsey moo said:


> Hi, I'm type one have been for six yrs been on a pump for four and a half yrs. It's so much more flexible. U have to change it every three days so that's one needle in every three days instead of like 12+. Cons would be some times the canulars bend then u have to change it . It links to your bg monitor . I wouldn't go back to the pens.



Thank you, I was only diagnosed last year October so it is all very new and scary and I'm just trying to find the common ground with my body if that makes sense? I'm okay with the pens at the moment it just very uncomfortable when I have to inject in public and you've got everyone staring at you


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## Northerner (Apr 24, 2016)

Have a look on the INPUT website, there is lots of really useful information on there 

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


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## everydayupsanddowns (Apr 24, 2016)

Hi @Reeceeey

I never particularly worried about injecting in public, but a pump might really be useful for you in those circumstances. As an example, I was always fine in a restaurant etc, but if I had to eat on the train I would feel quite uncomfortable as the person next to me was so close.

A pump is a small device that looks a bit like a phone/pager/iPod and so you can calculate and deliver a bolus really easily without having to get a needle out, airshot and all that faff. There are tubeless pumps and pumps with full remote controls which have a device that looks just like a PDA, but even handling a tubed pump itself wouldn't raise any eyebrows - unless the person happened to be another T1 pump user

Pros:
Flexible accurate basal insulin coverage
Precision of doses/micro corrections
Dose calculation
Fewer hypos
Extended boluses for tricky foods
Easier to be spontaneous - always have your insulin with you
Better overall BG management
There are lots more!

Cons:
I can't really think of many - or at least, none which counteract all the positives!
Getting used to being attached to something 24/7 (takes a few hours/days/weeks depending on person)
Theoretical greater risk of DKA as you have no long acting insulin (this would only happen if the pump failed)


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## Copepod (Apr 24, 2016)

Reeceeey said:


> Thank you, I was only diagnosed last year October so it is all very new and scary and I'm just trying to find the common ground with my body if that makes sense? I'm okay with the pens at the moment it just very uncomfortable when I have to inject in public and you've got everyone staring at you


Very rarely has anyone noticed me injecting, and only once did anyone comment - a woman at a healthy walks BBQ, who was intrigued about injection kit because she had to give herself injections to treat rheumatoid arthritis once every two weeks. So, either people are very unobservant, or my technique is very discrete or a combination of the two. Usually, I either turn away, if in an open area, or under table if sitting down. Personally, I wouldn't want a pump, and wouldn't get one under NICE guidelines, as my HbA1c is too good and I don't have serious hypos, nor fear of hypos.


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## HOBIE (Apr 24, 2016)

If you are on a pump its a couple of pushes of buttons when you want that bag of crisps etc.  If you have a blood test & you are say 11 .6 bg. Put that figure into pump & it sorts how much insulin to give you.  I am in my 50yr of T1 & hopefully doing Scarfel pike this year & all I will do is put a temp Basal on that day. You can not do that on MDI. Get you name down for one.  "Love my pump ! "


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## trophywench (Apr 24, 2016)

No Hobie?  Wouldn't you simply reduce your Basal jab the previous evening/that morning and knock a bit off your boluses?  I mean I agree pumping is better all round of course - and also easier to deal with stuff like Scafell Pike - but exercise is exceedingly possible on MDI ! - and I don't think any of us old hands should even be hinting to a relative Newbie that it wouldn't be!


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## Copepod (Apr 25, 2016)

Completely agree Trophywench. I still use MDI, after 20 years, including completing in and marshalling several mountain marathons, 40 miles Keswick to Barrow last year, lots of orienteering, over 60 parkruns, irregular cycling, swimming etc. Spent Friday on lambing duty, Saturday parkrun, Sunday being trained in coastal biology survey techniques, plus over 500 miles driving since leaving home on Thurs. Will be driving 100 miles home today after a work meeting. MDI can be very flexible :-


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## SB2015 (Apr 25, 2016)

Whilst exercise was perfectly possible on MDI if it is planned, the pump enables me to be a lot more flexible and deal with unplanned activity, and enables me to make changes that I don't want to have apply all day.

Using the pump I am now able to set a temporary rate for 30 minutes for a walk into town or for an exercise class and I don't need to plan those around the timing of my injections which I had to do before.

Nothing lease to add to Mikes summary except to say that I love being on my pump and would never want to go back to injections.


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## Redkite (Apr 25, 2016)

There's no comparison, pumps are the gold standard!  You can programme a basal pattern that is tailored to your exact needs, hour by hour throughout the day.  You can set boluses to run over a length of time rather than all upfront, so it can better match the longer digestion of foods like pasta etc.  Pumps try to mimic the action of a healthy pancreas.


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## Reeceeey (Apr 27, 2016)

Thank you everyone, it has really helped with all this information!

I'm going to bring it up in my next meeting with my DSN and she want she thinks but I'm going to the DAFNE course in May which will hopefully help me understand the whole carb counting thing,

Again thank you!!


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## trophywench (Apr 27, 2016)

Learn how to carb count and adjust doses for the food first.  It works a lot better than guesstimating and it's an essential skill for pumping anyway - often a pre-requisite for getting one in some areas!  You'll always need it anyway - whether pumping or on MDI.


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## HOBIE (Apr 27, 2016)

trophywench said:


> No Hobie?  Wouldn't you simply reduce your Basal jab the previous evening/that morning and knock a bit off your boluses?  I mean I agree pumping is better all round of course - and also easier to deal with stuff like Scafell Pike - but exercise is exceedingly possible on MDI ! - and I don't think any of us old hands should even be hinting to a relative Newbie that it wouldn't be!


I AM TALKING about 10mins before. YOU CAN NOT DO THAT ON MDI   TW !  What happens if its a windy day or bad weather ?


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## HOBIE (Apr 27, 2016)

Copepod said:


> Completely agree Trophywench. I still use MDI, after 20 years, including completing in and marshalling several mountain marathons, 40 miles Keswick to Barrow last year, lots of orienteering, over 60 parkruns, irregular cycling, swimming etc. Spent Friday on lambing duty, Saturday parkrun, Sunday being trained in coastal biology survey techniques, plus over 500 miles driving since leaving home on Thurs. Will be driving 100 miles home today after a work meeting. MDI can be very flexible :-


How long do you think I was on MDI Copeod ?   Around 40yrs. I used to leave the N,E. at 4in the morn drive by myself & be working in Oxford st at 9.30. Every 4/5 days for 2yrs.


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## Annette (Apr 27, 2016)

HOBIE said:


> ! What happens if its a windy day or bad weather ?


Then you adjust your boluses and corrections to deal with it, of course! Just because its easier on a pump doesn't mean it can't be done on MDI as Copepod shows.


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## HOBIE (Apr 27, 2016)

So you can stop the insulin you gave yourself the night before on MDI.  ?


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## HOBIE (Apr 27, 2016)

Pumps are so so much more adaptable


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## Northerner (Apr 27, 2016)

HOBIE said:


> Pumps are so so much more adaptable


I don't think anyone is denying that Hobie, the point is that things might not be as flexible on injections, but it doesn't mean they can't be done. I've run quite a few half marathons since diagnosis (and done hundreds of miles in training, plus other forms of exercise) and managed perfectly well. It's harder to be spontaneous, but I've adapted to things. I wouldn't qualify for a pump anyway.


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## Copepod (Apr 27, 2016)

Northerner said:


> I don't think anyone is denying that Hobie, the point is that things might not be as flexible on injections, but it doesn't mean they can't be done. I've run quite a few half marathons since diagnosis (and done hundreds of miles in training, plus other forms of exercise) and managed perfectly well. It's harder to be spontaneous, but I've adapted to things. I wouldn't qualify for a pump anyway.


Like Northerner, I wouldn't qualify for a pump, as I mentioned in post #6. 
Orienteering tonight, when snowfall was a surprise and my route choice was appalling, so I ended up clambering hand and foot up a steep muddy slope. After a few sweets, found 3 geocaches on the way home.
I must mention a friend of mine who uses an insulin pump, and had to carry spare pens, cartridges etc on a mountain marathon in late October a few years ago, in case her pump stopped working, which it did, when it couldn't cope with driving rain. That's another reason I wouldn't want a pump, even if I did qualify for one. 
I'm sure they work well for and suit some people, but I wouldn't want people newly diagnosed with type 1 diabetes to think that pumps are the answer to everything.


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## Annette (Apr 28, 2016)

HOBIE said:


> So you can stop the insulin you gave yourself the night before on MDI.  ?


No, any more than I can stop the insulin I gave myself via my pump 2 hours ago when I decide I am (or am not) going out for a walk now because it has stopped/started raining/hailing/snowing. But I can eat with or without bolus on both systems to make up for the insulin that is already in my system. Its amazing Hobie, you should try it...


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## HOBIE (Apr 28, 2016)

Annette Anderson said:


> No, any more than I can stop the insulin I gave myself via my pump 2 hours ago when I decide I am (or am not) going out for a walk now because it has stopped/started raining/hailing/snowing. But I can eat with or without bolus on both systems to make up for the insulin that is already in my system. Its amazing Hobie, you should try it...


I always give my insulin in % & time delays. It is one of the great things about Medtronic. If you have Pasta or similar you can give insulin 50% straight away Then 50 % 45mins later. (or not at all if you cancel it.  More in control & NOT like MDI. You try it


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## Annette (Apr 28, 2016)

Do you know, Hobie, so does my Combo, and I always use it. But I think we were talking about basal insulin here...


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## HOBIE (Apr 28, 2016)

Annette Anderson said:


> Do you know, Hobie, so does my Combo, and I always use it. But I think we were talking about basal insulin here...


Good so you know the difference between MDI & a how adaptable a pump is Annette .  If you are out for a meal & you don't like it or what ever. You can stop at leased a good % of the insulin going in MDI you cant ?


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## trophywench (Apr 28, 2016)

Well only if it  was an extended or multiwave bolus, and I certainly don't want or need to do that for every foodstuff available that I may wish to consume.

Nobody is arguing that pumps aren't better Hobie - only that if they hadn't made them available on the NHS - we'd all still be here and enjoying life as much as we ever did when they weren't !  You can't deny that you haven't had a life where you've done all sorts of things - like the kayaking and Lord knows what.  About the only things we were banned from was professional diving (and presumably oilrig work since you have to be able to dive and survive a helicopter crash into the sea) and being a commercial airline pilot - and I should imagine - being an astronaut.  Dunno about the latter, not something your average school Careers Officer broached ......

Most people never wanted or needed to do those things anyway!


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## Northerner (Apr 29, 2016)

HOBIE said:


> Good so you know the difference between MDI & a how adaptable a pump is Annette .  If you are out for a meal & you don't like it or what ever. You can stop at leased a good % of the insulin going in MDI you cant ?


Hobie, I don't understand why you have a bee in your bonnet about this  The thread is about pros and cons - everyone has said that pumps are more flexible than MDI. All people are saying is that someone who doesn't have access to a pump shouldn't think that things like exercise aren't possible on MDI, just that your approach needs to be different. As for not being able to 'stop' insulin if circumstances change, how often does it actually happen in practice that you would need to do it? If things change then you might have to chug some lucozade or eat a couple of jelly babies, not really a showstopper. Pumps provide different solutions and more options, but life can go on without them, and it's important, particularly for newly-diagnosed people who may not have access to them, to know this  

Personally, the prospect of a failed cannula or pump failure would outweigh the possibility to stop insulin half way through a meal, they seem to be a lot more common and leave you with no insulin at all - at least on MDI you generally have your basal insulin still.


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## HOBIE (Apr 29, 2016)

To me A pump is fantastic bit of kit. It was others who where getting on there high horse .  I f I were out for a meal & I did not like it etc I would not keep eating it. From the age of 3 I have HAD to.  Think about that    High Horse


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## Copepod (Apr 29, 2016)

Presumably you were using bimodal insulin, rather than the more flexible basal bolus regime when you were a child, Hobie? Eating out with basal bolus / MDI can be very flexible - if you are fussy with food and think you might not eat all, you can wait until it arrives, look & taste, then inject. Not a bad plan anyway, in case food is delayed or you're not sure about portion size. It's not as if you eat out every day. For most people it's a treat a few times a year at most, or perhaps regular pub meal after Thurs eve orienteering running group, as I did for several years, but now just once or twice a year.


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## Pumper_Sue (Apr 29, 2016)

HOBIE said:


> I AM TALKING about 10mins before. YOU CAN NOT DO THAT ON MDI   TW !  What happens if its a windy day or bad weather ?


I hate to tell you this Hobie but doing adjustments 10mins before exercise would be a complete and utter waste of time as it takes between 1 and 2 hours before a basal change takes effect. 

As everyone says though pumping is great and the gold standard for diabetes treatment with the added comment that the pump is only as good as the user, it only does what you tell it.


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## stephknits (Apr 29, 2016)

I think Northerner made a really valid point - lots of people (me included, although my DSN seems to think she can get round it) don't qualify for a pump, or wouldn't be able / willing to put in the work it requires at the beginning to change systems.  I would probably stick at MDI if my levels hadn't gone haywire after surgery and being a lady of a certain age.  It's not even that I necessarily think it will be the answer to all of my problems, more that I could actually do with having something positive by way of diabetes management to focus on.  It is perfectly reasonable for people to not want one, or not, hence the thread question!  To keep with the equine theme - surely it's horses for courses!


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## Matt Cycle (Apr 30, 2016)

Agree Steph it is - different steeds for different needs.   The vast majority of T1's in this country use MDI (or an injected insulin regimen of some sort) and manage perfectly well, myself included (some of the time anyway ).  I think what's telling though is that those who have gone onto pumps (some with many years of diabetic experience) have almost without exception stated they prefer it and are achieving better control.  I realise you need to put the work in to get the best out of it (the same is true of MDI - more effort in equals better results) but I think it's the closest thing in operation T1's have to a working pancreas.


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## stephknits (Apr 30, 2016)

When I went to my pump interest session (which my husband for some reason finds hilarious), I asked the DSN there how many people on her experience had tried the pump and gone back to injections.  She said she could count them on one hand (she has been running pump clinics for 12 years).  I asked why  they didn't like it and she said some were allergic to the stuff you stick the cannula on with, but the others had unrealistic expectations of the pump and weren't prepared tp put the work in.  Like you say, Matt Cycle, as on here, the vast majority of people once on the pump would never go back.


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## HOBIE (Apr 30, 2016)

Copepod said:


> Presumably you were using bimodal insulin, rather than the more flexible basal bolus regime when you were a child, Hobie? Eating out with basal bolus / MDI can be very flexible - if you are fussy with food and think you might not eat all, you can wait until it arrives, look & taste, then inject. Not a bad plan anyway, in case food is delayed or you're not sure about portion size. It's not as if you eat out every day. For most people it's a treat a few times a year at most, or perhaps regular pub meal after Thurs eve orienteering running group, as I did for several years, but now just once or twice a year.


All types of Insulin Copepod & am using the SAME in my pump as I was using on many years of MDI.


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## Copepod (Apr 30, 2016)

A very specific question, Hobie - what type of insulin regime were you using as a child when you said it was difficult if you didn't like the food that arrived when you were eating out? I'm guessing bimodal insulin, rather than basal bolus / MDI regime? I'm also pretty sure that you only use short acting insulin, not the bimodal nor long acting that you have used in the past, in your pump, to serve as both basal and bolus? Which is OK until pump fails in driving rain on a 2 day mountain marathin which is what happened to my friend, so she had to use the back up pens / syringes she was carrying. Personally, I wouldn't want to carry that extra weight as well as a pump and spares, hwne every gram counts. I'm happy that your pum suits you, but feel it's unfair to give people new to type 1 diabetes the impression that an adventurous, spontaneous and exciting life is possible only with a pump.


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## HOBIE (May 1, 2016)

I have been on the lot Copeod. 1 injection a day / 2 & 4/5.  As I have said in the past I used to spend hours out in the North Sea, Catamaran. Jet Ski & Windy Board. Personally I would NOT want go back to injections.  You stick to what you know.


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