# Pumps



## hazey276 (Oct 4, 2010)

Could anyone please enlighten me who has one of these.  Is it possible to have a hypo with one of these all singing, all dancing machines as i was under the impression that you can set both low and high levels warnings to prevent this from occuring.

Warmest regards

Hazey


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## everydayupsanddowns (Oct 4, 2010)

Hi Hazey

Both high and low bgs are perfectly possible for pumpers.

Some (but not all) pumps come with an in-built or associated CGM (continuous glucose monitor) which measures the glucose levels in interstitial fluid (lagging about 10-15 mins behind blood levels). However these only tell you your level, there is no automation in insulin delivery... yet.

I wrote about my own (confused and still slightly pump-averse) feelings here: My pump problem and CGMS envy. There's a link on that page to an account by _Shoot Up or Put Up_'s Alison which is an incredibly convincing case for pumps and well worth a read if you looking into the idea.

I think what you are talking about is more of a closed-loop/artificial pancreas system which is still a few years away.


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## Twitchy (Oct 4, 2010)

Hiya,

I think the alarms bit depends on if you have a pump with a continuos blood glucose monitor as part of hte package (not all do, mine doesn't). You still need to do blood sugar tests with most types of pump - mine is an accu check spirit combo, with a blood glucose test machine that doubles as a clever remote for the pump.

It is still possible to go hypo, ie if you over bolus because you got the carb count wrong or didn't eat what you had bolused for, or exercised & didn't tweak the basal rate appropriately.  The wonderful thing about pumps though is that once you get the rates set right, & carb count accurately, hypos are very rare.  You also only need quick acting carbs if you do go hypo, as you can set a temporarily reduced basal rate for a bit afterwards if necessary. 

I'm a fan! 

One of the parents might be better able to elaborate on the cgm type pumps, as I think they are what they tend to give to the kids...

Hope that helps, 

Twitchy x


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## Copepod (Oct 4, 2010)

Welcome Hazey. You may find more answers to your questions in Pumping section.


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## bev (Oct 4, 2010)

everydayupsanddowns said:


> Hi Hazey
> 
> Both high and low bgs are perfectly possible for pumpers.
> 
> ...





Alex's pump is the 'medtronic veo' with a built in cgm. It will turn off the insulin if levels fall below a certain level (this is determined by the user).Bev


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## novorapidboi26 (Oct 4, 2010)

bev said:


> Alex's pump is the 'medtronic veo' with a built in cgm. It will turn off the insulin if levels fall below a certain level (this is determined by the user).Bev



Hey Bev......

I may have discussed this before with you, with the cgm, does it measure the glucose levels the mentioned way through the interstitial fluid, and if so does this effect your dose calculations or is it simply a case of getting used to the +-error..........??


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## bev (Oct 4, 2010)

novorapidboi26 said:


> Hey Bev......
> 
> I may have discussed this before with you, with the cgm, does it measure the glucose levels the mentioned way through the interstitial fluid, and if so does this effect your dose calculations or is it simply a case of getting used to the +-error..........??



It measures the fluid. So what we do is set it to 4mmols - by which time he is normally about 3 - so this takes into account the difference between the 2 measurements. It isnt 100% accurate - but if the insulin is 'suspended' then the pump will alarm and then goes on to siren - this alerts us and we can do a 'real time' finger prick test to determine whether we need to treat or not. If for some reason, we didnt hear the alarm, then the insulin is suspended for 2 hours and then reverts back to normal basals.Bev


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## novorapidboi26 (Oct 4, 2010)

bev said:


> It measures the fluid. So what we do is set it to 4mmols - by which time he is normally about 3 - so this takes into account the difference between the 2 measurements. It isnt 100% accurate - but if the insulin is 'suspended' then the pump will alarm and then goes on to siren - this alerts us and we can do a 'real time' finger prick test to determine whether we need to treat or not. If for some reason, we didnt hear the alarm, then the insulin is suspended for 2 hours and then reverts back to normal basals.Bev



Nice........as long as you know the margin of error/lag I suppose its full proof.......is the cgm used solely for hypo/hyper warning......?


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## everydayupsanddowns (Oct 4, 2010)

bev said:


> Alex's pump is the 'medtronic veo' with a built in cgm. It will turn off the insulin if levels fall below a certain level (this is determined by the user).Bev



Thank you very much for the correction Bev.  Oddly I'd not heard of that function in any of my poking about. 

Another (very useful) part of the puzzle.


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## Ellie Jones (Oct 4, 2010)

Yes it's is possible to have hypo's and highs with the new pumps with the bell's and wizards on...

A pump is only as good as the user, even with wizards, as you've got to set up the perimeters for the wizards to work with, if you put the wrong data in at any point, the wizard will give a miscalculation to your request, resulting in either an hypo or high, also when you are telling your pump what to do, i.e, you checking BG for a correction, but you have no intention of doing any exercise..  You tell the pump it works out the correction using no exercise factor, you say yes to what it suggest..  Then you do exercise which it hasn't calculated hypo!

Even though CGM's are niffty pieces of kit, they do have there limitations, they've got to be calibrated right to ensure that they proform reasonably well, Alarms or info the provided has to be double checked with a finger prick before taking any actions.... Just in case

This actually gives the Veo's shut off features a negetive to it, if for any reason the CGM isn't calibrated correctly, fail or the information required hasn't been entred correctly, then it could shut down the pump at the wrong time, so instead of preventing a hypo and maintaining blood glucose levels, it could actually cause a major high causing DKA......  Not sure if I have faith in this feature personally...


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## bev (Oct 4, 2010)

novorapidboi26 said:


> Nice........as long as you know the margin of error/lag I suppose its full proof.......is the cgm used solely for hypo/hyper warning......?





Nothing in diabetes is foolproof! The answer to your question is 'no'. You use the CGM to watch for trends and patterns throughout the day and night - so for example if you thought you may be dropping at a particular time through the night - then it shows a little graph to make it easier to spot. Obviously the CGM being 15 minutes behind is not completely accurate - but at the moment its as good as it gets.

Where we find it most beneficial is the 'mealtime graphs'. If your having particular problems with a certain food you can watch the graph and work out when you start to rise and this is a huge advantage in working out dual waves or similar - so you learn how to either extend or decrease the % upfront or whether to lengthen the extended time or not.

It is particularly good at indicating when the DP starts - so easier to sort out basals. Obviously - you do still need to use finger prick testing to make certain of levels, but this is the next best thing for spotting any patterns and trends.

You do need to know what your doing regarding the use of sensors though to be able to make it as realistic as possible - so its a learning curve sorting out callibrations and when and how to do them. We have been using sensors for almost a year now (not continuously) and we are still learning. Adrienne uses them much more then we do and is excellent at explaining how they work.

If we were offered a pump either with or without a CGM - we would always go for the one with the CGM - no contest really.

Apparently Animas is bringing out a CGM for use with their pumps and there is a new one made by Medtronic about to come onto the market which is meant to be more accurate and easier to use.Bev


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## novorapidboi26 (Oct 4, 2010)

Thanks for the insight.............


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## Adrienne (Oct 4, 2010)

At the moment the sensors which are used to the for the CGMS part of the Medtronic pump (the only pump that does inbuilt CGMS at the moment) are being replaced in the New Year.

At the moment they are inserted at a slant and only the very tip takes the levels.   It is not spot on but it have been proven time and time again on the Children with Diabetes list that those with sensors (especially full time) get better overall results.

In the New Year the new sensors out will be inserted straight in and the whole of the sensor (ie sides and tip) will be taking the reading so should be a whole lot more accurate.  

They have got to get these sensors accurate before the closed loop can ever happen, just too dangerous otherwise.


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