# Tell Me About Pumps!



## TheClockworkDodo (Dec 15, 2017)

If you have a pump, please tell me about it!  The new diabetes consultant I saw today agreed that it would be a good idea for me to have a pump, so he's going to put me on the list for the pump clinic (as well as chasing up the list I'm supposed to be on to borrow a hospital CGM for a week) 

I've had a look at @Amberzak 's thread about which is the best pump, but I'm also looking for more basic information about how they work generally, so please assume I'm completely ignorant about them.  I'm going to need to research them before I go to the clinic (no hurry, the waiting list will probably be about a year  ) because I have severe cognitive dysfunction and I'm not going to be able to take in anything much they tell me at the clinic, so I want to know all about them in advance.

The one thing I know so far is that I want one with a self-inserting cannula, because I won't be able to look at it going in.  What else should or could I ask about?  What are good features and what are useless gimmicks?  I'm inclined to try to get one which is as low-tech as possible, as it will be easier for me - what can I do without?


----------



## TheClockworkDodo (Dec 15, 2017)

All this is assuming of course that I have a choice ...
But even if I don't, I still want to know in advance how the things work!


----------



## trophywench (Dec 15, 2017)

Both Roche pumps use cannulas you have to inset into an inserter to apply, so you never see the needle going in.  You then have to remove the inserter needle out of the Teflon 'tube' that stays inside you and dispose of it.  No more sharp things for another two or 2 days.  

Can you - will you be able to - fill reservoirs OK, are the needles on them OK on the basis they aren,t going to be stuck in you?  If you can't fill a reservoir (or a pod on the Omnipod pump) then you have no choice - only the Roche Insight (I use that one) uses a pre-filled cartridge - come in boxes of 5 like pen cartridges but half the size.  However most people get through less insulin in total with a pump than they did on jabs - so they last longer than you think.

The whole thing about pumps though is the fact that they drip a tiny amount of insulin into you every few minutes - so it's more like what you own body would do,  We still have to tell it the carbs and tell the pump to deliver our food boluses, we just don't need a pen to do it,  It's only the basal insulin you can program in so it does it 'automatically'.  You have to tell it to adjust for eg concurrent illness, exercise etc same as you have to adjust doses for things like that with pens.


----------



## Pumper_Sue (Dec 15, 2017)

Hi Juliette,
your best bet is to buy the book pumping insulin by John Walsh (Amazon) you can then read it at your leisure.


----------



## trophywench (Dec 15, 2017)

It didn't make that much sense to me Sue after the first few pages - but made a LOT more sense after I'd actually got a pump.  All these theories are fine - but I have to have a 'for instance' for them to sink in, like having to prove Pythagorus' theorem in first year maths by drawing triangles!  OK Mr H, it IS true cos I have a drawing .....


----------



## Flower (Dec 15, 2017)

TheClockworkDodo said:


> What are good features and what are useless gimmicks?



Hi Juliet

With the Medtronic 640g you need to fill the reservoir from a vial before filling the tubing and connecting the cannula. The pump gives you all the information in stages on the screen with diagrams etc so it is straightforward to follow. Very simple to twist the tubing off when you have a shower etc so you are left with just the cannula stuck to your skin.

You can use a pump without all its whizzy bits if that makes things easier. It delivers basal insulin around the clock with a tiny pulse of insulin every 3 mins based on the basal rate you need for each hour. You can ignore the Dual and Square wave ways of delivering a bolus (I think different pump makes have different names for these features) - one gives a proportion of insulin up front with the rest spread out over however long you choose (good for carby/fat meals such as pasta pizza etc)  and the other splits the whole bolus and delivers it evenly over a chosen time- or you can use the normal bolus which is the same way as an MDI pen delivery- all at once.

For me the invaluable bits are tiny insulin increments 0.025 units so if you are insulin sensitive you can get good control with tiny amounts delivered when you need it.. Temporary basal rates where you can increase or decrease your background basal insulin up to 200% or down to 0% in 5% stages  for as long as you need. Very helpful for when you are unwell or heading low. Suspending insulin delivery totally whilst you deal with a bad hypo or are struggling to get your levels up is very useful.

Insulin onboard helps to avoid stacking as well as being able to see the history of when boluses were delivered.

There aren't to my mind any useless bits- maybe I just haven't found them yet!. As you get used to using a pump it is good to have a practice with different bolus deliveries and see which one gets the best bg results.

You can make it as low tech as possible once all the basal rates and ratios are worked out correctly for your needs. Basal in tiny amounts delivered around the clock and bolus when you eat. 

I hope things go well for you and the waiting list isn't too long.


----------



## Radders (Dec 15, 2017)

Have you used an expert meter before? Some of the functions mentioned above are functions of the smart meter rather than the pump. I don’t use these very often because my first pump didn’t have a paired meter so I got used to working things out myself and pressing the buttons on the pump.


----------



## pottersusan (Dec 15, 2017)

Having had two Roche pumps and now the Medtronic. I would choose the Medtronic. The last Roche one seemed very slow and steam powered. The Medtronic does its calculations much faster.


----------



## pottersusan (Dec 15, 2017)

Also the Medtronic is good because it takes you through the steps of filling the syringe and cannula change step by step, which the Roche doesn't do.


----------



## trophywench (Dec 16, 2017)

The Combo doesn't do it but the Insight does - you can adjust basal rates in 15 minute chunks not just hourly though I don't know whether you can have more than 24 different ones per day, you could have one rate for an hour and a quarter and another for the following 30 minutes etc etc.

Good grief !  Isn't it already complicated enough?  I absolutely don't need that, but maybe some do?


----------



## HOBIE (Dec 16, 2017)

Yes pumps are good for control. "The best" up to now. The orders for the new Medtronic will be long. Good luck deciding


----------



## Radders (Dec 16, 2017)

trophywench said:


> The Combo doesn't do it but the Insight does - you can adjust basal rates in 15 minute chunks not just hourly though I don't know whether you can have more than 24 different ones per day, you could have one rate for an hour and a quarter and another for the following 30 minutes etc etc.
> 
> Good grief !  Isn't it already complicated enough?  I absolutely don't need that, but maybe some do?


I agree that I wouldn’t use different rates to that degree of precision, however I have considered whether it would be useful to change rates on the half hour, eg to combat dawn phenomenon. Perhaps it’s for that reason?


----------



## trophywench (Dec 16, 2017)

I daresay somebody knows but not I !  Do people really get DP starting at exactly the same time every day?  Is it ever that predictable?


----------



## Radders (Dec 16, 2017)

trophywench said:


> I daresay somebody knows but not I !  Do people really get DP starting at exactly the same time every day?  Is it ever that predictable?


I have read that for some people it starts the moment their feet hit the floor, so I guess if they get up to an alarm at the same time every day then it would be fairly predictable. And if that time happens to be 5:45, say, then I guess the people at Roche might have thought it could be useful to be able to set the basal precisely an hour or two earlier to combat that.... just speculating as it’s always been more of an art than a science for me at any rate!


----------



## TheClockworkDodo (Dec 16, 2017)

Thanks everyone for your replies, sorry I posted this and then didn't come back to it - braindead yesterday after clinic on Thurs, and today our central heating boiler went out and refused to relight, so it's been a bit frantic 

Am on laptop now so harder to read or post than on my machine, will try to look through your posts properly another day and try to work out the bits I don't understand, but they look very useful so far 

Yes, I can see a needle if it's not going into a person!
I have one fancy meter (don't know if expert, don't know what that means, sorry!) but I don't use the fancy bits because they link to windows and I have Linux.  I tend to use my old ordinary meter and keep the fancy one for backup.  I don't really like smart things, would prefer something I control myself.
I have really bad DP, can guarantee my bgl will start going up as soon as my feet hit the floor, if not sooner.


----------



## Radders (Dec 16, 2017)

TheClockworkDodo said:


> Thanks everyone for your replies, sorry I posted this and then didn't come back to it - braindead yesterday after clinic on Thurs, and today our central heating boiler went out and refused to relight, so it's been a bit frantic
> 
> Am on laptop now so harder to read or post than on my machine, will try to look through your posts properly another day and try to work out the bits I don't understand, but they look very useful so far
> 
> ...


A smart meter is one that you can programme with all your ratios and you tell it how much carb you are about to eat, and it calculates your dose for you including any corrections. A pump handset takes this a stage further by sending a message to the pump to deliver the dose. You still have complete control as you don’t have to push the button to deliver the dose and can override it if you want to.


----------



## everydayupsanddowns (Dec 17, 2017)

The ‘expert’ meter referred to was Accu-Chek’s Expert - which is very similar to their Combo pump handset.


----------



## HOBIE (Dec 23, 2017)

TheClockworkDodo said:


> Thanks everyone for your replies, sorry I posted this and then didn't come back to it - braindead yesterday after clinic on Thurs, and today our central heating boiler went out and refused to relight, so it's been a bit frantic
> 
> Am on laptop now so harder to read or post than on my machine, will try to look through your posts properly another day and try to work out the bits I don't understand, but they look very useful so far
> 
> ...


Hope you got the Boiler back on for Xmas, Life at times ?  Good luck


----------



## SB2015 (Dec 23, 2017)

I used an AccuChek Expert meter prior to going onto an AccuChek combo pump.  The transition was very straightforward as the handsets behaved in much the same way with the difference that the Combo then ‘talked to my pump’ rather than me injecting.  I suspect that few of us would sort out changes down to 15 min intervals as things a rarely that precise, or is it just that my life is mor variable?

Whatever pump you get it is important to make use of the facilities that it offers, which then increase flexibility.  I would never go back to MDI now.


----------



## TheClockworkDodo (Dec 23, 2017)

HOBIE said:


> Hope you got the Boiler back on for Xmas, Life at times ?  Good luck


Yes, thank you!  We spent last weekend huddled round electric heaters in our coats, but got boiler fixed Monday, thank goodness 

I'll come back to this thread after Christmas and probably ask a lot of really basic questions ...


----------



## Maryanne29 (Dec 29, 2017)

Hi. I definitely recommend the AccuChek Insight. No needle visible, prefilled cartridges so no,messing around filling reservoirs and very neat and small.  A colleague has the Medtronic and she has to fill a reservoir and the pump is much bigger so not so easy to ‘carry’. She said she wants the Insight when she neeeds to change having seen mine. But whichever you chose, it will be life changing in the best possible way.


----------



## TheClockworkDodo (Dec 29, 2017)

Thanks, @Maryanne29


----------

