# Any advantage using a pump



## Ingressus (Jan 9, 2020)

At the moment I am using injections, I am considering financing a pump is there a serious advantage using a pump as apposed to injection, it's a big investment if its just a small advantage i will not do it x


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## Pumper_Sue (Jan 9, 2020)

Ingressus said:


> At the moment I am using injections, I am considering financing a pump is there a serious advantage using a pump as apposed to injection, it's a big investment if its just a small advantage i will not do it x


Hello Simon, a pump is life changing as long as you put the work in. A pump is a lot of work and def not plug and play as some people seem to think.

You say you want to self fund, do you have a consultant who is willing to back you as without consultant care you wont be able to have a pump? The pump companies will not sell you a pump without authorisation from a hospital consultant or lead DSN


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## Ingressus (Jan 9, 2020)

Hi Sue thanks for the reply, I have been referred to a consultant by me diatition and my DBN they can not get a grip of my diabetes and suggested a pump, I know absolutely nothing about them, does the pump automatically correct and give you your blood numbers like my dexcom 6 I don't mind paying or the hard work but for the money will it really be a life changer


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## Sally71 (Jan 9, 2020)

The main advantage of the pump is the fine-tuning which you just can't do with injections.  For example, we have a half-unit pen but the pump can do boluses to the nearest 0.1 unit. For basal, instead of long-acting insulin the pump just gives you teeny tiny doses of fast acting every few minutes, and you can adjust this by the hour.  So for example if you find you are going low every afternoon at about the same time then you can adjust the basal dose just for the relevant few hours and leave the rest of the day alone. In theory if you have your basal set correctly you should be able to eat absolutely nothing for 24 hours and it will just keep you chugging along nicely in the normal range (although in reality it takes an awful lot of fiddling about and testing to get it set that accurately, and it never stays the same for long!).  You can also do things like temporary basal rates, which means you can increase or decrease your main basal pattern by a percentage for anything up to 24 hours at a time, which makes it much easier to deal with things like illness, exercise and so on.  You can also extend your food boluses, e.g. instead of just whacking the whole dose in at once you can drip it in slowly over a length of time, on ours it's anything from 15 minutes to 12 hours, or deliver part up front and the rest spread out, this can help you to deal with foods which are slow to digest for example.  Again what works takes a lot of trial and error, but the benefits are worth it in my opinion!

Some pumps can work with integrated sensors, e.g. the Medtronic if you have sensors with it will turn off your basal rate to prevent you going hypo if it detects you dropping too far, although you still have to set the main pattern up and do your food boluses yourself.  They are working on closed loop systems though that can adjust your whole basal pattern automatically, you will probably want to do some research into what is available and the pros and cons of each.

Disadvantages - being attached to the thing 24/7, although most people get used to this fairly quickly and barely notice it's there any more; and if anything goes wrong you have no long-acting insulin on board and so your blood sugars will shoot up very quickly, so regular testing is essential (easier if you have sensors). The pumps do alarm if there is a problem but occasionally they can't detect things, e.g. if the cannula is leaking, however if you are on the ball and notice blood sugars rising that don't respond to correction doses, then you start to check things like that!  Like Sue says it's a lot of work and can be frustrating at times, sometimes it feels like I’m constantly fiddling with my daughter's pump and never quite getting it right, and then when I do it lasts all of 3 days before something changes again!  But if you are prepared to put the effort in then it's well worth it. We were only on pens for 8 days before we got the pump so don't really know any other way, but I don't think I’d want my daughter to be on pens, it would be less labour intensive but I’d find them very crude by comparison.  My daughter is 13 and has been going through puberty for the past few years, and we've managed to keep her HbA1c pretty much rock steady all through that, which is not easy according to her consultant. I doubt I’d have achieved that with injections, although there might be someone out there who can prove that it is possible!  You have to find what works for you, and pumps don't suit everyone, but I’d highly recommend trying one at least for a few months if you can.  Hope that helps


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## rebrascora (Jan 9, 2020)

Hi Simon

What are the problems you are experiencing with your diabetes and what have you tried to manage your Type 2? ie Low carb diet, Metformin Gliclazide etc prior to the MDI you are now on.
A pump may not help if you are insulin resistant, which is often the case with Type 2 diabetics.
Are they sure you are Type 2?  Some people develop Type 1 in later life but are just assumed to be Type 2 due to their age.... you don't specify your age on your profile but I am guessing you are a mature adult. Unless specific Type 1 GAD antibody and C-Peptide tests have been done, an HbA1c reading of 48+ usually gets you a Type 2 diagnosis, which may or may not be appropriate. Having the correct diagnosis is important, particularly in your situation where a pump might need to be self funded for a Type 2 but could be available on the NHS for Type 1

Apologies if all this has been covered in previous posts, but it is unusual for Type 2 diabetics to even consider a pump.

How have you found the Dexcom? Is it worth the money? I'm still dithering about trying a Libre


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## Pumper_Sue (Jan 9, 2020)

Ingressus said:


> Hi Sue thanks for the reply, I have been referred to a consultant by me diatition and my DBN they can not get a grip of my diabetes and suggested a pump, I know absolutely nothing about them, does the pump automatically correct and give you your blood numbers like my dexcom 6 I don't mind paying or the hard work but for the money will it really be a life changer


Only the 670Medtronic pump will adjust everything for you when using sensors 24/7 (Closed loop system) You have to use the sensors provided by Medtronic though.
Diabetes nurses have no idea how to get a grip of diabetes so you need to do this yourself and be able to think for yourself and in advance on many occasions. If you are relying on HCP's to manage your diabetes then a pump is not a viable option for you.

I use the Medtronic 640 pump and run Dex 6 separately so obviously adjust my pump manually.
Cost wise a pump is about £3000 and at least £120/month for consumables plus your sensors so a hefty amount to pay. The pump has a 4 year warranty.


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## everydayupsanddowns (Jan 9, 2020)

Pumper_Sue said:


> Only the 670Medtronic pump will adjust everything for you when using sensors 24/7 (Closed loop system) You have to use the sensors provided by Medtronic though.



Or the Tandem Tslim ( which links with dexcom) once ControlIQ launches
in the UK which is supposed to be any time now.

For me the benefits are precision, flexibility, always having insulin with you, and when using sensors Smartguard to significantly reduce my hypo risk and increase confidence.

Really I think you’d want to be funded/supported by the NHS though really. It’s a higher risk insulin delivery mechanism in some ways, and you want good support available.


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## Pumper_Sue (Jan 9, 2020)

everydayupsanddowns said:


> Or the Tandem Tslim ( which links with dexcom) once ControlIQ launches
> in the UK which is supposed to be any time now.


Ah ok forgot about the tandem. 

Mind you I'm less than impressed with Dex 6 as it can and is quite often 30% out of range so I certainly would not use it for a closed loop system. Obviously this is just my experience and others are happy with Dex.


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## Lucy Honeychurch (Jan 9, 2020)

Being on a pump sorted out my dawn phenomenon and I generally have better bgs and it's lowered my A1c.


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## Ingressus (Jan 10, 2020)

Thanks all good information, the back story to this is neither my DBN or my Diatition can find the insulin ratio could be 3 or 2.5 for carbs, I never have the same day, I am constantly high I mean in the 20's after I eat them fall like a brick vertical two arrows as me dexcom shows, can not tell whether it's too much insulin or not enough they have decided that a pump would be better, personally I'm not seem to have extreme no tolerance one day and not another, I carnt keep running in the 20's we all know how it feels, I think my main concern having a pump is control what happens if it gives me too much, do you still have my morning background insulin?


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## everydayupsanddowns (Jan 10, 2020)

Ingressus said:


> do you still have my morning background insulin?



Well yes and no(!)

With an insulin pump you only have one type of insulin - Rapid Acting. But the pump allows you to set a ‘basal profile’ which trickles out tiny amounts of insulin through the whole 24 hours to cover your basal insulin needs. What is great about this, is that you can finally tailor your basal insulin to your exact needs, a bit more here... a bit less there... through the entire 24 hours, rather than having to accept the ‘best fit’ of a flattish profile basal analogue which might be giving you nothing like enough at 6pm, but way too much at 2am. A basal profile can also be tailored by the day so you can have a different one for weekends when you are more active or whatever. 

The downside of all this flexibility and precision though, is that you don’t have the 24 hour safety net of ‘some’ insulin, and if your insulin pump fails, or your infusion site stops working properly (very rare, but it can happen) you only have rapid the last rapid acting delivered - about 4-5 hours worth - before your BG can begin to skyrocket. 

It just means you have to keep an eye on things during the day, and have a little Hmmmmmm warning voice in your head if you see an unexpected (or even expected!) high BG to remember to recheck that things are moving in the right direction once you’ve taken action and/or visibly check your infusion site at least once a day. 

If the pump develops an error it will sail and warble, so that’s easy enough, but it pays to carry back-up insulin delivery method (a pen or a syringe) if away from base for more than 4 hours.


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## Pumper_Sue (Jan 10, 2020)

Hello Simon, how long before you eat do you inject your bolus and what insulin do you use?


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## Ingressus (Jan 10, 2020)

Hi Sue on a morning I take 44 units of Trisba don't eat breakfast,  lunch I take 12 units of Humalog and on an evening 20 units of Humalog, I take them at the same time as eating, I have tried taking before but the insulin works before my food starts to give me the sugars having to fight a potential hypo, one time for 3 hours, mostly I rise to 22


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## Pumper_Sue (Jan 10, 2020)

Ingressus said:


> Hi Sue on a morning I take 44 units of Trisba don't eat breakfast,  lunch I take 12 units of Humalog and on an evening 20 units of Humalog, I take them at the same time as eating, I have tried taking before but the insulin works before my food starts to give me the sugars having to fight a potential hypo, one time for 3 hours, mostly I rise to 22



Ok so what are your blood sugars like all day long? The more info we have the more chance of helping you hopefully  
Have you done any basal testing? There's a link at the top of the forum.


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