# Insulins Or Pump



## mandamoo1983 (Jan 31, 2011)

Hiya

Just a quick query really not sure if you will be able to answer it tho, ive been diabetic for nearly 18years and i have been on various insulins, for the past 6 years i have been takin novo rapid 3 times a day and levemir insulin on a night time, its a pain havin to inject 4 times a day but its help to maintain my weight been only 27 i dont want to increase chances of heart problems etc, and at the moment im tryin to get pregnant. i qualiifed as a pyschartic nurse last year but my insulin regime isnt workin with my shift patterns, its either hypos or hypers wher i miss breaks of insulins doses. ive spoken to my diabetes nurse and shes keen on me havin a pump, not sure if a pump would be suitable as im tryin to get pregnant, which i really dont like the sound of, do you know of any other insulins that would better suit a busy nurse, that i can look up or suggest ??? ive mentioned goin back on mixtard, but last time on this my weight piled on,  or any links where i could gain futher information. Im avoiding going to see my diabetic nurse as she doesnt seem to listen how much i dont want a pump attached to me 24hr a day, not really sure how it all works she did explain but i wasnt really listening as it freaked me out, im so used of injection dont know how it would be without???

sorry for the long message any help anyone xx

thanks amanda


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## novorapidboi26 (Jan 31, 2011)

A pump would be great and I think fine even if you are trying to get pregnant, as your control would be considerably much better once you had settled in to using one...............

But you say your job means your busy and often miss insulin doses, are you refering to your Levemir Insulin and if so is it when your on a night shift......

I think you may just need to make time for these things and let any superiors know this.......


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## mandamoo1983 (Jan 31, 2011)

i always take my levemir insulin its the novorapid that i have missed, durin the day, i contiue my same regime when on mights i just take extra levemir as id be snackin thru the night, then miss my morning novo rapid, just read the NICE guidlines on the pump n my last HbA1c reading was 6.8


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## randomange (Jan 31, 2011)

Hi Amanda

I've been on the pump for a year now, and I wouldn't give it back! I think it definitely offers more flexibility and and better ways to control your diabetes, which are ideal if you're trying for a baby and it should help you with your varying work patterns.  It's a lot of work, but in my opinion the results are worth the effort.  If you have a look though the pumping section there are a few other posts where people have written about their experiences with the pump that might help you decide.  You could also try having a look at the websites of the pump companies:

Animas: http://www.animascorp.co.uk/

Medtronic:  http://www.medtronic-diabetes.co.uk/

Roche:  http://www.accu-chek.co.uk/gb/products/insulinpumps/index.html

I think mixtard would be a nightmare with shifts - I always found I had to be much stricter with my routine when I was on mixtard and eat an inject at fairly specific times to avoid lots of hypos/hypers.

Have you been on a carb-counting course or something like DAFNE?  I'm a bit confused when you say you're missing novorapid doses - if you match your insulin dose to your carbs, and your basal is set right, you should be able to skip meals without too much problem - if you're having to eat to keep your blood glucose up, or take extra insulin to keep it down, then maybe your levemir dose isn't right?  Have you been taught how to adjust your insulin doses?

With regards to the NICE guidelines, you can be given a pump if you're having problems with hypos even if your HbA1c is lower than 8.5.


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## novorapidboi26 (Jan 31, 2011)

So you might not get a pump, as you have good control according to your HbA1c, if its the novo your missing then I would try my best not to snack or eat carbs........I would insist that I got a few minutes to test and inject, then you can snack all night............

Why do you take extra levemir then miss your morning novo dose.....?


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## Ergates (Jan 31, 2011)

+1 to suggestions of going with the pump.  It's actually better than injections, IMO, and it's not a drag to wear one.


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## mandamoo1983 (Jan 31, 2011)

@ randomange when i was on the mixtards my diabetes control was very poor, and i gained weight, i have only ever been taught about insluin doses and "exchanges" as they were called when i was first diagnosed with diabetes when i was 10 years, i just adjust my insulin doses to as what i think is best, i.e by what im eatin/ not eatin, how busy my day is etc, no day is the same amount with my novorapid, as most days i only take it 3 times instead of 4 cos i dont have breakfast or sometimes dont have lunch. I always have 40 units of levemir n 42/44 whenim working night shifts which seems to work for me. I know this is very poor control really and being a nurse i should take more care and no about carb intakes etc.... but after being a diabetic for so long i have just lost interest, and as i have had no problems untill i started working fulltime now i must have 2/3 hypos or hypers a wk. The last week has been a nitemare. My bloods have been in the high 20's as im on night shifts atm, tried adjusting my insulins and yesterday i have 3 hypos after having  good meals throughout the day, hense the reason for comin onto the forum for some advice. I have appt with g.p thursday, but will have to wait for an appt with diabetic nurse, its been over a y since i last saw her tbh. 

Amanda


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## Pumper_Sue (Jan 31, 2011)

mandamoo1983 said:


> Hiya
> 
> Just a quick query really not sure if you will be able to answer it tho, ive been diabetic for nearly 18years and i have been on various insulins, for the past 6 years i have been takin novo rapid 3 times a day and levemir insulin on a night time, its a pain havin to inject 4 times a day but its help to maintain my weight been only 27 i dont want to increase chances of heart problems etc, and at the moment im tryin to get pregnant. i qualiifed as a pyschartic nurse last year but my insulin regime isnt workin with my shift patterns, its either hypos or hypers wher i miss breaks of insulins doses. ive spoken to my diabetes nurse and shes keen on me havin a pump, not sure if a pump would be suitable as im tryin to get pregnant, which i really dont like the sound of, do you know of any other insulins that would better suit a busy nurse, that i can look up or suggest ??? ive mentioned goin back on mixtard, but last time on this my weight piled on,  or any links where i could gain futher information. Im avoiding going to see my diabetic nurse as she doesnt seem to listen how much i dont want a pump attached to me 24hr a day, not really sure how it all works she did explain but i wasnt really listening as it freaked me out, im so used of injection dont know how it would be without???
> 
> ...



Hi Amanda,
Ask your nurse to explain about pumping in more detail to you and show you a pump.
I can assure you that having it attached 24/7 is not a problem. I never noticed the pump after 24 hours.
The idea of the pump is that you can match your basal pattern to your own body needs. Thus you can skip meals or eat when you like without any ups or downs.
It takes a few weeks to sort out your right dose and pattern, but well worth the effort.
If you are either hyper or hypo durring your shifts then something is wrong. I would suspect your basal from what you are saying. Has it ever been sugested to you to split your Levemir?
Have you done any basal testing to see what is happening? Do you count carbs and adjust your insulin for what you eat?

I saw on another site the idea of wearing a yoyo as a pretend pump. Tape the string to your tummy and have the yoyo in your pocket  Another option so you don't have the temptation of playing with the yoyo  is to ask your nurse if you can trial a pump with saline in it for a week.
Mixatard isn't made any more so you can't have that anyway.


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## novorapidboi26 (Jan 31, 2011)

A carb course is a must and soon............coz your busy and on night shifts once your educated you can function normally, because your doses are all over the place you will be having lows and then highs so you wont be much use at work.........I was the same on the night shift before learning carbs....

DAFNE is the most common carb counting course, last 5 days though, so might nor be pratical..........


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## mandamoo1983 (Jan 31, 2011)

Pumper_Sue said:


> Hi Amanda,
> Ask your nurse to explain about pumping in more detail to you and show you a pump.
> I can assure you that having it attached 24/7 is not a problem. I never noticed the pump after 24 hours.
> The idea of the pump is that you can match your basal pattern to your own body needs. Thus you can skip meals or eat when you like without any ups or downs.
> ...



what are basal testing, tbh i havent taken much notice of my insulin just inject n eat..... how often do u have the canula changed in these pumps??? and how oftern does the pump last??


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## mandamoo1983 (Jan 31, 2011)

what are basal testing, tbh i havent taken much notice of my insulin just inject n eat..... how often do u have the canula changed in these pumps??? and how oftern does the pump last??


i will ask about these courses when i see my gp thursday, really need to take more control not only cos i want to try for a baby but future health and wellbeing, 

what happens to the pump during, sex, baths/showers/ exercise, will visit the website when im back on my pc as only replying from my phone atm xx


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## Pumper_Sue (Jan 31, 2011)

novorapidboi26 said:


> A carb course is a must and soon............coz your busy and on night shifts once your educated you can function normally, because your doses are all over the place you will be having lows and then highs so you wont be much use at work.........I was the same on the night shift before learning carbs....
> 
> DAFNE is the most common carb counting course, last 5 days though, so might nor be pratical..........



As Amanda knows what carbs are and has been used to the exchanges then the only dif is finding out her carb ratio and correction ratio. Then once basal sorted she well away. Her health care team should be able to help her sort this out.  As you say it is life changing for the people who suddenly learn this skill. It isn't rocket science.


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## Pumper_Sue (Jan 31, 2011)

mandamoo1983 said:


> what are basal testing, tbh i havent taken much notice of my insulin just inject n eat..... how often do u have the canula changed in these pumps??? and how oftern does the pump last??
> Basal testing http://www.diatribe.us/issues/13/learning-curve.php this can be aplied to injections as well as pumping.
> Cannula's are changed every 2 or 3 days most change every 3 days. Pumps are replaced every 4 years as this is how long the warranty is.i will ask about these courses when i see my gp thursday, really need to take more control not only cos i want to try for a baby but future health and wellbeing,
> 
> ...



Hope this helps. Ask all the question's you need. I have pumped for 3 years and can say it is completely life changing  and that was after 43 years on insulin. I like most would never go back to injections.


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## Ellie Jones (Jan 31, 2011)

If you know nothing about insulin pumps and insulin pump therapy, yes it can seem very complex and scary having this little box attached to you 24/7..

Getting use to wearing the pump, is no different that when you got used to wearing a bra, a watch a wedding ring for the first time, it's a matter of days really..

Before I started pumping I was apprehensive about this little box dribbling insulin into more so over-night while I slept, that was until my husband pointed out that I injected levimer every night at 11pm then went to bed whats the difference!  Wasn't a problem after that..

What advantages would a pump be for you, well as you said you do shift work, I used to work verious days shifts and even not working overnight it was difficult on MDI even though I could carb count very well indeed, the main problem was the diversity of my shift load being unperdictable both in workload and stress load, similar to you at the time I worked in dementia care, and theres no way of know what's going to happen on shift at the begining of the shift..

The pump is brill for this type of work, as you can increase or decrease your basal to compenstate the diversity of that particular shift load...  Which once you've injected insulin under MDI nothing apart from eating carbs or injecting a correction jab to counteract not a lot one can do...

As for trying for a baby it's perfect to take you through the pregnancy, and when pregnant pumping is a lot easier to keep up with the ever changing insulin needs during the different tri-masters, a better out-come for mum and baby...

As for fitting the criteria for pump funding with what you say hear, you do meet it even though your HbA1c is below the ones the guidelines state, as you don't have to fit every aspects of the guidelines, at the moment due to your shift patterns mdi isn't working, so you qualify on this aspect, and the hope of being pregnant this gives you a better fit...  You've tried different regimes (apart from fine tuning carb counting so you can adjust dose side of it) but that doesn't matter as such but you will need to learn this before or as you start pumping..  So don't worry do much about the HbA1c, if clinic says you fail the criteria due to this, then they are acting unlawfully as you do match some of the aspects of the guideline, clinic can't choose which aspects they want to use!

But have a good look around at pumping, ask questions etc, but from a pumper who did do several very demanding jobs both physically and mentally you can't beat it without a pump....  Best thing in my diabetic life I've fought for...  It has made so much difference in all aspects


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## mandamoo1983 (Jan 31, 2011)

thanks everyone for yr comments just reading the info on all the links ur have posted. 

how long did the process take from initally bein referred for the pump???


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## mandamoo1983 (Jan 31, 2011)

is on infomation overload here after reading n looking at info from the links

am i right in thinking boslus refers to the administer of the insulin from the pump and basal rates is the level of your blood sugar when no insulin or diet is bein taken?????? from this rate it provides a bassline on how much insulin is required for a set period???? but i dont get where the carbs come from??


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## Liz! (Jan 31, 2011)

Good luck Amanda! One thing you often find when you get a pump is that your basal rates are very different through the day and night - for instance I need a high on in the morning at breakfast, virtually nothing between 12am and 3am, and a very low does in the afternoon from 2pm till 4pm. This sort of range is not possble to replicate on any basal insulin, so the pump id fantastic for geting you right. If I had to stay up at night in the old days before my pump the same thing happened to me. When I was asleep, cos I wsn't doing anything, then I was not so bad.

I do hope you can sort this out, but another person here saying, the pump is not so bad!


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## Pumper_Sue (Jan 31, 2011)

mandamoo1983 said:


> is on infomation overload here after reading n looking at info from the links
> 
> am i right in thinking boslus refers to the administer of the insulin from the pump and basal rates is the level of your blood sugar when no insulin or diet is bein taken?????? from this rate it provides a bassline on how much insulin is required for a set period???? but i dont get where the carbs come from??



Hi Amanda,
bolus is what you have for food. Novorapid etc.,
Basal is background. MDI is Levemir or Lantus or whatever people use.

With a pump you just use one insulin novorapid (or your own choice.) The pump has setting which deliver the rapid insulin at the rate you set by the hour (basal) 
You then can bolus for meals so just tell the pump how many carbs and the pump works out how much insulin to give once you have told it your blood sugar. You then agree or disagree with the figure. You can decrease the bolus for exercise for instance.

It sounds complicated but it isn't.
When you see your nurse do ask her if you can see and talk to a real pumper. This will help you no end.


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## shiv (Jan 31, 2011)

Amanda where are you based?


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## mandamoo1983 (Jan 31, 2011)

I understand abit more now about these pumps...... Sounds a goo d method of controll I get the carbs part. Do u get a scale to how to programme the ratio dependin on carbs or bm or is it programmed in the pumps they are some pretty smart lookin ones.                                  I from west mids @ shiv


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## Pumper_Sue (Jan 31, 2011)

Here you are Amanda have a look at this
http://www.youtube.com/watch?v=9p0kispE7t0 please note there are other pumps on the market as well


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## mandamoo1983 (Jan 31, 2011)

Just read this its all clear now http://www.diabetes.co.uk/insulin/bolus-wizard.html


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## shiv (Jan 31, 2011)

Yep you have to pre-programme the pump with the insulin:carb ratio you have (this can vary through the day for some people, and the pump lets you set different times of day for each ratio).

I'm from Birmingham originally Amanda. I'd be happy to show you the pump I use next time I'm up. Which hospital are you with?


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## mandamoo1983 (Jan 31, 2011)

@ pamper sue thanks for the youtube link.... ive gone from bein completely confused and scared to actually likin the idea of the pump.. didnt realised how small the canula was, n it definately beats injectioning 3/4 times a day, n about 16,000 imjections ive given myself already bein a diabetic

how long does the process take to get a pump??? does it depent pct????


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## shiv (Jan 31, 2011)

It does depend on your PCT, I think it can vary from pretty instant to waiting a couple of months (from the moment the consultant writes to get funding). That's only the anecdotes I've heard though.


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## mandamoo1983 (Jan 31, 2011)

@ shiv im under walsall manor hosp, but not seen the diabetes team from there in yrs as i ve just been seen under my g.p the the attached dsn. As ive stated previously in this forum i havent really taken much interest in my diabetes luckily i haven encountered any probs, havent since i was a teenager, in n out of hospital with ketonacidois. Im lucky my HbA1c levels have remained stable tbh with the way i control my diabetes.


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## bev (Jan 31, 2011)

mandamoo1983 said:


> @ shiv im under walsall manor hosp, but not seen the diabetes team from there in yrs as i ve just been seen under my g.p the the attached dsn. As ive stated previously in this forum i havent really taken much interest in my diabetes luckily i haven encountered any probs, havent since i was a teenager, in n out of hospital with ketonacidois. Im lucky my HbA1c levels have remained stable tbh with the way i control my diabetes.



Hi Mandamoo1983,
My son is 12 and has been on the pump for about eighteen months now - and he loves it. He has the Medtronic veo and wears a sensor which tells his pump every few minutes what his blood glucose is so it can be easier to avoid hypo's or hyper's. Injections didnt work for him as he couldnt get good control and the pump is so much better. But you do need to be able to carb count and make changes when you need them. You can always trial a pump and if you dont like it you can go back to injections.Bev


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## mandamoo1983 (Jan 31, 2011)

Doubt ill get a pump as just read a report on spendin for walsall tpct  that they have already overspent on insulin pumps by 26k oh dear


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## mandamoo1983 (Jan 31, 2011)

Thanks bev I understand the carb count.... Goin to request a pump wen c my gp thursday xx glad ur 12 yr as good controll mine was xx terrible.at tnat age


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## bev (Jan 31, 2011)

mandamoo1983 said:


> Doubt ill get a pump as just read a report on spendin for walsall tpct  that they have already overspent on insulin pumps by 26k oh dear



Hi Mandamoo1983,
As far as I know there is not a 'pot of money' for pumps - if your Consultant says you need one then they cant use lack of funds as a reason not to give you one.Bev


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## Pumper_Sue (Jan 31, 2011)

mandamoo1983 said:


> Doubt ill get a pump as just read a report on spendin for walsall tpct  that they have already overspent on insulin pumps by 26k oh dear



Have a read of this Amanda http://www.input.me.uk/
If a consultant says you need a pump you have a pump. You are there anyway as the DSN has said you would benefit.
I don't see a consultant for my diabetes, my GP fought for funding for me. Last I heard I was the only one in the country with funding like this.
INPUT were ace with their help in getting that funding as was my GP.


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## shiv (Jan 31, 2011)

Amanda, as long as your consultant says you need a pump, the PCT by law must provide funding for one. They cannot 'run out' of funding. By the sounds of it, your team are keen for you to try a pump, and so you shouldn't have any problems getting funding.


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## Cate (Jan 31, 2011)

Hi Amanda,

You might find it useful to have a read through this thread: http://www.diabetessupport.co.uk/boards/showthread.php?t=5268 it covers a lot of the stuff you've asked about


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## Lauren (Feb 3, 2011)

Hiya

I was the same as you, didn't meet the NICE guidelines because my HbA1c was good but I was having hypos every day. Then when I said I wanted to start thinking about having a baby I was told the pump was the most suitable option.

I've been on it for one month now and it is soooo much better than MDI. I never ever have to inject, which makes it much easier at work when I need to eat. Its really easy to wear, its like when you first wear a bra and it takes you a few days to get used to it. Mine just lives in my pocket or clips onto the connecty bit between my two bra cups if I'm wearing a dress (you can't tell its there).

I can't praise it enough, its stopped the lows and my control is so much better. I too don't have time to eat sometimes but the pump keeps my blood sugar levels stable so its ok.

Basically it offers you so much more freedom, and it is a much better type of treatment for those trying  for a baby.

I would suggest trying it and then you can always give it back if you don't like it


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## Ergates (Feb 4, 2011)

I think if a pump reduces the numbers of lows that's also part of NICE guidelines from what I read recently.


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## heasandford (Feb 11, 2011)

mandamoo1983 said:


> Doubt ill get a pump as just read a report on spendin for walsall tpct  that they have already overspent on insulin pumps by 26k oh dear


where did you find the information? (I have just discovered that my GP surgery is worse that both local and national results for diabetes!)


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## shiv (Feb 11, 2011)

^they can't 'overspend' as they are not allowed to set a budget for insulin pump therapy. They are obliged by law to provide funding if a consultant requests it.


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