# Starting the pump - my thoughts after 2 months



## Matt Cycle (Feb 1, 2018)

I started pumping nearly 2 months ago and thought I'd put down my experiences on the process of actually getting it and then starting on it for anyone who may be thinking about it.   Be warned - a bit of a ramble coming up. 

So, in terms of getting it I'd been under GP care for my diabetes for a number of years but having issues in recent years with hypos and hypo awareness and liking the idea of temporary basals for exercise amongst other things I started researching and warmed to the idea of a pump having been put off originally by the whole 'attached to me all the time' thing.  After speaking to my DN at the surgery she was fine with it and I therefore had to be referred back to the hospital clinic.  I started back at the hospital clinic within a couple of months and completed the DAFNE style carb counting course (very useful in itself but an essential requirement if going for a pump in my area) and things seemed to be moving along nicely.  However, the slowly grinding gears of the local NHS meant months and months would pass.    If you find yourself in a similar position don't despair as things may move more quickly in your area.

However (bit of a rant coming up) I do sometimes feel those diagnosed in more recent times receive better care and advice than older hands who are just expected to know everything.  Diabetes management is changing quickly nowadays so whether it's DAFNE courses or information and access to the latest technology, everyone, regardless of how long they have been diagnosed, should have access to these resources.  I feel strongly about this and the so-called postcode lottery as the whole provision of Type 1 care across the country is uneven and unfair to say the least.  My time on the forum has shown this has led to some people (possibly not even confirmed Type 1) receiving any number of things and other Type 1's who may have been diagnosed for a long time missing out.  It often appears to be a case of luck as to who gets what or of those who shout the loudest. 

Back to the pump then and from a choice of five I chose the Medtronic 640G because as well as being a decent and well proven pump from all the reviews I read, there is always the possibility of getting the CGM sensors as well.  Once it was all approved, ordered and arrived at the clinic the start was dependent on the availability of the rep.  One thing I'd recommend is being well prepared before starting as I'd got myself a copy of Pumping Insulin by John Walsh and Ruth Roberts and had done a fair bit of reading and researching - the forums very own Mike (Everydayupsanddowns) has done some excellent instructional videos on the 640G on youtube.  My clinic would normally do 2 sessions with the rep.  The first (morning or an afternoon) involves the basic mechanics of it, going through setting it up - looking at the functions, creating initial basal profiles etc, loading the reservoir with insulin and inserting the cannula - and it's off you go.  The follow up appointment 2 days later would go through the first set change.  The rep wasn't available for the second session so I only had the one session and did the first set change on my own at home.  It was fairly straightforward - the pump itself guides you through it, the information booklet has step by step instructions and as mentioned there are online videos if you need them.  Just remember to remove the needle guard from the cannula applicator. 

How does it work?  The pump only uses rapid insulin for both bolus and basal with the basal being drip fed in very small increments.  The 640G requires a reservoir to be filled every 2-3 days from an insulin vial.  Those who remember using syringes just think of that on a bigger scale.  Tubing is attached to the reservoir and then loaded into the pump.  The other ending of the tubing is attached to a cannula contained inside an applicator (a bit like the Libre applicator) .  The applicator fires a needle in and leaves a plastic cannula held in place by an adhesive pad.  This part has a plastic clip where you can detach the pump if you want to when having a shower etc.  Every 2-3 days the reservoir, cannula and tubing is all disposed of and you start again.  It sounds complicated but it's all straightforward once you do it.  The consumables i.e. reservoirs, cannula/tubing and batteries are despatched directly from Medtronic via courier and you can order 3 months worth at a time.

What's it like actually using it?  Well, after so long injecting with syringes and pens I won't lie and admit it did feel strange at first having the tubing and pump attached.  I was concerned about taking my jumper off and yanking out the tubing but it's pretty secure and fastened well at either end.  The tubing I use is 60cm long but it still feels slightly awkward getting dressed and undressed with the possibility of catching the tubing.  The pump has a clip which I use on my belt and I bought myself a lycra pouch belt for when I'm on the bike and at night in bed.  I've not gone down the Great Escape route of cutting holes in pockets and feeding tubing through gaps in clothing that some people mention.  Yes, it took a bit of getting used to after injecting and I am aware it's there all the time.  For me personally it didn't take a big rethink in managing my diabetes when starting to use it as I see it as just another method of injecting insulin albeit with more options available.  If you can cope with that then the pump will not be an issue.  The initial settings regarding basal rates, ratios etc for the pump were put in at the first meeting with the Medtronic rep based on TDD and weight and used software with an algorithm but as with all things T1 diabetes related they required tweaking and adjustment.  Basal testing can then be done to firm things up.  I'd got into the habit over the years of travelling light with my diabetes related stuff - just a pen, meter and dextrosol tablets and I now found myself having a bit more 'equipment' to carry around.  Yes, the pump is bigger than a pen (about the size of a fat mobile phone) but it's not a massive deal really and is fairly discreet.  I still carry a pen around in case something goes wrong and sometimes a spare cannula in case of any problems with that.  Set changes - reservoir filling, cannula and tubing - are done every 2-3 days and although they don't take long (3-4 minutes) are a bit of a palaver compared to simply getting a pen from the fridge every couple of weeks or so and screwing a needle on.

In terms of pump operation anyone who uses a mobile, computer etc (pretty much the whole population then) would have no problems going through the button pressing.  Even if you aren't 100% comfortable with technology it's straightforward stuff.  One of the issues I had with myself at first was the complete reliance on technology and something I couldn't see happening keeping me alive.  With syringes and pens being mechanical you simply dial up, stick the needle in yourself and press the plunger and know it has gone in.  With the pump you can't see it but you soon know if something has gone wrong as your blood glucose quickly heads skywards but it just needed a slightly different mindset to begin with and the technology is well proven as the drip, drip, drip quietly does its stuff.

Is it worth it?  It's still early days but for me yes, absolutely.  Time will tell in terms of the figures but the finer adjustments, dual waves, multiple basal patterns and especially the TBR's have, I feel, given me greater control of my diabetes although of course it is possible to manage your diabetes successfully on pens for most people.  I had managed what I thought was 'okay' on syringes and pens for over 30 years but (with a fair bit of work) for me personally I feel this has made it easier (that's easier definitely not easy ) to manage.  I still get hypos and still go high but I think that's part and parcel of typical T1 however you manage it, but so far the highs and lows have been reduced.  If you work, are active in work or outside of work, doing different things on different days then you would probably notice the benefits more than someone whose only activity is pottering around the shops occasionally and going for a coffee with Ethel.  I know T1's can be reluctant to change things but my DSN said she sees a number of people on pumps who don't even use TBR's which seems a bit of a waste of the technology to me.  It's certainly not a panacea for all T1 issues, it takes a bit of effort and I realise they're not available to all but if you are eligible and are thinking about it then I would certainly recommend giving it a go. 

After that little lot time for a coffee!


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## Northerner (Feb 1, 2018)

Thanks for the write-up Matt, good reading and I'm glad you've taken to it so well


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## SB2015 (Feb 1, 2018)

Well done Matt.  A really good summary of your experience and so useful for anyone considering whether to get a pump.

I agree that there are differences for those diagnosed more recently and people who were diagnosed a long time ago, and often in the care of their GP rather than specialist care in hospital.  I haev been fortunate that I was referred to the hospital at the start and now that I am on a pump will remain in their care.  My GP really would not be able to help and he was the one that told me ‘Steve Redgrave must be a type 1 because he uses insulin’!!

Anyway I am glad for you that it is working out for you, and is giving you the flexibility you need for your varied active life.  All good, but as you say not easy.


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## Matt Cycle (Feb 1, 2018)

SB2015 said:


> Well done Matt.  A really good summary of your experience and so useful for anyone considering whether to get a pump.
> 
> I agree that there are differences for those diagnosed more recently and people who were diagnosed a long time ago, and often in the care of their GP rather than specialist care in hospital.  I haev been fortunate that I was referred to the hospital at the start and now that I am on a pump will remain in their care.  My GP really would not be able to help and he was the one that told me ‘Steve Redgrave must be a type 1 because he uses insulin’!!
> 
> Anyway I am glad for you that it is working out for you, and is giving you the flexibility you need for your varied active life.  All good, but as you say not easy.



I think my hospital clinic experience was coloured by those early years when the place was rammed full, leading to long waits (hours sometimes) to see a different consultant each time and it was quite a depressing place for a newly diagnosed young person to see old people blind and with no legs.  At that time types 1 and 2 were seen at the hospital.  In the late 90's/early 2000's I moved GP's and they said I could be seen at the surgery if I wanted - I was having a difficult time mentally with my diabetes at that point and I just said yes.  I can't fault the care I've received from the DN's at the GP's but the depth of knowledge about Type 1 is not the same as specialist care at the hospital.  Technology and T1 management has moved on considerably in that time.  I was also pleasantly surprised back at the hospital clinic - some evening appointments and no waiting.


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## HOBIE (Feb 2, 2018)

Good stuff Matt. I really really love my pump 640 !


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## Pigeon (Feb 3, 2018)

Hi Matt, think I got my 640G about a month before you, I'd agree with a lot of your reflections! It has been pretty much overwhelmingly positive, I'd recommend it. Not got my latest HBA1c back yet but I'm hoping it will have come down from 55. I think I've definitely had fewer lows and highs. I still need to sort out TBRs a bit better when I'm going for a long walk, I haven't been on many yet but I have used TBRs for coping after exercise and it seems to work well for stopping post-exercise lows. The only near disaster I've had was the first 36 hours - I inadvertently left the clinic with a basal rate of 0u/hr set up, even though we'd programmed a typical day's profile in for me, this wasn't selected. I kept getting readings of 16 and doing corrections, changed the cannula etc, increased to 130% TBR and the 16 mmol readings still kept coming back. Eventually I realised it was on 130% of 0 so all I'd had was bolus for 36 hrs! Once I was back on basal I felt a lot better, I did feed this back to the DSN so she can make sure they don't do that again!

The basal profile we set up with the rep was not too bad, apart from mornings around 11am I'd have a massive rise (again to 16, seems to be my unlucky number!) so I spent  a whole week missing breakfast to basal test this time, and increased by 2U total in mornings to get this sorted. The rest of the basal testing was just resulting in small tweaks, really. Having a Libre for the first few weeks definitely helped and it was satisfying to see the second week was a lot smoother than the first. Being attached to it has definitely not been a biggy, not many people notice it really and it doesn't cause a nuisance. I find it easier to be able to bolus with that than injections, especially over Xmas when there's lots of grazing going on, it's really easy to be able to bolus as you help yourself to another helping of something.

Hope our thoughts might help anyone else out there thinking of getting a pump!


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## HOBIE (Feb 3, 2018)

Pleased you like the Pump Pigeon. They are so adaptable


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## Aly Baabaa (Feb 9, 2018)

Hi. Really interested in your experiences with the Medtronic. Just got mine last week after having an accuchek insight pump. I'm struggling a bit, not with the actual using of it as it is more intuitive than the insight, but with the size! It is so much bulkier and heavy! Used to wear the insight on a bra pouch but although this one is supposed to be wearable on a bra, get the impression I'd need reinforced elastic! Just can't get used to having it on a belt. Certainly not sure how you'd wear it under a dress! Any ideas?


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## Sprogladite (Feb 9, 2018)

Matt Cycle said:


> I do sometimes feel those diagnosed in more recent times receive better care and advice than older hands who are just expected to know everything.  Diabetes management is changing quickly nowadays so whether it's DAFNE courses or information and access to the latest technology, everyone, regardless of how long they have been diagnosed, should have access to these resources.  I feel strongly about this and the so-called postcode lottery as the whole provision of Type 1 care across the country is uneven and unfair to say the least.  My time on the forum has shown this has led to some people (possibly not even confirmed Type 1) receiving any number of things and other Type 1's who may have been diagnosed for a long time missing out.  It often appears to be a case of luck as to who gets what or of those who shout the loudest.



I couldn't agree with this more!! I did DAFNE in October last year, at which point I'd been diabetic for 23 years.  I'd been on the DAFNE waiting list for 3 years prior to that, but until I really started screaming about needing a pump nobody paid any attention at all.  I learned how to carb count prior to DAFNE through this forum!! Now on the waiting list for a pump having done DAFNE but been told it's likely to be late 2018 before I get one.  Both relieved and antagonised by the wait lol.  Thanks for writing this, has been a good read!


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## Alasdair Martin (Feb 13, 2018)

As someone hopefully about to embark on a pump journey, I found this post particularly helpful!
Many thanks for sharing your experiences!


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## HOBIE (Feb 13, 2018)

Alasdair Martin said:


> As someone hopefully about to embark on a pump journey, I found this post particularly helpful!
> Many thanks for sharing your experiences!


Really good luck Alasdair. Read "Love my Pump" Let us know how you get on pls


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## grainger (Feb 13, 2018)

Aly Baabaa said:


> Hi. Really interested in your experiences with the Medtronic. Just got mine last week after having an accuchek insight pump. I'm struggling a bit, not with the actual using of it as it is more intuitive than the insight, but with the size! It is so much bulkier and heavy! Used to wear the insight on a bra pouch but although this one is supposed to be wearable on a bra, get the impression I'd need reinforced elastic! Just can't get used to having it on a belt. Certainly not sure how you'd wear it under a dress! Any ideas?



I use the clip directly on my bra rather than a pouch as I found it easier.
Dresses I find I vary depending on the cut of the dress - anything low cut and I use a thigh pouch holder but I find it slightly annoying, most I can still clip to my bra. 
I’ve found it’s v much trial and error. Hope you find something that works for you


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## Matt Cycle (Feb 14, 2018)

Aly Baabaa said:


> Hi. Really interested in your experiences with the Medtronic. Just got mine last week after having an accuchek insight pump. I'm struggling a bit, not with the actual using of it as it is more intuitive than the insight, but with the size! It is so much bulkier and heavy! Used to wear the insight on a bra pouch but although this one is supposed to be wearable on a bra, get the impression I'd need reinforced elastic! Just can't get used to having it on a belt. Certainly not sure how you'd wear it under a dress! Any ideas?



I'll have to bow to graingers greater experience in these matters as I don't wear a bra (well only on special occasions ) and as this is my first pump I can't really compare it to anything else but when people have mentioned about hanging them on bras I did think it it may be a bit bulky and heavy for that.  But what do I know.  I haven't found it an issue being on my belt but again I have no other pump comparison.  I'm guessing you use the Contour Next 2.4 for remote bolusing as otherwise it means having to rummage around trying to extract the pump.


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## trophywench (Feb 14, 2018)

Depends on what pump grainger has doesn't it?  The thing I believe the Minimed 'remote' lacks in comparison to Roche pumps is the bolus wizard for which you still have to access the pump itself so that would be a 'con' for me since this is my second Roche one and I've just always used it with both and rarely touch the pump whatever I'm wearing on the outside.  It would be a real PITA when I'm not wearing anything! - stays firmly in the Alcantara pouch on the lanyard round my neck - yes the tubing and cannula are on plain view but rarely annoys me - if it annoys onlookers, well, tuff.


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## grainger (Feb 14, 2018)

Matt Cycle said:


> I'll have to bow to graingers greater experience in these matters.I'm guessing you use the Contour Next 2.4 for remote bolusing as otherwise it means having to rummage around trying to extract the pump.





trophywench said:


> Depends on what pump grainger has doesn't it?



Medtronic 640g for me

To be honest I don’t use the remote bolus at all and I’m forever putting my hand down my top - think I just have no shame! No one has ever said anything and even if they did I’m likely to just tell them to stop looking if it bugs them or that they shouldn’t be staring at my cleavage anyway!


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## Matt Cycle (Feb 14, 2018)

grainger said:


> Medtronic 640g for me
> 
> To be honest I don’t use the remote bolus at all and I’m forever putting my hand down my top - think I just have no shame! No one has ever said anything and even if they did I’m likely to just tell them to stop looking if it bugs them or that they shouldn’t be staring at my cleavage anyway!



I use the meter and it's great for the bolus wizard when it sends the reading but I've never used it for remote bolusing either.  For some reason the Medtronic rep didn't seem keen on that function.  With the pump on my belt it's easy enough to access and I've become a dab hand at reading upside down.  When I'm on the bike and it's in the pouch belt around my waist it can make it a bit more awkward.  On Sunday with it being a bit on the cold side I was in Winter gear and at the cafe whilst sat down I had to unzip my jersey, unzip the bib part of the bibtights and lift up both base layers to access it without flashing anyone who might have been looking bearing in mind we don't wear any lower undergarments and the lycra pouch belt had twisted around on itself with the tubing also twisted around the belt.   Hey ho, enjoyed my macchiato though.


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## HOBIE (Feb 14, 2018)

I am now on my 3rd Medtronic pump & have always just put it in my pocket. An advantage for a bloke ! . Jeans or joggers. I used the clip on my M/bike leathers & never give in at fair rate.


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## trophywench (Feb 14, 2018)

Well I don't and wouldn't have a prob in trousers if they have a decent deep enough pocket, or indeed a skirt ditto.  However so many ladies trousers don't have decent pockets if they have any at all and it does restrict shopping choices, possibly a good thing sometimes but can be exceedingly frustrating at other times!

However dresses obviously are a prob so don't get worn very much by me these days.


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## HOBIE (Feb 15, 2018)

There is all types of holders available ?


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## trophywench (Feb 15, 2018)

They don't do a sensible 'waistband' clip for the Roche Insight Hobie - I used the 'skin' for the Combo constantly even when I did have pockets in trousers or skirts - the hard plastic container for the Combo was far too big to use and the hard one they do for the Insight is useless cos you have to completely unclip it to do anything on the pump!  Plus difficult to wrestle the pump into to begin with and the clip itself doesn't open far enough to clip on in the first place, let alone on and off and back on easily, when you have weak fingers which not being a typist or piano player, mine are.


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## HOBIE (Feb 15, 2018)

I would make my own. A few stiches. There are lots of places that would make the perfect holder . Well said Grainger !


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## everydayupsanddowns (Feb 15, 2018)

trophywench said:


> They don't do a sensible 'waistband' clip for the Roche Insight Hobie - I used the 'skin' for the Combo constantly even when I did have pockets in trousers or skirts - the hard plastic container for the Combo was far too big to use and the hard one they do for the Insight is useless cos you have to completely unclip it to do anything on the pump!  Plus difficult to wrestle the pump into to begin with and the clip itself doesn't open far enough to clip on in the first place, let alone on and off and back on easily, when you have weak fingers which not being a typist or piano player, mine are.



Not sure if they are suitable, but I saw something today which I'd heard about before which is 'Hid In' - a person who makes underwear and other soft fabric bands with a pocket for an insulin pump. Not so good if you need to access constantly I would think, but OK for Insight/Combo? Funky Pumpers always used to sell Spibelt type things too which people liked.


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## trophywench (Feb 15, 2018)

Urghh - I've seen it before Mike, it's made of synthetic material - now I know it's TMI but this diabetic lady learned 30+ years ago that synthetic underwear is a no-no! (Thrush mainly)  Plus it costs silly money!  LOL

If I was 45 years younger, taller and thinner than I've ever been and bodycon dresses were fashionable - then maybe I'd be tempted !!


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## TheClockworkDodo (Feb 15, 2018)

Thanks for this thread, @Matt Cycle - lots of interesting info. as I'm on the waiting list for a pump


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## Pigeon (Feb 16, 2018)

I mainly wear dresses with pockets (White Stuff and Joules are good for these) where possible, I cut a little hole in the pocket and feed the tubing through. I have the 640G too and it is bulky, but do-able. I have put it in my bra on occasions I'm wearing  a dress without pockets. I've got a SpiBelt-type band from TK Maxx that I use when running and I put this under my bra for the xmas party, had to wear a push up bra as my cleavage isn't very big, but it worked. You can program the meter with preset dual waves or do a manual bolus, and so I guessed in advance that I'd eat 100g carbs and set a 50:50 dual wave over an hour so I could deliver it remotely. The carbs were about right but then with a bit of dancing I ended up hypo, but that would have happened with using the pump directly too - a learning point for next year! 

I've also got a couple of dresses with bat-wing type sleeves and I can put the pump (without the clip) in the side of my bra and use the remote functions, it's not too uncomfortable and you get used to it. When I went to choose a pump at the clinic I actually borrowed them all and went to the loos to try stuffing them down my bra and see how discreet it could be. The Insight did appeal because it is smaller, and has the full remote functions, but I don't really like touch screens and the remote seemed very slow to respond, so I choose the 640G because it seemed to have more pros than cons for me, but everyone is different, so make sure you get to handle a pump and try it for size if you're getting one.


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## SB2015 (Feb 16, 2018)

I just tuck my pump in the side of my bra whatever I am wearing now.  I don’t to access it once it is in as I have a Combo with the Bluetooth facility.  The front of my bra holds the Libre, so like Grainger I am regularly fishing into my cleavage.  People who know me know why, others don’t much notice.


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## Pigeon (Feb 17, 2018)

Update, got my first A1c post pump..... down to 47 from 55! My best value ever!


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## HOBIE (Feb 17, 2018)

Pigeon said:


> Update, got my first A1c post pump..... down to 47 from 55! My best value ever!


Good stuff Pigeon. They are so adaptable


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## anniehi (Feb 18, 2018)

Are there two sizes of Medtronic 640 pumps?  I seem to remember there was a small pump with 1.8 unit cartridge.  Is that still available do you know?


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## Pigeon (Feb 18, 2018)

Don't think so. I have 1.8ml cartridges but they go in the 640G normal pump. I wasn't given a choice of size, anyway!


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## Matt Cycle (Feb 18, 2018)

The pump is the same but accepts both 1.8ml and 3ml reservoirs.  They allocated me the 3ml ones but I'm using less than 50 units a day so the 1.8's would have been fine.  I may change them.


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## everydayupsanddowns (Feb 20, 2018)

anniehi said:


> Are there two sizes of Medtronic 640 pumps?  I seem to remember there was a small pump with 1.8 unit cartridge.  Is that still available do you know?



They were going to make one, but didn’t in the end. There wasn’t much difference in the size of the casing to be honest, but the smaller one didn’t have the little sticky-up bit where the reservoir comes out. I gather lots of the extra size in 640G is for battery, and the next version (currently available in the US) the 670G uses the same overall design and casing. Looks like Medtronic are sticking with their ugly pup look for the foreseeable.


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