# pump versus injections.



## Joan Getty (Aug 23, 2010)

Just wondering if any seasoned pump users can let me know if they would recommend this for my 20 year old student daughter. I think if would really help her control but she doen't like the idea of having something attached to her at all times. WOuld love any advice on the pros and cons of pumps.

Thanks.


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## Gasman1975 (Aug 23, 2010)

Joan Getty said:


> Just wondering if any seasoned pump users can let me know if they would recommend this for my 20 year old student daughter. I think if would really help her control but she doen't like the idea of having something attached to her at all times. WOuld love any advice on the pros and cons of pumps.
> 
> Thanks.



Hi Joan, 

I have been on a pump for nearly 2 and a half years now and I find it really good. 

Like your daughter I was very wary about having it connected 24/7 especially with things like playing with the children, sleeping, noctural activities etc. However, within 48 hours I had almost forgotten it was there, to the point where on a couple of occaisions I have almost worn it in the shower!

It has withstood my kids using it as a step when climbing on me, me rolling over and tying myself up in knots in my sleep!!

I would hate to go back to regular injections now. 

Hope this helps, and am sure members from the pumping section will be able to add more. 

Andy


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## Freddie99 (Aug 23, 2010)

Joan Getty said:


> Just wondering if any seasoned pump users can let me know if they would recommend this for my 20 year old student daughter. I think if would really help her control but she doen't like the idea of having something attached to her at all times. WOuld love any advice on the pros and cons of pumps.
> 
> Thanks.



Hi Joan,

I've been pumping for about four months now, nearly five. By happy chance I am also a student. I really do find it wonderful for me. I must point out that yes it is there all day every day but you forget it's there. You really do. For me a favourite reminder is when I'm wearing shorts with the tubing hanging outside and that takes me back to the door handle I've just caught it on.

As for being a student and a pumper I've found that it suits my life much more than MDI did. However, it must be noted that it suits me very well and it may well not suit your daughter. For me the pump suits the, please pardon the rugby player terms here, tap and go style of student life. It is also very accommodating when it comes to needing to forget about Levemir/Lantus injections which I did find ruled my life a little. I can safely say that pumping is liberating as it has opened many more doors to me than MDI ever did. What a pump does require is alot of motivation for good control and dedication to your diabetes. If you want to leave diabetes on the back burner and get on with life more than anything I'd say MDI would be better as there is less to go wrong with MDI than on a pump. A pump also weighs upon the mind a little more I find as there are a few more variables and thus a few more things that can go wrong.

Hope this helps,

Tom


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## Adrienne (Aug 23, 2010)

Hi 

Tom's reply is brilliant (as is Andy).

I am a parent of a pumper and I will tell you from a parents point of view that having a pump will lift a weight of dread (for want of a better word) off your shoulders.  It is hard (for most but not all) people to get great control on MDI and by this I mean levels between 4 and 8 mmol.   On a pump you can have this and from a parents point of view it just means that there is that hope that the future is bright (sorry nicked that from the Orange ads).  

The better control the less the complications later in life hopefully.

However it doesn't suit everybody but unless your daughter tries it she will never know and it is better to try it and give it back if she doesn't like it rather than always thinking, 'if only'.   

I only know two children who gave it back.    Both were about 12 years old and were hitting that puberty stage and just couldn't deal with them anymore.    One child is now thinking about going back to it and we are only 2years on.

What Tom says is right.   A pump gives you so much more freedom than MDI ever could.    

If your daughter is sporty then a pump is definitely the way to go as you can control the insulin feeding in to the minutest amounts.

Even going to the pub a pump will help, especially if you know you are going to be having a few or dancing in a club the pump would help more as you just turn down the insulin.

However the downside is that you do have to be switched on to the pump.  You have to carb count (which you should do on MDI anyway) and you can pre plan things.    

My daughter is only 10 so no clubbing for her yet so I can only tell you about swimming lessons and it will give you an idea of what your daughter could do for a party, or club or some sort of sport.

An hour before swimming starts we set what is called a temporary basal rate.  The basal is the background insulin rates (like Lantus or Levemir but it is Novorapid).    So in essense we turn it down and we set it on that lower rate for 4 hours even though the lesson is only 30 minutes.     We know from experience that Jessica will go low from swimming so by giving her less insulin from the background rate (basal) it will stop her from going low.   May sound complicated but its easy once you have a pump in your hands and you can see.

A pump will take some getting used to, you have to learn a different regime.   You have to learn that to treat a hypo you only need quick acting and no long acting carbs at all, odd to get your head around to begin with but it works.

You have to bolus (give insulin) for every single carb you eat, no snacking without insulin but on a pump it gives you the freedom to snack like your mates do if you want to easier than on MDI.

So I say, try the pump, your daughter may love it.   There are lots of young people on here who have recently started pumping and apart from a couple of hiccups they all love their pumps.

Hope that helps.


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## novorapidboi26 (Aug 23, 2010)

Adrienne, that has convinced me........

Think I am going to test one out or at least see if they are available where I am.........


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## Adrienne (Aug 23, 2010)

Excellent.  

Also be aware that if your hospital 'don't do' pumps then you can get referred to any hospital in the UK that you like and don't let your consultant or GP tell you otherwise.  You can look on the Patient Choice website and it tells you so.  Don't them them baffle you with 'we will have to ask the PCT' that is also rubbish, they don't need to ask the PCT, they can just refer you.


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## Twitchy (Aug 23, 2010)

OK, now I'm REALLY excited!!! 8 days to go...!!!  Hope I like the darn thing after all the fuss I've made about getting one!!


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## Adrienne (Aug 23, 2010)

Woo hoo that is fantastic Twitchy.   

I'll warn you now so you aren't shocked, most people, in the first few days want to throw the pump out the window so don't be surprised if you do.  Persevere and go with it and get through that and you will be fine.


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## novorapidboi26 (Aug 23, 2010)

Going from the MDI dose to a pumping regime...........is there much bother to be had with dose amounts.............all I can think of would be the basal doses, ratios would stay the same yeah?


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## Twitchy (Aug 23, 2010)

I guess I will have to bribe the hubby to field the kids for a few days so I can get to grips with it!   Bit apprehensive as it's straight on, onto insulin (no saline trial etc) so I guess a steep learning curve...s'pose I will just have to get my 'engineer' head on!   Yikes...!


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## Adrienne (Aug 23, 2010)

Twitchy said:


> I guess I will have to bribe the hubby to field the kids for a few days so I can get to grips with it!   Bit apprehensive as it's straight on, onto insulin (no saline trial etc) so I guess a steep learning curve...s'pose I will just have to get my 'engineer' head on!   Yikes...!



Good idea.  Don't forget we are here Twitchy and there are loads of pumpers now.

I am hoping that you will get a couple of days training (maybe not) and I would expect the DSN to ring you once every for a few days to tweak things with you.   You should be told to be testing overnight for a few night at 2 hourly intervals.   If you can get the overnights right from the off then you will get the days sorted very quickly.


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## Adrienne (Aug 23, 2010)

novorapidboi26 said:


> Going from the MDI dose to a pumping regime...........is there much bother to be had with dose amounts.............all I can think of would be the basal doses, ratios would stay the same yeah?



No doesn't quite work like that.   You go with the assumption that you will need less insulin when pumping due to the way it is all delivered.   Jessica has 9 different basal rates throughout the day.

She has three different ratios but we have friends who have the three ratios for meals but have found they need different ratios for snacks at different times of the day.   We have never had to do this and it is trial and error.

Jessica's day time ratios are breakfast 1 : 7, lunchtime is 1 : 9 and tea time is 1 : 13.    Those tiny amounts of insulin between breakfast and lunch make all the difference.

You will understand what I am talking about more when you get a pump in your hand.


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## novorapidboi26 (Aug 23, 2010)

I am on much greater amounts and so my ratios are given slightly differently........

3:10g in the morning, 1.5:10g the rest of the day.........

Would I have to go back to 1:10g when starting a pump, what would the HCPs say.................


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## Adrienne (Aug 23, 2010)

novorapidboi26 said:


> I am on much greater amounts and so my ratios are given slightly differently........
> 
> 3:10g in the morning, 1.5:10g the rest of the day.........
> 
> Would I have to go back to 1:10g when starting a pump, what would the HCPs say.................



It makes no difference whether you are on smaller or larger amounts.  You have been taught the same way as Northerner counts carbs.   For pumping you should do it the other way.   You always work with 10 carbs which is what some DSNs or dieticians teach.  They will soon change their way of teaching when they start pumps.

You have to count carbs using 1 unit of insulin as your basis not 10 carbs.

So your ratios, with what you have given me,are  :

morning :  1 : 3  which is 1 unit to 3 carbs
Rest of day : 1 : 6.5   which is 1 unit to 6.5 carbs which would be rounded up to 7 so it would be 1 : 7

That is the way you need to do it as that is how pumps are set up.   You would programme in times and numbers starting at midnight.   So using Jessica as an example (and I appreciate you are on more insulin but lets say your breakfast is 1 :3 and lunch is 1 : 7 )

Jessica's settings for her ratios look like this  :

0000  7
1130  9
1630  13

Which means from midnight to 11.29 am she is on 1 : 7
from 11.30 to 1629 she is on 1 : 9
and from  1630 to 2359 she is on 1 : 13

Yours would look like this  :

0000   3
1130   7

So from midnight to 1129 you would be 1 : 3
and from 11.30 am to 2359 you would be 1 : 7

No you would not have to start again at 1 : 10.   I have no idea what your DSN would set you at.     It would make sense to start at say 1 : 10 as your lunch time is not that out and I bet at tea time you would need about 1 : 10.   You will find you will need less by tea time.

Within the first day you would have tweaked the breakfast own possibly down to 1 : 6 to begin with and maybe the next day tweak the lunch time down.

It is all bit by bit and for a few days you may feel horrid as your levels will be up and down and not much pattern that you can see.   An experienced pumper or DSN will, however, see a pattern and will be able to tweak.

Hope I am making some sense here for you.


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## novorapidboi26 (Aug 23, 2010)

You are making perfect sense.................

So basically, the more accurately timed delivery of basal should bring my bolus ratios down.............in theory.....

Thats my main objective, my control is reasonable, but its lots of insulin.........


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## Freddie99 (Aug 23, 2010)

The amount of insulin I need has dropped by quite a bit. I used to inject about a hundred or so units a day in both Levemir and Novorapid. I now use about sixty units a day. That covers all my bolusing for meals and my basal rate which totals up to 26.6 units a day. I used to use about forty pre pump and at times I was on sixty or so units of Levemir. 
I used to have a ratio of 1.5 units to ten grammes of carbs when I used jabs. Now I use one unit per ten grammes. That's dropped my needs quite a bit too. I do like the drop in insulin use. 
I have reservoirs that take about 1.8ml of insulin. That lasts me two and a half days or three at a push if I'm not eating as much as I normally do. You've got to bear that in mind when you're eating/ going out for the day. Some days I end up taking insulin and reservoirs into work. There's always a cannula in my locker too. It does require a bit of talent for logistics.


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## Adrienne (Aug 23, 2010)

Agree once again Tom on everything you say.

I know that insulin needs go down but it is hard to quantify that when you are talking about a child, which I am.   Her insulin needs went down significantly but of course they are now way higher than they were as she is 4 years older so requirements go up anyway so am glad you stepped in there.


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## Cate (Aug 23, 2010)

Twitchy - I started a pump straight onto insulin, no saline trial here either.  I had about 3 hours training, and got plugged in as part of it - I was walked through a "set change" and at the end of it, the pump was working and I've never looked back.

For me it was fairly simple, and I just phoned in my test results for a while after it went live, discussed them with my DSN and talked about what changes I could/should make based on the readings.

The thing I found hardest was to remember to bolus for eg the digestive with my cup of coffee mid morning!  They actually snuck a biscuit into me during the training, which I didn't bolus for, and they picked me up on it shortly afterwards - good way of making a point!

And Adrienne/others - my insulin requirement went down by about 1/3 after I started on the pump, I think for adults that's fairly standard.  I normally use about 60 units per day, less at the moment due to breastfeeding.


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## Joan Getty (Aug 26, 2010)

Thanks to all those who took the time to reply - it certainly gives us a lot to think about. I am convinced but not sure my daughter is. Will keep on researching. Thanks again.


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## Copepod (Aug 26, 2010)

I can relate to your daughter's reluctance to be attached all the time. I think I'd be even more reluctant if I didn't already have an established relationship. Fortunately, as I  have good control on MDI, I don't need to consider a pump.


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## Abi (Aug 26, 2010)

If control is suboptimal- either HbA1c or day to day levels in terms of hypos or hypers, despite your daughters best efforts ( carb counting, adequate monitoring and attention to all those other variables like physical activity- and making rational alterations to dose based on all of above) then she will probably benefit from a pump


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## rossoneri (Aug 26, 2010)

Joan,
One other factor that I would bear in mind for your daughter if she does decide to try using a pump and it gets approval then be careful about when the change in treatment occurs.  I think the first few weeks of being on a pump can be tough and troublesome as you get accustomed to the new approach to managing diabetes - just look at some of the posts of new pumpers on this forum.  I would therefore try and avoid making the switch near, for example, a period leading up to exams.

It might help your daughter's enthusiasm if you point out to her that if she tries it for a couple of months and does not like either the regime or carrying it around with her 24/7 then she still has the option to switch back to her current MDI regime.  I think it was recognising this fact that finally convinced me to give it go, before that most of the enthusiasm for me to switch had come from my (admittedly very good) GP and diabetic nurse who were both pump advocates and thought the pump was the best way of sorting the problems that I was experiencing with MDI.  This and the fact that I also started to think that my reluctance to accept change was making me appear to be an old man!

Having made the switch I very quickly got the point where I became even more reluctant to switch back to MDI and this was despite the initial period being far from plain sailing for me.


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## Patricia (Aug 27, 2010)

Agree with all said here - and Tom, thanks for capturing so clearly the 'lifestyle' bit. We were unusual on MDI in that our son's control was really quite good, esp for an adolescent. However, the pump has enabled MUCH finer control but as importantly, the liberation is worth every moment of commitment to pumping. I cannot stress enough the freedom my son now has in being with his friends and eating in restaurants, drawn out family meals etc. Yesterday for instance: in town with friends he guessed a bolus for a small ring doughnut out with friends. He then went back to a friend's where they made beans on toast - some of which he had to guess. He knows to guess on the low end when out and about. By 4pm he was 10 mmols - bit high, so he gave a little, painless correction dose to get in range. 

He did what he wanted with no lows and no proper highs. As long as he tests and acts upon his tests, the trade off of 24/7 is control AND impressive flexibility.


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