Anybody out there with an insulin pump?

In My Humble Opinion
1

I had an appointment with diabetes counselor today, and it looks like I might be getting an insulin pump some time in the future. I haven’t made any decisions yet, because I want to know more about it (and I have to get my HbA1c back first). I have one friend with a pump and she likes it, but I only have two diabetic friends, so it’s not like my sample is very big.

I’m looking at one because my HbA1c has been creeping up since puberty basically, and it’s the postprandial sugars that are making that happen. I’ve been a Type I diabetic for nearly 20 years, and I’ve been on either NPH and Humalog or Lantus and Novalog the entire time. This means I’ve spent about 85-percent of my life with dime- to silver dollar-sized bruises on my legs, arms and stomach, which sometimes means I have well-intentioned women at the beach telling me about women’s shelters. (Where do these people come from?) So there’s my second reason: I’m tired of the bruises and scar tissue. My schedule also isn’t as regular as it was in high school, so that doesn’t help with control; I can’t guarantee I’ll be able to eat dinner every night at 5.

So, if there are any Dopers out there with pumps or are intimate with someone who has one, would you mind answering a few questions for me?

How long have you had one?

Were you on injections before? Do you prefer the pump or injections?

Is there anything especially tricky about it? (I’ve seen my friend assemble hers, and it doesn’t look too intimidating.)

Was it covered by your insurance or were they assmunches about it?

Has it helped your control? How many times a day are you checking your blood sugar?

How does it fit into your life? Is it more adaptable to unexpected happenings? (One of the things I hate most about having diabetes is that I have to plan everything.) Does it limit you in doing any activities? How does it work with dresses and clothing like that?

I think that’s it! I appreciate any input you guys can give me.

2

Just a word of support for making the decision that’s right for you right now. I’m sure some folks will jump in soon with data.

3

No personal experience, but I talked recently with one of my patients who started on the pump a few months back. He absolutely loves it and says he gets better control. He’d been on injections for a long while before that.

4

I’ve been using a Medtronic pump for about a year now. Before that, I was on a Humalog/Lantus regimen. I am a type 1 diabetic, but my pancreas didn’t start to fail until I was in my 30s. I prefer the pump for several reasons: I don’t have to worry constantly about hauling supplies around. I can adjust my basal rate immediately as conditions dictate. I don’t have to inject before meals, and more important than the injecting itself, I don’t have to excuse myself in restaurants or at others’ homes to inject.

It’s not hard at all to use. My biggest gripe is a personal shortcoming – it’s too easy to forget to prime it before inserting the canula when changing my set.

My HMO covered it with no problem. There was a little hassle with filling out some forms, but the pump manufacturer was quite happy (politely insistent even) to help with that.

Overall, so far, it’s been neutral with respect to control. But that’s because of the adjustment period I went through when I first got it. It took a little while for me to get the settings dialed in correctly, and my control was worse than it had been previously when I first got it. You can expect an adjustment period. Now, I’m back to about where I was when I was injecting, and I still expect to be able to achieve yet tighter control. I check my blood sugar 6-7 times a day.

It is far more adaptable to unexpected happenings. I don’t have a physically demanding job, and my pre-pump basal Lantus use reflected that. But on weekends when I was working around the house, on days when I commuted to work by bicycle, and pretty much any time I was more active than usual, I would often become hypoglycemic unless I had planned in advance and injected less Lantus the night before – and I was terrible at planning ahead enough to do that. It was frustrating to me that almost every time I exercised, I had to stop and consume some sugar, countering some of the benefit of exercising. With the pump, I can drop the basal delivery any time I need to, and I become hypo far less often.

It doesn’t really limit me in any activities, but it can be a small source of anxiety. I like to ski, and I’m always worried that I’ll fall and damage it. I like to kayak and to sail, but I’m always worried that I’ll accidentally dunk the thing. It can also be a bit awkward during physical intimacy – although you can detach the pump, you’ve still got a plastic connector attached to your abdomen.

I’m a guy, and I don’t any experience with using it while wearing a dress. I do know that you can use a strap to attach it to your inner thigh, and I know one woman who is accustomed to nestling her pump between her breasts. Or maybe under them – I don’t know her well enough to ask where exactly she stores it, but I can tell you it can be a little disconcerting for others to see her reach in and pull it out when she needs to make an adjustment. I wear mine on a belt clip, and there’s really nothing I’ve ever worn that’s presented a difficulty.

I’m glad I elected to switch to the pump, and I hope that if you go that route, you are too. When I was first considering a pump, I did a bit of searching around on the web, and I can say that almost everyone who had switched seemed to be glad that they had done so. I’ll be happy to answer any follow-up questions regarding my experience, if that would be helpful to you.

5

My sister has one. Frankly, I believe she uses it as a excuse to eat badly, however she just loves it. She had to take it off and use regular insulin on her wedding day because of the dress and when she gave birth. She couldn’t strap it to her thigh for the wedding because the strap didn’t fit because she uses the pump as an excuse to eat badly. I’m not sure how her numbers are exactly, but she hopes to try to get pregnant again in June and let it slip that they aren’t really good enough for that.

6

Thanks, everyone! The info my doctor gave me was pretty thing on personal experience and thick on technical jargon. I still have to meet with the guy who does pump set-ups and blah blah blah. Hearing the from real people is great.

What happens when that happens? Do you get a burning sensation from the air bubble?

That’s good to hear. My insurance can be a little bit weird, sometimes. For example, for the past few months, they’ve only been letting me have 50 test strips a month, which is not enough at all. Then I got a new prescription, basically identical to the old one, and all of the sudden I get 250 strips a month. Weirdos. I figure if the pump manufacturers are pushy with the company, things will go more smoothly.

How long was your adjustment period?

I’m supposed to be checking my blood sugar about the same number of times, though it ranges from 4-8. My doctor made it sound like that would remain the same.

I don’t do any adventure sports, so I think I’m in the clear there. I’d be more worried about it getting mucked up in the barn, honestly, but if I can clip it between my breasts, that reduces the likelihood of that.

Well, cyborg is the new sexy, and it can’t be anymore awkward than a thousand other things that could possibly be awkward in that situation.

That’s what I’m discovering, too.

One more question: How do you manage your diet – counting carbs and all that? Now I just give myself a unit of Novalog for every 10 carbs, no allowance for glycemic index or anything. Do you take the GI rating into consideration?

7

My friend who has one doesn’t like the elastic strap because it sometimes slides unexpectedly down her leg and toward her ankle. Like pantyhose, but more awkward.

Can you explain what you mean by the last sentence? Do you mean her control isn’t tight enough to get pregnant?

8

Nothing so terrible as that. Immediately after inserting the set, I’m supposed to give myself a small bolus to fill the cannula. When I look at my pump, and see that it’s still in prime mode, I immediately realize what I’ve done, and smack my forehead. It’s only the forehead bruises that are painful.

Then, I detach the tubing from my abdomen, prime that, and re-attach. My only concern is that by doing it this way instead of the way I was taught, which is to prime before inserting, with the cannula bit still attached, I might be getting more air into the injection site than I would otherwise, and somehow affect my absorption rate. From experience, though, that doesn’t seem really to be a problem.

About 6 months. Longer than it should have been, for a number of reasons. Before I got the pump, I was under the care of just my GP. When I got it, I switched to a new doctor for diabetes-related stuff, an endocrinologist. I’m pretty insulin-resistant, and it took a while to convince him that I really needed as high a basal rate as I did. This was partly my fault as well; I was overly reliant on his advice, and hesitant to make the adjustments to my pump that I really knew were needed until he had approved them.

I count carbs, and base the size of each bolus on that. And then I try to estimate the overall GI for what I’m about to eat (this comes from experience more than anything else,) and base the bolus delivery on that.

With my pump model, and I suppose most others work similarly, I can schedule an arbitrary portion to be delivered immediately, and the remainder to be delivered over time, for as long as 30-minutes to 4 hours, in 30 minute increments. For a high GI meal, I push more up front. For a high-fat meal, I lengthen the tail-end of the delivery, because I know the fat will slow the absorption of the carbs.

9

With my sister, the strap didn’t fit around her leg.

Yes, that’s what I mean. She really pushed it with the first one, conceiving after her control had been good only about 6 weeks. One doctor had told her it should be at a certain place for a year. She declared him a “quack”. It takes all kinds of diabetics, I guess.

10

I’ve read in multiple places that you should aim for tight control for a minimum of three months prior to conception. That’s what I personally aimed for with my second and third pregnancies. (I was actually diagnosed during my first pregnancy, as a result of the GD test they do in the 28th week, so lord only knows what my numbers were early on in that pregnancy, but luckily Whatsit Jr. came out okay.)

Anyway, I’m type 2, but I used an insulin pump during most of my 2nd pregnancy and all of my 3rd, after having been on multiple daily injection therapy during some of the 1st and part of the 2nd. I loved it. Loved, loved, loved it. And I hung on to the pump because if I ever need to start insulin therapy again (a possibility; my numbers haven’t been great lately) I’m going straight to the pump. No more needles for me, thank you very much.

Although actually it wasn’t the injecting that bugged me, it was the inconvenience of having to carry around syringes if I wanted to eat at a restaurant or whatever. The pump is really, really convenient that way. If you want a quick mid-day snack, no problem, you just bolus for it. If you decide to go out to eat for dinner instead of eating at home, no problem, your insulin is automatically with you. Coming off of NPH, it also allowed me to sleep in on weekends instead of having to get up to eat in order to catch my NPH peak, but I think that is not so much of a problem for people who are on Lantus or whatnot.

We never had an issue of it getting in the way during “intimacy”. The hardest thing for me was learning to sleep with it, because I typically sleep sans pajamas, and so the pump just kind of floats nearby, not attached to anything. This was a bit weird at first, but I got used to it pretty quickly. Although one morning I woke up and the tubing was actually tied in a perfect square knot. I’m still not sure how I managed that one. (The tubing is flexible but still stiff enough that tying it in a knot didn’t affect the insulin flow.)

As for carb counting, I just bolused on a set ratio. The ratio changed as my pregnancy progressed, but I think I started out at 1:15 and then wound up at something like 2:5 by the end. I had five basal rates set for various times of the day.

Anyway, I personally would highly recommend an insulin pump. I loved, loved, loved mine.

11

Spouse checking in here. We just did one of these a few months ago when Lynn Bodoni was looking at it, perhaps she can chime in with the results?

My wife just changed to the OmniPod and loves it. Aside from the “no tubing” aspect which makes sleeping a lot easier, it also forces more control. Each of the pods you wear holds a certain amount of insulin. And you can’t add any more to that pod once you’ve filled it. The pods only last for 3 days maximum…so you have to really plan out how many units you’re going to use. And then stick to it. It makes it easier for her to not eat that extra snack knowing that it may cause her to run out before the 3 days are up.

I can’t speak to the different types of insulin or long term sugars or anything like that, but I’ll ask her to take a look at this thread tonight.

12

This is the spouse of Atrael replying…
I have been diabetic for 26 years. I was on two injections a day for 19 years taking R and NPH then switched to a pump about 7 years ago.

I definitely prefer a pump to injections without a doubt!! Let me try to explain it like this… One shot in the morning to cover breakfast…snacks…and lunch. A shot at dinner to cover dinner and snacks and throughout the night. It was a set amount for each shot…something like 5 R and 50 NPH for the morning shot and 5R and 15NPH for the evening shot. To me it worked for 19 years because I didn’t know any different. I watched what I ate and hoped and prayed when I had my H1c checked that what I ate was okay.

I went on the pump to get under better…tighter control. My H1c was usually around 8 or 9 when my doctor suggested the pump. I did think about it and talk to my husband about it when I got more information from the doctor.
It just makes sense to go on a pump!!! I call it my external pancreas. It is set…with help from the doctor for an hourly amount…it is called a basal amount. It is a small amount given each hour to cover what your body just naturally needs. Then…whenever you eat…meals/snacks, you give yourself extra insulin called a bolus amount…insulin to cover whatever you decide to eat at that time. I use the Humalog insulin…it is quick acting…covers what you need at that moment.

I check my sugars when I get up…before breakfast/after breakfast…midmorning…before lunch/after lunch…midafternoon…before dinner/after dinner…mid evening and before bed. Checking during the night is a good idea if you just happen to wake up for any reason.

It is sooooo discrete. I carb count. I think about whatever I am eating then give myself the insulin I need at that moment to cover that food.

I used holder called a “bra thing”…the pump sits in and it hooks to the side of the your bra and just hangs to your side. Very easy…very discrete…and once I got used to it, it would put it on in the morning…pump through my clothes during the day and take it off my bra and hook it to whatever I slept in at night.

The also have something out there called a “thigh thing” that you could wear under a skirt.

It wasn’t tricky to use or assemble once you are taught…just please make sure you go through training and ASK questions…there are never too many questions.

I started with a Disetronic pump that I loved for six years (went out of warrenty and the company was sold and they wouldn’t do any repairs)…moved to a Deltec Cozmore which I loved for a year…then found the Omnipod which is completely wireless and tubeless…
it is all personal preference…do a lot of research first. Once you get one, the insurance companies don’t like paying for them then having you change your mind if the pump is still under warranty…usually four years.

The insurance companies are tricky…check into yours first…ask if the pump is covered…and if the supplies are covered. Every company is different and every fight is different…pump/insulin/test strips…the amount of coverage is sometimes set regardless of what your doctors says unfortunately.

My sugars are under tighter control with the pump than without…before the pump, like I said earlier…8 or 9 H1c with the pump, they are 6.5-7.

Beach days…pool days…some are water proof others are not…check before you buy. I just take it off…swim then put it back on…same thing I did when I showered.

They are the best things I think…takes time to get used to. Your doctors office will help you get everything set…it took me about a week to get the numbers right and a few months to get used to it. Check your sugar often and sleep with OJ by the bed at night if you are nervous…You will be fine…The are WONDERFUL!!!