The Pump and Good Control + Any Psychological Issues

 How long does it take wearing a pump to get that good control and are there psycholgial issues to get past ?? thank you ...

Meme,

I don't think there's a hard and fast rule for that.  Everyone's situation and mindset is different.  Also, a pump does not always equal good control for everyone - so that's a tough question to answer.

 

When I wore my pump the first time around - ages 15-20, i had good control the first year, and then i didnt.  And it was because i couldnt get over the psychological issues. 

After a short amount of time, i got burned out explaining my pump to people.  "no its not a beeper.  no i'm not a drug dealer.  yes, it sure does look like a cell phone. or an ipod.  or whatever else.  no, there are no games on it. etc, etc."

And - this is going to sound awful - but in college i enjoyed going tanning quite a bit, and i found that i would get little circular tan lines where my infusion site was. 

i dont know, for a while i just got tired of being such a spectacle, and after a while, it was just too much.  my control was terrible anyway, so i went off the pump for a while.

I currently wear a pump again, but i didnt make the decision lightly.  i saw a therapist before-hand, and it really has made all the difference.

as i've said before, pumps come with their own set of frustrations and insecurities.  treating the emotional aspects of T1D (i think) is just as important as insulin and food.

(to be honest, this site has proven to be very helpful in that aspect)

I agree that it's absolutely different for everyone.  In my case, I had a very easy time getting over any hang-ups I had about being hooked up to a "machine."  But I was 26 when I was dx'd and had a little brother who'd had D for 13 years and had been on a pump for 3...and he LOVED his pump, so it made it a much easier transition for me (I only did MDI for 2 months). 

It was absolutely the right therapy for me because I was really active (100-mile bike rides, triathlons) and I needed the flexibility of treatment that a pump offered me.  I've read what other have said about it sticking out and sometimes it is a pain to hide (especially if you're dressed up for a wedding or a nice occaission) but I'm not one who really gives an eff what anyone thinks about me or my diabetes, so in that way, it hasn't bothered me.  I just spent a week in Hawaii and wore a bikini with my infusion set on my belly and my pump hanging off my bottoms and didn't care one bit about it.  But again, I was much older (late 20's) and already married to a man who is extremely supportive and loving when all this happened to me, so it makes it a lot easier for me to deal with some of the psychological issues associated with it.  I think if I had to go through this as a teen, I probably would have felt a lot differently and may have struggled more with my emotions about it.  Actually, I know it would have been different.

I think the biggest thing is that a person who goes on a pump should want to do it for themself.  Not for their endo or even their parents.  If you have made the decision for yourself that it's the best thing for you (and not anyone else) then I think  you may have fewer issues later.  This is just my theory though, maybe I'm way wrong.  I guess I'm just trying to caution you against making your daughter feel like she HAS to do this.  There are plenty of people who have great control on MDI, and don't feel the need for the pump.  It really is an individual and personal decision. 

Ive known people who it worked great for, and those who it didnt -- some just get too careless with it and dont consider how much they give or dont give, b/c without taking an injection its soo easy to bolus too much, etc.. & some unhook it for too long. my bf does the MDI and he really takes maybe 1 injection of Novo R a day, and then the Lantus, his bgl's are great, diet exercise, etc.. a1c at dx was 12.3 and bgl at 700 :*( and been 5.4-5.7 A1C since about four months after :)

each individuals need their own individual plan, it depends on the person, & I know there are some who prefer others only know about the type 1 on a "need to know" basis and that a pump would make it obvious, & they dont want ppl treating them different or asking questions --

Yeah, totally depends. For me, the first day I was on the pump I had no lows, and I was sold. I cried a lot for the first month or so of wearing it, but it wasn't because of the pump. I actually really loved the pump - that I could be high tech, that I could bolus without people saying "ew" or "i could never give myself shots," and most of all that I could eat fruit!

I think it's really interesting that so many people say that the pump makes them more conspicuously diabetic, because I had the opposite experience. I went from feeling like a freak anytime I had to pull out a syringe and draw up insulin to feeling like a person who could go out to eat with friends, or eat seconds, or go for a hike without carrying a picnic basket full of juice boxes. I feel like being on a pump has made me so much more normal. And because of that I don't mind clipping it to my harness when i go climbing or to my pants when I go running. It lives in my pocket most of the time, and sometimes it gets in the way, and sometimes i get mad at it for alarming when it's low on insulin, or when i should test, but i hope to never have to go back to MDI, to the comments from people all the time about how hard it must be, or about what I can't eat, to the constant lows and constant stress. 

So, anyway, for me the psychological issues were largely solved by the pump, and I had noticeably better control immediately. YMMV.

If you are not ready to change your approach to D and managing it and are not anal about BG testing, you will get over the psyc challenges. After 14 years on four pumps, I still have a few choice names for it and all that it brings. However,  I thing your patience level must be greater than when on MDI to handle the "pump" challeges.

The big thing for me was the difference between knowing exactly how much insulin was in my system and guessing with long acting insulin, which cannot be adjusted based on activity, sickness, drug induced resistance, and other things that had me guessing for days with MDI, only to find that the change I made is not needed that day. 

Add the CGM to the mix and your ability to control BG is astounding compared to MDI. But with MDI I did not have that "thing" attached to my body.

I had some issues but not with the explaining things to people. For me II have a difficult time with knowing that my life depends on the machine. Now I know that it's not going to kill me but it can does have a great impact in my life. I was on the pump for 2 years starting when I was 18. The pump did as I feared and I had forgotten some of the rules when you go high on the pump and stay high. I ended up in the hospital and than made the choice to go on lantus. I hated the machine at that point. I was under control up until that time, being on the pump. After a few years on lantus and once again having bad control the doc's and I made the choice (and they had to really work to talk me into it) to go back on the pump. A new model this time. I do have good control on the pump, better than when I am off of it. I do still bounce around a bit and some days are worse than others, it's just not as bad. It does depend on the person wearing it and how you feel and deal with other people (non-diabetics), for me getting to educate them is fun, but it can get tiring at times. I have known small children that are on pumps and most of them seem to be okay with the little machine. The hardest part is getting the infusion set in, it looks like the needle is WAY big at first.

[quote user="MaryMartha"]

The hardest part is getting the infusion set in, it looks like the needle is WAY big at first.

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Yes, I affectionately call it the "harpoon".  :)

[quote user="Kim"]

[quote user="MaryMartha"]

The hardest part is getting the infusion set in, it looks like the needle is WAY big at first.

[/quote]

 

Yes, I affectionately call it the "harpoon".  :)

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no kidding huh! I still get nervous when I change my infusion set. The worst was when I lost the devise that inserts it, I had to cram that thing in by hand! I have 4 extras now, one in the car, one in my travel kit, and 2 spares, just in case!

i'll have to admit, i never had any psych problems related to the pump. i'm plenty crazy, but it was all there prior to pumping and will be there after it :D  like i've said before, i had good success with MDI and have had good control with the pump. i switched for convenience, not better BGs. i think because of that, i never worried about where to hide it, or think about being attached to it. the only time i ever notice it is when it's beeping at me or i've snagged the tubing on something, then i get frustrated, then i get over it . :o)

even when i'm wearing dresses or skirts or tighter clothing, i've found plenty of places to put the pump. nestled between the boobs seems to be a good place (there's plenty there) to hide. clipped to my undies, in a pants pocket, or on my waistline are the other places i put it. no one seems to notice a lump under my clothes and it looks like a pink cellphone or a pager anyway. i have a few halloween photos where i'm wearing some skimpy outfits, and unless i told you where i was hiding the pump, you'd never find it. i also think that because pumps are more prominent now, people pay less attention to them.

i have always had a good group of friends and family who really don't care that i have diabetes. the switch from shots to the pump never phased them or me. because i don't treat diabetes like a big deal, i think it's made it easier for my friends and family to be comfortable with it.

When I had a pump I had control immediately.  I got it around 15 and I had for 1-2 years.  Psychologically I had a very hard time with it.  I was never the "cool kid".  I had thick glasses, a space between my two front teeth (in middle school) and morals.  Moral which sorely lacked in the middle school and high school I went to.  When I got the pump I was teased constantly. "There goes the freak..." "Did you see that thing in her stomach?" and "Hey baby, what's your pager number?" (In a mocking tone of course).  I even had some horrible classmates come up to me and rip the cord right out and it hurt really bad.  I would have to say that young people really need to think hard about it because not everyone is the same physically or emotionally and kids can be mean.  Also the school officials didn't really deal with the situations at all, including students ripping it out, (incredibly painful, btw). On top of everything, I had bright red spots on my stomach (which took forever to heal and fade) and I just wanted to fit in as a normal teenager.  I was teased so bad I hid in the bathroom during lunch.  I also got in trouble if an alarm went off due to the pump during class, teachers don't always understand. Sometimes you get one that puts all students into one box and any child that doesn't fit in the box gets in trouble.  I think I expressed my point that it's really tough getting through the barriers as a teenager and it was very exhausting for me.

I stopped using pump therapy and now I am 25 and married.  I want to have children and I think the pump is the right way to go, especially with the busy lifestyle I have.  Society is more understanding of individuals with exceptional needs than when I was a kid.  (Also adults are more mature, sometimes) I think I will have an easier transition because I now surround myself with people who care about me and I don't think about the people who don't.  The people who care about me care about what's best for me.  I suggest discussing it with a significant other.  I talk to my husband about it now, to help him transition.  Sometimes people are scared of medical equipment because they don't want to hurt the people they love.  I think a discussion about the pros and cons of pump therapy will help a lot with any concerns a significant other might have.

It's a hard decision but what matters most is your health.  I think it's important to let you kid decide.  I would also suggest finding better ways to conceal it for safety and for self esteem especially in teenagers.  At 15, girls just want to fit in and the pump just got me more negative attention.  For some people it's okay having the pump because they don't have the same circumstances with classmates.  For the kids who just want to be left alone and not have to explain everything to everyone, I think there should be a convenient way to conceal it.  There are a lot of interesting tricks on the web.  Also, buy pad inserts for a bra.  Put the pump on one side and the pad on the other.  No one can see it and you can wear a low cut top.  The internet is wonderful because there are many useful tricks.

Hi Meme,

I read your post on the other thread as well, but I thought I'd just reply to you here.

Good control is really an individual matter.  The best control with a pump is usually achieved when the user really understands all the functions that the pump can perform, and takes advantage of them.  For both of the pumps I have had (one Minimed and one Animas), it took me about 1 week to really get comfortable with the mechanical use, but this can differ greatly by age or by general technological inclination.  It also depends on the user's ability to devote the necessary time and energy needed to succeed with pump therapy.

Psychological issues with pump therapy can range from severe to not present at all, and obviously depend upon the person in question and their surroundings.  Judging by my own observations and conversations, I think that emotional difficulty with the pump is more prevalent in women than in men, and more so in younger women than older.  Although I could talk forever theoretically about all the potential issues, it is probably best just to share my own experiences.

Before I talk about the emotional downsides, it is important to note that I did make the choice to start and continue insulin pump therapy.  No one convinced me to go back, and the decision was completely my own, although the pressure from the diabetic community to use a pump seems ever-present to me.  I had reached a point in using MDI that I couldn’t really improve my glucose levels any further.  This was largely due to the restrictive nature of the basal insulin used in MDI- I couldn’t adjust the amount for different times of the day, and it was clear that being able to do so would benefit my blood sugar levels.  This is why I switched back to pumping.  I could’ve cared less about the number of times I had to inject or the amount of stuff I had to carry around.  (To me, having a 3-day long injection is worse than multiple daily injections that lasted for mere seconds, and two little insulin pens hardly made a dent in the amount of room that exists in my collection of large purses.)  My ability to manipulate my basal rates is what keeps me on the pump.  As I said before, I have chosen to prioritize my physical health over my psychological health- therefore I remain on the pump even though the pros DO NOT outweigh the cons.

My biggest psychological problem with the pump is that I feel like it takes away a certain level of control over my life.  Many people might think this is contradictory to what the pump is supposed to do, but I disagree.  The pump inhibits my ability to be myself.  When I choose what to wear everyday, I must think about whether it is feasible with the pump, instead of simply if the clothes reflect my personality, mood and comfort preferences.  I have heard many times that I am vain to have such concern over my wardrobe, but it is not a matter of vanity as much as matching the outside to the inside.  I have high self-esteem, and I love who I am and how I look, but the pump interrupts that.  It is hard for me to feel beautiful with a machine attached to me, or when I see the tape holding the insertion set to my skin.  Also, I constantly have to be aware of the placement of my infusion set- feeling like I have to protect a certain part of my body (beyond the natural tendency to do so) is a burden.  Playing with kids, playing with my dog, playing sports, and being physically intimate are all cause for nervousness on account of the pump, which doesn’t let me be my normal self.

Another issue is that the pump is a physical symptom of an otherwise invisible disease.  Its continual presence on my body reminds me constantly of something that I hate, and opens up my condition for the world to view and comment on.  Using MDI, people have the power to control who sees the evidence of their disease.  Seeing the pump seems to be an open invitation to some people to address you about it.  I do not understand this, and I do not like it.  I prefer to have control over disclosing my condition, which allows me to easier prepare to answer questions and correct misconceptions.  The only way to control this with the pump is to attempt to hide it, which is not an easy thing for me to do without severely limiting the type of clothes I wear.  I am not significantly endowed up-top, so hiding it in my bra is a poor solution- the bulky, hard rectangle in my lack-of-cleavage would obviously draw more attention than just clipping somewhere to the outside of my clothes.  I have tried many strategies for hiding the pump, but most of them sacrifice my comfort, take too much work, or keep me from wearing what I want to wear.  There is no easy fix- often times, I have to give up something in order to make it work.

There are lots of smaller issues, but this post is already ridiculously long and I’ve included the things I think are most important.  I’m sure people will think I have things I need to “get over”, but I don’t see how it would be appropriate to change who I am in order to accommodate something that I do not want.  I do envy those who do not have these kinds of problems, but that doesn’t mean that I can become that way with a simple change in attitude.  The way I see it, the issues I have are permanent.  Meme, your daughter may decide to use the pump and never have any problems, but if she does start pump therapy, and finds that she has emotional issues, the best thing you can do is be there to support her, listen, and try to understand her feelings.  Some people discontinue pump therapy because of something psychological, and there is nothing wrong with that, but physical health needs to be considered as well.  For me, there isn’t any GOOD way to treat diabetes, but it’s definitely easier when the people in my life support me and help me feel less alone.