The Pump Debate

Hi! My name is Ashley and I have had type 1 diabetes for 16 years. I’m currently in nursing school and work as a CNA in a hospital. I have recently started to debate the subject about getting a pump. I’ve been on insulin injections my whole life and I have a CGM. I have good control of my blood sugars, my A1c is usually around 6.2. I’m considering getting the pump because I live a busy life between school and work. I’m trying to keep good control of my numbers while making it easier for me. Any thoughts?

Ashley, a few thoughts. 1. wait till 2017 when artificial pancreas pumps hit the market. 2. As you age and move more into a career, you will likely burn fewer carbs, which begins the possible trek to higher A1Cs 3. The pump always brings improved control and frees you from the constant pain of injections. This will be all the more true with the advent of the AI devices. It will even likely reduce the frequency with which you have to visit the doc.
Finally, it will likely extend your life.

check these two sites on APs:

Just researched a web link; got some new advice that seems to be well-confirmed; very important.

"After you fill the reservoir with insulin…usually people take off the plunger and then screw on the cap that is attached to the tubing.

Don’t do this. Leave the plunger on and screw on the cap. Then flick the bottle and push the plunger up ever so slightly to get rid of the extra bubbles and get the insulin started up into the tubing. Just couple inches of insulin in the tubing will do. THEN take off the plunger and continue with your other steps."

I’ve had T1 for 32 years, MDI for 19 years and pumping for 13. I would not give up my pump unless I absolutely had to, for these reasons. First, the ability to set different basal rates for different times of day, because I have dawn phenomenon and I could not make the long-acting insulins cover that correctly. Second, the ability to bolus insulin for even the smallest bite of carbohydrate (think potlucks or when you just need a little snack). Third, the ability to turn down my basal insulin before and during exercise to avoid going low or having to eat first. There are many more reasons others could list, but it’s all about flexibility and trying to mimic how a normal pancreas works. I know there are lots of people who make MDI work for them, but most are the type that adhere to a pretty rigid schedule and do and eat roughly the same things at the same time each and every day. For them, I can’t dispute that MDI works great. For the rest of us that have erratic schedules, like to travel, or like variety in life, pumping is quite simply the bomb. : )

Hello again @Ashleymkuhn,

I second everything that @angivan said and add another point or two in favor of using a pump. For years I resisted trying pumps that were offered - the first approached the size of my forearm - because I mistakenly thought they would “control” my lifestyle and limit my activity. I discovered how wrong my was when a little over 11 years ago I got my first pump - very freeing.

My first dozen years I tried surviving [yes, surviving as it was then put by the medical profession] on one daily shot of NPH, then spit the NPH into two shots daily because my insulin needs started exceeding 100 units the largest size syringe. In the later 1970’s a Joslin doctor suggested that I try Regular with meals and NPH at bedtime for background. Being extremely brittle and only very crude test strips for guessing at BG levels [low, medium or high] I was able to get pretty good control. Then came the pump for me.

As Angi said, we are able with the pump to have various levels of background or basal flow at different times of the day - mine vary from 0.65 uph for four hours to cover “dawn phenomenon” to my afternoon 0.175 uph. I have found that a rate change of .025, which my pump allows, has a significant effect in my life. What I most like is the flexibility with meal scheduling which came in very handy when in business with travel and of course during receptions where snacks were available - yes, without stepping away from a conversation a few button pushes on my pump was a comfort knowing I wouldn’t get into trouble.

Being somewhat familiar with hospital worker environment [our daughter works ER and is often running around non-stop for 12 hours, and my times as patient] my belief that you would certainly benefit from a pump.

I’ve been on 4 different brands of pumps. I am currently on a T slim and love it! I have hade type 1 for 53 years and was on MDI’s for a few years before I got my 1st pump. I’ve had Medtronic, Cosmo, and Accu-chek. The T slim is all electronic and comes with a CGM. I quit using the CGM because, although it is the most accurate out there now, you have to double check before you act on an alert. This didn’t seem to accomplish anything to me so now I just do finger sticks. The pump requires a few steps to deliver a bolus but that makes it far more unlikely to accidently give a wrong bolus. You can give a quick bolus, without looking at the pump, by just pressing a single button. I do it for meals. You can give a correction bolus and the pump shows you “insulin on board” and adjusts your bolus to it. I can’t say enough about all of the good things this pump has. I wouldn’t go back on MDI’s again. You really need to check it out.

I was diagnosed in '82 and have been on pumps since 2006. As Dennis said, it was “freeing”. However, recently I have been dealing with scar tissue left by the pump needles. I have a new pump, the 530G from Medtronics. It has built-in CGM, which helps with the control but has the problem with creating more scar tissue. To deal with that, I take “breaks” from the pump and use pens with Lantus and Novolog for two or three weeks at a time. I hope the info helps.

I have only had T1 for 4 years (I was diagnosed at 20). I have been on the Omnipod for 3 and I LOVE it. Before I was using pens, and I was resistant to pump therapy because I didn’t want to worry about tubing or about having to disconnect. With the Omnipod, none of that is an issue, and it works well combined with your CGM. (I also wear the Dexcom G5).

Just to balance the views here, my daughter and I both used the pump for 12 months. We both hated it. My A1C results were NO different on the pump as off (7.2%). I suspect you will be similar, as CGM is already providing you with information - this is what the pump lacks.

MDI does not give you insulin on board (IOB) tracking - and this is the major thing that prevents over-dosing. Your CGM is helping you avoid that.

We now use the PredictBGL App, which calculates doses like a pump, tracks IOB like a pump, and also give dose coaching and predictions. My A1C is now 6.1%. My daughter’s also dropped from 9.2% to 8.1%. Can’t speak highly enough about this product. Game changer.