Replies to This Discussion

Permalink Reply by Stephen Gobin on October 5, 2010 at 10:21am

Can't really offer you advice either way because I'm in the UK where pump usage barely registers on the radar. Pumps tend to be used only by those diabetics who despite every effort find it difficult to get HbA1c down to within a decent diabetic range, or who are pregnant, or who need third-party assistance to get out of a disabling hypo. You actually raise an interesting point, though, when you say that the pump hasn't helped your HbA1cs that much - this is another argument that's used in the UK whenever there's talk about expanding pump usage.

So, as you can probably guess, I'm on MDI and my last HbA1c in August came in at 6.8%. I've mostly tended to hover around the low 7%s in recent years. What I suppose I'm saying is that it is possible using MDI to get your HbA1c to within the current recommended range for diabetics, but like everything with diabetes it's hard work.

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Permalink Reply by Jessie on October 5, 2010 at 11:00am

I have had the pump for 6 years and I do remember being pretty frustrated in the first years because my A1c actually went higher. Then I started checking my sugars like crazy (8 - 12 x a day) and using the pump fully as a tool. They have been steadily dropping and I am no longer on the blood sugar roller coaster... I stay nice and steady.

I started using the continuous glucose sensor because I wasn't feeling my lows anymore, and now my sugars are always between 60 and 200, which is very tight for me! My last A1c (October 1, 2010) was 6.2! My lowest since diagnosis!!!

As for your post, I felt the need to respond because I do Health Psychology research and am investigating the decision-making process for choosing the pump. One thing that you should really look into is the "pump holiday." There are people who take a pump holiday each weekend, or one month out of the year, etc. Just be sure to discuss this with your doctor. I take sensor holidays and they help me relax :)

Best of luck in making your decision!

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Permalink Reply by Kelly WPA on October 5, 2010 at 11:22am

I just started pumping at the end of June, so take my 2 cents for what is worth! My A1cs were in the 5s on MDI so I am not expecting big changes with my A1c either. Having the pump attached to me doesn't really bother me. I do like the multple basals - I can't do that with Levemir. I did my Levemir 3 times a day because it onlys lasts about 7 hours before me. For me, that mean hearing alarms at 11 Pm in case I fell asleep early and 7 AM in case I did not wake up early. Even though most days I am up early, I did not sleep very good last night and fell asleep about 6 AM and slept until almost 9. That wouldn't have hapened if my alarm was going off at 7 to take Levemir. For me, the basal is the biggest reason for continuing on the pump.

What I don't like about the pump is that my Apidra seems to die off at about 45 hours so I am having to change my cartridge every day and a half. If I forget, my BS skyrockets. I am using steel sets so I have to change those out every 2 days. I seem to hit alot of bad spots. I feel like I am having more highs on the pump for those reasons and that bothers me. If I give myself an injection,. I know the insulin went in.

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Permalink Reply by Trudy on October 5, 2010 at 11:23am

When I started on MDI some fifteen years ago, I was on a terrible roller coaster and felt awful. Earlier insulins were not as good as now, but starting on the pump was the biggest factor in getting control. After a few years, I lost places for pump sites, so now I'm on the pump part time, saving it for holidays, active weekends, and so on. However, the difference between MDI then and now is how much I learned being on the pump. I try my best to imitate what was going on with the pump, from basals to boluses. I feel better and more free on the pump, but my A1C is just slightly higher on MDI.

When/if you go on MDI, I think which basal insulin you use and getting the amounts right will make the difference. I prefer Levemir, but whether Levemir or Lantus, please split the dose. Best luck.

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Permalink Reply by FHS on October 5, 2010 at 12:05pm

On MDI, I had everything from horrible control to phenomenally good control depending completely on how much work I was willing to put in, so I don't think the method used is really all that criticai.

I've been on the Ominpod for a month. I have to say, as a new podder, I prefer pumping, or I should say pumping with the pod, way more than MDI. I don't know if I have better control yet, That will ultimately determine if I stay on the pod or not, but it would have to be a lot worse than my control with MDI.

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Permalink Reply by Heather on October 5, 2010 at 1:07pm

Hi Kimmy,

Coincidentally, I just made a similar post a couple of days ago. I've had a pump for 4 years. The other day it broke, and that little hiatus while I waited for the replacement pump prompted me to buy some Levemir and go back on MDI for a while. Like you, I haven't found that the pump has made much difference at all to my A1c levels, and I have to say that I'm really enjoying not being tethered, as you say, to the device! Having used a pump, I feel more knowledgeable about the whole business, and I expect my pump knowledge will help me manage MDI better than I did before. I have no idea how long this pump holiday will last, but for now it's great.

Cheers,
Heather

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Permalink Reply by Jennifer on October 5, 2010 at 3:31pm

The other thing you want to consider is do you use or pump as a tool now? As in, do you frequently do dual wave or square wave bolusing? I find that the pump gives me a tremendous advantage when it comes to foods that I had to completely avoid while on MDI (or give 2-3 spaced out injections just so I could eat, say pizza).

I have been pumping for just about 5 months now, and currently do not mind the tethering. The pump has changed my life. I do agree that sometimes you just need a "pump vacation" where you take a break to regroup. Have you considered "untethered" pumping - or getting your basals from an injection, and leaving an infusion set in to bolus/correct? Many kids are doing this in order to fufill their very active lifestyle/playing.

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Permalink Reply by barbraann on October 8, 2010 at 6:42pm

I was on MDI (actually vials and syringes first) for 34 years. Finally went on the Omnipod about a month ago (like you FHS) I've always had excellent A1c's (5.8-6.4) so I don't expect a lot of improvement there. I never had a problem taking shots or really any part of the whole MDI thing, what I really want is to be able to exercise and not eat 200 calories to keep my BS up! I could never do the tube thing so the only choice for me was a tubeless pump.
Maybe the Omnipod could be the answer You're not "tethered" but you have the control and freedom that a pump offers.

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Permalink Reply by Gerri on October 8, 2010 at 9:20pm

People take pump vacations, so take a break & you can always go back to pumping.

I'm on MDI. Other than the expense of a pump, the problem of scar tissue concerns me.

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Permalink Reply by ClumsyChemist on October 9, 2010 at 6:17am

I love my pump but it did little for me in the way of improving my A1c until I made a conscious decision to be a better diabetic. In the beginning, I treated it the same way I treated my shots - never made any effort to improve my basal settings and just boluses exactly as I did pre-pump. Now, I have multiple sets of basal rates for different activities, I measure my food and bolus ahead of time (sometimes - I'm still pretty bad about this one) and follow my Dexcom closely after meals to fend off spikes and learn how to adapt my bolus routine and basal rates. These are the types of things that finally brought my A1c that was over 9, and sometimes in the double digits, down into the 6s. If you hate the hassle of the pump cord, by all means, go back to the MDI, but still work on improving in some other areas to bring the A1c down.

Michael Hoskins went on a pump hiatus a little while back and wrote some good things on his blog about his expereinces of pump verses MDI that you might find interesting: http://thecornerboothcc.blogspot.com/2010/03/parting-is-such-sweet....

Good luck figuring out what you want to do!

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Permalink Reply by Leo2 on October 9, 2010 at 10:26am

Kimmy,
Pump vacations sometimes bring out what's good about a pump. So if you go off, will the insurance company go nuts about letting you have it and its supplies again without difficulty? Are you able to ask someone who has knowledge at the insurer? The problem is that if they think you can do without, you'll end up doing without. Are you willing to live with that? Are you using the pump's statistics, dual and square waves, etc?

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Permalink Reply by ClumsyChemist on October 9, 2010 at 1:16pm

You have a good point, but I'd like to add that if you are planning for the pump to fix your problems you will always be disappointed. The tool is only as good as you make it. Before giving up on the pump, try using some of the advanced features and see how you feel about it then. If you're still not liking it or it's still not helping you get better control, then switch back.

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