What's the worst that can happen when you go onto pump?

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Permalink Reply by Cara Bauer on March 5, 2009 at 3:18pm

I've been on a pump for 10 years. I love it. I've never needed medical intervention ever. The worst thing which can happen is a malfunction on the pump either the catheter is bent and no insulin is going in, or something malfunctions in the pump itself. Its happened to me a handful of times, but Minimed overnights a pump to me when the pump malfunctions.

The pump makes life easier, but you still need to test, esp. after changing infusion sets, to make sure its working properly

I will never give up my pump. Its made my life much easier. I don't have to eat on a schedule anymore.

Cara
Mom to 3 (Lily - 10, Caroline - 7, Samuel - 4)
type 1 for 12 years
pumper for 10

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Permalink Reply by Jessica Rasmus on March 5, 2009 at 3:52pm

I am not on the pump but i have heard some negative feedback about it, mainly concerning other people thinking it was something else. A friend of mine who was on it during high school said she had several people think it was some kind of new MP3 player and go reach out to grab it to look at it off her pants.... or a teacher assume it was a cellphone and end up telling her she needs to remove it, and when she said no would end up in the office (atleast during the first month of school)

The only other negative story i know was a girl at my university had a low BS but her pump malfunctioned and continued to give her insulin and she ended up passing out and in the ICU with her skull cut open to relieve the swelling. She may have been a new pump user, im not aware of those details... but it makes it sound scary enough to me

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Permalink Reply by Dave   _ on March 5, 2009 at 4:12pm

Pumps have safeguards to prevent "runaway" action. The more likely culprit is she simply programmed too large of a bolus and or basal for her needs. MM pumps have numerous redundant safety checks--the pump constantly monitors it's electronic condition.

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Permalink Reply by Stuart on March 8, 2009 at 12:02pm

The "risks" of pumping are absolutley no different than using MDI, with a couple of exceptions... in my limited experience at least.

DKA whether from being disconnected/non-delivery of the insulin gave me far, far more dangerous DKA's than I had ever had in the decades previously combined!!! In short the pump severely increased exponentially the number of DKA's I had for proceedural and technical delivery errors. I was definately not a fan of pumps at all because of it..

I offer that as a serious problem to be careful-watchful about.

There are a couple of mechanical problems w/ using any pump, eg Getting the tubing pulled out/caught on something because of where the pump and infusion set were placed. It can get snagged on a door handle, etc., etc. A little practice should take care of that one.

The other was simply the expectations, the hope, the mandatory belief that the pump will be some kind of magic wand, and "fix" things does not mean it will do so. Folks try them, for short time and long time periods and many do walk away after those experiences!

Stuart

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Permalink Reply by Dave   _ on March 8, 2009 at 12:30pm

If you manage pumping correctly, you shouldn't encounter ANY DKA episodes in decades of pumping. The fact that you've had issues points out the fact that your monitoring for such issues was not sufficient. Frequent testing will stop a no-delivery issue from becoming anything worse than an annoyance. For you to constantly harp on the problems you had as indicative of what a new pumper might encounter is not in the best interests of those who come here for experience and answers about pumping. Your point of view is the "minority viewpoint".

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Permalink Reply by Stuart on March 8, 2009 at 5:20pm

Anne asked what the drawbacks , risks were to using a pump. Its a very reasonable question.

She was asking what were some of the negatives, risks involved, not, if you were in love with your pump. You confused my actual statement as being an encouragement to "walk away". That was not what I said, read with more dispassion this time. Being forced to walk away from a pump is IMHV the worst case scenerio that I can conceive. But it is a genuine risk, if the pump does not work out for someone. (ie If the best technology available does not work out as intended, where do you go from there???)

The ~best interest~ is to give many different sides of any issue, discuss, debate and let Anne, or anyone else decide their path. If we give ONLY the rosey, cheery side of any issue, the marketing if you will... regardless of what the particular issue is... how can anybody make an informed and intelligent decision with only ~one sided~ information presented?

As for your DKA sillyness that's absurd. Shouldn't get it ok sure, but it absolutely does happen, Completely correct that I did not moniter in the middle of the night, etceteria. Regardless of when there was no valid cause to be monitering until the alarm went off and ~declared~ the problem existed and required damage control. By then there was DKA danger.

I won't bother to broch the "effects of disconnection" from a pump for longer than say an hour. If you doubt my expereince is valid, feel free to detach yourself for that or longer and prove my point. Keep a insulin pen handy you're gonna need it brother..

Said with no malice...
Stuart

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Permalink Reply by Dave   _ on March 8, 2009 at 6:00pm

Being disconnected for an hour is not an issue and furthermore, it's well documented by pump trainers to be permissible. In practical terms, it only raises one's bg's a small amount (assuming they didn't miss anything but their basal OF COURSE).

Missing 4 hours of basal will definitely raise one's bg's to the point of consternation, but still it doesn't result in an emergency.

Missing basal for 10 hours can be a real bummer! :) I've missed insulin for up to 7 hours and I sure don't like getting high, but then I didn't end up with anything other than a 400+ that took a nice big bolus to correct for.

If one uses safe sets like the Sure-T, and test every 4 hours or so (that's just 6 tests per day), a pumper need not concern themselves with DKA as you'd have them believe is just waiting to happen.

Most pumpers are quite successful at it--the "dropout rate" is quite low. There will always be some folks for which pumping didn't work out, but that should not be seen as a failure of pumping as the best means of normalizing the bg's of both T1's and some T2's.

no malice either...just the facts. :)

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Permalink Reply by MelissaBL on March 8, 2009 at 7:12pm

Most people can count on a 1 mg/dL rise for every minute of missed basal. Depending on the range a person is comfortable with, a 60 point rise could be dangerous or at least potentially so. I know if I was 130 and went an hour with no insulin and then was up around 200 or higher, I would feel sick and could possibly see some small ketones. DKA, maybe not, but definitely a situation in need of correction from an hour of missed insulin.

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Permalink Reply by Stuart on March 11, 2009 at 8:49am

Hello Melissa:

Excellent statistic

Generally 1mg/dl per minute rise w/o a basal dose onboard? Any idea when that "acclimation" happens? The second you first get attached? After a week? After two weeks?

Stuart

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Permalink Reply by MelissaBL on March 11, 2009 at 10:21am

Without a bolus or food on board, yes, that's supposedly the statistic. If one has no insulin from a meal bolus on board and it has been several hours since a meal, one can assume roughly that rate of change in the blood sugar. Your body requires a basal insulin (which injectors get via their long-acting insulin and pumpers get through their basal infusion of fast-acting every couple of minutes) for natural metabolic processes - not just to cover a meal. So if you're going without your basal, it stands to reason that there will be a rise in your blood sugar.

Significant? Depends on your personal high/low thresholds, your control range (tight vs. lax), your starting blood sugar when you begin to miss your basal, your activity level while disconnected (your body needs basal insulin even while exercising), and the amount of time you're disconnected.

I think there's not really an acclimation period - or at least there wasn't in my case. When you begin pumping, you're not adding new insulin, you're substituting your long-acting for a more frequent short-acting. Either way, your body is used to receiving insulin in the background whether you realize it or not. When I first started pumping, I ran empty once while at work and thought "no biggie, used to go hours between shots - I'll fill the pump when I get home." After about 3 hours, I was sick and throwing up. At the time (8 years ago), I didn't understand that, before, my body had had NPH on board. Once I started pumping, I didn't have that safety net of longer-acting insulin.

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Permalink Reply by Riette on March 11, 2009 at 10:40am

I found that my son's Bg go way up after 2 hours and then he throw up and becomes very sick

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Permalink Reply by Bernard on March 8, 2009 at 5:40pm

Anne, pumps are a useful tool in controlling diabetes. They are not a panacea. It will probably take you several months to really learn how to use it effectively. I think John Walsh's book Pumping Insulin is worth the investment.

There are several bad things that may happen, the likelihood of some of these is low.

1. Run out of a battery Risk: low because it generally runs for several hours on a low battery.
2. Completely stops working. Risk: low because the pump tests itself constantly. This has only happened to me once in nearly 11 years of pump.
3. Accidental or deliberate disconnection. Risk: low to medium. If you're disconnecting develop some trick to remind yourself to reconnect. Because you will get used to it and may forget. If you're disconnected for 2-3 hours your blood sugar will rocket up because there's no long acting insulin in your system.
4. Insulin stacking. Risk: Medium. While the pumps help you figure out how much insulin you need at any time, it's possible to ignore the suggestion. Given how easy it is to take a dose, it's possible to take two or more boluses (doses) of insulin and end up going really low because of the surplus of insulin. I probably do this several times a year.

Despite all this I still think a pump is great for me. You can achieve the same results with injections, but it's harder work.

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