To pump or not to pump? Things to consider…
Wednesday, July 30, 2014 - 13:07
Gareth Collins weighs up the pros and cons
Any milestone in this life with Insulin Dependant Diabetes, whether it is the first test or injection or just the first time you try something new and you calculate your diabetes to perfection, is a feat to behold. In this age one of the biggest management changes that can be made is to choose whether or not you start pumping or stay on MDI.
As with all big decisions there are positive and negative aspects that need to be considered. But with every decision there is always a balance between the two and hopefully with sound judgment, the right decision is made.
I have spoken in part of my decision about pumping and even the decision to have my two-year-old daughter on a pump but I suppose I haven't gone through the consideration process.
First to consider is what stage are you at:
- Are you a long-standing or well-experienced Insulin Dependant Diabetes and have you been giving so many injections over the years that you're tired of the routine, the feeling of being a pincushion, the inflexibility and to a degree the blindness that can come with MDI?
- Are you a long-standing or well-experienced Insulin Dependant Diabetes with control and a view to maintaining the control and avoiding complications well into the future?
- Are you new to Insulin Dependant Diabetes and looking for a management method that will be as like to normal function?
- Are you a parent trying to work out what is going to suit your little one the best to ensure that they can minimise the risk of complications?
For me some 8 years ago I was 16 years in to my journey. I was living on 5 injections a day and calculating my food intake by exchanges. I was a slave to feeding my insulin rather than having my insulin to what my body requires. I was tired of the needles, I was tired of managing my intake by knowing what I had to have hours beforehand so that I could have my insulin 30 minutes prior to eating.
All of the above stages have elements to them that will have a dramatic effect on what decision will be made.
…the worst hypos that I have had is when I was on MDI with a long acting insulin.
As with all methods of controlling Insulin Dependant Diabetes, pumping can in fact be a method that can be stable and also have quick change if not paid attention to. By using short-acting insulin only, you can have something go wrong and it can change your BSL in minutes. This is not to say that on MDI with a long-acting insulin this won't happen and to tell you the truth the worst hypos that I have had is when I was on MDI with a long acting insulin. I suppose that with the short acting insulin you can make changes and have them applied within minutes and hours rather than days.
If you have gotten to this point and you think pumping, which is the most advanced method of Insulin Dependant Diabetes management, is something that should be considered (which I completely agree with) then you need to take the following into account.
- What type of pumps are there? Well in our market there are 3 that can be prescribed. All of which do the same basic job. However, this is where you need to do the research and understand about the support and company behind them. A pump is only as good as the support that goes along with it. Do not expect that each of the companies is the same. Do your homework.
- What functions do you and your health team think are important? Is it small dosage ability for your basal rates, is it the ability to connect a CGM to the pump to help with a little bit of automation and reassurance throughout the day or is it a combination of all the little things that make up the pump?
- How do you work with your Team? Do you wait until your 3-monthly appointment before you review your BSLs and rates or do you expect the information to be available to you and your team no matter the day or even where you are in the world. For me this is a big thing. I download my pump and that data is available for my team to review whether I am there with them or on the other side of the world. This allows me to speak to my team and tweak my settings to ensure a maintainable range is kept.
- Is it more about the aesthetics? Can you read the screen, can you navigate through the screens in an easy manner and is it in user-friendly terminology?
- Does your endocrinologist have a vested interest in understanding how your pump can work for you to ensure your life immediately and in the future will be better? Even though I was on a Medtronic pump for nearly 8 years prior to my daughter being diagnosed and knowing that I wanted her on a pump, I still asked her medical team for their professional opinion on what they thought was best. Of course I could have argued with them if they didn't agree with me as to the best but that wasn’t to happen.
- Is it a concern that you will have a device attached to you 24 hours a day, 7 days a week? Well this is an interesting question as there are many similar situations. My wife is not a Insulin Dependant Diabetes however she has a device that I would say is attached to her 24/7 and is rarely more than a metre away from her. The difference is that I think she can live without her phone compared to me not living without my pump. It is a change to have a device attached, however the pros quickly outweigh the cons and within days you live like it isn't there. After seeing me with my pump her whole life, my daughter never second-guessed her pump and to her it is now normal.
- Can you teach old dogs new tricks? It’s never too late to make a change and if you have gotten through years on MDI and have little to no complications, then pumping could be a management style to get you through the next years, minimising the possibility of complications.
- The pump is not a cure! This was one of the first things my endo told me. It is a management tool that if abused can be dangerous but used in the purpose that it was made for and if you have awareness of your body and the drive to always want the best for yourself, the pump will be a shimmer of normality back in your life.
For me and my daughter, the pump has been a welcome addition to life. It has put flexibility and control back in our hands. It was the best decision I could have ever made in my years so far as a Insulin Dependant Diabetes. I understand that people could be averse to the change but if there is an inkling that any one point above has made you think, then at least ask the question and investigate. Do not be afraid to make a change for the good.
The patient testimonial relates an account of an individual's response to the treatment. The individual's account of his response is genuine, typical and documented. However, the individual's response does not provide any indication, guide, warranty or guarantee as to the response other persons may have to the treatment. The response other persons have to the treatment could be different. Responses to the treatment can and do vary; not every response is the same. The views and opinions expressed are those of the individual poster or author and not representative of Medtronic or of the third parties referenced. 1366 – 072014.