To pump or not?

[redmcgee]

We have talked about the pump but not sure about the insurance company and how to go about it, and what all is needed with the pump like right now this is what we get every month:
lantus vial
novolog vial
shots
meter strips
Does life seem to be easier with it?

[kodasmom]

We are wondering the same thing!
What are the pro's & cons of pumping?
As of right now, we found out our insurance will NOT cover a pump. I will be fighting for coverage if it will make my son's life easier!

[Kaylee's Mommy]

HI! Typically when you go to a pump you get rid of the Lantus... most people use novolog or humalog in their pump.. some use the untethered method where they are still using lantus (or levemir) as a 'basa' insulin and hook up to the pump for bolus and corrections..

you need to do meter checks at least every 4 hours with the pump to be able to catch site issues before they get serious.. you change a site about every 3 days, although some people change every 2 days.. In the beginning pumping is a lot of work, getting basals and ratios set right can get very frustrating, once you get that figured out there is tweaking here and there, just like on MDI.. it gives the kids more freedom, they can graze for snacking, you can give smaller, more precise amounts of insulin..

we love pumping, one of the best decisions we've made for Kaylee, its not for everyone, wouldn't trade it for anything once they get use to to it.. like everything else, YDMV (your diabetes may vary ;) )

[Val]

There is so much information here & people with all different opinions - it's great!

Here are some recent posts that may help...

http://forums.childrenwithdiabetes.com/showthread.php?t=11961&highlight=pump
http://forums.childrenwithdiabetes.com/showthread.php?t=11961&highlight=pump
http://forums.childrenwithdiabetes.com/showthread.php?t=11772&highlight=pump
http://forums.childrenwithdiabetes.com/showthread.php?t=11419&highlight=pump

Hope this helps!

[Judy&Alli]

Hi Red and Koda'smom,
I'm right between the two of you. We are currently waiting for pump approval. It scares and excites me all at the same time. I want my dd to have the freedom of having a snack without the shot. I'm looking forward to better control. Alli, my Dd is insulin sensitive, any little change in dosages we have severe hypo's. So I think the pump is our best bet as we can get smaller dosages from the animas pump than we can ever get from MDI. That being said I'm scared of site failures and DKA. With all I've read I think being more vigilant will mostly remedy that objection. The decision is personal. We let Alli make it. We figured it is her body and she should have the final say. She without a doubt said yes. We explained everyting to her and so did her endo. She was still full steam ahead. Good luck with your decision!!!!! I hope that helped.
God Bless,
Judy

[Kaylee's Mommy]

Hi Red and Koda'smom,
I'm right between the two of you. We are currently waiting for pump approval. It scares and excites me all at the same time. I want my dd to have the freedom of having a snack without the shot. I'm looking forward to better control. Alli, my Dd is insulin sensitive, any little change in dosages we have severe hypo's. So I think the pump is our best bet as we can get smaller dosages from the animas pump than we can ever get from MDI. That being said I'm scared of site failures and DKA. With all I've read I think being more vigilant will mostly remedy that objection. The decision is personal. We let Alli make it. We figured it is her body and she should have the final say. She without a doubt said yes. We explained everyting to her and so did her endo. She was still full steam ahead. Good luck with your decision!!!!! I hope that helped.
God Bless,
Judy

The smaller doses was probably the biggest reason for us going to the pump.. Kaylee was very sensitive.. we had to wait until she was over 400 to correct her (and that was with a 1/2u) otherwise she'd drop way to low... SHe's pumping with MM 522

in the 1.5+ years that Kaylee's be pumping we've never been anywhere near DKA, yes, we've had site failures, but they are pretty easy to spot and figure out.. as long as you test on a regular basis you should be able to spot any problems before they become serious problems:)

good luck with the pumping:)

[miss_behave]

Here is a very biased website to convince you to switch to the pump! http://2betr.com/

But seriously, pumping is the best decision I ever made. Pumping is the closest way possible to mimic a human pancreas. There are things you can do pumping that you cannot on MDI.

- the ability to have different basal rates at different times. Some people need more or less insulin at certain times eg at night from growth hormones
- the ability to give tiny doses (try dosing 0.05 units in a syringe!)
- the abilty to set temporary basal rates, eg when you're sick or during exercise
- the pump takes IOB into account, so you can eat as often as you like without stacking insulin.

Pumping makes life so much more flexible. Imagine if you want another piece of cake, but you have to have an injection first. So its a choice between an injection or no cake. That sucks, especially for a young child. With the pump, you simply push a few buttons, then have the cake, and cookies and maybe some candy too :p

No more getting out a syringe and calculating the carbs, drawing up the insulin and injecting. The pump does it all for you, including the calculations. :D

Pumping truly changed my life, and I urge every diabetic to at least give it a try! Its not the be all and end all, if you don't like it you can always go back to injections. I guarantee you won't want to :cool:

[nebby3]

I wouldn't worry too much about the insurance and supplies. These days most insurance companies pay for the pump. The pump company will deal with them and set you up with someone to supply all the infusion sets and cartridges and all the other things you need. The upside of the pump is: potentially better control, better abilty to respond to changing circumstances, flexibility in mealtimes and carbs eaten, no shots. The downsides are: site changes, greater possibility of DKA if the pump fails (we've never had this happen), just having a device attached to you if this bothers you or your child.

[twodoor2]

I just wanted to mention that it's probably good to keep one vial of Lantus in the house for emergencies, like if the pump breaks down. I think it lasts one year in the fridge if unopened.

[twodoor2]

you need to do meter checks at least every 4 hours with the pump to be able to catch site issues before they get serious..

Does this include sleeptime as well? Just curious.:)

[staciebco]

Does this include sleeptime as well? Just curious.:)

We've been pumping since June, and don't test overnight unless there's a reason too. Extra exercise, pizza for dinner, growth spurt, etc

[wilf]

I would say for families with smaller or very insulin sensitive children, the pump offers compelling advantages.

For older children/teens it is not as clear, in part because in my view they need to be part of the decision and in part because the diabetes tends to be easier to manage and MDI can work well too.

A great deal of education/training is given to families before they go on the pump. My feeling is that with that much education/training more families would do just fine on MDI as well.

We have certainly found that it is possible to have BG and A1Cs that are just as good on MDI as on a pump, but we put a lot of work into it..

In the end it's a personal decision - carefully do your research, weigh the pros and cons, talk to your doctor/endo and child, and decide what's right for your family.

[Jeff]

The science supporting pump therapy for kids is pretty convincing. See:
http://www.childrenwithdiabetes.com/clinic/care.htm

#3 is "Consider pump therapy" with lots of citations.

Key benefits, especially for pre-teens, are improved control (lower HbA1c) and improved quality of life. Studies in teens haven't shown the same HbA1c improvement but have shown quality of life improvement.

While the choice of therapy is very personal, the science at this moment supports pump therapy. I believe that pumps will become even more important as we see more integration of continuous sensors with pumps.

[hawkeyegirl]

For me, it's a two part decision. (We're not pumping yet, but we're starting the application process.) (1) Is it better for my son right now? Answer: Yes. A bit. We have good numbers on MDI, but there are things that we can do with the pump that will help us get even better control. (Pre-bolusing part of a meal, square wave and dual wave boluses, varying basal rates, etc.) Now, there are downsides to a pump - site failures, mostly, but also having him be connected to a machine 24/7. I weighed the pluses and minues, and I do think that it will be a bit better for his overall control at this point.

(2) Where is the technology going? The pump is the future, I have no doubt in my mind. The CGMS technology, combined with the pump is only going to get better and better. I honestly think that in the next 10 years or so, injections will seem as "old school" as the old Regular insulin twice a day regimes. So if pumping/CGMS is indeed the future of diabetes care, why not get in on it now?

(3) (Yeah, I know I said there were only 2.) My son is three. I get to make the decisions for him at this point. I'm convinced that the pump is the way to go, so I don't particularly want to wait for a time when he is able to refuse to get a pump to try to get him on it. We do it now, it becomes a way of life for him, and then when they come up with the Holy Grail (the closed loop system), I'm not trying to convince a recalcitrant 13 year old to do it.

[twodoor2]

I'm still curious, only one person answered my question. Do you have to check your children more often at night when on the pump, than when you were on MDI, or less, or is it the same amount? The reason I ask is not necessarily due to lows or highs, but due to site failures that might happen at night, is that something to be very concerned about???

[Nancy in VA]

I'm still curious, only one person answered my question. Do you have to check your children more often at night when on the pump, than when you were on MDI, or less, or is it the same amount? The reason I ask is not necessarily due to lows or highs, but due to site failures that might happen at night, is that something to be very concerned about???

We actually check LESS at night. She was less stable on MDI. We know that her basal rate is good to go at night, so where she is at 3 or 4 hours after dinner is basically where she'll be when she wakes up. So, we do a check when the last one of us goes to bed (11 or 11:30) and then as long as she is above 100, we leave her be and know she'll be close to there in the AM.

I have only had one what I could call site failure - I got an alarm on the pump but of course, it was while Emma was napping so I didn't hear it - for 2 hours. I checked her and she was at 450. A new site, and a correction fixed her right up - no biggie. But we've had the sites start to degrade during that time - and she woke up a bit higher than I would have liked. I just changed the site, treated the high and moved on. A few hours running the high doesn't cause lasting damage and we've been able to clear ketones quickly when she gets them. Emma gets more starvation ketones than she does insulin-lacking ketones anyway - and we have always been able to clear them within 2 hours of identifying them.

If you are approaching your 3rd day, it would be worthwhile to do another check overnight. Not because of a site failure - but because the site starts to DEGRADE at the 3 day mark. We try to have our site changes come due during a time I would be checking her.

If you do a check 2-3 hours after dinner and a check before you go to bed, the site isn't usually just going to FAIL at that point. You would have seen indications in the earlier checks if something was going wrong - but the instances of the site FAILING during that time are extremely rare.

[Abby-Dabby-Doo]

At our house, we check every night.
I sleep better (not literally I mean emotionally).

[twodoor2]

Thanks Nancy, that was a really good explanation, but what about sites failling out or cannulas kinking when sleeping since you're rolling around in bed. Is that also something to worry about??

We use the sure-t's so we're not worried about bent cannulas, and the skin-tac has been a blessing. Her sites don't fall out anymore, but I would be more concerned with a plastic cannula, is that something to be more concerned about?

[Momof4gr8kids]

I'm still curious, only one person answered my question. Do you have to check your children more often at night when on the pump, than when you were on MDI, or less, or is it the same amount? The reason I ask is not necessarily due to lows or highs, but due to site failures that might happen at night, is that something to be very concerned about???

We have never had a site failure in the middle of the night. I test when I go to bed, and I test if it is an odd day or numbers are off at my bedtime, during illness, but a site failure is the least of my worries honestly.

[bkfkmc]

Before we started CGM, I checked more at night with the pump than with MDI. The reason is simply because his numbers ran higher on MDI and his range was higher. Since starting the pump, his range is lower and I keep his blood sugars lower. Thus, I checked for peace of mind. We have had very few site failures that have resulted in ketones. I was never told by the Endo. that we needed to check at night- it is all me.

Braden's A1cs have been much lower while pumping. His quality of life has improved. In the event that he wanted to eat something between meals, there was the dilemma of shot and eat or skip the food and no shot.

When on MDI, we corrected at meal time for high blood sugars usually. With the pump, we correct as needed. We like pumping because it seems more natural.

All this being said, my son is the first one to yell "freedom" when he disconnects so I can prepare his pump for a site change. It is different being attached to something 24/7. There is more trouble shooting involved with high numbers because there are more variables involved.

[vettechmomof2]

the omnipod alarms really well. You cannot miss that evil noise so no we do not fear pump failures.:D
We do test a lot because we live a very active life with karate and kickboxing that goes late into the evening.:rolleyes:
Allene

[Nancy in VA]

Thanks Nancy, that was a really good explanation, but what about sites failling out or cannulas kinking when sleeping since you're rolling around in bed. Is that also something to worry about??

We use the sure-t's so we're not worried about bent cannulas, and the skin-tac has been a blessing. Her sites don't fall out anymore, but I would be more concerned with a plastic cannula, is that something to be more concerned about?


We have never had a site fall out. And she runs and jumps and climbs and rolls like a typical toddle - these days we have literally seen her jumping up and down on her mattress like a trampoline. And we don't use any extra tacky at all - just stick the site on and go. They have been designed so that typicall rolling around is not going to make a site fall out or a cannula bend. And, I'm pretty certain that most of the bent cannulas come at insertion, not after being worn for a while.

[momtojess]

I'm still curious, only one person answered my question. Do you have to check your children more often at night when on the pump, than when you were on MDI, or less, or is it the same amount? The reason I ask is not necessarily due to lows or highs, but due to site failures that might happen at night, is that something to be very concerned about???

We check the same at night nowas we did on mdi. Dh will check her around 11 when he goes to bed, i sometimes chck around 2a (depenind on #s, activities, food, etc), and then she is up at 6:30 on school days. On weekend we chck when we or she gets up.

[nebby3]

Checking at night can be a heated subject. We check at least once every night because I would not be comfortable otherwise. I am more worried about lows from a illness or activity than from highs from a bad site. We haven't had her go into DKA since dx. Often the first sign of an illness is unexpected lows (day or night) and th first sign of a growth spurt for us is nighttime highs (which we could completely miss if not checking). On MDI we did not check often at night because our endo never told us to and because there was nothing we could do about highs then. My dd ran in the 300s the first part of every night on MDI but we couldn't up her insulin because she would crash by morning. That was not good for her. I would much rather check every night and not have her have numbers in the 300s for many hours of every day.