Considering the pump

[cassandra]

I am currently on Lantus and Novolog, have had diabetes since i was 7 (now 24), and am really interested in switching to the pump.

I am curious who the pump isn't for, and if there are any people who have tried it and found that using regular injections is better.

Basically, I want better control. My last HbA1c was 9.0, and it has been even higher than that. Lantus either has me with lows in the night or waking up with serious highs. I recently increased my blood sugar monitoring to nearly 10 times a day, but I used to do it so much less.

I am going in to see my doctor again in about a month, and want to learn as much about the pump before then so I can decide whether to propose it as my new treatment.

For the time being I am thinking of splitting my Lantus into 2 doses, as I've heard that helps gain better control.

---------------
Cassandra ～☆　24 yrs old. dx'd 9/1989.

[Hollyb]

HI Cassandra,

The pump is great for exactly the problem you describe. You can set your basal rate to give you less insulin earlier in the night (when you would normally tend to go low) and then rise towards morning, meeting your increased insulin needs at dawn.

WHo is it not good for? People who aren't willing to test quite frequently (but you are already doing that). Most pumpers seem to feel the standard 4X a day is bare minimum. My 14-year-old tests 4 times on a day when nothing unusual whatsoever happens, but extra for phys ed, feeling low, extra snacks, late night sleepovers, etc. I'd say seven is average. The testing is important not only to make best use of your pump (make corrections in a timely way, for example) but because if something malfunctions with your infusion set you can go really high, really fast.

I've hear some people say they don't want a pump because they play a lot of sports. I've heard other people say they got a pump because they play a lot of sports. So many of the other considerations come down to personal preference, I think.

Good luck with your decision!

[cassandra]

Thank you Holly. Nice to hear that kind of news. For some reason, a long time ago (maybe 10 years ago?) I asked my dr. about the pump, and he said it was for people that were already in great control, and i gathered that my sugars weren't low enough or something. I guess that has nothing to do with it, and it is more about checking your sugars. That makes sense.

Well, this month I am going to continue to see if I can tweak my Lantus around to make it work for me, and depending on how successful i am, perhaps i may be on a pump in the new year.

I just started splitting my Lantus into 2 doses, so I will see if that helps me at all.

[mischloss]

Hi Cassandra,

My son is 11 and was diagnosed last year in Sept. He has been on Lantus and Humalog until recently when we decided to go on the Animas 1250 pump. He was getting so, so results with BG and his A1c actually went up to 7.4 at the last testing (prior to pumping). Now with the new pump, we can tweak his basal which Lantus cannot possibly offer. We up his rate for "dawn phenomenon" and lower temporarily for sports etc. In fact his correction factor also had to be changed...used to be BG-100/50 and now it is BG-100/85 because the pump is so efficient and the delivery of insulin so "uninterrupted" that a little goes a long way. Injecting daily vs. one site change every 2-3 days is also so much nicer. His little arms were getting all bumpy and bruised up.

As far as activity with the pump. So far he has played tennis, and skateboards all without suspending it or detaching it. Just puts the pump in his pocket for tennis and uses a special hard case pouch for the skateboarding! As far as sleeping with it on. He wears boxers and we have a special pouch with a "fop" key type ring on the top that just clips to the top of his shorts. Stays safely on all night, so no worries.

As far as what information you had 10 years ago when you first asked your doctor about pumping....I would throw that all out the window. The technology is so much more advanced now then even 3-5 years ago. So many new software advancements within the pump for adjustments to rates, schedules etc. I am not a diabetic but if I were, and see what my son went through with daily shots vs. the pump, I would be jumping on the pump immediately!

Good luck! :cwds:

[rickst29]

That's why I got one.

Even using the peakiest slow-acting insulin, NPH, I still couldn't get the right combination of LOW Basals Midnight-4 AM with REALLY HIGH Basals from 5 AM to 9 AM.

So exactly like you, I was attempting a balance between crashes in the early AM hours and 200+ readings when I woke up. It was always one or the other, no way around it except to wake up at 4 AM just for a shot of fast-acting.

Pump is A+ for handling this problem, and there's really no good alternative except for the 4 AM alarm clock and Humalog/Novalog/Apidra shot. Which is VERY unpleasant.

The ability to dial up or dial down a basal after more or less activity is also really nice to have. But 'dawn effect' is why I *HAD* to get one.

[cassandra]

thank you for all of the comments. i think i will ask my dr. more about the pump when i see her next month. i noticed on some kind of survey that the most popular pump is the minimed. any other favorites/warnings regarding other brands?

meanwhile... now i am not so sure if it is the dawn effect or just my lantus. i just started splitting my lantus into 2 doses, and so for the past few days, i have woken up with a slightly low or normal bg (60~100). but then it takes me 2 hours to get ready, get out the door, and get to work, and i generally eat breakfast at work, so i don't do my shot first thing in the morning. but, 2 hours later, check my sugar, and it is above 200. from 95 to 200 without any food (or insulin). i am not sure if it is a) dawn effect b)my lantus wearing out c)a little exercise causing a spike (i walk about 10 min to the train station every morning, and then another 10 from the station to work).

i guess i should start doing my lantus first thing in the morning. I get up about 7 am, and thought I could split my doses into a 9:30 am and 9:30 pm, but maybe I will try 7:30 am and 7:30 pm and see if that helps at all.

thanks for all the help everyone!!!

[Momto4]

Just FYI - We got the Minimed 522 and they have a 30 day 100% refund policy if you aren't happy with it or just change your mind. I would check the details, but it might help you decide if pumping is for you.

[Ali]

It is probably both an insulin problem and a dawn problem. The exercise should reduce your BS-very few exercise routines raise your BS, I believe weightl lifting might raise it. Good Luck.

[cassandra]

thanks! i just checked out the minimed website. how much does the 522 cost? i will have to check whether they have the same model here.

so here is a question. i swim and i go to hotsprings a lot. i know you can't wear the pump in water. so, is there anybody out there who frequently does sports where thy have to disconnect from the pump? In fact, I read that for the hostpring and sauna type of stuff, I shouldn't wear the infusion set either because hot water is bad for it. So I am just curious how convenient/inconvenient people have found it to disconnect for whatever reason. I imagine for long periods of time you may have to correct with an injection or something (although perhaps not if you are exercising, you can handle the time away from the pump...?)

[rickst29]

I think that their pump technology isn't as 'leading edge' as Deltec, Animas, or Accu-Check/Disetronic. (Obviously, this is MY opinion).

The way the cartridge just "floats" on top of the Drive "plunger" is considered a poor design by many (although I don't at the moment have a link for that assessment).

The Animas and Cozmo are both waterproof for swimming: the Animas spectacularly so, the Cozmo is bit less so. Minimed is merely "water-resistant" and they don't approve of swimming with it. The Cozmo insulin calculator considers Bolus insulin which you've recently taken ("insulin on board"), and the Minimed calculator doesn't: so Minimed will typically recommends a too-large dose if you've still got active insulin working from a previous Bolus (for either food or correction).

Some people strongly prefer the implementation of the Bolus calculators in other pumps (e.g., Deltec Cozmo's "Meal Maker" feature, and Accu-Check Spirit's PDA-based system).

And, although Minimed has a pretty good selection of infusion sets, they use a proprietary connector which does limit you to a much more narrow selection of choices. All of the others which I just mentioned use Lauer-lock connectors, and you can use ANY Lauer-Lock infusion set with any of them. (For example, you could use the Deltec Cleo-90 with an Animas pump, or the Disetronic Ultraflex with the Deltec Cozmo... they're all interchangeable.)

The one thing which Minimed DOES HAVE right now is integrated CGMS. You add the R/T "feature" to your pump, and you won't have to carry a separate 'box' (as I do with the competing Dexcom CGMS system).

But if you want to have the MOST ACCURATE and MOST CONVENIENT CGMS, you'll probably want to switch to the Abbott Navigator when it becomes available anyway. (I plan to, even though my trusty Dexcom has been a lifesaver over the last 8 months.) Neither Abbott nor Deltec has released any statements or information about plans to integrate the Navigator into the Cozmo ---- But the fact that the Cozmo currently integrates Abbott's best finger-stick meter (the Freestyle) as a clip-on module, and the 'Cozmonitor' meter communicates directly with the pump, is (I think) a pretty obvious clue about what they're gonna do.

Right now, I own none of these. And many Minimed owners are EXTREMELY satisfied. But I know a man with a 722 pump who uses it only as a CGMS Display/Control unit-- he wears a Cozmo *AT THE SAME TIME*, and uses the Cozmo for all his pumping and bolus calculations.

And Cozmo has historically provided upgrades for their pumps for free, all the way back to 2002. In contrast, Minimed charges $hundreds to upgrade from a 515 to a 522.

So, Minimed is not on my shopping list (even though it's not terrible, I think that it's not best). Lauer Lock infusion sets are Good. Waterproof is Good. A cartridge which is held firmly in place, not just by the plunger, is a Good. And Navigator-compatible COULD BE real Good, if my guess is right.

So I'm considering Cozmo and Spirit, the Animas cartridge is just too small for my large daily dose.

Whatever you do, I say you should TRY AT LEAST TWO!
You wouldn't buy the 'most popular' car without at least test driving it, and learning a bit about the other cars in the same price range, would you?

[rickst29]

How much does the 522 cost? i will have to check whether they have the same model here.
Here in the USA, all of the pumps are within a few hundred dollars of each other- About $5500 to about $6200, excluding big-ticket add-ons like the CGMS R/T "feature". (That adds another $999.)

If your daily dose is adult-sized, you might prefer the 722-- same pump, but holds a bigger cartridge.

i swim and i go to hotsprings a lot. i know you can't wear the pump in water.
The Animas and Cozmo pumps are approved for swimming. But for hot springs, "cooking" the insulin in the pump isn't a good idea.

I read that for the hostpring and sauna type of stuff, I shouldn't wear the infusion set either because hot water is bad for it.
Not so. hot water is bad for the insulin in both the pump and the infusion set tubing, so you disconnect the tubing. But the infusion set itself can stay in your body. There's little "plugs" which you plug in place at the tubing connector to keep water from leaking in.

Depending on the kind of infusion set you use, the adhesive might not hold up. There's glues to stick them on better, I use the one called 'Mastisol'. (It's probably available in Japan, because hospitals go through lots of infusion sets for non-diabetic purposes and they need high-quality glues).

[QUOTE=cassandra;24018] So I am just curious how convenient/inconvenient people have found it to disconnect for whatever reason. I imagine for long periods of time you may have to correct with an injection or something (although perhaps not if you are exercising, you can handle the time away from the pump...?)

Disconnect is real simple, real easy. But you want to leave your $6000 pump in a SAFE place. If more than an hour, a tiny 'make-up for the Basal I'm gonna miss' dose adjustment is a good idea, but it has to be reduced according to any extra activity being done.

BTW, I have no idea if Animas, Accu-Check, or Deltec sell in Japan. But I suspect that at least one, and probably 2, of these 3 do business there.

[cassandra]

thanks for all the info!!! i think when i get on the pump, it will be when i go back to the states. i'd rather just have the best.

kind of nice to know i can do all of that stuff with it on. i guess the minimed wouldn't be a good choice since i swim so much.

i tried to look up the Abbott Navigator and found so little information. And the dexcom too. i went to their webpage. couldn't find much about it though. very curious.

at first i had heard that CGMS are not very good or they don't work, but the more i hear about how they work, the more interesting that sounds to me too.

of course, the price is incredible. i would definitely have to go back to the states and get a job that pays insurance. that is insane. i don't even know if the pumps here are covered under insurance. i suppose if they were i could use a pump even if it wasn't the best on the market right now...

hmm... so much to think about. thanks for all of the good advice. keep it coming!!:)

[rickst29]

in our 'Continuous Glucose Sensing' area (from the starting page, it's about 20 forum areas down from this 'People with Diabetes' area.)

But Dexcom is definitely NOT available in Japan, it's USA-only.

And Dexcom would *SUCK* for a frequent swimmer-- the current model of their Sensors isn't waterproof! Minimed's is 'waterproof' enough for showers, but probably would show funny numbers after a lengthy total immersion.

Abbott is supposed to be waterproof, but *how much* 'waterproof', I have no idea.

[3against1]

The Cozmo insulin calculator considers Bolus insulin which you've recently taken ("insulin on board"), and the Minimed calculator doesn't: so Minimed will typically recommends a too-large dose if you've still got active insulin working from a previous Bolus (for either food or correction).


I wanted to comment since my daughter is on the Minimed 522. The Minimed actually does take into consideration active insulin from a previous Bolus. As far as all the other information provided, I have not done that much research. We simply picked the Minimed 522 because of the Continuous Glucose Monitor that they offer. I honestly have no idea if other companies offer something similar.

The only thing that I have been disappointed in with the Minimed, is Medtronic's customer service. They fell horribly short in that department right after we purchased the pump and I learned quickly that I needed to find other resources to have questions answered and problems solved. Luckily we have a great endo. that specializes in children.

There is a learning curve going on to the pump, but it has been so worth it!

[cassandra]

yeah, i also notice that the minimed shows how much active insulin is left. how do they calculate that anyway? is the amount of active insulin in your body a general calculation, or do they take into consideration individual rates and sensitivities, etc?

[Jen Jen]

They(Animas, Cozmo, Minimed...) all generally go off of individual rates and sensitivities(on my Animas pump...Insulin to Carb ratios, Insulin Sensitivity Factor, Insulin On Board..), which you set and have the pleasure of tweaking and finding out what works best for you(some people have a hard time with this, some just breeze on through it). I will never go back to shots, I love my pump. Insurance generally will cover a pump, not all of it, but a good portion of it. I'm not sure how it would work coming from over seas, but in general, with insurance, you have a waiting period usually if there is any gap where you didn't have any insurance coverage, depending on the company, before preexisting conditions are covered. In my experience, they'll cover the insulin right away, sometimes other things, but it took a year for me to get my pump approved. Also, the CGMS are not covered yet by insurance companies, that will likely change though, especially as the technology becomes more reliable and ages a bit. Anyway, wish you the best of luck on getting a pump, it's certainly a big decision and nice life changer.

[cassandra]

thanks for all of the information. it is so helpful. it seems that everyone on a pump loves it. so far, from looking at just websites, i am liking the animas and the cozmo. oh, so many decisions... i appreciate all of the information and advice!!!

[sstrumello]

Hi Cassandra,

I am one of the few who has switched to a pump, then switched back. Based on my experience, I can tell you that a pump will help you resolve issues that Lantus cannot, but you may also find that you could accomplish the same thing with an evening dose of N(PH). For example, some people with dawn phenomenon or slow digestion of proteins find that N is actually a better fit than Lantus, but if your need for basal insulin is relatively high, then N can make things more challenging.

The critical factor is understanding what is causing your blood glucose to do what its doing, and thats something that you can benefit from regardless of whether you use a pump or injections.

From my own perspective, I did not find that the pump really made my life any easier (although some believe it does) nor did it improve my control. But I did find that I disliked wearing the thing 24/7 and having all the miscellaneous stuff that went along with it. Treatment is very personal and there's nothing that works for everyone. If you want to try pumping, you should definitely try it. But don't feel that you can never return to shots ... some people do prefer them!

[someone]

Although similar control may be achieved in some cases with Lantus or NPH, the pump offers more flexibility. When you eat, all you have to do is hit a button.

[cydnimom]

Cassandra,

I can't give you info on pumps, I've just chosen not to go that route (for costs reasons, plus the 24/7 deal).

I also had to split my Lantus dose and so did my son. I found that it didn't quite give 24 hour coverage. Even it if did, the effects start to wane so even it you gave it at exactly 24 hours, it still takes the new dose a few hours to reach its peak, thus causing the highs for that 2 to 4 hour time.

I would wake up high all the time and we'd increase the Lantus and I was finding that I was basically taking none or very little bolus or I'd run low. I did some middle of the night testing at 2:00 am and 4:00 am.

I used to take my Lantus in the morning only to find by 4:00 am it had basically run out. I split my shot 60/40 6:30 am/6:30 pm. I don't have highs in the middle of the night anymore.

For my 6 yr old son, his split the other way around with his larger dose at night because of his growth spurts which have wreaked havoc on his nights. If you find that you have a significant dawn phenomenon that might be the split you could try out, but your endo would be the person to check that out with.

[Amy C.]

I split my son's Lantus shortly before going on the pump and had the best blood sugar control ever on shots! I did one shot at 10 pm and the other at 7 am. The inconvenience of so many injections with different ratios finally overwhelmed me. I wanted my son to be able to go on scout camping trips and so many shots would not work when away from home.

The pump is great for convenience.

[BennysMom]

Wow, we're in the exactly same boat- I'm 24 years old and was diagnosed at 7 as well! :) I have nothing but good things to say about going on the pump. I went on it in December 2005 shortly after I found out I was pregnant with my first baby. It took some time to adjust to having the thing attached to me after 15 years on shots, but pretty soon I barely noticed it at all (unless the site got irritated or pulled). My a1c went down from 9.2 in Nov 05 to 6.8 in Feb 06. :) My a1c's have been in the 6's and 7's since. I also was able to deliver a healthy (albeit a little bit big) baby boy, and I thank the pump for a lot of that. I highly recommend it. if you have any questions about it feel free to message me. :)

[Dee]

I think you should go for it.I am in the process right now of selecting a pump.I think I like the Deltec Cozmo the best.I just wish it had a CGMS with it.I still might get it.If you have the means to go on the pump, do it!