Pump Questions

[KatelinsMom]

Hi, My 15-year-old daughter was just diagnosed with type 1 diabetes on 1/5/07. She was very sick and in diabetic ketoacidosis when she was diagnosed, as well as concerns over cerebral edema. She was intubated and had to be life-flighted to a hospital that had a PICU that was a 6-hour drive from our home. That was definitely the longest 6-hour drive of my life.

Anyway, my daughter currently is on a 1:10 carb ratio with breakfast and lunch and a 1:15 carb ratio at dinner. She also takes 34 units of Lantus at bedtime. We are curious to know if using a pump is easier than doing the several shots each day. Also, what about swimming and sports? My daughter plays softball for her high school and we were wondering how the pump might interfere with that activity. We also have a swimming pool and were wondering how water sports would interfere with the pump. Is pumping really expensive versus the shots? Thank you all in advance for any information you can share. :)

Lori

[Amy C.]

We are curious to know if using a pump is easier than doing the several shots each day. Also, what about swimming and sports? My daughter plays softball for her high school and we were wondering how the pump might interfere with that activity. We also have a swimming pool and were wondering how water sports would interfere with the pump. Is pumping really expensive versus the shots?i

I am sorry you had to join this club. Your daugher's diagnosis and initial treatment sound very scary. I am sure you are glad she is alive.

The number one reason for using the pump is the convenience. Not having to drag out the insulin and syringes every time a shot is needed is so very convenient. Once you determine the basal rates (what the Lantus does now) and the sites and insulin to use, things flow very smoothly.

Most kids take the pump off for water activity. There is a cap to put on the site. There are methods to use and keep the pump off for several hours.

The pump can go in a pump pack that goes on the belt for softball. She can wear it in the back to keep it out of the way. She can wear it close to her body under her shirt, or put it in her pocket.

The pump itself is $6000, with most insurances paying about 80% of the cost. Supplies are very expensive, but with insurance covering around 80%, it should run about $150 extra a month.

[piratelight]

Sorry to hear about your daughter's diagnosis. Our son is 8 and is on a pump and loves it. We love the flexibility of the pump. He wears his pump swimming and at the beach all summer long. This time of year when we do family swim one night a week he takes his pump off for that hour. I am sure that a pump would not get in the way of your daughter playing softball, Jason Johnson (currently pitching for the Reds) wears an insulin pump while playing.

[KatelinsMom]

Thank you for the information. My daughter will be pleased to learn that her favorite activities should not be hindered by the use of a pump.

One more question, my daughter uses NovoLog with meals and Lantus at bedtime. When using a pump, do you pump both types of insulin or just one? Thanks!

[jeep_bluetj]

My 8yo was on lantus for 4+ years, pumping for 6 months or so.

Lantus (MDI): Cheaper. Somewhat easier at times (Injections are easy compared to site changes, fills, debugging, etc). We had good control (a1c's around 7). We bolused with a Humalog pen. With snacks and corrections, he would get 6-7 shots a day. Had to have the pen everywhere, with the associated stigma of the risks of sharps.

Pump: More expensive. The "cool gizmo" factor is there. Great to be able to tune the basals. Better control for us (a tiny bit). Less 'pokes'. Nice things like remider alarms, bolus wizards, etc. Can bolus as many times as necessary - so it's much easier to just bolus for an apple or something that you may not do so on MDI. Site changes have a bit of "stuff" that goes with them - it's not a 10 second deal to change one. We have sites fall off in the water all the time, but there are ways around that.

You can easily have great flexibility on MDI - You can't adjust basals hour-by-hour, and you cant easily bolus in very small amounts. But everythign else, you can do on MDI (you can eat what you want).

So the choice really is personal - what gives the best results? The most "liveability"? The cost factors?

Other thoughts:

1. If you're using syringes for the fast-acting insulin, try a pen. It's easier to dose and carry. It's also a bit more 'discreet', if that matters.

2. Pump reps are happy to show you thier products. You can often do a trial wearing (with saline) for several days to see if you like it.

3. Some pumps are waterproof. Some are not. The omnipod is, and there's no tubing.

[jeep_bluetj]

Question, my daughter uses NovoLog with meals and Lantus at bedtime. When using a pump, do you pump both types of insulin or just one? Thanks!

Just one. The pump pumps out little bits of the fast-acting insulin all the time as the basal insulin. This replaces the lantus.

[Budapest]

Hi,

We are curious to know if using a pump is easier than doing the several shots each day.

Not only it is easier and more convenient, it also allows for even better BG control preventing long-term complications. If you are able to understand the basics of D and the way insulin and carbs work and willing to spend somewhat more time on your child's wellbeing then try to go for the pump. Check with your insurance and be prepared to fight and argue in case they initially say no. With the pump you are in charge of your life and you control your D, not the other way around. However this is not what the insurance co. cares about. If you have to argue you want to demonstrate that it is cheaper for them in the long run because of fewer complications.

Also there are different infusion sets that might cost different. However, with the pump you might also have to test more often, using more test strips. This is all for tighter, better control.

Also, what about swimming and sports? My daughter plays softball for her high school and we were wondering how the pump might interfere with that activity. We also have a swimming pool and were wondering how water sports would interfere with the pump.

The Animas pumps are fully waterproof. You do not have to take it off neither do you have to your pouches or packages. Also exercise especially competitive sports requires special attention with D and the pump allows for that. Once you gave the 34 U of Lantus there is nothing stopping that. With the pump you can reduce the basal rate before and during the exercise to avoid going low.

An excellent book that we relied on heavily when starting to pump is "Pumping Insulin". http://www.diabetesnet.com/ishop/product_info.php?cPath=58&products_id=691&osCsid=cbb488a588b752d148b84f5c0160f0b0 It has a detailed section on sports and exercise as well.

Good luck. If there is any way you can make it work financially, go for the pump.

[Mojo's mommy]

You can easily have great flexibility on MDI - You can't adjust basals hour-by-hour, and you cant easily bolus in very small amounts. But everythign else, you can do on MDI (you can eat what you want

I was wondering what you do for the kid on MDI that likes to snack? :confused:

Courtney is on MDI and I have a terrible time with her wanting to eat 30-1hour post lunch, she is sick to death of the free foods still from the NPH regimin and I cannot stack her insulin because she is super sensetive.In this case and for many others "eating what you want " really is not very accurate.

Do you have any advice for this particular scenario??

Thanks in advance:cwds:

[jeep_bluetj]

I was wondering what you do for the kid on MDI that likes to snack? :confused:

Courtney is on MDI and I have a terrible time with her wanting to eat 30-1hour post lunch, she is sick to death of the free foods still from the NPH regimin and I cannot stack her insulin because she is super sensetive.In this case and for many others "eating what you want " really is not very accurate.

Do you have any advice for this particular scenario??

Thanks in advance:cwds:

You get a pump :) Or eat alot of donuts...

My point of you can keep flexibilty with MDI is indeed not 100% accurate. The original poster was asking about a 15yo. So she's going to need LOTS of insulin, not the tiny tiny amount the little ones get, (1:10 iirc, so a typical teenager meal is up around 5+ units, TDD in the 40's to 50's i'm guessing)

But I agree that the delivery devices of pen or syringe aren't very good when you need .25u. We had that problem, and would just let him eat. We'd give him a bolus mid-afternoon for pretty much what he'd eat. He got some extra juiceboxes every now and then when we guessed wrong. Once he was 5yo or so, we were at 1:15 and we could easily bolus all snacks. We then wore out injection sites - just too many injections. That's our major reason for going to a pump.

You could always dilute too, but I'm sure that's a major PITA.

Sub-unit bolusing is indeed a major+ for the pump. We really do like pumping. We'll likely "untether" for summer though. I just want to make the point (particulary for a new DX) that MDI should not generally be lifestyle limiting.

[Mojo's mommy]

Hi Jeff,

Thanks for your reply, it truly is a PITA...lol that is why I have started the ball rollllling on the pump. We have already been approved and are just awaiting our appt at Children's on the 15th..

I guess from your answer that there is no great fix to the snacker when they are little/sensetive. I , like you just try to guesstimate a bolus and keep my fingers crossed. Always a bonus when you get a few jelly beans thrown in for Mommies overage on the insulin I suppose:)

Thanks Jeff

[Amy C.]

I was wondering what you do for the kid on MDI that likes to snack?
Courtney is on MDI and I have a terrible time with her wanting to eat 30-1hour post lunch, she is sick to death of the free foods still from the NPH regimin and I cannot stack her insulin because she is super sensetive.

If your daughter wants to eat soon after lunch, give her a shot at a much higher ratio than for the meal. She will need insulin, just not as much if it is immediately after eating. Another tactic is to wait 10-15 minutes after she eats before giving the insulin. Yet another idea is to know she will be doing this (eating extra) and stretch lunch out over an hour. I do this with my son -- he boluses for the entire meal, but desert is consumed an hour after the bolus.

I am unclear -- is she using NPH or is she on Lantus/short acting insulin.

[beckybuckley]

You've already gotten some great advice so I'll just jump in with my 2 cents...I'm so happy that my daughter is on the pump now. Yes, we still have to count carbs and make sure she gets insulin, but she can snack now whenever she wants and not have to get stuck in the arm. Also makes going out and about much easier. Would also recommend the salter scale if you haven't already gotten one. Good luck -- and sorry you had to join us.

[Mojo's mommy]

Thanks for the advice. I try to anticipate the extra snacking but Murphy's law says when you expect it , it will not happen and vice versa. She likes to keep me guessing!!!!!

Now I just try to keep her to 3 hours post lunch and that way I know I can safely give her at least a 1/2 unit without worrying that it is going to spill over into dinner injection.

Oh Ya! Courtney is MDI, we used to be NPH for just over a year but it was a pain:mad: Switched her to MDI in June of 2006 and now we are in the early stages of prep[ing for the pump. Yet another learning curve..guess it really never stops:( Hopefully it works well for her!!!

[hold48398]

Out of the mouth of a 5-year old:

"Mommy, I still don't like having diabetes but I LOOOOOOOOVE the pump. It's awsome! It's sooooo much better than shots! I hate shots!"
:)

[KatelinsMom]

Thank you for all the wonderful information. I have been looking at the different pumps on line. Is anyone familiar or using the Omnipod? My daughter was kind of leaning towards that one, as there is no tubing and no need for infusion sets, etc. We are just looking at all of the options, we are not yet ready to dive in yet..we want to get all the medical bills taken care of from the long hospital stay, life flight, ambulance, etc., from our initial diagnosis, before we start seriously looking at pumps. Thanks again!

[wendyc]

There are a few posters here with kids on the OmniPod. I like the whole concept, but Abby is very lean and our d-team really did not think for us it would work well. Maybe a few years down the road when she is older this will be an option. They have an excellent website with a very detailed presentation of how it works. I think for a older kid, this is a great option especially if they want to be discreet.

[jeep_bluetj]

Fish around for the threads on the Omnipod - those that have them seem to really like them.

Last I heard, they were still in limited availibility - east coast U.S. only IIRC.

We have a MM522, and it's fine. But I sure like the idea behind the Omnipod - fill it, stick it on, press a button, and go. I also really like the remote PDA - it'd be very nice for parents that have little button-pushers.