Grazing -Pump vs. MDI

[Lindy]

I'm confused! I read so many posts in which people state that with the pump they have so much more freedom to eat/graze/snack etc.. WHY?

It is my understanding that when our D kids eat, their BS goes up - fast acting insulin takes approx. 3 to 4 hours to bring it down into a normal range (which is why you test 2 to 3hrs after eating?).. So if we continually let our children graze, how does that allow their bs's to come back into a normal range??

I understand the beauty of the pump and not having to draw up shots or give 6 to 8 injections every day - but I don't understand how it changes the eating habits and allows more freedom to eat whenever without having a negative effect?

Right now our 4yr old is saying "no way" to the pump, but I'm hoping that after the CWD conf. this summer, he might change his mind.. :cwds:

[Kaylee's Mommy]

When Kaylee was on MDI she couldn't graze at all.. we weren't allowed to give shots within 2hrs of each other.. so she had to eat then, or loose out.. well, she could have 'free' stuff.. but nothing with carbs (her free stuff had to be under 5grams.. still does, so we were very limited). With the pump I can give her a bolus (an injection of insulin through the pump) and time she decides to eat something (typically 20minutes after we're done a meal.. she is notorious for this!).. no extra shots.. if I check her 2 hours out and she's high.. I go to correct her with the pump and it says she has .2u left and her correction is just that it won't give her anything (although you can override it if you feel its necessary)... it works the opposite way as well.. if I check her and she's on the low side, and she has active insulin then it will subtract it while I'm giving her another bolus, so she won't go low later on..

say your child had something 20 minutes ago, you bolused appropriately and now they want something else.. they've already got the insulin working in their system.. so the food they are consuming will be kept lower by that isulin that is already working in their system... so you may get that spike with the first batch of food but not necessarily with the second batch just because you've got active insulin in their bodies..

I hope that made sense, its late and I'm tired.. I tend to ramble when that happens LOL..

[Lindy]

I must be missing something - because I still don't get it... How is a bolus different from the pump vs. a syringe? How is it that that insulin works differently?? From what I gather, the only difference is the conveinance.. It is easier to push a few buttons vs. drawing up a shot. As far as managing D. (A1c) I don't understand the "freedom" to eat whenever with the pump... but, please someone explain...

[Mama2H]

In our case Hailey is only allowed to do an injection no closer than 2 hours together soooo like today after school she had a snack and insulin 30 minutes later she decided she was still hungry and I had to tell her no. For Hailey anything with more than 5 carbs requires a shot and it is really hard to find something filling for a 10 year old that is less than 5 carbs. She whined about being hungry until supper time when she could finally eat and take more insulin. Then about 1 hour 15 minutes later she is hungry again, once again nothing she wants to eat under 5 carbs and she has to wait another 45 minutes before we can give more insulin so she can eat more food. Once we start the pump I will just input the carbs into the pump where it will look at how much insulin is already there compared to the total carbs and add or subtract the amount of insulin she would need to get back into her target range. For example supper is 1:12 and she eats 48 carbs so the pump would figure in that she needs 4 units of insulin. Now say 45 minutes later she wants to eat something else I just put in the amount of carbs, lets say 24, and the pump looks at how much insulin is yet to be delivered, lets say .75 units, and it will subtract the amount that she still has to be delivered to make sure you do not take too much insulin and go low. Now we are not pumping yet so someone please correct me if I am wrong but this is the way that it was explained to me.

[kel4han]

Hey Lindy, I wonder this exact thing all the time! Becuase to me, a bolus is all about hour 2-3, and whats barely working in hour 4, 5. You can only hope in that time you are where you need to be.....so, why can you graze so much more anyway when pumping? We were told as long as you are not correcting more than every 2 hours you are not "stacking" the insulin. So, you could eat 15carbs now, bolus for that and in ten minutes want more, bolus for that again. Which is what we do if we have to, and it isnt stacking the insulin if you are bolusing for carbs. I can see the great part of not having to inject each time......but I dont get it either. :confused:

[Kaylee's Mommy]

I must be missing something - because I still don't get it... How is a bolus different from the pump vs. a syringe? How is it that that insulin works differently?? From what I gather, the only difference is the conveinance.. It is easier to push a few buttons vs. drawing up a shot. As far as managing D. (A1c) I don't understand the "freedom" to eat whenever with the pump... but, please someone explain...


When Kaylee was on MDI she wasn't allowed to eat carbs within two hours because we had to give an injection.. we weren't suppose to give injections within 2 hours of each other.. My guess is that because the pump keeps track of everything, including the IOB that its hard to 'stack' insulin and get to much going in their system..

also, on MDI we had to wait until she was completely done eating (which could take an hour or more) before giving insulin.. now, she can eat 10 carbs, I can cover that. and the next 10 I can cover, and so on.. so that food isn't sitting there absorbing into her body, making her BG go through the roof while she's finishing.. she can space out a dessert or treat.. instead of jamming it right in after the meal..

not sure I answered your question or not.. hopefully I'm not confusing you anymore LOL.. :D

[Mama2H]

If your Endo allows you to give insulin more than every 2 hours then it isn't much different. In our case we are not allowed to give ANY insulin before the 2 hour mark is up and in our case we cannot correct before the 4 hour mark unless she is terribly high and we call first.

[EmmasMom]

Yes insulin is insulin, and it works the same, but the delivery method really does make a big difference.
A huge part of the difference is that the pump keeps track of the insulin in your body, so you can eat every 20 minutes all day long, and just add more insulin with a button push. Everything is tracked for you and you don't have to worry that you child needs say 15 carb grams for the injection he just got.
The pump calculates the doses based on all of your settings and can give you very small, very accurate boluses for a 2-3g cracker here and a 5g piece of candy 30 minutes later...etc. you would never want to do that with an injection 10+ times day, (and you probably couldn't measure it anyhow). You can really eat whenever you want w/o worrying about carb restrictions. Or you can spread a large bolus out over hours so you can eat things like pizza and ice cream w/o the notorious low followed by a high later.

Accuracy is so much better with a pump and the convenience of being able to graze all day and cover each carb accurately with no pokes is priceless for us.

The insulin doesn't work faster, but it can work much more efficiently. You can give 1/2 of the meal dose 15 minutes before they eat, this helps prevent a spike from ever happening. Then give several more boluses during the meal to match what they actually eat, (rather than saying you have to eat xyz or you'll be low later, Or giving an injection after a meal which is a disaster for post meal numbers). Then if they want dessert later you can pre-bolus, to again, prevent the spike, or use a special bolus feature to cover higher fat item w/o worrying about a bedtime low.

It really is a huge difference from MDI. Same concept, both can work, but one offers many, many more options with way fewer pokes!:) It is the closest thing to a functioning pancreas.

[Carrie]

Here's another tired mom taking a stab at it! :D The bolus isn't different between MDI and the pump. I can give it ahead of time or while she is eating. Just no shots! Every time my daughter pops something into her mouth, I can grab the pump and give her insulin. Even down to a piece of bubble gum which is about 4g. We had the same problem as Kaylee's mom. She would no more then get done eating, I'd ask her if she was done, give her a shot, and she wanted to eat again. That's what makes the pump "freeing" for us. You're not stacking insulin because each time you bolus, they need that insulin to cover the food they're eating. They keep eating, you keeping bolusing. And yes, it is hard sometimes to get accurate readings if they are "grazing".

As far as correcting...you can program it right into the pump the required time between corrections. It won't allow you to give too much insulin (yes, you can override it). That's what I would consider stacking. It won't allow you to give too much insulin for the correction because it will know how much "active insulin" is still left working in her system.

[miss_behave]

Insulin pumps keep track of insulin on board, so you can add more boluses without stacking insulin. So I can eat something, bolus and then decide to eat something 45 minutes later, and my pump will reduce the amount of bolus I need, because of insulin still working in my body.

Insulin pumps are a far more sophisticated way of delivering insulin, than injections ever will be. It is definitely worth it. IMO everyone should leave the hospital after diagnosis with a pump if they want one... but thats just my opinion :)

[D-Dad]

Here's my pump top 5.

No shots.
Can give .05 of a unit at a time.
Can customized basal (background insulin).
Can reduce basal if not all food is eaten.
Can give basal upfront to help reduce a bg spike.

[Mama Belle]

Also, because of the way the pump works, we have found that Samantha's body seems much more responsive to boluses now than when she was on MDI. There are times I test within and hour of eating a high carb meal and she never rises above 150. She's 8, so I am sure being a bit older helps. But when she was on MDI, it seems that her boluses always were playing catch up. Now her body is using insulin in a much more efficient manner and because of that boluses seem to work really well with the peak of foods. Plus we almost always pre-bolus. And as long as we bolus for every bite of food that goes into her mouth she doesn't end up low or high.

[wellsfamily]

I dont know about you, but when we were MDI, Aidan never asked for second helping, b/c obviously it would mean a second shot. Therefore, he would just stop eating whether he was full or not. With the pump, I can say yes to seconds and only have to push a button. He knows asking for seconds is not going to mean a painful shot. Like already mentioned I can bolus for 5 or 10 carbs no problem. His ratio when MDI was 1/2 unit for 45 carbs (now we are up to 1 unit for 30 carbs) so there was no way to give a small snack. It was either 45 carbs or nothing (no one told us about diluted insulin, so not sure if that would have made a difference.) Let me tell you how many nights I ended up in tears begging him to finsh all of his 45 carbs (a lot for a 3 year old) so he wouldn't drop. With the pump, I can give half up front, and half if and when he finishes.
Stress level dropped dramatically w/ the pump!

[wendyc]

Yes insulin is insulin, and it works the same, but the delivery method really does make a big difference.
A huge part of the difference is that the pump keeps track of the insulin in your body, so you can eat every 20 minutes all day long, and just add more insulin with a button push. Everything is tracked for you and you don't have to worry that you child needs say 15 carb grams for the injection he just got.
The pump calculates the doses based on all of your settings and can give you very small, very accurate boluses for a 2-3g cracker here and a 5g piece of candy 30 minutes later...etc. you would never want to do that with an injection 10+ times day, (and you probably couldn't measure it anyhow). You can really eat whenever you want w/o worrying about carb restrictions. Or you can spread a large bolus out over hours so you can eat things like pizza and ice cream w/o the notorious low followed by a high later.

Accuracy is so much better with a pump and the convenience of being able to graze all day and cover each carb accurately with no pokes is priceless for us.

The insulin doesn't work faster, but it can work much more efficiently. You can give 1/2 of the meal dose 15 minutes before they eat, this helps prevent a spike from ever happening. Then give several more boluses during the meal to match what they actually eat, (rather than saying you have to eat xyz or you'll be low later, Or giving an injection after a meal which is a disaster for post meal numbers). Then if they want dessert later you can pre-bolus, to again, prevent the spike, or use a special bolus feature to cover higher fat item w/o worrying about a bedtime low.

It really is a huge difference from MDI. Same concept, both can work, but one offers many, many more options with way fewer pokes!:) It is the closest thing to a functioning pancreas.

Very, Very well said Amy:)

[sam1nat2]

another thing, if they are on the low side and you don't have a cgms to see if they are dropping or rising, you can set the bolus to be delivered over 30 min, so you don't have to worry about them going low.

As for the not bolusing for 2 hours, we were never told that. We were told not to check bg for 2 hours post meal. If he eats something and then a half hour wants something more, we enter in just the carbs, not the bg. This way it boluses for just the carbs eaten, it does not correct.

Gotta love going to buffets with the pump. We have found it offers us much more freedom. We used to go out to eat or wherever and bring just a syringe with a half unit in it. If he wanted more--too bad. If he was high and needed a correction, we had to come home.

[Lindy]

thanks everyone - I am very excited to have "more options" with the pump.. and oh wonderful it will be to be able to dose .3 units, .75 units etc.. and the prebolus - yep, that will be fabulous!!

from what I understand now, you are able to keep your kids more even, less highs and lows - and being that they are in range more they are able to eat whenever?! is that it in a nutshell?