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Pumps - Pro's and Cons

Discussion in 'Parents of Children with Type 1' started by andiej, Jan 1, 2014.

  1. andiej

    andiej Approved members

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    Hi All

    It might be early days but the dr has raised the discussion of insulin pumps. Rather than just read the text about the pro's and cons I would like to hear from people actually using them. What benefits did you experience from moving over to a pump and does it outway the cons, plus what do you find the downside to using a pump over injections to be?

    Thanks

    Andrea
     
  2. Jeff

    Jeff Founder, CWD

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  3. MomofSweetOne

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    Pros - only one injection every 2-3 days instead of multiple per day (we were hitting 8 at the onset of puberty), the ability to add seconds, the ease of dose calculations, being able to "temp basal" as needed (reduce basal at the touch of a button for exercise, increase for growth spurts, illness, etc.), being able to accurately dose tiny amounts of insulin, ability to have differing basal rates at different times of the day so that the kids feel their best at all times, letting the child be independent earlier than they can be on MDI to go places and to have food more normally. I remember a birthday party when she was on MDI where food was brought out at three different times. Three shots...meltdown in car afterwards.

    Cons - no long acting insulin so risk of DKA can be higher (we CGM and catch problems long before then, though), pump failures, pump alarms at inopportune times (getting an alarm at 4 a.m. that she only has 12 units left:(), more "stuff" to carry, the scars from the infusion sites we used for the first year.

    The pros outweigh the cons, in my opinion, after doing MDI for a year and now pumping for 2+.

    Has your doctor talked to you about CGM? Many of us here use them, and most of us wish we'd left the hospital with the kids on them. They are truly game changers and stress relievers.
     
    Last edited: Jan 1, 2014
  4. Sarah Maddie's Mom

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  5. hawkeyegirl

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    I know people list the risk of DKA as a "con" of pumping, but there was a recent study that concluded that people on pumps actually have a lower incidence of DKA than people on shots. Quite a few studies have shown that people on pumps have a lower incidence of nighttime hypoglycemia than people on MDI.

    For us, it's not even close. The pros of the pump FAR outweigh any cons. Fortunately for me, my son loves his pump. If he ever wanted to go back to MDI, I'd be devastated.
     
  6. Sarah Maddie's Mom

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    Obviously YDMV, but I would just note that we've never had a DKA incident, in fact I'd go out on a limb as say that if a pump user develops DKA because of a pump issue then they must be generally quite negligent and inattentive managers of type 1. You don't need a CGM to spot persistent and sustained highs - you just have to check with a meter a reasonable number of times per day.

    We have had pumps break - I never know if people write, "pump failure" and mean site occlusion or what, but yes, pumps break and when they do you go back on MDI (or a back-up pump if you've got one) and 24-48 hrs later you get the replacement. Sites go bad but generally are more likely to do so when you "oooops!" forget to change it and realize that it's been in there 4, or 5 days :p

    I think we carried way more stuff when on injections.

    And the degree to which pumping leaves "scars" is probably pretty individual and dependent on where you put the site, how often you change it, how much you rotate, how you care for your skin and how sensitive your skin is.
     
  7. obtainedmist

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    Mostly Pros for us:
    1. Loved being able to adjust basals to body needs!
    a. Took control of the insulin resistance mornings with higher basals.
    b. Took control of the insulin sensitive afternoons with lower basals.
    c. Temp basals for pre and post exercise
    d. Temp basals to ward off a low in general
    e. Temp basals to get a stubborn high down
    2. DD could snack without multiple injections
    3. DD could be more discrete when dosing.
    3. Psychologically, DD felt much more "normal".

    Cons:
    1. Supplies can be more expensive than MDI (depending on insurance coverage for DME).
    2. More pieces and parts to trouble shoot if high for no apparent reason.
    3. Needs a pat-down instead of scan/x-ray when flying.
    4. Longer learning curve than MDI to get it working well. Lots of trial and adjustment and a basal test here and there!
     
  8. MomofSweetOne

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    Responses in red.
     
  9. Mish

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    While I think pumping is fantabulous, I also think CGM is even better and wish it was something we had early on.

    I can't really come up with too many cons on pumping though. More stuff is about all I can think about and the occasional pump fail (it is a piece of machinery). We've had more broken pumps than just about anyone I think, and we've never had DKA,
     
  10. GChick

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    I'm still somewhat ignorant as I have just started on a pump on Sunday gone myself.

    But one thing I am finding more and more useful is Insulin On Board (IOB)

    Previously, while yes I'd try to keep track of what I did as far as eating and shots when and why... but still, often when I'd get a 120bg reading (+/- 6.66 for you) I'd think PERFECT... and then proceed to go low in an hour or two and wonder why. Now when I test and get a 120 (6.66) and then see that I have like 3 units of Insulin On Board, I know that at some point soon I am going to still need to eat something (or decrease my basal... or both). Just knowing that background information of what is still going on is proving to be really helpful.

    I however probably disagree with A LOT of parents in here (which is fine) that I don't believe you should go on the pump for at least 6 months or so after diagnosis. 'cus it gives you a long time understanding of how to do it (shots) when and if you need to (pump breaks, site issues, child just "doesnt want to" anymore etc). So when not pumping all of a sudden, it wont be as big of a shock. But... that's just my opinion, and even I will agree that certain circumstances can dictate otherwise.
     
  11. TheFormerLantusFiend

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    I think the people who talk a lot about pumping are the people it works for. About 10-20% of people who try pumping quit.
    The people I've known who quit have quit for these reasons:

    1a. Infusion sites that were too painful or didn't work. I have a friend who quit pumping after 8 years because the insulin wasn't absorbing, and another who quit pumping omnipod because more than half of her pods were failing. Myself, I'm having horrible luck with infusion sets and I really think shots were way way way less painful. Maybe I'll figure something out since I'm still in early days.
    1b. Skin issues with adhesives- rashes and allergies.

    And let me say that although I have seen different studies on DKA risk with shots vs pumping, I've so far had three sites fail to the extent of giving me large ketones and making me feel sick sick sick. No, it wasn't DKA. And I'm sure that I'm on top of it enough that there is no real risk that it would turn into DKA. But even without acidosis, the ketones are not fun, and they're not something I would have experienced with shots.

    2. I have known a couple people who just felt that it was too complicated. Honestly, I think it was the way they were thinking about it that was too complicated.

    3. Cost. Although many insurances pay enough for it that it isn't an issue, if you pay out of pocket, both start up and continuing costs are considerably higher.

    4. Visibility. Although it's not super obvious, the pump is visible. Depending on the particular pump, how you wear it, and your feelings about it, it may or may not be an issue. Personally, I do not at all mind that somebody could see that I'm wearing a medical device... but I'm not a 13 year old girl.

    My reason for not pumping for years was that shots worked well for me (my A1cs have been 6.0-6.3 for the last couple of years and I have no particular problems that pumping would be especially likely to help with), I suspected that I would have site issues (and boy howdy, was I ever right!), and I didn't want to give insurance or myself the extra cost. I feel safer when I know that I could go out and buy my supplies with the money I make (NPH + Regular and test strips at Walmart are well within my budget; a pump is not). However, I am still hoping that pumping will reduce my night time lows, particularly since this one has a low suspend feature.
     
  12. MomofSweetOne

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    I wanted to add: The BIGGEST factor at your child's age should be whether your child wants to pump. If no, then leave pumping or do a trial until he wants it. If yes, then pursue it with everything you have and work your hardest to make it work. We were told at pump start that most pumping problems are caused by the child not wanting to pump but feeling like they couldn't tell their parents that. My daughter asked for a pump immediately upon meeting the dr. at diagnosis, changed her mind the next day when she saw the adhesive and sites, did MDI for a year, trialed a pump under duress & changed her mind and now has zero interest in a pump break. If she still wanted MDI, we'd be working hard to be successful at it, but it would be much harder than it is on the pump without the ability to temp basal rapidly and aggressively.
     
  13. Sarah Maddie's Mom

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    I think there may be some range of opinion on this. I think it's pretty impossible for an adult to fully imagine the impact of switching to a pump without having actually tried it and that's twice as true for a kid.

    Every family is going to differ with regard to their own "age of consent" and the degree to which the D kid's opinion (on a matter about which they cannot really have an informed opinion) is taken into account.

    I haven't ever seen that stat that troubled or failed pump starts are the result of kids being coerced into pumping... you could almost say the same about all "noncompliants" kid though, couldn't you? That failure to mange Type 1 can be traced to a kid "not wanting" to do injections, check bg, get their quarterly A1c or count carbs? The whole of managing type 1, be it by MDI or a pump is coercive in one way or another.
     
  14. MomofSweetOne

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    I think the age at diagnosis plays a big factor into it. For you, your daughter grew up used to you making the D decisions and it makes sense that for a long time, you would continue to make the decision. If my daughter had been 4, color choice would have been the limit of her decision. For me, my daughter was a tween - the age of this child - and for me to have forced her to wear a pump she emphatically didn't want that first year would not have been a good thing. She had had enough adjustments. Even recently, she told me how mad she had been that I asked her to humor the pump rep when we trialed the CGM a year in. I had been such a mama bear to protect her right to say no to the pump to the drs., etc. She had been through so much, and if she wanted to say no to the pump, that was her right. Even when she was ready to quit the CGM because she was sick of the sof-sensor, I laid out the options to her and she made the decision she did not want to run higher at night for safety. I personally didn't want to give up CGM for any reason, but I wasn't the one enduring the sensor. If she wanted to go back to MDI now, I would honor that choice, though we would talk carefully about the impact of that decision on management. I co-manage D, but it's her life, her body, and her decision how she wants the insulin injected. Whether she takes the insulin is not a choice.
     
  15. hawkeyegirl

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    Yeah, I make tons of decisions for my kids. His body, his life and all, but at age 10, he doesn't have the maturity or knowledge to be trusted with his healthcare decisions. I make him do all sorts of things with his body he isn't very excited about. Wearing a CGM is just one in a long list. It's non-negotiable here, and I am unapologetic about that. I guess I draw the line at non-negotiability well after "you must take insulin."

    I get sort of irritated when people get all high and mighty about "their body, their choice." Whatever. We all have our different lines, but we all dictate certain non-negotiables to our kids, both D-related and otherwise. I don't think we can tell another parent what the biggest factor should be in their decision whether to pump or not. Every child and every family dynamic is different, and as we all know, YDMV.
     
    Last edited: Jan 1, 2014
  16. StacyMM

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    I have a daughter that has done MDI more often that pumping, I think. I'd have to do the actual math to see, but I think so... And I have a son that asked for a pump before he left the hospital. For them, the pros and cons are different.

    My daughter thinks pumps are fussier - more gear to cart around, more stuff to remember when we go places, more beeping, more dramatic injections (that 'you only need one every three days' line doesn't cut it for her - she'd prefer 40 shots to a site change if the benefits weren't worth it to her), more timing worries (does the pump need charged before school? when will my insulin run out? do I have to change the tubing today? questions that she really does think about even though she's only 10), more conspicuousness around peers because it's always visible. However, she loves temp basals. LOVES them. And she likes not having to worry about syringes and vials at school. And she likes that her levels are more consistent and that she therefore feels better. And she loves that she can decorate her site with fun tape shapes. It's the little things. If she went back on MDI tomorrow, she'd be perfectly fine with it, though. It's fairly even between pros and cons and right now the pros have the edge. When that changes, we'll go back to MDI again.

    My son thinks pumps are the greatest thing that has ever happened in the treatment of diabetes. He hates shots. HATES them. Hates dealing with them in public (school, restaurants, vacations, etc). Hates basal insulin shots. Hates the more structured eating schedule we use on MDI. His only con is that pumps fail (and since that seems to be ambiguous to others on this board, "fail" to us means that the pump did not work as intended for a full three days and could be due to adhesive issues, bolus errors, PDM errors, failures to prime, failures where the needle fails to move or gets stuck halfway, the 'squeal of death' when the pod admits that it isn't working. ANYTHING that prevents that pod from working as intended.) He wouldn't willingly go back to MDI unless there were absolutely no other option.

    Pumps are great for some kids and some families. And MDI is great for some kids and some families. I think that if it's something you want to look into, do a little research first, then talk to your son about it and see what he thinks. It's your decision in the end but understanding his fears or concerns or worries or disinterest will help you reach the decision that works for your family. AS to how much input your son has in the decision process, that's completely up to you. In our family, pumps are optional but CGMs are mandatory, for instance - but that doesn't mean I think that everyone should share my approach.

    Good luck. It's so overwhelming when you are first diagnosed. Give yourself time to adjust and maybe put this on a 'think about later' list if you aren't sure what to do :)
     
  17. RickNE

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    My son was on an MDI regimen for 18 months, before moving to a pump at age 7. It worked well for him for a while. He's now 16 and struggled with the pump for various reasons, the last few years. He's very active and plays 3 physical contact sports year round. The biggest issue he had was the fact that he has no body fat. Sites would fail left and right and we didn't have many "good" areas to put them.

    He's back on MDI and his numbers are better than ever. It's really working out well for his lifestyle and his body type. I'm sure he will end up pumping again some day, but for now, he's loving MDI.

    It's really a personal choice for you and your child. Pumps are great tools but certainly not for everybody.
     
  18. glko

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    I have a husband who has had Type 1 for 29 years and has tried pumping twice, both times has gone back to MDI. For him the con's were 1) feeling the "gear" was a constant reminder of diabetes and too public 2) never found a good way to sleep while wearing the pump 3) he did not get any better A1cs on the pump though I believe he had fewer low BGs.
    Our son was dxd in August this year and he started on the Ping in November. I wondered about the benefit since he is in such a honeymoon that his total insulin is <6 units/day (he is 9yrs and weighs about 70lbs), but so far I think that he and we agree it has been a good change. Perhaps that would be a concern to others new to diabetes too - his BG control was great on MDI and his doses were small but the hassle factor was high for him and us.
    Why it has worked for my son:1 ) At 9yrs he doesn't have the body issues of a teen or adult and is so adaptable that wearing the pump is not an issue for him - hopefully starting before puberty it will accept it as part of him before body issues set in 2) because he is on such low doses we had a hard time with shots as even 1/2 unit would drop him a ton so we often did not correct. Now on the pump he is on a basal as low as 0.05unit/hr and we can give him fractions of units for meals or corrections if needed. He was one of those kids who hated the shots more than anything so one big poke every 2-3 days was a win for him. We did have some issues with sites falling out or being painful the first month but now that we found a system that works his sites last a solid 3 days and we haven't had a "bad" site for almost a month.
     
  19. Dave

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    For my son its all about what gives him the best control, best a1c and best chance of removing complications. We love the pumps ability to increase basal during the rise at 4:00 AM. We hate pump failure and the subsequent rise and possible DKA (so we use levemir for basal and clean up the remaining basal with the pump. Even still, we see variability in insulin absorption from site to site. This is no good. We have a CGM and so we stay on our toes. Basically if you are trying to go from an a1c in the 6's to a 5.5 or higher, I'd say pump, if you are trying to go lower, I'd say MDI. If you are in the 7s or 8s, the pump or mdi choice doesnt matter and you'd better adjust your diet - complications arent just for adults.
     
  20. Beach bum

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    I know you are just a wealth of information and seem to know it all, but I disagree with you. Diet is not the only thing that plays a role in A1c. A kid going through puberty will see A1c's in the 7's or 8's. It's not the death sentence you make it out to be. Yes, it's not great, but it also isn't the end of the world. My daughters last A1c was 6.3, the one prior to that was 7.2. During that time we saw some major growth spurt and hormonal fluctuations. Two things we have absolutely no control over. We worked hard at keeping her numbers in range, but there were times that it just wouldn't work.

    To the OP, we have been pumping for 8 years and it's been incredibly helpful. We are able to adjust basal insulin by the hour, decrease for sports and dance, set up a plan for summer so that we can still pump and swim. You can keep track of IOB. For us, it's been great.
     

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