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Question on "control" while pumping.

Discussion in 'Insulin Pumps' started by GChick, Jan 24, 2014.

  1. GChick

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    Have I got it all wrong?

    Prior to pumping, I got the impression that pumping... if you stick with it through the initial rough patch that you would "usually" (everyone is different) gain better control (excluding the few failures etc).

    But from reading the parents board, it is seeming like most (even those that prefer pumping) believe that MDI actually gains better control than pumping does :confused: but pumping "can" just be easier (or harder, depending on what you think is hard).

    That was kinda the whole reason I started pumping, because I thought that if I could just "figure it out" I would have vastly better control. While some switch for the "ease" of it and not having to take shots all the time. While I have found that to actually be a bigger benefit of pumping than I thought it would, it was never really one of the reasons for me starting in the first place as I thought shots were actually a pretty "easy" thing to do (though did have to actually make sure to bring the lantus etc if I was gonna be out late etc, which was a pain, cus sometimes I wouldnt know until after I had already left home).

    Does pumping actually more often than not lead to even slightly worse control than MDI, but just a more "normal" feeling about life etc?
     
  2. Sarah Maddie's Mom

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    I think that's a wild exaggeration based on a few comments by a small subset of parents of kids who grew tired on pumping and switched to MDI. I do not believe that "most" parents or "most" type 1s believe that MDI in and of itself produces lower A1cs or "better control".
     
  3. nanhsot

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    I think this is one of those issues that will vary hugely by individual. Every so often my son gets sick of being hooked up and takes a break, but for him the breaks never last more than a day or two, it's simply too hard for him, his lifestyle, his eating, and his overnight rise to get MDI to work. He wakes up high every single night (or has to have a correction around 4am) and fights highs all day. For him, the ability to fine tune basal by hour makes pumping invaluable. Then there's the fact that he eats around the clock!

    I think that whatever method works for you, is the right one. I personally do believe pumping does give my son better control than MDI ever did or could.
     
  4. Beach bum

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    No. I think it's a matter of what you put into it, is what you get out of it. There are those who are MDI here who put in a lot of hard work finding the right balance of when to give long acting, using mixes of long acting, regular, splitting doses when it comes time to bolus. Then there are those who pump. Through tracking and observation they figure out what amount works for basals, so similar to MDI.

    For us, pumping works very well. But in the summer, we go on untethered (mix of pumping and mdi) and with a lot of hard work in the beginning figuring what works and what doesn't, we find that works well for us too. In our case, we've had good control in both situations, but I have to say overall, we have better results with pumping, mainly because we can fine tune the basals, increase or decrease basals.

    There is no right or wrong method. I think what you are most comfortable with and what works best for you is the right method.
     
  5. GChick

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    Now that I could totally understand... the need for a very brief break.

    I'd hope that it wouldn't be a frequent thing, but just the way I feel about it now, I could see me wanting "a day off" every now and again... but not any time soon for me, as I'm just now getting started and need the time in to figure it all out as much as possible first before I go taking "breaks".
     
  6. GChick

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    Understood and fair. Consider it a poor choice of words and replace "most" with "many"... or even "more than I would have thought who have actually tried pumping long term" if you like.
     
    Last edited: Jan 24, 2014
  7. Mish

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    I've actually heard very few parents of kids say that they thought they had better overall control with MDI. That's a curious statement to me, really.

    I think the difference here is that you're an adult with diabetes and your reasons for pumping may not be the same as a parent doing it for their child and the benefits that a pump gives to a teen might not be something that's relevant to you as an adult.

    For many of, pumping allows our children to have a more normal relationship with food. It isn't normal for a child to spend time thinking about eating vs taking a shot, or being limited to certain times to eat and in certain amounts. Think back to the NPH days, which I'm sure you experienced, I know we did. Yes, you can really have great control by doing MDI as a child, but it comes with a price. And for a teen or a child with wildly variable lifestyles, basal needs, and food intake, having the tools to modify insulin on the fly is really a benefit. I easily remember the problems we faced with a 5 year old who decided he didn't want to eat. Or decided that right after eating he was going to jump on a trampoline. That, after a shot of NPH. It was nuts.

    Current thinking for kids is that 'control' and 'normalcy' need to live hand in hand. And I venture to guess that's why many parents choose pumping for their kids. Great control in a child that is pissed off about diabetes and food doesn't really bode well, long term.

    On the other hand, an adult without the variable basal needs of puberty, with a more defined eating schedule, with a more scheduled life, may do just as well, if not better, with MDI.

    You've had 31 years of doing diabetes your way. It was a way in which you were comfortable and doing well. 31 years. You're now starting over from scratch, like day one of diabetes. And it's something you just have to learn. You probably know how to dose for pasta, to deal with exercise on MDI. Now you have to relearn those things. I can't say for sure if you'll like your pump 6 months from now, or even if it will allow you to gain better control. But, I will say that one month in, it's still too early to tell for sure. :)
     
  8. GChick

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    Oddly enough, I have no experience with NPH (unless NPH can be compared to Lente?)

    Insulins I've used in my life:

    Monotard (and Actrapid... but that only got used for super high highs): 1 shot a day from age 3-16 (should have changed to more shots earlier on... but we just didnt know any better)

    Novalin L and Novalin R: 2 shots a day from 16 to 20 and for a brief time (a year or four? dont really remember) after went to three shots a day of that combo.

    Lantus and Humalog: for the rest of the time up until basically this year

    So as such, I had very strict eating schedule for very much of my childhood and even a little into adult. The Lantus/Humalog combo was already in itself quite freeing, though all the shots did get quite tiring after a while.

    and here I sit now pumping... something I swore I'd never do.
    (I just had a little scare when I was 16 and in the hospital after having back surgery (when they made me switch to two shots a day... something that REALLY did need to happen, but I just wasn't happy about it at the time) and then they started just "talking" about pumping and I was just terrified that they would also just make me pump as well.

    My original post I believe was interpreted wrong by some. I am really not experiencing "that" much frustration with pumping yet... I've had one hiccup, but something that got worked out. I just found a statement or four in the parents forum something out of the ordinary of what I had expected, so I figured I'd ask about it.
     
    Last edited: Jan 25, 2014
  9. C6H12O6

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    Lente was very comparable to NPH. It peaked at a slightly different time and was not available in pen form. but had a lot of similarities to NPH


     
  10. TheFormerLantusFiend

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    The majority of people who switch to pumping get lower A1cs than they had before pumping. In many studies the difference is dramatic.

    I think those people who quit pumping tend to be the people that pumping didn't work as well for, which is part of why many people who go from pumping to shots do get better control than they had on pumping. For example, two of my friends have gone from pumping to shots, and in one of those cases it was because of poor absorption on the pump, and in the other case it was out of frustration from pod failures (she used Omnipod). In both cases, they had worse experiences pumping than the average.

    I also think that switching therapies (from shots to pump or from pump to shots) makes people take a good look at what they're doing, and that in and of itself can cause people to get better control.
     
  11. Samuroot1987

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    Dont think i could have gotten much better than a 6 for my 1st A1C on shots!
     
  12. Sarah Maddie's Mom

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    I think that your analysis is spot on ;-)

    I also think it's a linguistic trap for any of us to read "back on MDI" as some sort of step backward. There's no, "natural" progression from MDI to pumps. It's just that pumping is more expensive so people are generally started on injections. We should say, "switched over to MDI" or something because "back to MDI" sounds sort of punitive and reeks of failure - wrongly.
     
  13. GChick

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    Yes, that is I think a point that I was missing. Basically anything you switch to by choice or even by just "being tired of the last thing", you will probably try harder at, especially at first, even if for no other reason than to prove to yourself that you made the right choice for you... and as such actually makes it the right choice for you. Makes sense.

    BTW... Mr. Fiend :), how is your time with it going? Any better than it was a couple weeks ago? Figured out any sites/set etc that work better?
     
    Last edited: Jan 26, 2014
  14. Don

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    Totally, how many more of us would pump if it didn't cost so much?!
     
  15. TheFormerLantusFiend

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    No site failures for ten days! I call that progress.
     
  16. GChick

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    Impressive! :p

    Absorption I assume has also improved?
     
  17. TheFormerLantusFiend

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    Well... no dramatic, out of nowhere, I have no idea what happened, highs.

    But my insulin usage according to the pump is still way higher than it was on shots and I have NOT gained weight. Also the insulin seems to absorb slower especially compared to my jet injector.
     
  18. Ali

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    You may need a different type of infusion set or it just may be you use more insulin on a pump. Not a good or bad thing. The absorption rate for meals is an issue. I suspect the set type will take care of that or try Apidra.
    Ali
     

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