I have been T1 for 19 years. I thought I would never want a pump. I could not see how it would be more beneficial to the pen which I could discretely have in my bag and administer without too much fuss. My main concerns about the pump were:
- the practicalities of wearing a pump – especially for a female wearing many different types of clothing to men who always have pockets or waistband on their trousers or shorts. Things like how do I manage to quickly try on clothes in a changing room if I am wearing a pump and line, where do I put it? Will it get tangled? Will I take twice the time to do spontaneous activities like that?
- going swimming – what do I do with my pump?
- sleeping – where do I put the pump and what happens if I accidentally roll onto it or disconnect it?
- intimacy – What do I do with my pump during intimate moments with my partner?
I always considered it to be too cumbersome and impractical and figured I don’t have these concerns staying on the insulin pen/MDI treatment so why change at all! However, due to some test results not hitting my target range over a prolonged period of time, I realised that my MDI pen treatment was not accurate enough and I decided to apply for the pump to improve my control and reverse any fledging complications. All professionals and users with whom I have spoken have only positive things to say about it. So, I finally concluded that the downside of wearing a pump 24/7 would be totally outweighed by the benefits I would get from it. I enquired in May 2013 and went on the pump program in August 2013. I also found the application process to be straightforward and was fully supported by my diabetes consultant. They are eager to increase the T1 pump usage in UK as the take up here is trending much lower than other European countries and the improved control statistics support spending in this area.
My foray into my new life on the pump was daunting at first because, of course, it’s new and strange. However, I recalled how I got used to injecting myself after diagnosis, which at the time I thought I could never do. The first week is a big adjustment of course and I was very aware of the pump and paranoid about hitting it off hard surfaces, unintentionally pressing the buttons or accidental disconnection of the line as well as all my initial concerns as listed above. How did I surmount these concerns? I found the centre part of my (underwire) bra to be the perfect place to wear my pump. It’s tucked in nicely, doesn’t knock off anything and you don’t need to move it when using the loo (unlike if it’s clipped to your waistband/belt). You can wear it pretty much unnoticed with t-shirts, tank tops, blouses, dresses. I always find wearing a camisole underneath provides added discretion. You can purchase, make or use a little baby sock to stop it from getting sweaty against your skin but this isn’t huge problem unless you are working out or in a hot climate. And for swimming or taking showers, you simply remove the line and pump place onto kitchen paper in a tubaware box and plug a cap into the cannula to prevent water entering it. When going to sleep, I initially clipped it onto my nightie/PJ’s and was very aware of it whilst asleep but now I just leave it loose in the bed and it follows me if I turn. I sleep much better as a result. For intimate moments, simply unplug it, like you would before a shower. There is a function which locks the pump to prevent you from accidentally pressing the buttons. The line is quite hardy and difficult to disconnect but if it does it’s not a huge problem as the cannula is a tiny flexible teflon tubing which flexes with your body so it doesn’t hurt at all.
I am now 7 months on the Medtronic Minimed Paradigm Pump and my learning curve consisted of:
- learning the basics of the pump via classroom based learning, on-line tutorials and your own experience
- moving from Carb points system to Carb gram counting – (I highly recommend purchasing the Carbs & Cals book and app to help with this)
- adjusting to wearing & sleeping with the pump
- experiencing your regular activities in a new way with your new pump
- playing with the settings e.g. dual wave bolus when eating Pizza or Curries etc. which delivers a percentage shot of insulin at first and the remainder over a longer time period. Through trial and error I eventually worked out what works best for me, which is a great excuse to eat take-out 🙂
- adjusting settings to allow for higher intensity exercise e.g. setting a temporary reduced basal rate or during illness e.g. increasing your basal rate
So in a nutshell I have listed the pro’s and cons below:
- no more injections – just change cannula and insulin reservoir every 3 days.
- no more long acting insulin, drip fed quick acting insulin only. The pump mimics the action of the pancreas more closely than the pen does.
- dramatically minimised hypo frequency.
- eventual improved HbA1C.
- makes me more disciplined and aware of my diet because I have to enter carb amount for each meal, which contributes to eventual weight loss.
- uses 25% less insulin than pen treatment again contributing to eventual weight loss.
- new glucometer wirelessly sends reading to pump and I just press buttons to give correction dose if above target range.
- data: can download all my pump data into several reports which enables me and care team to view trends and make changes.
- excellent support: in-person classroom training with diabetes professionals, detailed online tutorials and direct contact with care team.
- minimised lumps n bumps.
- wearing it – can feel awkward at first.
- still need insulin pen as backup and to carry with me if out for long periods. I thought I could throw them away but I still need them in the event of pump malfunction or emergency correction if I have ketones. But I don’t find this a problem.
- air bubbles in line – If there are a lot, they may prevent insulin going in. Solution: just check line frequently for air bubbles. Just unplug and fill line to expel or change line.
- can be a long learning curve and frustrating waiting for my blood sugars to settle into my new regime. But I had to remember that all initial dose settings are conservative and usually tweaked in small doses until I found what works for my body and activity level.
My opinion on whether to get the pump or not can be summed up in 3 words…GO FOR IT!