When MDI is B-A-D — Time to Pump

I suppose people on insulin pumps have bad weeks, too.  But I’m officially D-O-N-E with the last few, that’s for sure.  And now, three days of SUS activity, catapulting and crashing, realizing with ever-more clarity that multiple daily injection (MDI) therapy is very imprecise.  (Either that, or I can’t count carbs worth a [farthing]; I’ve also ordered an expensive new gram scale to test my alleged skills.)

Sooooo, outcome:  All you (pushy-pushy) pumper types out there will be gladdened to know that I have sufficiently cleared the fear and reluctance hurdles: Ready. To. Pump.

Here’s why:

* It’s so not about the embarrassment or awkwardness of taking shots in public

* It’s so not about the inconvenience of it all, even

* IT’S ABOUT THE BG CONTROL, STUPID! (note to self)Thewave

So I’m starting to reading everything I can get my hands on about pumping — or rather, everything I can squeeze into my insanely packed schedule.  All this talk about “fine-tuning” your basal rates and square-wave bolus doses/dual-wave bolus doses.  Wha? Fine-tuning? The wave? Don’t you just dial up and stick it in?  (if you’ll excuse the expression)

And suddenly the rain is gone and I can see clearly now: I probably won’t ever achieve an A1c under 7.1 without changing something drastic around here.  I can kill myself for a few more years chasing decent glucose control with my insulin pen (which, absurdly, I actually quite like)… or I can CHANGE SOMETHING by transitioning to the most precise dosing method available today: the gosh-darn insulin pump.  So I am officially ON A NEW MISSION.

How the DexCom has helped:

* Well, there’s nothing like actually viewing your glucose control, now is there?

* I’ve been wearing a sensor, i.e. experiencing an “infusion site” for more than 4 months now, without pain, discomfort, or infection (extremely comforting for potential pumpers)

* Knocking myself out to make this new-fangled CGM thing work for me and then still not achieving my BG goals has pushed me just enough over the edge — it can’t be more work than this, and things can only get better

So my new Pre-New Year’s Resolution, or better yet, National Diabetes Month Resolution (that’s November, in case you didn’t know) is to Get Pumping

Of course this won’t happen immediately. I’m exploring my options, and then come the many matters of doctor authorizations, ordering product and waiting for it, getting signed up for pump training courses (yes, they insist on that here), and so on.  And so it shall be a long journey.  But for today, that’s the new obsession of my D-thinking.  I thought you’d all like to know…

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Oh, and Final Observation of the Day: this is getting surreal; people I haven’t seen for YEARS are tracking me down via this nutty diabetes Web stuff.  The ambitious ones know all sorts of personal odds and ends about me by reading up a bit here.  On second thought, perhaps the title of my next book might be Diabetes in a Fishbowl.

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23 Responses

  1. shawn
    shawn November 6, 2006 at 8:56 am | | Reply

    i have been on a pump since july, and i like it much better than the mdi’s
    you will not regret it

  2. Suzanne
    Suzanne November 6, 2006 at 8:56 am | | Reply

    Great news, Amy! I have been a happier person since switching to the pump 14 months ago. Talking to friends helped me decide upon the Animas IR1250 (love it!), and reading “Insulin Pump Therapy Demystified: An Essential Guide for Everyone Pumping Insulin” by Gabrielle Kaplan-Mayer and Gary Scheiner sealed the deal for me. The book is getting older now, but answered so many key questions for me and really prepared me for the move to pump therapy.
    Thanks for your outstanding blog. I read it daily!

  3. Living With Diabetes
    Living With Diabetes November 6, 2006 at 9:23 am | | Reply

    I told you so!

    Took her long enough to figure that out! Diabetes Mine: When MDI is B-A-D — Time to Pump I suppose people on insulin pumps have bad weeks, too. But I’m officially D-O-N-E with the last few, that’s for sure. Seriously….

  4. johnboy-d
    johnboy-d November 6, 2006 at 9:43 am | | Reply

    Congrats and good luck, Amy! Let us know how it goes.

  5. Gina
    Gina November 6, 2006 at 9:48 am | | Reply

    Congrats and welcome to the pump club!

  6. Bernard Farrell
    Bernard Farrell November 6, 2006 at 9:53 am | | Reply

    Amy

    I think you’ll be pleasantly surprised with the benefits of a pump. Good luck on choosing the right one – and now there are real choices.

    I can heartily recommend Pumping Insulin. It’s an easy (not a quick) read and very informative.

  7. Robert
    Robert November 6, 2006 at 10:10 am | | Reply

    I think that’s probably a pretty good idea, the pump gives you a lot of extra flexibility as long as you’re over the hump of having devices attached to you all the time.

    I just started using the Minimed combo sensor/pump but have been on a Minimed pump for about 5 years. No magic bullets here but I can’t really imagine going without either to be honest.

  8. Scott K. Johnson
    Scott K. Johnson November 6, 2006 at 10:55 am | | Reply

    Congrats Amy!

    You know where to go with questions if you need some “real world” input.

  9. Anne
    Anne November 6, 2006 at 11:04 am | | Reply

    Congrat’s Amy!

    I have an Animas 1250 and love it. It’s the size of a pager and delivers insulin quickly. One reason I chose the Animas over Minimed is that it delivers insulin every few minutes regardless of the dose. I used to be on a Minimed and the frequency of its basal delivery was based on the basal rate. (I.e., it delivered in increments of 0.1 U; so for a 0.3 U/hr rate you would get 0.1 every 20 minutes, and for a 0.6 U/hr you would get 0.1 every 10 minutes. I think that increment amount is 0.05 U now. I don’t know if they use the same method still.) Anyway, I wasn’t so crazy about it since I have some pretty low basal rates at certain times of the day.

    Also, the Animas is waterproof. I don’t actually swim with it or purposefully get it wet, but I no longer have nightmares where I’ve fallen into water and am holding my pump in the air to keep it dry!

    Plus, I just like the folks at Animas!

  10. Bill the diabetesdoc
    Bill the diabetesdoc November 6, 2006 at 11:25 am | | Reply

    Go for it, Amy!

    PS: how long has it been since Steph and I nagged you about starting?

    (big grin!)

  11. David Edelman
    David Edelman November 6, 2006 at 11:52 am | | Reply

    Glad to see you’re investigating it. I watched Elizabeth go through all the emotions you’ve expressed here before she got plugged in. Her one-year reflection reminds of that famous saying: “Democracy is the worst form of Government — except for all the others.” Pumping is certainly the worst method of glucose control except for everything else. I can’t wait for you to report some sub-6 A1cs.

    For anyone investigating the pump or fine-tuning their performance, there are dozens of pumpers that share advice in the Diabetes Daily Insulin Pumps forum:
    http://www.diabetesdaily.com/forum/insulin-pumps/

    Sorry for the shameless plug, Amy!

  12. Kevin
    Kevin November 6, 2006 at 12:17 pm | | Reply

    Being a cyborg is fun!

  13. Kerri.
    Kerri. November 6, 2006 at 3:26 pm | | Reply

    Congrats on your leap from MDI to Pumping! I echo Scott’s sentiments – You need Real Answers, you know where to come.

  14. Barbara
    Barbara November 6, 2006 at 4:56 pm | | Reply

    Good to hear, Amy. I have been on a pump since 1982 and have used every possible pump…I currently have a Cozmo and love it. And I do swim with mine. I love the attached meter as well. However, I just started on the Dex Com and I am in love. I can make minute adjustments via small pump doses as I watch the trends throughout the day. I didn’t hear the low alarm the other night, but my hubby did, woke me up and I fixed it with a small amt of juice–caught at 75 instead of my unaware 38′s and then corresponding huge surges. I have had no false alarms, no “noisy” readings…I am completely sold on the CGM…and the dexcom price is right. I’m connected to a pump, the dex com and symlin (using an old pump) and although it can be awkward at times, the peace of mind and stable blood sugars (for once in my 43 years of diabetes) are worth every tube and gadget!

  15. Tink
    Tink November 6, 2006 at 4:57 pm | | Reply

    Congrats on the decision to start pumping Amy. All pumps are good, they just have different bells and whistles. Would strongly suggest reading Pumping Insulin and joining (or at least checking out) Insulin-Pumpers.org

    Good Luck!

  16. Karen
    Karen November 6, 2006 at 5:00 pm | | Reply

    Amy,

    I did MDI for 36 years and now pumping for almost 4. I was the biggest chicken about switching over to a pump and now I realize what an easy concept it truly is. A big syringe with a fishline like tubing inserted just under the skin and pushing buttons instead of shooting up. But with that being said, remember it is so not a cure. You may still have issues accomplishing your quest for Alc’s under 7.1. You will still have highs and lows if you don’t count your carbs correctly or decide on the spur of the moment to run around the block and have a major low. All that being said I can not imagine going back to shots, and I have 7 different basals and can change them for that lovely time of the month. There are so many more options for fine tuning your diabetes with a pump and you will be amazed as to why you waited. Pumping is the best form of insulin delivery, and you will be so glad that you changed, but do remember it is far from a cure and it is not a pancreas.

    Karen

  17. Megan
    Megan November 6, 2006 at 7:04 pm | | Reply

    Congrats! I’m so happy for you, and all I have to say is, “It’s about time!”

  18. Scott
    Scott November 7, 2006 at 6:03 am | | Reply

    I am a former pumper myself, I tried using my Animas R1200 for about 4 years but found it did not deliver any real improvement and actually had more problems with it than I had with MDI (multiple daily injections) and concluded that while pumps are great for some people, they aren’t the best solution for everyone.

    We’re all individual, and what works for one person does mean its right for everyone. Also, something may work great for a while, but things change, and so it might not work for you forever. Also, don’t be afraid to try something for a while, but change to something else, and then go back and revisit it again a few years later. There is no one solution that works forever, so it might work for a while, then something changes, and maybe it will find that its not right for this moment in time. Remember, we’re not fixed to any one treatment, so things may evolve over time. The important thing is to determine what your needs are right now, and assess whether a particular form of treatment is meeting those needs right now, and if not, revisit it and don’t be afraid to try something else.

    I found that I have no basal needs all day long, but need it overnight, therefore a pump wasn’t right, Lantus wasn’t right, but NPH overnight seemed to work great! Similarly, don’t be afraid to try different insulins. I tried Humalog, and that worked ok but not great, Novolog had its plusses and minuses, but Apidra seemed to work best at this time (who knows what will happen a few years from now).

  19. goosta
    goosta November 7, 2006 at 12:29 pm | | Reply

    Hi,
    I am so glad to hear you are going to try a pump. I have been a MiniMed user for six years. After several malfunctions and disappointments with my current pump (the Paradigm) I am switching to the OmniPod system. It should be on my doorstep today or tomorrow and I am being trained on it on Friday. I am looking forward to being tubeless. In my profession as a middle school teacher I think it will be very helpful.I will keep you updated on how it goes. Again, I am so excited for you and wish you luck!

  20. Kelsey
    Kelsey November 7, 2006 at 1:14 pm | | Reply

    Hi Amy,

    I was a pump holdout for many years and just started with the Cozmo 6 weeks ago. I love it!

    That said, it’s definitley been an adjustment and I’ve had more highs in the last 6 weeks than for the previous year before this! Lots of new stuff to get used to. However, I’m having much fewer lows and am able to stay in the 80-120 range for hours without going too low or high. Pretty amazing!

    Also, keep working on the carb counting because it matters even more with the pump, that’s been part of my adjustment!

    Looking forward to hearing how it goes for you, it’ll be great!

  21. robjohnston
    robjohnston November 8, 2006 at 12:19 pm | | Reply

    After three months on the pump, my ophthalmologist could see the improvement that tighter control made on the state of my retinas. After six years (with regular A1C counts at about 5.5) there is no way I’ll go back to other approaches.

    Carbo counting and portion control are essential. I have used the Disetronic D-Tron Plus for the last few years. Its best feature is that it uses a 300 ml cartridge of Humalog that I can get in boxes of five at the pharmacy. Replacing the insulin supply is fast and does not require moving insulin from one container to another.

  22. Kathy Mclaughlin
    Kathy Mclaughlin January 24, 2007 at 10:37 am | | Reply

    I have an Animas R 1200 pump that I want to sell. I bought this pump in February 2005, and stopped using it March 2006. It is in perfect working condition, as it was only used for 1 year. Also included is the ezManager Palm Pilot, all the user guides, plus some unopened cartridges, canulas… Thank you

  23. ed
    ed July 31, 2007 at 7:04 am | | Reply

    well I am using mdi and don’t have any problems with it whatsoever. I do not understand why people are pushing the idea “I can’t control with mdi, so I am using a pump.” with mdi and about 5 min effort over the whole day, I have hba1c of 5.5. I race bicycles and watch my carbs, and maybe hit 3 glucose tabs once in a while but that is it. shots do not hurt whatsoever…fingersticks hurt a little. I just do not understand why anyone cannot get control via mdi doesn’t make sense to me. I am type 1

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