Should I go with an insulin pump?

[froggypond]

Hello I have been diagnosed now for 4 yrs yet I have been diabetic since a child (or so my doctors think) because I have gone undetected for so many years I am now very insulin resistance. I am on Humulin R 500 and Lantus for insulin and take numerous different pills- too many to list My sugars normally run any where from 270-450 on a daily basis.I was about 75 lbs overweight when I was first diagnosed and was able to lose 48 lbs by diet and excercise as well as watching my calorie intake I am still doing the same thing but am unable to lose my last 30 lbs or so which I can't understand. The last few nights I have been waking up around 3 in the morning having the shakes from low sugars, but my sugars are only 130-150 which is somewhat good but the doctors tell me because my sugars run so high that this is really low but i do grab something to eat during this time and they eventually get back up to the 300's which I dont want.Those numbers are good and here I am eating sugar to up it? Also I have been told to eat something high calorie before bed so my sugars dont run low but after dinner and before bed is where I am at my highest 400 or so and if I do that my sugars go extremely high and I get sick as well and then in the mornings I get the "pukey" feeling and light headed- A lose lose situation- I have been seeing a specialist in Pittsburgh Pa and she wants me to go on the pump she thinks it will help yet my family doc says no so I guess my question is What do you think about the pump? I am a little scared because I thought it dosed the insulin itself according to your sugar levels but later found out that you have to count carbs and calculate it all by yourself and I am just afraid I will mess up and give to much. I would just like to know of anyone out there that may use one and what they think Did it help? Is it really that hard? I just know that something has to give I am at the drs every week and they cant get it to come down but say I am doing everything I can right I have been told twice that if they don't get lowered I could have 6 yrs at most and my kids are 5 & 7 and that scares me. Thanks to anyone that may be able to set my mind at ease

[SamQKitty]

Your doctors are right that a drop of blood sugar from somewhere around 270-450 down to 130 or so would produce symptoms of low blood sugar. The problem here is that if you treat it as a low and eat to raise your sugar level, you will never adjust to the lower levels. At 130 (heck, even at 70), your blood sugar is not so low that you have to fear going into insulin shock, passing out, etc. Your body can function perfectly well at that level. Unfortunately, it will take several days to a week for you to get used to it, though. But it is imperative that you get those numbers down!

For now, I'd suggest treating "the shakes" with no more than 5 grams of carbs (into the 155 range, approximately), where you probably won't have the shakes, but you won't be up around 300 either. Don't just "grab" something...have a plan! There are some mints on the market that are 5 grams each, I usually take one or two if I'm low. I use the hard candy type mints that are round and white with pink or red striping around the edge. I don't like them enough to snack on them, but I can get one down if I need to...thus, the perfect thing to have around

As for the pump, they are great, but they require a huge commitment of time and learning. You do have to learn to count carbs, and you have to test very frequently. On the plus side...you can easily correct highs without overdoing and going too low.

But before you go on the pump (which is very expensive and a waste of money if you're not going to make the commitment), you can use a regimen frequently referred to as "the poor man's pump"...this is Lantus plus either humalog or novolog. The lantus is your basal insulin (what you need even if you don't eat); the humalog/novolog is your bolus insulin (what you take based on the number of carb grams you're planning to eat.) It means you take at least 4 shots a day, but it's a really good way to see if you're cut out for the pump, as you learn how to count carbs, how to bolus for carbs, test more frequently, etc. You could try it out for a few months and, if you can do it, then the pump will be easy for you after that (and involve fewer shots, give you more flexibility, etc.), but you will still have to test a lot.

Ruth

[ScharpeStGal]

I am no expert, but I have been married to a type 1 now for 2 years, and I have known him for about 3.5 years. I started out knowing about 3 things about diabetes, and now, I feel that I have learned quite a bit. My husband actually just went on the pump about 2 weeks ago, so we are still very much in the learning stage. He goes to see an endocrinologist who specializes in diabetes, and generally he just sees the Physicians Asst, but she is incredibly knowledgeable. Because of time restraints put on doctors, she met us at the office on a Saturday morning, and we spent 2 hours on pump education. The way my husband's pump works: you only use fast acting insulin and stop using the slow acting insulin altogether, but it is set up in such a way to deliver the fast acting insulin in very small doses all throughout the day, and thus used by your body the same way the slow acting insulin works (basal). Then when you eat, his pump has 2 different ways of administering a bolus (dose you take when you eat.) One way is an insulin override that he can just program in how much he wants to give himself, but the better way is to use the bolus wizard. If used correctly, it is very very difficult to "overdose" on insulin. In fact, my husband's pump will even tell him if he is about to take too much when he uses the wizard.

My husband has dealt very little with highs because he mainly deals with lows, but his PA did tell us that most people go on the pump when they have a hard time keeping their bg in the range it needs to be in. She told us, though, that if used correctly, the doctor will work with the pump so that you don't go from extreme highs to a "normal" range because you will just feel very low, the doc should bring you down slowly so that you get used to the normal range. I feel like I am just rambleing, but I think it is definately worth looking into the pump. I would go with the advice of the diabetes specialist over your general practicioner.

If you are completely unsure as to what to do, there are some great books out there on the topic.

[drrps3]

Before you commit to the pump, I would try what one of the other posters suggested. Use Lantus or Levemir to give you your background insulin (usually 1 shot per day) then use a fast acting insulin such as Humalog or Novolog to provide you a fast acting insulin when you eat (usually 3 shots per day). These insulins come in a convenient pen applicator so there is no need to worry about a syringe or vial. All you have to do is dial the dose and inject. The amount of fast acting insulin must correspond with the amount of carbohydrates injected so I would suggest you also see a dietician in this initial stage. If you learn to count carbohydrates, it will only help you in the management of this disease. Once you see how this works and have that learning, then you may want to try the pump. Yes, you will have fluctuations....highs and lows....but that is the nature of the disease, beacuse there is more to the body and glucose metabolism than insulin, but for the most part the above regimen will give you consistency and control and make you more confident. I use the Levemir / Humalog regimen ("poor man's pump"), and it is what works for me. Personally, I don't think I'd like having something attached to my body that is why I stayed with the shots. For the lows, I keep sugared hard candies in my pockets. 2-4 seem to do the trick. When you are low, your body craves the sugar so it is hard to avoid a big snack, but that big snack then will swing you completely in the other direction. We've all been there. Just develop a plan that works for you, and keep at it. Good luck!

[Coravh]

I LOVE MY PUMP!!!!

Ok, I start every post about pumps that way. Here is the thing to keep in mind. A pump is a huge committment. You need to put in a huge amount of effort and you really need to know what you are doing. You need to know your insulin sensetivity (how much one unit of insulin brings down your blood sugar). You need to know your insulin to carb ration (how many carbs you eat for one unit of insulin to compensate). You need to figure out how long the insulin lasts in your system (the fast acting) and how fast it starts to work. And for most of these things, yiou need to know if the ratios are the same all day long, or if they are different at different times of day.

As you can see, a pump is a lot of work and requires a lot of research. I'm sorry to say that if you "feel bad" at 130 and treat enough to bring yourself back up to around 300, I don't think that you are ready for a pump. First you need to have a plan, as the other poster said. You need to work hard to get your sugars more under control. You will have some shakey periods as your body gets used to a lower blood sugar, but you need to use your head and just power through it. Intellectually you know that 130 is fine and that you shouldn't need to eat anything. It is easy to get scared on a pump and I would worry that you would become concerned with lows and still remain at the higher levels. I think that once you have some better control, you might be ready.

I wish you the best of luck.

Cora