Insulin Pumps

My wife's having more problems with her diabetes and her endocrinoligist suggested we consider an insulin pump. Anyone have one or expeience with one that has an opinion on which type to look at or questions to ask?

I should know more than I do, I've been doing some hacking/tinkering with continuous glucose monitors recently. If you want to know about those, fire away.

I'm trying to remember which pumps my sister and nephew use, but I'm drawing a blank.

I know my sister has used the OmniPod in the past, but I don't think that's what she's using now - the damn thing can only hold so much insulin, and you can't refill it, so if you run out (and it doesn't actually use all that you put in the "tank"), you have to put in a new site, which sucks.

I'm sorry I don't know more. I should. My sister has had T1D for 25 years. My nephew (her son) was diagnosed last fall (age 5). The family business has gotten into some frankly really cool stuff based on these CGMs, but my end of it is the hacking end, not the therapy end.

That said - I know there's a lot of tinkering and user participation to get the pumps to work right. It's not fire-and-forget (yet). Occlusions suck and learning to identify them when they happen is important and can be really subtle.

Do you have a good endocrinologist? Will you have someone to teach you how to use the pump? I think you're in/near the city, there are some good resources here. Naomi Berrie would be a great start.

I know he's not local but my doctor, who is a type 1 diabetic himself, has a support group for pump users. He would probably be open to answering questions by email and he has a website at www.mikeheile.com and , yes, he is also a musician.

Gonna point a friend of mine over here and he can help. He's a type 1 and an EE so he geeks out on the latest and greatest in monitors and pumps and has some good input on them.

My late wife was a type 1 diabetic and an insulin pump user for 11 years. I have lots of experience with them.

Quite frankly they are a life changing thing. The single greatest point of light in the diabetes world, short of a cure. No combination of shots can come close to the amount of control and freedom a pump gives you. It will be like going from a crappy out of tune carb to standalone with a wideband.

Her last pump was the minimed with the continuous glucose monitoring system. Before the pump she was considered a "brittle diabetic" whose constant spikes and lows were inevitable and unavoidable. With the new setup she went a year and a half with only 2 instances of a blood glucose level over 240 and zero low blood sugars. An A1C of 5.9 IIRC.

An endocrinologist can't really recommend a pump brand but ours preferred minimed. They seem to be the gold standard. The reports that they spit out are invaluable to the endocrinologist. After about a year of pump use the trips to the endocrinologist will be more like a trip to the dyno tuner. He would wirelessly beam the info from the pump, print it out in easy to understand graphs and make changes to her pump to optimize everything.

I cannot overstate how amazing and life changing these things are. They aren't easy and it will require work on your guy's end but they are very worth it.

Any specific questions fire away. I was involved in every training session, webinar, endocrinologists visit and any other thing that had to do with both brands of pumps. I know quite a lot and will be happy to share.

Hey there, Jim's buddy here. I've been hanging out a lot on the reddit diabetics page reddit.com/r/diabetes you should check it out for tons of good info.

The pump will change your life. It offers the type of freedom and control unfathomed I resisted it for a while and now I can't imagine going back to injections.

Is the Endo a young person? That's what I look for, somebody who is open to the technology since the landscape is constantly changing and the endo is the person to really push your insurance to get you the right stuff (for instance a CGMS). I have a minimed paradigm and it has worked wonders for me, the thing with the minimed is though that it is old feeling 90s tech, it has indiglo... wtf?... It also can't go underwater at all, like at all at all.

The two pumps I have been looking at changing to are the http://www.tandemdiabetes.com/ T:slim, which is also very not water proof, but pretty sexy in terms of new tech. The smart choice though (the one you'll want to give serious consideration) is the http://www.animas.com/ ping, there is a new new one that our country still needs to approve that works with continuous glucose monitoring devices (the cgms is a separate RF device, but the new pump replaces it.. so instead of carrying around two electronic whatsits I just have one shoved in my pocket). The CGMS is something to consider later but holy hell it improved my life since getting it (A1C dropped a whole point in 3months). At any rate any competent pump should act as a storage device for glucose levels and wirelessly communicate with the glucose monitor (the finger stick thingy).

The adjustment takes a little bit but it is such a good step that you should just jump in, for the most part you can't make a terrible choice in this regard. Though the omnipod I can't really fathom being good, like a giant tumor attached to you?... not my bag.

The pump also unclips for when you shower and stuff, and you are left with a small adhesive pad with a little connector thing. Inserting the infusions sets isnt so bad most stuff has like a spring loaded thing that can insert the needle for you, but i lost mine and dont really care about sticking needles in.

Some stuff you have to deal with is kinked tubing and bad sites, so keeping on the blood glucose levels is a big deal, just to make sure that the pump is operating properly.

ok I could keep going for hours. Let me know if you want to know anything else!

good god there is so much to cover here.

I am more sure every day that the answer to life, the universe and everything isn't actually 42, and it isn't miata either. It's GRM.

I hope you guys finds a solution that works well for her Wally!

I run the risk of rambling on this subject because it is something I strongly believe in. So here is some more info

The beauty of pump therapy is that it gets rid of the long acting insulin. Lantus or NPH or whatever. To slow down the action of long acting insulins they add proteins or other compounds to slow their absorption. This works in a curve. If you take your long acting insulin in the morning it starts off weak, gets gradually stronger, peaks hard and then its effectiveness declines over the last few hours. Now toss in hormonal changes throughout the day, activity level changes, the occasional illness and yes even things like menstruation and it is pretty much impossible to know what that long acting insulin is doing at any given time. This sucks. This is also why people have high blood sugars after breakfast, lows after lunch and highs all night long. Try and compensate for that with your meal bolus and you run the risk of more lows.

Insulin pumps use only very fast acting insulin and give you minuscule amounts constantly. This is much more predictable. Add in the ability to vary the amount by 15 minute blocks throughout the day and the magic really starts to happen. Your insulin needs are obviously going to be lower at 2am when you are asleep and no food is being broken down. The dawn phenomenon kicked in at 5AM for my missus so her pump started to deliver a higher basal rate at 4:45 ensuring no lows in the night and not waking up high. Once she was up and moving around her requirements went higher so at 6:30 it bumped it up another amount. The ability to change the rates at times when you need it are key. Other bonuses include delivery rates based on carbohydrates, different bolus types for different foods (higher fat content slows carb absorption so something like a pizza will go for a few hours without peaking and then jump up when the bolus is no longer effective.

I am sure I will be back for more.

Wally,

If you like, I can refer you via FB to some people that might be able to help locally.

As was stated, it's a frustrating disease....way too many factors to even try to understand. If you both feel that the pump is the best option, go for it. It seems that most of the people that I talk to are very pleased with it.

~ John

Got nothing productive to add except best wishes for Ms. Wally.

Thanks for all this. I never heard of them until yesterday and this has been a big help. I was concerned that being hooked to a machine was a bad sign but it seems like it will work better than what she is doing now. The Endo is fairly young and very on top of things. She did a lot to get my wife off other drugs that docs had given her. She was born with a number of problems and they just kept piling on more for each complaint. She worked us down to abou 6 pills and put off needing insulin far longer than any of the other ones we saw thought would be possible. Looks like I've got some more reading to do.

The machine is about the size of a cell phone and is connected via a thin, flexible plastic tube that can be disconnected in a matter of seconds. The actual cannula (the flexible needle that connects her body to the pump) is very tiny, NOT MADE OF METAL, and kind of like a round band aid you replace every 3 days.

I stress that they aren't a rigid metal needle stuck into a person because that seems to be the greatest fear most folks have. Sure there is a needle that inserts it but you remove that and are left with a very thin flexible plastic tube that you cannot feel.

I actually wore one for the 3 days just to see what it was like. Totally painless.

Don't think of it like a life support machine. Think of it more as a 21st century robotic pancreas or megasquirt for insulin!

In reply to Tetzuoe:

Seriously cool that you could help..and that you were already a member here!

Aside to Wally: Cheering for y'all, dude!

Sometimes I gotta prod him to look at stuff but Tetzuoe is alright in my book :)

I like to point others here for advice on this subject. I work for a pharma which primarily makes diabetic products but due to the current state of laws and regulations I can't say much myself on the subject (even though Im just an IT weenie) We dont make pumps so I guess I wouldn't be in much trouble for talking about them but I know Tetzuoe is a user of the pumps and has done a lot of research into the latest and greatest because he's also and EE geek.