Many of you may already be aware that I’m in the process of getting an insulin pump upgrade-my fourth. My pump journey was slow to start but once I was on this path I struggled with access to the latest technology - here in Ireland we have to push hard for access to advancements in technology. In this post, I’m reflecting on why I decided to try an insulin pump to begin with. I did a similar post titled Why I decided to go on an Insulin Pump? in March 2011, when I had been using one for less than a year where I also talk about the process I went through to get my pump because, at the time, I attended a consultant endocrinologist privately who didn’t provide insulin pumps so it took a bit of “working the system” to finally get one.
I thought about this topic for three reasons; one the new pump upgrade, secondly a couple of people have asked me if I think a pump is a good idea for them which unfortunately only they can decide. And lastly, when I read this article titled The Golden Age of the Insulin Pump by DiaTribe and now I’ve just realised that this month is my 12th Pumpaversary ;-)
If you are wondering if an Insulin Pump is for you here’s a post I did last year that might help you answer this question for yourself.
When I got my first insulin pump in June 2010; it was a basic insulin delivery system only - in those days there was no such thing as a CGM integrated pump much less an automatic insulin delivery device. I got a CGM integrated pump on my second one when sensors became available in Ireland. I love this description of what a pump does from James Hirsh:
What a Pump Does
“A healthy pancreas continuously releases a small amount of insulin, day and night – known as background insulin – and then it increases that insulin release when food is consumed.
And that is what a pump does. In its simplest form, it’s a machine that pushes insulin through a tube and into your body, flowing through a cannula that rests beneath your skin.” from The Golden Age of the Insulin Pump by James Hirsh from DiaTribe.org
Life before My Insulin Pump
I was on rapid-acting insulin called NovoRapid which I took with my meals, snacks and if I needed to correct high blood sugar levels. I also took long-acting insulin, which I initially took once daily at bedtime but then for a while I took it twice daily; both morning and evening. I used the Insulin Pens which meant this added up to at least 5 injections daily.
I measured my carb intake, I checked my glucose levels before and two hours after meals to make sure that I was taking the correct amount of insulin for that meal. From one test to the next I could never predict what my blood sugars would be and every day would have at least one high (greater than 10 mmol) blood glucose reading. I got frustrated about all the effort I was putting into my diabetes and not seeing my HbA1c budge even a little.
My Pump Journey at a Glance:
2010 My first Pump; Animas
2014 My Second Pump: Animas Vibe
2015 Added CGM
2018 My third Pump: Medtronic Paradigm
2022 My fourth Pump: Tandem T:Slim Control IQ
My Personal Reasons for Pumping
The following is a list of reasons I decided to try an insulin pump. Numbers one, two and three I knew in advance but number four was something I learned once I was using the pump. The list hasn’t changed much since 2011 but I have added to it.
No 1. My Efforts were not paying off
I was doing all the work that being on a pump involved; carb counting, testing my blood glucose 7 times daily and paying attention to the glycaemic index of food but on pens, my HbA1c results were not improving. They always hovered above the 7%. I was so burnt out; it felt like I was pushing a giant boulder up a hill but getting nowhere so there comes a point where you either give up or change your approach. It was worth trying something different in an insulin pump.
No 2. Mimics a Healthy Pancreas Better
The biggest reason I switched from pens to a pump was the research I found told me that it might be more possible to mimic what my body needs in insulin with a pump. I looked at graphs of how basal-bolus insulin worked, especially basal, where I saw that on paper I might have more flexibility in insulin dosing to have more flexible eating patterns.
No 3. Make Exercise Easier
For many years I avoided exercise because of the planning involved with pens to try to avoid hypos. I also resented having to eat twice as many calories because of exercise hypos if the idea of it was to maintain a healthy weight and improve overall glucose levels. If life was predictable it would have been easier to exercise; children would get sick or be up all night and last-minute things wouldn’t come up. There were already so many variables (see 42 Factors that Effect Glucose Levels from DiaTribe.or) with diabetes that I didn’t want to introduce another one. This started to concern me as I felt the ageing process catching up with me and I felt not having background insulins would make this more possible and being able to put a temporary insulin delivery rate to reduce exercise hypos. The pump definitely helped with this.
No 4. More Choices in Insulin Dosing
My numbers did stabilise in those first four years of pumping but my HbA1c still hovered at 7% (53 mmol/mol). But, life did get just a smidge easier; I could use extended bolus’ for fatty foods such as takeaways and pizza, when I needed to do a correction dose my pump was right there attached to me so this became more convenient and less likely to be put into the “I’ll do that in a couple of minutes” pile and then forgotten. The pump was far less invasive than pens because instead of stabbing myself with a pen needle five times per day I was now reduced to inserting a new cannula every three days.
Living with an Insulin Pump
I did a trial period on the insulin pump before going “live”. This means that I would practice attaching it but not using insulin just yet. I used a saline and water solution instead of insulin. The purpose of this was to become less afraid of it, familiar with the button pressing, and more important to figure out where and how I was going to wear it.
During the trial period, I wanted to fling the thing at the nearest wall – the tubing was always in the way. I had some doubts about whether or not I would be able to do this but I knew that if it didn’t work out I could go back to MDI. I adopted an “if you never try, you never know” attitude. Plus, there were so many pump users in the world raving about its benefits that I had to believe the pros were going to outweigh the cons.
Once I went “live” this all changed. I adapted to the button-pushing in about a week, in about two weeks I was comfortable with the infusion set change and within six months it all clicked together. I can predict my blood sugar readings most of the time now and it’s absolutely glorious to look at my record book and see blood glucose readings of 5’s, 6’s, and 7’s. The normal range of blood sugar readings was becoming normal (Note: this was the information I had from my blood glucose meter). I manage to fit it in 30 minutes of walking a day and on the days I don’t get to fit it in I’m not trying to keep up with hypos or vice versa because of long-acting insulin injections.
My pump increased my quality of life quite a bit; because with injections, there was still a bit of eating to feed my insulin but now I could match the insulin better to what I needed. I was able to stabilise my HbA1c but it was still swings and roundabouts with my blood glucose levels. For me, the biggest diabetes game changer was having a Continuous Glucose Monitor which I was able to access in 2015. The impact of this device has been revolutionary in my life with diabetes! I feel like before CGM I was only able to see my diabetes through a pinhole. With CGM, I can see everything.
All those wonderful things that were possible to do with an insulin pump were now actually doable. The impact of being able to see how long it takes for my insulin to start working, and how long it takes for food to have an impact on my glucose levels meant that I could be proactive instead of reactive with my diabetes management.
When I was on MDI my blood sugars would bounce like a rubber ball now that I’m pumping my blood sugars are like a see-saw – they seldom go any lower than the ground or higher than the tipping point. Life with diabetes and life, in general, has just become that little bit easier.