Great expectations met

By | 14 March, 2011
The other Great Expectations

The other Great Expectations

Readers with a memory slightly longer than your average goldfish may dimly recall that I before I started on my pump I made some predictions about how I thought a pump might benefit me.  So four months after starting said pump, have these predictions come true?

Basal rates

I mentioned that like most of the pancreatically challenged horde, my insulin needs vary throughout the day. I used to put in about twice as much Humalog in the morning as I did in the evening. I hoped that a pump will ultimately allow me to up the basal rate early in the morning, allowing me to smooth off that irritating post-breakfast high.

And this is exactly what has happened. My pump automatically ups the background level of insulin that dribbles into me while I sleep and then tails off during the day. This means I wake up at a good level and carry on throughout the morning without having my traditional before-lunch-hypo. Score one to the pump!

Basal rates (again)

I mentioned that during the week I lead a relatively sedentary life, sitting in my office and only venturing out into the daylight to grab a sandwich at lunch time. However at weekends I am, sometimes, a ball of energy – long walks in the Pentlands, cycling, working through the long list of chores Katie has given me and so on. Hypos at the weekend were therefore much more of a problem.

Lantus just didn’t have the flexibility to allow for on-the-fly adjustments. However, the pump allows me to temporarily reduce the amount of insulin that goes in when I’m out of the bike, walking round John Lewis (a notorious hypo spot) and so on. After a bit of practice, I’ve got the amount I need to adjust my basals down to a tee. Exercise hypos are now a thing of the past. Score two to the pump!

Difficult meals

We all have our diabetic food nemeses – fish and chips, Chinese take outs, pizzas. I hoped that I could use dual wave boluses and other fancy pump things to help take account of dietary misery.

I tend to use dual waves occasionally but they don’t seem to have made a wild difference to tackling difficult foods. Maybe that’s because I don’t tend to eat them often and so haven’t had much practice. So we’ll call this one a draw.

More flexibility

I muttered about the crudeness of injections – the Autopen 24 for Lantus could only do double units and the finest control you can get with a Humalog-filled pen is a half unit. My pump goes down to 0.1 of a unit. When combined with the wonderful bolus-wizard, tiny units really come into their own. You can really, really fine tune things. A definite score for the pump.

The cyborg thing

I wondered whether being attached to something all the time would be a problem. It’s not. I got used to having the pump within a few days. Even in bed. Yay!

Other stuff

A few other benefits of the pump spring to mind after using it for four months. Firstly I have far, far, far fewer hypos. Instead of being an everyday occurrence they are now a rarity.

I used to expect to have a hypo before lunch and before dinner – it was just part and parcel of having diabetes. Now I realise with a pump I didn’t need to have all these hypos – I could adjust basal rates and carb ratios to keep my levels just right all through the day.

As well as avoiding the misery of hypos, this also has had the added benefit that I now consume far fewer fruit pastilles, Lucozade and so on to combat said hypos. This has meant I’ve lost nearly a stone in weight. Bonus!

I’ve also found that using a pump in public is far more discrete and convenient. I’ve never been shy with injecting in front of other people, but just dialling up a few units on the pump is three million times easier than getting a pen out, pulling up my shirt and injecting. In fact, because it’s so convenient I bolus for tiny things – like apples, oranges and other snacks – for which I wouldn’t have bothered before. This inevitably leads to better overall control.

So the pump has given me everything I expected it would do and more. It’s a brilliant bit of kit that has given me much more flexibility in day to day life and has genuinely improved my quality of life (it wasn’t bad before, it’s just better now). So all-in-all double thumbs up for Englebert Pumperdinck!

14 thoughts on “Great expectations met

  1. Alison

    This sounds very familiar, I’m disappointed you’ve not discovered some novel benefit that I’m currently missing out on 😉 Seriously though, I’m really pleased it’s working for you.

  2. Stephen

    I think I agree with you on all the above, square wave I’ve not played with yet.

    Mildly shocked it’s been 4 months, already feels like second nature now 🙂

  3. Donald Thomson

    Your comment about expecting pre-lunch and dinner hypos, plus increased hypos at the weekends rings very true with me. As does putting on weight from having to combat them. My HBA1C has dropped from 8.4 to a much more laudable 8.0 (hurrah!) but the number of hypos I’ve had to endure as a consequence has meant I’ve put on about half a stone in 4 months. Might not all be down to the hypos, of course, but it can’t help to be cramming glucose and biscuits into my body every day…. can’t wait for my pump but I’m way down on the waiting list.

  4. jasonf

    Hi Tim, I’m t1 for 22 years and can really relate to your experiences before using a pump: lots of hypos, sweets and the limitations (as a former golf pro) of MDI with regard to sport and exercise. I’ve been on the pump for about six months and my H1C has reduced to 6.3% with less hypos. Since starting on the pump, I’ve also reduced my overall daily insulin requirement by about 25%, despite eating more or less the same carbs.
    For me, one other benefit of using a pump is not actually anything to do with the pump, it is the education process one has to go through, to cover carb counting, dietary issues etc. I reckon this in itself helped me to reduce my H1C by a few points!
    I love the pump and so grateful for it everyday. Next on my wishlist is a CGMs please!

  5. Tim Post author

    @jasonfielden – oh yes, that’s another point – I’ve reduced my insulin intake my about 25% too. I don’t know whether this makes much difference either way, but hey hum!

    I had only been diganosed for 5 years when I got my pump and my original diabetes training was very good – so I’ve always carb-counted and so on. But even so, going on the pump allowed me to brush up on my mad diabetes skillz again – which always helps I guess.

    1. jasonf

      @tim we had to attend a carb counting course at the hospital, and do an online test at as well as a seven day food diary before starting on the pump. This stuff is probably basic enough but I found it to be an excellent “refresher” and made the transition to the pump that bit easier. Wouldn’t be without it now, although I’m still fine tuning the bolus to cover the 15g for a pint of Guinness. Happy to report that much more testing is required! 🙂

  6. Hairy Gnome

    As someone for whom a pump is never going to be the answer, I find this extremely interesting, Such excellent control means fewer problems down the line, so that must equate to a massive saving for the NHS in the long term, so why can’t ‘the powers that be’ take the long term view, and invest in pumps for all the T1s that are suitable?

    Daft as it seems, I get a vicarious pleasure from knowing you pumpers won’t suffer the effects of diabetic neuropathy that I suffer, and you can expect to live a much more normal life. Diabetes in either of its guises is a cruel condition, but for you the technology is making a huge difference. Hopefully, a closed loop system will be available for you soon, that will be another quantum leap forward. Well done all of you, and long may your precision control continue! 🙂

  7. Tim Post author

    @jasonfielden – I stick in a unit per pint of Guiness. But I’m still uncertain whether this is the right amount, so more testing required. I wonder if we could get some sort of grant for this important research?

  8. Tim Post author

    @Teloz – I entirely agree. I think, though, that one of the problems is that researchers go on objective measures like comparing A1C before and after pumping. They don’t tend to see much difference.

    However, from personal (and subjective) experience I know that while my A1C is much the same as when I was on MDI the *range* is much, much less. Instead of massive blood glucose peaks and troughs leading to an A1C of 6.5% I now have gentle inclines up and down leading to an A1C of 6.5%. Objectively it looks the same, but subjectively and in terms of quality of life the pump is 16.4 million times better.

    I speak to Medtronic later in the week and see if they can do a pump with a three gallon insulin reservoir especially for you! 😉

  9. Mike

    @tim you could probably get a grant if you were Polish? Maybe something crowd-sourced perhaps? 【ツ】

  10. Lola

    I’m about to start 3 weeks of stroke and diabetes on placement as a student dietitian. I’ve been a lurker for a while, but thought you’d like to know that your blog makes me feel
    a) inadequate – you obviously know far more about diabetes than I do, even though I will be expected to advise patients in clinic, but you also make me feel
    b) informed – at least I know the extent of my ignorance. And I’m learning from you all the time!

    This has been a splendid post, really specific about things that I might use in future practice, and I’m including the comments too. Thank you all very much.

  11. Alison

    Hi Lola, welcome to ShootUp, I’m glad you’ve found it useful. Having read some of the blog you can’t possibly be inadequate, because you now know that diabetes in the real world is very different from diabetes in the text book and that’s the most important thing a health care professional can learn. Anything else you can look up in a book.

    I love your pic, very appropriate 🙂

  12. Annette A

    Yes, something a lot of healthcare bods have forgotten (or never learnt) is that diabetes (along with a whole host of other things) doesnt follow any rules other than its own, and then it makes some of those rules up as it goes along. Listening to the patient is an important part of caring for them! Sounds like you’ve already got that one down to a fine art @lolablogger !

  13. Tim Post author

    @lolablogger – welcome to non-lurking on Shoot Up! Glad the site has been helpful! I think the main point is that in most cases people with chronic conditions really do know their condition better than anyone else. If you want to really irritate a knowledgebale diabetic then make sure to patronise them or say you know more about their diabetes than they do! 😉

    Anyway, good luck with the placement and I hope you really enjoy it. Please do feel free to post or email if you have any questions for real diabetics!


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