Have been recommended use of a pump!

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Veena posted on Sun, Aug 26 2012 6:01 AM

Well, I am 47 years and Ive been diagnosed with LADA about 4 years back. Theres no family history of diabetes and Im not obese. Im very regular with my walks..

Though I started on oral medication, I had to move on to insulin shots in about a year after diagnosis. Im now on 5 units of novorapid before every meal(3times) and 12 units of Lantus at bedtime. My HBa1c still hovers around 8 to 9. Any increase in novorapid leads to hypoglycaemia. My sugar levels move in the range of 70 to 300 in a day!! My doctor has advised me that the pump will be very effective to control my Hba1c. 

I am not comfortable with this thought as yet.. Would like to hear from users of the pump the good and the bad of using pumps. 

Also would like to know from a practitioner if a pump will be effective for a patient like me


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amrad replied on Sun, Aug 26 2012 2:13 PM

I wonder if you need to increase the Lantus, as it sounds like the meal time doses are fine. That would be my first step.

Not on the pump.  Somehow I just could not see myself having one, unless the regime I am on now no longer works. Although my Dr. mentioned it in jest at my last visit.

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ShirlB replied on Thu, Sep 6 2012 5:32 PM

Hi!  I have had type 1 diabetes since age 5 in 1954.  I was on MDI with around 6 injections per day.   In 2005 I moved to the southwest and my new endo asked if I would consider a pump.  I knew nothing about them but she helped me look at the different pump companies.    I finally decided on the Animas 1250 pump and loved it!    I would never go back to MDI.    The pump is about the size of a cell phone and the infusion set needs to be changed every 3 days - at least that is the industry standard.  There is a lot to learn but so worth it.   I now use the Animas PING which has a meter/remote so once I check my BG I just use the meter to enter carbs, etc. It looks at my BG reading and then suggests the amount of insulin I need for what I'm going to eat.   Because I have gastroparesis (diabetic complication - slow stomach emptying) I can "extend" the delivery of insulin using the pump so that it matches more closely to when my food hits the bloodstream.    Even on MDI my A1c was around 6.0 but that was from the peaks/valleys of my BD readings.  At least with using the pump it is still there but there are less low/high BG readings.  Good luck.  Let me know if you have additional concerns.

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floydf replied on Fri, Sep 7 2012 2:05 PM

Hi, it might help to talk about controlling your blood sugar with your current medication.

The intake of food will raise the blood sugar, the insulin lowers the blood sugar, if you match the intake of food to the release curve of the insulin then the blood sugar remains stable, unchanged.

When you look at the release curve for Rapid-Acting Humalog(Lilly release chart) you see a 4 hour insulin release, with about 50% released after 2 hours. The intake of food at 8:00 will raise your blood sugar for 2 hours(30 minutes for fruit and 2 hours for starch and milk), so you are ok for the first 2 hours, you have matched the food intake and insulin release, but you still have 50% of the insulin to be released, which causes your blood sugar to start going down after 10:00 and you become hypoglycemic.

The method I use is to eat every 2 hours(Nph insulin), I moved half my 8:00 to 10:00, allowing me to reduce my insulin requirement and eliminated the hypoglycemic problem because I matched my food intake to my insulin release, I eat every 2 hours.

Note that your current insulin requirement is based on your total calorie intake, which includes the calories to overcome the hypoglycemic problem, as you adjust your food intake to eliminate the hypoglycemic problem(eliminating the extra calories), then your insulin requirement should also come down to match the lower calorie intake.

I have ignored veg and protein in this discussion because their impact on blood sugar is not as great.

Check with your Dr to see if this method might help solve your problem.

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mainer1 replied on Sun, Sep 16 2012 1:53 PM

When I when to pump orientation at the Joslin, I was struck with many of the other patients needed to know more about insulin and diabetes management in general before going to the pump. You seem to have a good idea about what works and what's not working for you with injections. I think you should give the pump a shot.

I had a strong "dawn effect," which caused me to chase high blood sugars all day long. I'd be under control by diner time, go to sleep and it would start all over again. My dawn effect is still there, but its less elevated and much more controllable with the pump.

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