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Dr. Bill's Commentaries

A year on a pump   (June 21, 2009)

I was thinking about how long it's been since I started using my insulin pump, and looked it up: it's now over a year; I started pumping on June 16, 2008, and have been using the device continuously since then.

Thinking back over this year, several thoughts pop up:

1) Would I ever go back to syringes and vials? I really can't imagine doing so. Sure, the pump is more expensive, and more work, but it allows fine-tuning of insulin dosing that simply isn't available with shots, and I suspect I've had less hypoglycemia while on the pump than when I was on shots.

2) Would I consider taking a "pump holiday" (a period of time when pump therapy is discontinued for convenience or for a clinical situation, such as pump failure)? No, not unless it was for pump failure. I keep a supply of syringes and insulin nearby, just-in-case of pump failure.

3) Has the pump been reliable? Yes. There was one time when my BG after eating was way too high (245, as I recall), and I double-checked the BG with another test (same), and then double-checked the pump's memory about whether I had bolused -- and yes, I had. And the site where the catheter tubing goes into the skin looked good. And I wasn't feeling sick. I gave a compensatory bolus, and it dropped slightly. And another later, and again some drop. Eventually I realized it was time to change insulin and change sites, and thereafter everything was fine. I later concluded that the insulin was "bad" -- I had just reloaded the pump before that meal, with insulin from an older vial, with not much left, and had been at room temperature for a while. In conclusion, this episode was not a pump problem per se.

I've dropped it once or twice, and had that sinking feeling as I pick it up: will the displays work? will the device work? So far, so good. BTW, I haven't yet dropped it into the toilet, but there were times when it came close...

4) Which pump will I get next? I'm a very satisfied customer as far as my present model (Deltec Cozmo), but the company has withdrawn from the pump market (grrrrrrrr!). I looked briefly at other models while at the exhibits at this summer's ADA meeting, but I really couldn't work up the desire to talk in detail about what features their pumps have and why I should switch, despite some financial deals that some of the companies are offering -- for a limited time only: yeah, sure!

Presently, I think of my pump like I think of a one-year-old car: it's working fine; it's still under warranty; there's simply no good reason to switch to another brand at this time.

5) Should I get a continuous glucose monitor (CGM) to help tighten up my glucose control even better? My A1C is at 5.7, and has been below 6 the entire time I've been pumping, but it was below 6 before the pump. Obviously, the pump hasn't magically caused my A1C to decrease. CGM does hold some promise of allowing even finer tuning of the rate of insulin delivery, but the more I ponder it, the less I'm convinced that a stand-alone CGM device would allow my averages to decrease substantially. And it's another expensive device, and one that still requires calibration, and one that seems (at this moment anyway) unnecessary for my lifestyle, as I'm perfectly willing to do fingerstick blood sugar testing as often as necessary to check where my BG levels are. Someday, there will be CGM that's truly integrated with the pump and then I'll reconsider. But as of now, CGM is either free-standing, or, for one company, partially integrated with their pump. I'll wait.

6) Should I have switched to a pump sooner than I did? I answered that question a month after starting pumping, and I still feel the same way as I did then: "No. Starting insulin pumping is a decision not to be taken lightly, and not to be rushed into. It's a life-changing experience. One has to be motivated to use these things, and it's quite a leap of faith to trust one's life to a little mechanical and electronic wonder."

7) And a final question: Is pumping worthwhile?

For me, yes.

For you, if you are taking multiple insulin shots every day and your control is less-than-optimal, or if your lifestyle is variable, or if your physician and/or diabetes nurse educator suggest that you use a pump, it's probably worthwhile for you, too.

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Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.



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