Cheryl has been using an insulin pump for more than 15 years and says she would never go back to injections (unless someone stole her pump!). To help people who are considering insulin pump therapy, she shares with us some common concerns and the benefits of making the switch from injections.
The biggest concern that most people have is the psychological aspects of being hooked up to a device 24/7 and having to learn a new way of living and thinking about their diabetes.
If you’re on injections you can get your pen out, you can give yourself an injection and then you can put the pen away again. Whereas with the pump, you’re hooked up to it 24/7. You carry this device around with you everywhere you go. Most of the patients when I see them, that’s one of the things they say. They’re not sure about how they’ll feel about carrying this thing around. For most of them, once you explain the benefits, are happy and it doesn’t really create a problem, but that’s definitely the most common concern. Most of the girls, if they want to dress in a nice tight dress, they want to know if it is going to show through. For the boys, they want to know if they’re out and trying to attract the attention of a young lady and they’ve got this device hooked up to them, is going to affect their body image. It’s a constant reminder that you’ve got diabetes.
When people have these concerns I let them physically handle the pump and give them a mirror and get them to try and hide it in different places under their clothes. I also talk about the actual benefits of pump therapy. That would often reassure them that the positives outweigh the negatives.
Flexibility with dosing is a big positive of insulin pump therapy. They get much more choice over when and what they eat. They’re not locked in to eating at certain times just to match their insulin needs. Also, because they’re using just one type of insulin, they’re not using a long-acting and a short-acting insulin, they get much more even blood sugar profiles. It gives them more stable and predictable blood sugar levels.
Usually you use less insulin when you’re on a pump, so for people who are concerned about their dose it can bring the dose down. Having less insulin often makes you less hungry, so you’re less likely to put on excess weight.
I’m on an insulin pump. I’ve been on it for more than 15 years. For me personally, flexibility is the biggest advantage. I work in a job where you don’t always get a regular lunch hour, so it means that if I’m busy and I don’t have time to have lunch I’m not going to have hypos (they doesn’t impress my patients very much).
I would never go back to needles and pens unless someone stole my insulin pump and I had to. But because I’m much older, I’m a grandmother, body image isn’t as important to me as it is for a 16-year-old who wants to wear a bikini to the beach. They’re more worried about the body image side of thing and what it looks like to be wearing it.
Before someone starts insulin pump therapy it’s always really important to emphasise that people have realistic expectations. It’s not a cure. You can still have highs, you can still have lows. It’s just a very sophisticated way of giving insulin, but ultimately, the success is going to come down to the amount of work that the person wearing it puts in. If they’re not doing enough blood sugars, if they’re not entering their carbs accurately, things won’t get any better. It’s a major commitment and people have to be prepared to take the time and put that commitment in.
If someone says I want to start on an insulin pump today and run a marathon tomorrow, that’s really not very practical. They’ve got to give themselves time to find out what’s normal before they start trying to do really fancy and advanced things. Otherwise you can allow yourself to get disappointed.
If you are already on a pump you should have regular follow-ups with your diabetes educator, as well as their endocrinologist. The doctor is very busy and often doesn’t have the amount of time that’s required to spend with the patient to discuss all of those finer issues around what types of bolus or verifying rates, often it’s the diabetes educator who can actually do that part of the work. Also, when there are advances released in different types of infusion sets and some types suit different people. There are constantly new sets that come out on the NDSS and unless you’re seeing a diabetes educator regularly, you don’t hear about those advances. Or if one cannula is not working particularly well, they will know what you can swap to.
Cheryl Steele is a Credentialed Diabetes Educator and Manager of Western Health Diabetes Education Services. She has been living with type 1 diabetes for nearly 30 years. The opinions and thoughts expressed in this blog are her own.
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