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Medical Forum / Diseases and Disorders / Diabetes / March 2006OB recommends insulin pump
I went to my initial OB appointment today. It was a different OB than last time, he was recommended by my endo as being the best with very high risk pregnancies. After the examination, we reviewed my previous records, including the two previous pregnancies. He said he would like to see me on an insulin pump. He has sent this recommendation to my endo. I have read a little about insulin pumps, mostly on ASD. From what I read, I would have a problem with the injection sites because I am so thin. Any information on pump use by very thin people will be appreciated. I am willing to do anything that will increase my chances. Andrea2 Type 2 > I have read a little about insulin pumps, mostly on ASD. From what I > read, I would have a problem with the injection sites because I am so [quoted text clipped - 4 lines] > Andrea2 > Type 2 Andrea, There are different types of infusion sets and some work better for thin people. There are sets available for all of the pumps that are inserted at an angle, so you don't need a thick layer of fat. Skinny little kids can use them, so can a skinny adult. Depending on the brand/pump, they're called Silhouette, Tender or Comfort (I think). They would probably be better than the sets that go straight in, like Quick-Sets, Insets etc. -- Liz Type 1 4/1987 MM715 5/1005 >> I have read a little about insulin pumps, mostly on ASD. From what I >> read, I would have a problem with the injection sites because I am so [quoted text clipped - 13 lines] >called Silhouette, Tender or Comfort (I think). They would probably be >better than the sets that go straight in, like Quick-Sets, Insets etc. I'll do what my endo recommends, but I would rather not do the pump. I worry that during the training period I would have poor control and I dread being hooked up to that thing all the time. I don't think there are many other T2's using pumps, I did hear of a few when I was pregnant last time. Andrea2 > I'll do what my endo recommends, but I would rather not do the pump. I > worry that during the training period I would have poor control and I [quoted text clipped - 4 lines] > > Andrea2 Andrea, I got over being hooked up to a pump 24/7 pretty quickly. I clip it to my bra (in the middle) and the pump & tubing are out of sight all day. During the first few months my numbers were driving me crazy, because my CDE was being very cautious in setting my basal rates. When I finally decided to just make my own changes without consulting her, things got much better. With a pregnancy, I'm sure your doctors/endo/CDE would be very aggressive in order to keep tight control. Pumps are great and if it helps you to have a smoother pregnancy you should really give it a try. On the IP list, there are many Type 2's that are pumping and love it. -- Liz Andrea2 wrote in message ... . . .(snip). . . >I'll do what my endo recommends, but I would rather not do the pump. I >worry that during the training period I would have poor control and I [quoted text clipped - 4 lines] > >Andrea2 A few more things to consider while making your decision: 1. You want a dull, uneventful, boring pregnancy 2. The very best way to do that is by using an insulin pump. 3. The second best way is to use a very diligent, almost obsessive Multiple Daily Injection (MDI) scheme 4. In either case, the training and workload are very similar. Note that: a. Many Pumpers avoid MDI because it is so burdensome. b. Many MDI avoid Pumping because it is so burdensome. BTW: One of the reasons I'm not interested in a pump is because I don't want to be hooked up to the thing either. So long as I can match a Pumper's control with an obsessive MDI, I'll stay with the MDI. (I do attend the Pumpers support group meetings though) Regards Old Al >>> I have read a little about insulin pumps, mostly on ASD. From what >I [quoted text clipped - 30 lines] > >Andrea2 I hope it works for you. Who knows, maybe you will end up liking it. Fear of the unknown is what you are facing. Sleepy ------------------------------------------------------------------ It is easier to make a saint out of a libertine than out of a prig. -George Santayana (1863-1952) ------------------------------------------------------------------ > I went to my initial OB appointment today. It was a different OB than > last time, he was recommended by my endo as being the best with very [quoted text clipped - 12 lines] > Andrea2 > Type 2 I wrote a lengthy post to you concerning pumping last week. I deleted it because I felt you have more than enough on your plate at the moment. There are many T2s on pumps that post on the insulin pumper's (IP) mailing list. All have said it has made a tremendous difference in their control. The same can be said for women who have pumped during pregnancy, mostly T1s, but it would apply equally. Check out the pumpers website http://www.insulin-pumpers.org Join the mailing list if that interests you. There is one lady posting there right now who is pregnant and pumping. Choose the browser option unless you want 100+ emails per day. The pumper's bible is "Pumping Insulin - Everything You Need For Success With an Insulin Pump" by John Walsh and Ruth Roberts, published by Torrey Pines Press, ISBN 1-884804-84-5 You can purchase it through the IP website or online or order through a bookstore. There's a section devoted to pumping and pregnancy. Walsh and Roberts are both members of the IP list. Infusion sites wouldn't be much of a problem, even if you're very thin. There are sets made just for thin people, because being thin is a characteristic of most T1s. Your pump trainer would help you choose an infusion set that would be best for you. At worst, your control would be no worse than it is now when you start with a pump. Starting basal and bolus rates are worked out with the amounts of insulin you're using now by injection. The advantage with pumping is it allows far superior micro management of insulin delivery, which results in less highs and lows. The biggest drawback is the lows you may experience the first couple of days as the basal insulin you use works its way out of your body. As long as you're aware and prepared, you can take action to reduce the amount of insulin you're using immediately (instead of eating). It does mean you'll have to test often, but you're already doing that. I too was a bit concerned with being hooked up 24/7. I got over it in about 48 hours, now I feel wierd without my pump. A pump is small, and I just wear men's sleep pants at night with the pump in the pocket, or clipped to my waistline during the day. Many ladies put the pump in their bra, but if I did that, I'd look like I had a third boob. ;-) If there's anything you'd like to discuss, feel free to send me a note. My email is valid. Vicki Animas IR1200 On Wed, 01 Mar 2006 16:22:47 -0800, Andrea2 <andrea6192001nospam@yahoo.com> Huffed and Puffed the following into the madness of usenet: >I went to my initial OB appointment today. It was a different OB than >last time, he was recommended by my endo as being the best with very [quoted text clipped - 12 lines] >Andrea2 >Type 2 there is no problem with being thin if you can use the silhouette type infusion sets. However! A pump purchase is about 5000.00 to 5500.00 U$D. Isn't it unusual to get one only for the term of the pregnancy? Just curious, that is way outside my level of knowledge. I have no idea what your insurance would approve. pumping would allow you a great deal of control and freedom over your BG and diet. plus it would spare you having to take multiple injections per day. But it would not reduce the amount of BG testing you would have to do, and would in all likely hood increase it a bit. If your endo has any patients who pump, then he/she should have direct contact with one or more pump makers directly. Get the endo to get a couple of sample infusion sets and show you how they are inserted and worn for the 3 days between set changes. And remember, you are not limited to your abdomen only for infusion sites, you can use your upper thighs, and with a little help from your husband you can use your arms as well. The tubing is long enough to go where ever you want to wear them.  SignatureMâck©® Deltec CoZmore Pumper Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org "To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt (o ô) --ooO-(_)-Ooo-------------------- "I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." ....Bilbo Baggins Jesus never hated anyone. Thanks for all the information. I want to see what my endo says about me pumping. If she says it would be better for me I will do it. If I do it, I will be asking a lot of questions to the medical team and you hear on ASD. I have become quite proficient with my MDI regime. I first started it when I was pregnant last time and maintained an A1c or 5.9 or below all the time. I don't mind the injections, there is absolutely no pain, I use the smallest, shortest pen needles made. During the last pregnancy, the biggest problem I had was morning sickness. I had it for 3 months, not just in the morning but most of the time. I had a lot of close calls when I injected premeal insulin then threw up. I kept glucose gel and tablets on hand at all times. I don't see how a pump would help with this problem. It's not just being connected all 24/7 or injection sites, that worries me. When I was working, I worked with computers. They are very reliable but they do malfunction sometimes at the worst possible time. These pumps are small computers injecting insulin when their program tells them to. If it malfunctioned, say when I was sleeping, could it inject its entire store of insulin all at one time? Could this be fatal? I don't think I could get over worrying about that. For computers they usually list in their specifications the mean time between failures, it is never infinite. They are all expected to fail sometime. Andrea2 > Thanks for all the information. I want to see what my endo says about > me pumping. If she says it would be better for me I will do it. If I [quoted text clipped - 24 lines] > > Andrea2 Pumps don't do "runaway" any more. that's something you may have heard about in the early days of pumping. Worry more about forgetting to fill your reservoir, or worry about a bent cannula. or forgetting to put out the garbage. Pumps fail in the no delivery mode; not over delivery. Dave > Thanks for all the information. I want to see what my endo says about > me pumping. If she says it would be better for me I will do it. If I [quoted text clipped - 22 lines] > between failures, it is never infinite. They are all expected to fail > sometime. I think what it all boils down to is finding a way to keep bg's at a minimum to ensure the best chance of producing a healthy baby and mother at the end :) Whatever it takes. If insulin shots work, fine. If not, keep an open mind. > During the last pregnancy, the biggest problem I had was morning > sickness. I had it for 3 months, not just in the morning but most of > the time. I had a lot of close calls when I injected premeal insulin > then threw up. I kept glucose gel and tablets on hand at all times. I > don't see how a pump would help with this problem. With the pump you can bolus (take pre-meal insulin) a few different ways. You can do a normal bolus, which gives you the full dose of insulin all at once, like taking a shot. You can also do a square wave bolus, which will give you the insulin over a set (set by you) period of time, like an hour, 90 minutes. Then there's a Dual Wave bolus that is a combination of the two - you can have the pump give you part of the insulin right away, and spread the rest out over time. If you know how much insulin you should take for a given meal, you can have the pump take its time delivering it in case you don't/can't finish the meal, or end up throwing up. If that happens you can cancel the bolus delivery. The pump will tell you how much insulin was actually delivered and you can decide if that was enough to cover what you did eat, or if it was too much and maybe you'll need some help from the glucose tabs. > It's not just being connected all 24/7 or injection sites, that > worries me. When I was working, I worked with computers. They are very [quoted text clipped - 8 lines] > > Andrea2 As Dave said, you don't have to worry about the pump giving you too much insulin (unless you programmed it wrong, but that would be user error). The do sometimes fail but the pump companies will ship a replacement overnight, or a sales rep in your area might even be able to bring over a replacement the same day. If that does happen, you can go back to injections until a replacement arrives. The only problems I've ha with my pump is bent cannulas in the infusion sets. My BG will start to go up for no reason, or the pump will give me a No Delivery alarm. When that happens I put in a new set. -- Liz Type 1 4/1987 MM715 5/2005 Elizabeth Blake wrote: >>During the last pregnancy, the biggest problem I had was morning >>sickness. I had it for 3 months, not just in the morning but most of [quoted text clipped - 43 lines] > Type 1 4/1987 > MM715 5/2005 In the two years I've been pumping, I've never had a problem with a bent cannula or bad infusion set. I've only had one no-delivery alarm, and that was because I was using cartridges in my IR1000 that had been recalled. I use Comfort infusion sets and always insert them manually at a bit shallower angle than recommended. With my IR1200 I have had 2 screen failures. That was the most common bug with this particular pump. I had a replacement pump the first time in 8 hours, the second time I got a brand new pump in 3 1/2 hours, delivered to my workplace by medical courier. I didn't go completely back onto shots, I let the pump do the basal and I bolused for meals by injection because I couldn't see the screen except in full sun. The software problem that caused the screen failures has been resolved. The IR1250 that's available in the US doesn't have this problem (no reported problems, as far as I know) and it has a food database built in. Very cool. Vicki > Elizabeth Blake wrote: > [quoted text clipped - 59 lines] > > Vicki Didn't the 1200 have an audio bolus feature? Dave >> During the last pregnancy, the biggest problem I had was morning >> sickness. I had it for 3 months, not just in the morning but most of [quoted text clipped - 38 lines] >the pump will give me a No Delivery alarm. When that happens I put in a new >set. These alternate bolus functions would help a lot if I get morning sickness again. Last pregnancy I had to inject my bolus insulin in 2-3 stages when the morning sickness was the worst. That was a suggestion from Old Al that my endo went along with. The automatic pump functions would be better. I assume that I could stop the extended bolus with a button or something. The suggestion of using arms or thighs for set sites does not sound good to me. I like to be active and can't imagine jogging or biking with a tube attached to my thigh or arm. It will be up to my endo to decide if a pump is right for me. She won't be available until next week so I'll just have to wait. Andrea2 On Fri, 03 Mar 2006 15:19:02 -0800, Andrea2 <andrea6192001nospam@yahoo.com> Huffed and Puffed the following into the madness of usenet: >These alternate bolus functions would help a lot if I get morning >sickness again. Last pregnancy I had to inject my bolus insulin in 2-3 >stages when the morning sickness was the worst. That was a suggestion >from Old Al that my endo went along with. The automatic pump functions >would be better. I assume that I could stop the extended bolus with a >button or something. yep just a simple push of a button to stop the delivery. >The suggestion of using arms or thighs for set sites does not sound >good to me. I like to be active and can't imagine jogging or biking >with a tube attached to my thigh or arm. never stopped me. I bike, roller blade, work go to the shooting range with the infusion set in my thigh or abdomen, wearing all types of clothing without any problems. >It will be up to my endo to decide if a pump is right for me. She >won't be available until next week so I'll just have to wait. > >Andrea2 I'm not trying to push it on you. I just don't want to see you setting yourself up to psych yourself out. SignatureMâck©® Deltec CoZmore Pumper Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org "To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt (o ô) --ooO-(_)-Ooo-------------------- "I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." ....Bilbo Baggins Jesus never hated anyone. >>It will be up to my endo to decide if a pump is right for me. She >>won't be available until next week so I'll just have to wait. [quoted text clipped - 3 lines] >I'm not trying to push it on you. I just don't want to see you >setting yourself up to psych yourself out. I will be sticking with my MDI program. My endo decided it would be best because I was already so stressed and I am doing good on the MDI program. My last A1c was 5.8 and most of my BG tests were good. She also didn't think my insurance, Tricare, would pay for it. They decided I could resume my exercise program as long as I didn't "over do it". They don't want my heart rate to exceed 125. I'm not sure but I think I could run a marathon without exceeding 125. I am going to get a chest band heart rate monitor to check it, the watch one I have don't work well on me. I think it is because my wrist is so thin. She suggested I see a specialist about my stress but I declined because at previous sessions the only thing they ever did that helped was give me Prozac. It works well for me but I would refuse to take it while I am pregnant. Dealing with the stress will be my biggest problem and hardest to overcome but. Andrea2 Type 2 ------------------------------------------------- If one finds a sagacious friend, who is a virtuous and steadfast companion, one should live with him joyfully and mindfully, overcoming all dangers. The Dhammapada, verse 328 On Thu, 09 Mar 2006 13:12:10 -0800, Andrea2 <andrea6192001nospam@yahoo.com> Huffed and Puffed the following into the madness of usenet: >>>It will be up to my endo to decide if a pump is right for me. She >>>won't be available until next week so I'll just have to wait. [quoted text clipped - 7 lines] >best because I was already so stressed and I am doing good on the MDI >program. My last A1c was 5.8 and most of my BG tests were good. hell you're doing better than most of the people in here who are not pregnant. She >also didn't think my insurance, Tricare, would pay for it. Cost/insurance is always a hassle with pumping. You'd think, with the advantages that a pump gives, OBs and endos would keep pumps and supplies on hand specifically for short term use by pregnant women and simply bill them for the supplies >They decided I could resume my exercise program as long as I didn't >"over do it". They don't want my heart rate to exceed 125. I'm not [quoted text clipped - 16 lines] >all dangers. > The Dhammapada, verse 328 I try to vent frustrations at inanimate objects, cheating and going into God mode while playing violent video games or going down to the range(not okay for pregnant women). Other times meditation and music work. Other times stepping outside of myself or the situation and looking back in as if from the outside is usually good for a hearty belly laugh or a puzzled head shake at the idiocy of most situations. Then there are those times you just can't let it go. I've had my share of them. They haven't discussed things like this for stress management? >>She suggested I see a specialist about my stress but I declined >>because at previous sessions the only thing they ever did that helped [quoted text clipped - 19 lines] >share of them. They haven't discussed things like this for stress >management? Everyone has their own way to deal with stress and depression. Mine is exercise. When I am jogging/running my mind seems to clear and troubles things seem to grow insignificant. Sometimes they come back after I return home. My hubby suggested I make a list of things that are stressful and depressing. When I was having trouble thinking of them, he said to list the things that stressed me out in the past. After I listed several, I realized they were spur of the moment, trivial things. A doctor once suggested I might have a Bipolar Disorder. I do identify with most of the symptoms of mania. Andrea2 Type 2 -------------------------------------------------------- The lotus will grow even in rubbish thrown away. It will delight the heart with its sweet smell and beauty. --- Dhammapada On Thu, 02 Mar 2006 16:08:11 -0800, Andrea2 <andrea6192001nospam@yahoo.com> Huffed and Puffed the following into the madness of usenet: >Thanks for all the information. I want to see what my endo says about >me pumping. If she says it would be better for me I will do it. If I [quoted text clipped - 11 lines] >then threw up. I kept glucose gel and tablets on hand at all times. I >don't see how a pump would help with this problem. well with this particular problem you could hold off on bolusing for your meal until you actually ate the meal and waited a short period to see if you got sick afterwards. Then bolus for it. However, if you find that you need to stop the delivery of the bolus before it is all "delivered/injected" you can with a simple button push. Your meal may have called for 15 units of insulin but you got sick and threw up and decided to stop the delivery and you stopped at 8 or 10 units. If you had to deal with a hypo, it would be far less severe than if you had received the full 15 units. If you really needed to, you could stop the delivery of your basal insulin altogether slowing the likely hood of a hypo do to not being able to keep anything down. Where as with the injections once you inject. you have to eat something to feed the insulin. so if you ate, injected, got sick you would have to eat again to cover the full amount of insulin injected. >It's not just being connected all 24/7 or injection sites, that >worries me. When I was working, I worked with computers. They are very [quoted text clipped - 8 lines] > >Andrea2 there has never been one reported incident of this type of pump malfunction, ever, with any pump, regardless of brand name, to my knowledge. The pumps are designed to stop delivering insulin in the event of errors and malfunctions and to give audible and if chosen vibrating alarms. You can even program them to alarm if you do not touch any buttons on the pump for a user specified time period. The list of alarms and customized alerts and alarms are long and vary from pump to pump. The only way to read up on them all is to go to the insulin-pumpers.org web site and follow the links on the lower left side of the page to each of pump manufacturer's homepages to read up on them. Email them directly with any specific questions about their pumps you may have, they will gladly give you direct answers via email or by phone. But yes, they are micro computers and they machines with some moving parts, malfunctions can happen. Getting a replacement is a matter of an overnight express at the company's expense and then you shipping the faulty pump back to them at their expense. During the waiting period you are of course injecting insulin via syringe/pen. The insulin-pumpers.org group will give you an idea how frequent pump malfunctions are. I've never had one. When I was calling around asking to speak with pump reps, I told them the decision to buy a pump was already made. I was simply shopping around considering pump features. And comparing those features to my specific needs and complications. I also made it clear that any attempt at giving a sales pitch would lose me as a customer. So no one made any sales pitches. They answered all my questions, sent me any literature I wanted that was not on their web sites. The only pump company I cannot recommend is minimed. And that is solely based on my personal experience with their billing practices. Their pumps are top quality. Their service and billing went down hill since the merger with the new company that bought minimed. SignatureMâck©® Deltec CoZmore Pumper Type 1 since 1975 http://www.alt-support-diabetes.org http://www.diabetic-talk.org http://www.insulin-pumpers.org "To announce that there must be no criticism of the President, or that we are to stand by the President right or wrong, is not only unpatriotic and servile, but is morally treasonable to the American public." ...Theodore Roosevelt (o ô) --ooO-(_)-Ooo-------------------- "I don't know half of you half as well as I should like; and I like less than half of you half as well as you deserve." ....Bilbo Baggins Jesus never hated anyone. |
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