T1D and Starting Pump Therapy – The Things We Worry About
Common Questions before Switching to Pump Therapy:
by IDS Director of Intensive Diabetes Management, Tavia Vital
Starting a new insulin plan when living with T1D can be exciting! It can also be nerve-wracking and overwhelming! In life outside the focus of T1D change makes most people uneasy, irritable, and causes stress. Moving, a change in jobs, a change in your family: all could be positive changes, but all positive changes will still cause some discomfort when looking ahead before the change takes place and many will still cause some stress or unease after the change takes place. Fear of the unknown is a common showstopper for people thinking about making a change to their diabetes therapy.
Changing from multiple daily insulin injections to insulin pump therapy or even changing from one type of insulin pump to another pump can cause the same types of feelings!
If you are a natural-born adventurer, you may feel mostly excited and just have a few "how to" questions you are wondering about. If you are a slow and steady wins-the-race type of person or a person who enjoys making a solid plan, a backup plan, and then a backup of your backup plan type of person, changing to pump therapy can feel BIG.
If you have not yet tried pump therapy, it may be helpful to know what most people worry and wonder about. After learning about pump therapy lingo (e.g. basal, bolus, carb ratio, correction factor or insulin sensitivity factor, and insulin on board or active insulin time), and learning the general concepts about how algorithm-guided insulin pump and CGM systems work you are likely still thinking about many unanswered questions!
The fact of the matter is that while there is no ONE right solution, type of insulin(s), pump model, type of therapy, CGM brand, or insulin regimen that will work for every single human being living with T1D, there are plenty of research studies that conclude that insulin pump therapy can provide many benefits to a wide range of people living with insulin-requiring diabetes. Algorithm-driven insulin pumps and CGM systems can, when programmed, adjusted, and used as designed, provide some background support by making automated adjustments that the wearer of the diabetes technology does not need to calculate and execute every 5 minutes, around the clock.
If the pump and CGM system are working efficiently and effectively, and if the person wearing the technology has ample education concerning what the system can and cannot do, how it does what it does, and strategies to use the technology to best meet their individual life needs, the person living with diabetes should see any or all of the following:
- improved time in range
- decreased time below range
- decreased frequency of severe hypoglycemia
- decreased time above range
- decreased variability
- decreased mental burden and workload to achieve the same glucose outcomes, or improved glucose outcomes compared to the previous method of insulin delivery used
Today I will answer the easiest questions about switching to an insulin pump:
Question: How often do I need to change the infusion set, tubing, and insulin cartridge or reservoir?
Answer: Every 2 to 3 days, depending on which type of infusion set you use and/or depending on how many units of insulin per day your body requires.
Question: How do I deal with dosing for foods that I do not know the exact carb count for, like when eating with friends or at a restaurant?
Answer: Have no fear! NO ONE KNOWS how to exactly count carbs when eating with friends or at certain restaurants! You will use the same resources (e.g. apps, books, websites, measuring tools) and tools (e.g. eyeball comparisons against a similar food you know how to count, or using your hand to estimate the portions) you currently use for injection therapy to make the best educated guess you can in those situations, and you will adjust later as needed.
Question: What if I do not like using insulin pump therapy, or what if I do not like using this specific insulin pump once I get started?
Answer: This specific worry often traps people and causes people to NOT move forward with trying something new.
However, most pump companies offer a 30 day no risk trial. If you decide before the 30 days is up you do not want to use the pump, they will take it back as long as you communicate with the pump company and follow their instructions on time. To find out more, communicate with the pump company and ask questions. Outside of that 30 day window, if someone needs more time to determine if they prefer pump to injection therapy, or if they prefer their old pump to their new pump, remember: You are not "trapped" into your new pump therapy system FOREVER. You can always go back to what you did before you made the change! If you did injections, you can stop using the pump and go back to injections. If you kept your old pump and did not trade it in as part of an in-warranty upgrade, you can go back to your old pump for a time. You may need to have prescriptions adjusted and may need to wait until you can fill a new supplies prescription, but you will have options.
The remaining questions listed above and any other questions you have about pump therapy are best answered by your trusted Certified Diabetes Care and Education Specialist.
