Season 1, Episode 3
Welcome to the Diabetes Goddess podcast and I’m your host Barb Wagstaff. This podcast focuses on the fact that you’re more than your carb to insulin ratios or your time in range. Your diabetes may vary. Please remember that, while I’ve played a doctor in real life for years, I’m not a medical professional and any opinions expressed on this podcast do not replace medical advice. Please remember to always consult with your doctor before making any changes to your diabetes care
Barb Wagstaff: Insulin pump therapy is something that I believe strongly in. I really think that pumps are important and helpful tools. And if it were me living with diabetes, the first thing I would do is get an insulin pump. That being said, there’s a lot of things to consider when choosing an insulin pump.
An insulin pump really isn’t for everyone. It kind of pains me to say that, but it’s a fact. Some people really just don’t like to be attached to something 24/7. They don’t like relying on something mechanical that could go wrong. They don’t like the fact that, you know, you put in an infusion set and maybe the site kinks, maybe something happens in the tubing, and things can go wrong.
1:44 They like the idea that they’ve injected insulin into their body, they’ve seen the insulin go in, and they know that they’ve received the insulin. And they don’t have to be concerned about any of those things that I mentioned. They don’t have to be concerned about cannulas kinking. They don’t have to be concerned about crystallization in their tubing, their tubing breaking, a cat chewing on their tubing, their dog chewing on their tubing. Someone’s tubing getting caught in a door. They don’t have to be concerned with any of that. They don’t have to look for their PDM’s. They don’t have to be wearing pods. They just don’t have to be concerned with any of that. They can grab their insulin pump—oops, they can grab their insulin pen, they can grab their vial of insulin and be on their way.
Some people also really don’t like the cost. There’s a lot of costs involved in insulin pump therapy. And if you don’t have good insurance or a public provider that can help offset some of those costs. Insulin pump therapy is exceptionally expensive. So it’s all well and fine for people like myself to say, “Oh I haven’t insulin pump in a heartbeat!”
I don’t have insurance. Would I have an insulin pump in a heartbeat? Hmmm…I’d really have to think about it. I’d have to look at my bank account and see if it was financially doable for me to use an insulin pump without insurance, without great coverage, and I wouldn’t, at my age, qualify for any public programs. So insulin, the cost of insulin pump therapies definitely is prohibitive for many people.
3:35 Some people also don’t like the fact that changing an infusion set takes a lot of time. Now some people feel that, for the amount of time it takes to change an infusion set that only happens once every two to four days versus an injection that happens every single time? But for some people that time that it takes to put it in a fusion set? It’s just not worth it. They just really don’t want that kind of hassle.
There’s also a concern that there’s an increased risk of going into DKA, diabetic ketoacidosis. If you’re using insulin pump, you’re only using rapid acting insulin. So many people feel that that’s just not worth the risk. They like to have a long-acting insulin in the background in their system that’s always covering their basic needs. When you have diabetes, you have no insulin production and your body needs insulin just to do simple things like breathing and thinking. So if there’s no insulin in your system, no background insulin, which again in an insulin pump that’s coming with rapid acting insulin. It’s being delivered to you on a regular basis. If that fails for any sort of reason, you can find yourself in DKA very quickly and there can be problems. So a person who injects insulin feels that, a lot of times, that they are a bit more protected because they know that they’re not going to have a site failure and their insulin is already there. They’ve already got that background insulin to protect them.
People who prefer injections sometimes they also worry about an increased risk of infection. If you have an infusion site that you’ve put in, and maybe there’s some irritation around the site, or something happens, or it wasn’t cleaned properly. Well they can get infected and that’s no fun. So, people who don’t want using some pump sometimes worry about that risk of infection.
But as I said, personally? I like the idea of an insulin pump. The reasons to use an insulin pump? Well obviously, the, the first glaring one is you don’t have to be stabbed as often. That would be the bonus for me. I’m not really a fan of needles. They said nobody is. Even if you use injections over an insulin pump, there’s a pretty strong chance that you’re really not a big needle fan, but you just prefer it over the alternative. But many people will choose an insulin pump because there’s less injections especially with small children. You know, trying to pin them down, unfortunately, and inject into them. A lot of parents find that an insulin pump gives them a bit of a break from that. So being able to inject yourself, your child, once every two to four days versus having to inject. My son was probably injecting at least eight times a day, sometimes 10, when he was on multiple daily injections. And now the irony there is, he was five when we switched insulin pump and he was totally fine with the injections. At five years old, he was like, “ Yeah no problem. Give me the injections. I don’t want an insulin pump.”
7:16 Obviously, I didn’t give him a choice. I let him choose a colour. That’s as far as his choice went. But he was OK having injections and some people are. They’re, they’re fine with that. So that’s something to consider when having…when using insulin pump. Now one thing that my son did prefer, when we went to an insulin pump over injections, is he was able to graze. Now grazing is just like it sounds. You think of the cows and such, that graze in their fields and nibble at a bit of grass here and nibble at a bit of grass there. When my son first got his insulin pump, they had a bake sale at school. And that was pretty amazing for him because instead of picking up a few things, and then having to save, you know, be able to have a few things for snack right then and there because we had the insulin to cover it. And maybe anything else that he wanted to eat, he’d have to wait until lunchtime or suppertime or snack time and we would fit it into his meal then and doses insulin. But he wouldn’t be able to just pick up this and then go pick up that. After he got his insulin pump, we went to this bake sale and he picked up a cupcake and he brought it over to me and he ate it. And we put in the carbs into his insulin pump and then he went away. And he found cookies somewhere else and he came back. “Mom can I have a cookie?”
“Sure.” I gave him the insulin for the cookie through his insulin pump and then he went off and found a little mini cupcake. And he came back. “Sure, why not. You can have that too!” and we gave him the insulin for that. He probably had three or four different items. Its not that we would normally do it, but this was a special occasion. It was an event. Other kids were doing the same thing and he got to be a kid. He got to graze and pick and eat a little bit of this and eat a little bit of that, and just coming back to me each time, dosing on his pump and away he went. And I know for a fact that he found that so much better then if he’d of had to get a needle for each time that he ate like that. Or having to wait until later on when all of his friends were running around eating and racing around and nibbling and picking at this and that. Now that my son’s older, he’s also very interested in fitness and weightlifting. He’s been interested in weightlifting for probably at least eight or nine years now. And by using an insulin pump you have a little bit more flexibility in doing that with your insulin pump. And I won’t say that it’s perfect, but you are able to suspend your insulin pump.
10:19 Now there’s very successful people who use multiple daily injections who do that and exercise. There’s avid fitness people like Ginger Vieira who, you know, she, she was doing weightlifting, bodybuilding. She’s doing aerobic exercises and she’s more than capable of working with an MDI routine and multiple daily injection routine and managing her insulin levels. So an insulin pump does provide flexibility, but you certainly can learn. And it is not impossible to exercise and still maintain really good control. One thing that an insulin pump does offer at the moment that you can’t get with injections, no matter how good you are, is insulin pumps, at the moment, now offer an option, more and more, to be integrated with your continuous glucose monitor. So if you’re someone who enjoys using a CGM. You like the data that you’re getting off your CGM. You find your CGM very, very helpful and you want it to be able to speak to your insulin delivery system. That can only be done if you’re using an insulin pump.
So if you were on injections, the CGM can’t tell your injected insulin, “whoa, back there! We’re going a little or pump it up a little bit more! We need some more insulin because you’re going high.” So, in order to use a CGM and have it speak to, or be integrated with…into your diabetes management system, you have to be using an insulin pump. But again, that’s totally up to you. Some people don’t want to have that extra gadget on them. They don’t want to have anything on them. That’s, in part, why they don’t want to have an insulin pump. So, they certainly wouldn’t want to have a CGM as well.
Another thing that insulin pump offers, that’s a little bit more of a challenge if you’re using injections, is to really micromanage your blood sugar levels. If you’re using a syringe, it can be a challenge. And again, it’s a challenge that some people do manage to rise to. To get just tiny, microscopic amounts of insulin. I’ve seen people draw up a quarter of unit. It’s amazing. It can be done, but an insulin pump can allow you to deliver very, very small units of insulin. Very, very small basal amounts. So if you want that really tight control or if you’re using a very, very small amount of insulin and need to micromanage blood sugar levels, often an insulin pump is the way to go.
13:40 Some people also feel that an insulin pump, because it is delivering such a small amount of insulin on a consistent basis, that it will help to reduce the amount of variance. And, it makes it so that you are less likely to have extreme episodes of hypoglycemia. It’s not going to totally stop you from going low. Extreme lows will happen, if you’re not really, really careful. If you’re not exceptionally vigilant. But the feeling is, is that with an insulin pump you have that little bit of extra control. That you don’t have quite the same variations in absorption levels that you do when you’re using certain… longer acting insulins. and you’re injecting.
One of the other big things, depending again on the type of insulin that you’re using, is an insulin pump– there’s no peaks to have to chase. Nowadays, many people use flat baseline insulins like a Levemir or Lantus, so they also don’t really have a peak that they have to, to feed. But because there’s no peak, they also have to any snack, to cover anything extra that they want to eat. Every morsel of food has to be covered with an injection whereas when you’re on an insulin pump, every morsel of food that you want to cover your going to cover through a bolus—through a push of a button on your insulin pump.
And the other joy of an insulin pump is it’s a computer, which as we’ve said before means that it can fail. But it can also be helpful in doing the math, in figuring out how much insulin you need to bring down a high blood sugar level, how much insulin you need to cover a meal, how much insulin you have on board before covering a meal or covering that high.
So, there’s a lot of pros and cons in choosing an insulin pump. Ultimately you have to choose what’s best for you and that can be a challenge. In part because there’s so much information out there. There’s so many different pumps. There’s so many different things to decide. You can feel really overwhelmed.
The first time that I chose my son’s insulin pump? My brain was exploding! You know that that feeling? Where you just feel like, like your brains just splattered all over the inside of your skull and you just can’t think anymore? That was kind of me and at that point there were four insulin pumps on the market. So we were kind of lucky that, at the beginning, that was the time when there was choice. But insulin pumps didn’t update like the tSlim now does, and the new Medtronic pump will update for you. They update their software. So when I was first looking at an insulin pump, I had to look at what had the best features? What had the newest features? Because I was locked in on that pump. We were paying for it cash and I had to…we were going to keep that pump for the next 4-5 years before having to pay for another one. So I had to really look at every feature and I didn’t even necessarily know what features that I needed. My son was five. I needed something that delivered small doses of insulin. I knew that. And he probably needed to have some flexibility in that type of infusion sets that we needed. Swimming wasn’t really an issue because we kind of—we live in an area where you could go to swimming lessons, but we weren’t going to be at the beach all of the time and worrying about being in the water. And we certainly didn’t have a pool in the backyard, so that wasn’t something that we had to consider. But there were so many other things to look at.
There were so many pumps. I reached out to all of the insulin pump reps and they were very kind. I had one pump rep that–she was great she actually gave me a list of questions to ask other pump reps! And she gave me a good idea of things that I needed to, to understand and things that I should be asking.
18:36 So, I felt a little bit stronger and a little bit more knowledgeable. And she sent me a pump. A pump? She sent me an insulin pump book called Pumping insulin, so I could go through and learn a little bit more. And then I spoke to another rep. And this rep was exceptionally kind, and he met with me. And he talked me through everything. And his pump seemed wonderful but, I knew there was another generation of that pump in the US and it hadn’t made it to Canada. So if I purchased this pump, it wasn’t going to be good, as good, as the pump that Health Canada would probably approve the year after I made this purchase. So then we’d be kind of at the lesser generation that wasn’t as good as what was going to be coming out. But he was really kind and I felt horrible not wanting to buy his product. And then there was another insulin pump, but my son had ruled that insulin pump out, because I did give him some choice, and his choice was, “I don’t want the blue pump!” So that– there was one pump company that a lot of people were using and their insulin pump was blue and that wasn’t pump that he wanted. I’ve no idea why he didn’t want that pump, but that was, that was his only stipulation–no blue pumps. So OK.
But there was a pump, that was coming to Canada. I had a lot of friends in US that were using this pump. I really liked this pump. It had so many of the features that I felt would be very helpful for us. There was alerts. It had the right amount of background insulin–it was small enough for him. And it would grow with him and when he needed more insulin, it had a big enough insulin reservoir. And it just seemed the absolute perfect fit for our family. It wasn’t the insulin pump that our educator wanted us to use. It wasn’t the insulin pump that the first rep who gave me the insulin pump book, ah was representing. And it wasn’t the insulin pump that this other gentleman was representing, but I really felt that this was the right pump for us. It was a pump that would fit the needs for our family and the needs of my son. So I set about the–getting the paperwork and getting, getting this pump ordered for my son.
21:24 And then we had a problem. Because this pump was brand new to Canada at the time, there wasn’t a lot of training–including our pump centre, hadn’t been trained on how to use insulin pump. Without them being trained, they would not put my son on this insulin pump. And at the time, I lived in a very remote community. And getting pump training required us to drive an hour and a half to two hours into a different community. And we were going to have to stay overnight there for a bit. And winter was coming on. It was just getting kind of messy, and I didn’t want to have to go in for appointments in snowstorms. And that was going to be a very real possibility as things were getting pushed back and pushed back and pushed back, so I really didn’t know what to do. And I reached out to a friend. And I said, “I’ve got a problem. I really want to use this insulin pump, but I can’t get the training for my centre. And then I can’t get the training for me. And now my centre is saying, well why don’t you just use this other pump? I can get you one of those really quickly, and it’ll work for you just as well, and it’ll be fine.” I was like, “but it’s not the pump that’s right for our family. It’s not the pump that I really want.”
22:58 So, again I had reached out to this friend and this friend said, “let me, let me see what I can do.” She knew a lot of people in the insulin pump industry including this new pump company that I was using. And she made a few phone calls. I eventually got a phone call back from the gentleman who was going to be representing this new pump. And he called me up, and he laughed. And he said, “I don’t know who you know. I’m on a plane to go and train your clinic so that your son can get his insulin pump. So I’ll drop off the insulin pump on my way. You guys should be set to have his insulin pump up and running just a little after Christmas.”
That was the best Christmas gift ever! To be able to have–the pump training was done. We were able to go a few weeks later and get my son on his new insulin pump. He was ever so–I don’t know? He was so proud. I was so proud. He kind of liked the colour of the pump. We didn’t get the blue pump. He had a different colour. He wasn’t overly impressed by having to put in the infusion set. But he quickly did like, as I said, things like being able to graze when he ate. He really appreciated not having to eat at specific times anymore. And, as much as I had made accommodations and had learned how to adjust his insulin, work with his insulin, so that he wasn’t left out of parties, or, or certain things. He definitely did get to appreciate this new level of freedom that he had. And now? 19 years later, he would never be without his insulin pump. He loves his insulin pump.
But my point is, is that choice is so important. It was important for us to have that new insulin pump that he went on to use right up until he was 16. That’s when he switched to a different brand of insulin pump and only because that pump was no longer on the market. But that was the best choice for us, and I always, always advocate how important choice is! I’s important we have choice in the marketplace so that there can be competition and things can improve. And it’s important because your diabetes may vary. Your needs are not the same as my son’s needs. Your needs are not the same as your friend down the street. Everyone’s needs are different and what they need and want an insulin pump is different.
My son has no problem having tubing with his insulin pump. Some people hate having tubing and will only use pods. And I’ve looked at the, the new Omnipod and at the Omnipod Dash and they’re fabulous. And for some people, that is the perfect fit for their life. For other people, they don’t want a pod, a pump, nothing. They want to use injections. Fabulous! If you are finding that you get great control–your happy with the A1c that you have, your doctor’s fine, you are healthy? Fabulous! It’s all about choice. It’s important that you use the insulin delivery system that’s right for you.
As someone wisely said, “you don’t have a choice that you have diabetes. You do have a choice in how you manage it.” And I think that is so very important that you have a choice in how you manage your diabetes care. So make sure that your choice is informed. Learn about the options and learn about what is right for you.
I hope that today’s show has helped you in some way. Maybe it provided you with a tip, something to think on, or just simply made you feel a little less isolated in the world of diabetes. Please make sure that you subscribe to the Diabetes Goddess Podcast on iTunes or Spotify or wherever you are listening so that you don’t miss another episode. While you’re at it, if you found some value in the show, I’d really appreciate if you would write it on iTunes or simply tell a friend about this show and how much you’ve enjoyed this podcast!
Wishing you all fabulous blood sugar levels. Until we meet again. Join me as we talk about more things diabetes related–happier things and things that just need to be talked about! Until the next time wishing you all great blood sugar levels.