Life With A Pump
Swimming with a pump; A Season on the Pump
Channel Swimmer Mark Blewitt
I started using an insulin pump in May 2008. Here is short report of my first season swimming on the pump. Since 1996 when I took up swimming I have been swimming further and faster. This year I got the chance to use an insulin pump.
I have had type 1 diabetes since 1980 and took up swimming to keep fit.
Overview
Animas 20/20 Pump and infusion set - Waterproof tested* for over 100 hours and counting…
*(To a depth of .5m in cold (12oC-15oC) sea and fresh water and warmer swimming pools.)
Results
Lower insulin dosage
Weight loss
Lower HBA1C
Quicker swimming times
Race Card
In 2008 I have competed in the following organised swimming events:
Irish Champion of Champions, Cork sea swim
Budworth Mere Championship lake swim
Exmouth Fairway Buoy sea swim
BLDSA Champion of Champions, Dover sea swim
Dee Mile, Chester river swim
Marbury Handicap, open air pool gala
BLDSA Rivington Reservoir
Llyn Padarn, lake in Snowdonia
Great North Swim, a mile dash in Windermere
Lynn Regis, a river swim in Norfolk
All wearing the Animas 20/20 insulin pump
Training
Furthermore I have worn the pump during all training sessions completing an average of 55 miles per month.
Insulin needed
I have noticed a drop in the amount of insulin needed on a daily basis.
Weight Loss
An unwanted side effect of going on the pump (unwanted when training for cold water swimming) is weight loss approx 5lbs in the first month. I have now addressed this by eating more, an extra meal each day, or a can of coke or cereal bar with appropriate insulin.
No Hunger
A concern about going on a pump was that insulin would be available all the time and I would be using the pump all the time to snack on. The opposite happened. I have never felt hungry since going on the pump and not had an insulin driven hunger. The weight loss is genuine as my training has stayed constant, my HBA1C is down.
Lower HBA1C
Immediately before going on the pump my HBA1C was 7.5. Eight weeks later it was 7.1. Not much but remember the HBA1C is a measurement is a 12 week measurement so it is moving and in the right direction. Furthermore this eight week period has included a steep learning curve of getting used to pump therapy. I am looking forward to my next result.
Injection sites
Before going to an infusion set or canular I was concerned that the same “injection” site would be used constantly for three days and make a mess of my skin. What I found is that on removing the canular there is a tiny dot and small bump which soon disappears i.e. within 12 hours. No longer do I have the pin cushion puncture marks and lumps associated with four injections a day.
On a couple of occasions I have felt pain and had to replace the canular almost straight away. On one of these occasions I was bleeding for a while on removal.
I am now experimenting with the shorter 6mm canular and so far so good (originally I was on 9mm).
Lower Waste
With four injections a day waste needles and disposable syringes were always an issue. My GP would prescribe a sharps bin, my pharmacy would dispense it. But each would say the other was responsible for disposing the full bin or refer me to hospital to take may waste there.
With Animas 20/20 the waste is much less sharps waste:
1 plastic cap and insertion device, 1 sharp needle, with canular and tube, plus an empty 10ml bottle once every 21 days approx
Previously I created 4 needles per day plus packaging, several disposable syringes per month.
The result less waste and 16 times less needle waste.
Weight Gain!
In an effort to gain weight I changed my diet to include fish and chips, cream and fatty foods where I would have previously had a so called healthy option. On taking a portion of fish and chips I calculated the CHO to be about 100, my pump told me to inject 14units (due to previous results I had changed the insulin to CHO ratio for lunch times). Thinking this a little high I called up 12 units to be given 30% upfront the balance over the next three hours. My results… before lunch BG 5.6, Two hour later 7.6, four hours later 7.3. That is quite simply amazing and I am confident that others will too. Unless you are already getting results like this – if you are that is brilliant.
I have, however, struggled with a higher fat diet. I always felt a little unwell. I have since reverted back to my original diet and simply added an extra snack to increase my intake.
Other concerns
Whilst on 4 injections a day I would suffer from bad twisted dream. I suspected this was due to the low night time BGs.
Race Day Results and observations
Lynn Padarn, 4 mile race in North Wales. The lake is two miles long and sits in the shadow of Mount Snowden. The four mile race is simply two lengths of the lake with an extra stretch at the end to give spectators a good view of the finish.
What we have learned
Using the results to date of Swim Day BGs, we know that bolus doses should be avoided at all costs as the effects of bolus are magnified several fold with increased sensitivity to insulin once excercising. At the same time I would not reduce my basal.
For this reason I missed the 2 mile race in the morning and simply went to Padarn to focus on the afternoon 4 mile event starting at 13:45. I took an early lunch of a couple of bagels following an early breakfast of porridge. My BGs were perfect, for a normal day, so around 12.30 I pushed them up with an energy bar 20gCHO and sweet fizzy drink 30gCHO. Immediately before the race my BG was 10 and I took a can of Coke 30gCHO.
After the race had settled, I noticed a canoe about 25m in front escorting a swimmer, I had no canoe escort. I realised who the swimmer would be that the canoe was escorting, it was to be a much faster swimmer than that I had never come close to. Don’t panic, I stretched out my stroke and relaxed. I was keeping up. A little later I noticed the swimmer had taken a more westerly line than I had which suited me fine as I could keep the canoe in my sight, but not be on top of it. At the half way turn buoy we had to come together to round the buoy. We did, I was immediately behind. Again don’t panic, nothing has been won its only half way. I had also counted the swimmers in front pass me on their return leg before I got to the buoy. I counted seven, I knew two were female, there were 24 men in the race, and I was in sixth place!
About a quarter of the way back down the lake I had managed to pull ahead. I had asked the pilot of the safety boat to find me on the return leg and offer me a drink. He did, I refused as I was going really well. As soon as I had done so I realised that I needed to take some food or I would fade in the last mile. I took 20gCHO of energy gel (kept down my trunks). The pilot found me again and I decided it would be wise to take a drink – I took 20gCHO fast acting energy drink. Whilst refuelling the other swimmer passed me and I would follow all the way to the finish, coming in about 40m behind.
I was delighted with my time 1hour 55minutes for the 4 ¼ mile course. My BG at the end 8.3.
I had pushed hard all race and beaten last year’s time by 17minutes! And my 2002 time (the year I last swam the channel) by 40 minutes!
A swimmer found me to ask about swimming with diabetes as his 10 year old daughter had just been diagnosed and had lost her confidence. I advised him generally and specifically.
Dee Mile 2km
It is difficult to compare year on year performance in this swim as the finishing time is invariably affected by the artificially controlled flow rate on the night of the swim. The water felt good and I swam well finishing 24 out of 90 in a time of 32:13.
I left my basal flow on full .425U/hour as it is was just a short swim.
Marbury Handicap 1 mile – Friday night
Marbury pool is always cold, but tonight as it was a race and you have to hit it hard it felt good. The swim was followed by presentation and meal. My BGs were great before, after and pre and post after swim supper.
Rivington Reservoir 4 miles in the morning 2 miles in the afternoon
This swim takes place in the Lower Reservoir at Rivington, no matter what the lake and sea temperatures are this reservoir never seems to change and you can expect a cold swim every time. Overnight my BGs were good before swim.
06:25 7.5
09:35 6.8 time to push BGs up before first race with 40gCHO maltodextrin drink
10:20 9.4 immediately before the start of first race 4 miles. I knocked basal down 50% to .21U/hr
After 2 miles I took on board a further 20gCHO maltodextrin and again after 3.
13:13 3.8! No wonder last lap did not feel great.
With lower than wanted I took the following for lunch
Noodles – hot 120
Crisps – sticky fats 30
Bagle 36
Chocolate bars x 2 50 Total 236gCHO and a bolus of 7U combo
14:35 8 my BG had struggled up to an 8
15:01 7.6 by 3pm they had settled out! Before the second swim of the day swim I took a further:
Chocolate bar 30
Lucozade 65
I knocked my basal down to .12U/hr. The first lap went well, I passed a couple of swimmers and felt good. 2/3rd into the race I felt my shoulders cramping (low BGs?) I took some hypo stop and was immediately sick. With 400m to go I thought suspend the basal, but it was no good, my eyes could not adjust to see the monitor screen. So I simply unplugged the tube from the canular. At the end of the swim my BG was 4.2 No wonder I felt the cramp. I was determined not to pack in.
16:46 4.2
If this were a non-swim day my BGs would have been perfect for what I wanted to achieve lowest 3.8 highest 9.4. But it was a swim day. What have I learnt? Does my basal need to be .050U/hr or less!
I took the opportunity of showing my Animas pump to the first aiders at this swim who are quite excellent. Last year I lent them my glucometer as they had to treat another diabetic at the swim.
This was a tough day, and one I learnt a lot from. What I amazed me was that I thought of Novorapid as the fastest insulin in the West! It is but it still takes time to get through you and swimming on a bit of a bolus is a NO, NO from now on.
Race Day Results
When I have compared my results this year against last year there are some interesting comparisons.
Budworth Mere May 31st (within two weeks of the Pump switch over)
Three Miles
2008 1:27:02
2007 1:27:07
Improvement 05 seconds
Champion of Champions 9 miles in Dover harbour – results not comparable as this year’s race was held on a neap tide and last year’s on a spring.
2008 4:04 provisional
2007 5:34 spring/neap time snot comparable
Improvement 1hr 30minutes
Rivington Reservoir 4 miles
2008 2:14:15
2007 2:18:42
Improvement 4minutes 27seconds
Rivington Reservoir 2 miles
2008 1:14:41
2007 1:23:01 (breaststroke) so no direct comparison is valid
Improvement 6minutes 20seconds
Llyn Padarn 4 ¼ miles
2008 1:55minutes My BG at the end 8.3.
2007 2:12
(and my 2002 time by 40 minutes!)
Improvement 17mintues
As both of the comparable swims were faster it is fair to say that I am swimming faster this year over last.
Thursday night training 1 hour
On one particular Thursday evening I trained indoors so cold would not be a factor. My BG before my swim was 4. I took 40gCHO fast acting to pick me up and took a further 60gCHO Maltodextrin during the first 15 minutes of the session. I felt terrible and was waiting to see my split times drop before I got out of the pool to take further action. The thing is, although my hands felt like cotton wool, my times stayed fast and I completed the set. When I tested at the end my BG was 4.6.
What this tells me – you can still perform on lower BGs (just above 4)?
The Maltodextrin pulled me through?
Dolphins 2hour sessions – no aches
My first swim using the pump in training was during a two hour training session. For the first time I was not feeling the level of muscle ache that I did part way through such a session.
Having Type 1 is tough. As my diabetes nurse says every day is a struggle. But with type 1 I swam the Channel in 2002. Now with the pump I am looking to revisit some of my tougher swims and see just what is possible.
Mark Blewitt
Saved by the Pump
Hi I’m Allan, aged 47, married with 2 young daughters and have been Type 1 since aged 19. In my job as an Aircraft Maintenance Engineer, safety of the aircraft fleet and everyone working or flying on them is the highest priority. For me that means Diabetic control must be maintained at all times, and on shift work, with a huge variation in work load & type, this takes a lot of achieving. On top of this there’s a whole pile of H&S bureaucracy ready to bite me if I don’t keep well controlled.
History
Luckily I have been OK for the last 28 years as I’ve not only managed to keep my job, but have also avoided any Diabetic complications. Most of the credit goes to the wide range of Health Professionals involved in Diabetes Management, as, without the Insulin, and associated equipment, test gear, R&D, plus, diagnosis, advice and support over the years, I would have reached my sell by date over a ¼ century ago! A small part of this may possibly be down to my choice not to smoke, and my Diabetic reaction to alcohol, which made drinking a non-starter. Oh OK, so I did drink for a couple of years prior to becoming Diabetic, but not enough to miss it when I had to give up!
My first syringe was a ‘Jules Verne’s’ looking, metal & glass instrument which was high maintenance and only used once a day. In case you think one injection a day would be ‘a cruise’, consider the planning required to align meals with the 4 hourly peaks the Insulins of that time were designed to produce, and whilst on shift work too! With only urine testing to rely on, the results were history even before doing the test. This meant every move had to be carefully thought through, like a never ending game of chess.
There were considerable improvements over the years such as disposable syringes, blood glucose testing, better Insulins including standardization to u100 strength. Some of these changes took a bit of a learning curve, however, all helped improve control significantly. Once the rate of innovation had slowed I settled into a ‘comfortable’ position where my Diabetes was reasonably well controlled.
Setbacks
Then, 15 years ago I was knocked off my pushbike and suffered a head injury leaving me with badly degraded senses of taste, smell, and both long & short term memory problems. Without going into detail, this caused me very occasional missed or (worse still) double doses if insulin to be injected, for which I never managed to find a reliable method of prevention.
At the time I worked in the relative safety of the hangars where the work was of an overhaul nature, i.e. a steady pace, and involving lots of people. Everyone knew me and was aware of what to do in the event of a hypo. In this situation the risk of injury as a result of a hypo would be unlikely so the problems caused by poor memory were deemed tolerable. Recently, due to the recession in the aviation industry I had to transfer to operational aircraft work at the airport terminal. This meant working on several aircraft at a time spaced up to two miles apart, on 12hr shifts, with no set meal breaks, sometimes alone, and always to tight deadlines.
Just to make matters more interesting, I have been denied a permit to drive airside so getting about with tools & spares is done on foot, averaging nine rushed miles per day.
Saved
My response to this dramatic change was to run my BG deliberately higher than preferred during work hours in order to build in a ‘safety margin’ to avoid a hypo. This resulted in a significant rise in my HbA1c, which Dr Gallen spotted, and advised that this was unacceptable.
An Insulin pump was deemed to be the ideal answer and has proven itself beyond expectations over the last 8 months. Lots of people have their own reasons for preferring pump therapy but I think mine are a little different.
The pump history keeps a full record of all the Insulin taken so double doses are impossible. Missed doses can’t be prevented, but there’s no safety risk with this, and due to the frequency of blood tests would be picked up within a couple of hours anyway.
The theory
Injection therapy tended to be fixed dose and relied on regulating CHO intake and adjusting exercise to achieve acceptable BG levels. This was always at best, trial & error with any success being due to tremendous discipline. Pumping is a whole new step-change; you eat what you need (or want) to, or even skip a meal, and vary your bolus Insulin intake as required to keep the BG’s in limits. To make this method work, everything is quantified and tabulated. Your weight & lifestyle gives a specific CHO intake per day. From this a matching Insulin intake is calculated and split into basal & bolus doses. For the basal rate, you adjust to give a level BG under fasting idling conditions. This can be adjusted to a different rate every hour if needed so you can ‘iron out’ the dawn phenomenon and other such variables. For the bolus aspect there are several things to consider but initial settings are calculated for you, and you are given a set of figures to work to; Insulin ratio = how many grams of CHO to eat per unit of insulin, typically 10g:1u. Insulin sensitivity = how much your BG drops per unit of Insulin taken. Mine is 2.5per 1u for example and this is used to drop high BG’s quickly but safely. This seems strict but all this info and more is tabulated to help you make changes to pump settings and know beforehand with confidence what to expect. It’s so much safer than guesswork.
The tools
You’ll need to choose a make & model of pump, and if you’re on shift work, check the specs of all pumps on offer very carefully before choosing. This seems to be a big area of neglect for both pumps and BG meter/log software. I have found my BG meter log and associated PC software to be hard work when trying to make it ‘fit’ shift work. Good ‘olde fashioned parchment’ logging still seems to be easiest to work with, and if you have access to a scanner you’ll be able to e-mail your data to your Diabetic Nurse team just as well as if you were using the BG meter software. As for the pump, my own one makes a token gesture at catering for shiftwork….only for one function and even then, only if it fits into a 7 day pattern.
To complement the high precision of a pump a ‘Diet computer’ is a great tool to have. As well as CHO they hold several other nutritional values for over 400 different foods so all you need do is dial in a 3 digit code for what you are measuring and press the CHO button. The display reads directly in CHO, so you don’t even have to check what it weighs. It also has all the usual memory features of a typical calculator and retains data when switched off. You can shock yourself by recalling how much you’ve really eaten in a day!!! The one pictured is a Swiss instrument so the meat section is heavily biased towards Swiss/German love of sausage! There are ‘designer label’ British machines available which hold data for more of the branded foods sold in the UK, cereals for example. Of course, you can enter data manually and I only regularly use 20 or so of the 425 preprogrammed entries, plus about 5 that I’ve changed to my own values. And of course, if you are into cooking, it makes a very accurate set of weighing scales too with fluids displayable in ml, g, or oz, and weights in g or oz .
The other must have is a manual called Pumping Insulin. I tried a few books that my local library could get for me, and found them to be very lacking in technical data. This one is not available, even in the big UK bookshops, but can be obtained very easily and cheaply through the first online bookseller that comes to mind. Yes, the jungle one! (ISBN 1-884804-84-5).
The training courses given by pump dispensing hospitals do tell you what to do, but they simply don’t have time to go into why you need to do it. This book goes into enough detail to leave you well informed and able to diagnose problems with confidence, but not so much that you’ll be confused.
Once you’ve got over the novelty of pump operation, you’ll be hungry for details of how to fine-tune & troubleshoot Diabetic control on a pump, and this book is the best I’ve come across. Most of the figures for BG are given in UK and USA units, and the occasional entries that have mmol/L left off can be compared to one of the many useful charts a few pages fwd or back.
Supplies of pump consumables are direct from the manufacturers, as they are non-prescription items, with settlement of your account by direct payment by your PCT. You need to get this set up well in advance of attempting to place an order.
These two items are ‘must haves’ to go with a pump
Advantages/Disadvantages
For my own personal situation, the main advantage of a pump is the high level of safety with regard to hypo avoidance without sacrificing tight control. By using the metered bolus facility (square wave) a meal bolus can be given over a long period. For example, had I taken a normal bolus (or injection) for a meal based on an expected easy day, and the situation subsequently changed to become very busy, I would not be able to suck out what I now wish I had not injected! With a bolus over time, I have the option to suspend the delivery in order to prevent a hypo or remove the need to eat more CHO. In the event of a hypo occurring, suspending the pump helps slow or even reverse the onset. On taking glucose, no further complex CHO’s are required to prevent re-occurrence of a hypo.
Of course the other advantages are that you can’t forget to take your insulin with you, as it’s permanently attached, and for those who never liked taking injections, there are none. Once the pump is fine tuned to provide a near normal BG, it takes a lot of the hard work out of achieving good control.
There are a few disadvantages but once pumping becomes ‘the norm’ these disadvantages become unnoticeable to you.
The biggest one is that because Insulin supply is made to be as close as possible to ‘on demand’, there is no residual pool of insulin in you ( as an injection would provide) to damp out an unplanned glucose intake, or possible insulin delivery interruptions. The result is that the BG can soar to high levels very quickly if you eat too much or interrupt the pump delivery. On pump therapy, it’s normal to take about 8 BG tests per day which would catch this rise before it causes any serious problems, such as ketoacidosis. Some may see this level of testing as a disadvantage in itself, but it’s amazing how quickly this attitude reverses. When I was on injections, on a non-driving, non-working day I got away with as few as two tests per day, without any concern. Now I feel very insecure if I don’t know what my BG is doing.
The fact that the reservoirs are supplied empty is somewhat annoying. Filling them is a bit fiddly if using Insulin straight from the fridge as the bubbles stick firm! The adaptors and plungers all contribute to unnecessary environmentally unfriendly waste, and adaptor disposal requires costly biohazard waste handling. The sooner the pump producers supply pre-filled reservoirs the better it will be for all concerned.
Wearing the pump soon becomes normal, and is no worse than carrying a mobile phone, and won’t be anywhere near as annoying!
Reliability
Whilst I’ve only got 8 months experience, it’s usual that if something is going to go wrong, it will do so during the learning stage and/or when the equipment is relatively new. My pump has been totally reliable over this time with not even a spoiled or blocked insertion set. The insertion sets stick well for the full 3 days and the only time I’ve had one fall off is after a heavy morning gardening in hot sun where I was very hot & sweaty and moving around a lot. The set had done 2 ½ days, and under those conditions it was probably a good idea to change site early anyway. Swimming for long periods in the sea doesn’t seem to affect adhesion either. An altitude increase causes normally invisible bubbles to become big enough to upset BG control, so keep a watchful eye if you fly, ski mountain climb, etc.
Insurance
I found that some insurers won’t cover a pump, but the place to look is under home contents in the personal possessions section (which is usually an optional extra policy section). Due to the cost it will need to be recorded as a ‘specified item’, and as such, for some insurers, will not be covered by the automatic index linking. You may have to manually re-advise them of price increases. With this section activated cover is included away from home so you don’t need to go through all the pain of getting it insured under holiday insurance. On my policy, an item insured under personal possessions as a specified item carries a slightly higher excess than other contents items, but it’s still negligible when considering the cost of replacing one of these pumps.
Driving
On reporting this new treatment to DVLC medical dept, they don’t appear concerned that you can be driving whilst insulin is being administered automatically. It still only requires a 3 yearly renewal review, but it would be advisable to let DVLC know you’ve changed treatment.
Summary
Well, that’s probably enough info to give an overview of Pump therapy. Multiple injection therapy, using some of the pump therapy best practices described in the book would help improve control issues, but the best feature of the pump for me is the safety associated with delivery over time and delivery records.
Insulin Pump Treatment
By Trisha Hyde
My name is Trisha Hyde and I am 31 years old and have had insulin dependant diabetes since 1976. I have Necrobiosis Lipoidica Diabeticorum, slight damage to my eyes and have been uncontrolled for many years. My aim is to stop the high HbA1c results and therefore reduced complications before the complications get the better of me. This is my brief story.
Life Before an Insulin Pump
It was hard work!! Constant highs and lows made my sugar levels so erratic that my mood swings seemed to follow also. My weight has also been a problem for as many years as I can remember and I put this down to mood swings as well as hypos and extra food to come out of them.
Four injections a day meant that I was totally reliant on time, times to inject, time to eat and even to an extent time to sleep (making sure that Glargine was given at the same time everyday) usually 10.30 pm.
I have been an insulin dependant diabetic since 1976 (27 years) and treatment has changed over the years, from glass syringes needing soaking in solution every night and urine sticks to disposable syringes and blood machines. Even the insulin has changed from pig to human. I've witnessed many changes in the treatment of diabetes but none that has changed my life as much as an Insulin Pump.
In the past 27 years of being diabetic I have been through various emotional stages.
· The rebellious phase
· The "I want to be like everyone else" phase
· The depressed phase.
I believe these phases were due to my diabetes "controlling" the way I live and the way I thought.
Starting Pump Treatment
D-Day, off to the Diabetes centre to meet the diabetes specialist nurse who was incharge of the program. I had read up about the pump to save time. After only an hour I was preparing the pump for use with insulin, priming and putting my own infusion set into my tummy. I was absolutely amazed that it didn't hurt (in fact I didn't even feel it go in). From then on, no more injections, something I have done every day for the last 27 years!! If I eat anything with carbohydrates in it I will need to give a bolus, but thats not a problem when you don't need to inject to put insulin in the body.
I have been testing my blood sugars more, pre-meal and pre-bed and also tested at 2 am one night to check that the basal rate of 1 unit per hour is right. I don't mind doing this as I have a machine (Medisense Softsense) that takes blood from upper arms instead of fingers so that doesn't hurt either. I don't even mind getting up in the middle of the night to test as for years I have been getting up in the night with hypos anyway.
The DSN was fantastic phoning me late at night and early morning to check my progress. I would just like to add that she is my type of Diabetes Professional. She has the attitude that diabetes should live as normal a life as possible, for instance, why wait for a hypo to eat a Mars Bar, just bolus for it instead.
By day 5 of using the pump. Hive changed an infusion set, which again did not hurt, and even changed my basal rate from midnight to 8am to cover the period of rest where I don't need as much insulin. I am amazed at how easy it is to control my diabetes. There has already been a marked difference to my mood, as well as my sugar levels and my hope is that the Insulin Pump over time will enable me to live a normal life and that my HbA1c will go down and therefore my risk of complications reduce dramatically.
Some Specific Issues
Exercise - I could never quite get the injected dose correct. I'd either go high or low. How much insulin was absorbed when injected? I never knew. In fact with multiple daily injections there is up to 52% absorption loss but with Insulin Pump Therapy there is only 2.8%. Of course this means that what insulin goes into your body is what you actually decide to put in. You can programme your pump to administer any amount of insulin more than 0.1 unit per hour whilst exercising whether at a regular time each day or as a temporary basal rate over whatever length of time that you decide.
Sleeping and sleeping-in late - Its a great feeling to wake up at 2 am and find that your blood sugar is 6.6! Sleeping with the pump attached was easier than I originally thought. I just attached it to the waistband of my pyjama bottoms and it didn't affect my sleep at all, in fact I'd forgotten it was there. Next morning I even got to lay in which I haven't done in 27 years.
Sick Days - if you are not feeling well on a particular day and the last thing you want to do is eat -YOU DON'T HAVE TO!! The pump is set up to deliver insulin 24 hours a day on the basis that you don't eat. Therefore if you do eat any carbohydrates you just need to bolus for them (which is done at the push of a button).
Long meals - we've all done it. You go for a meal with friends or colleagues and the restaurant is busy. By the time you've ordered it can be 2-3 hours later when you finally finish your last course. With the insulin pump this is no longer a problem. It has the option available to give a "dual-wave bolus". This basically means that when your starter arrives you could bolus for that amount of carbohydrates immediately, then set another bolus of insulin for the remainder of the meal over a time specified by you -whether it is half an hour or 5 hours.
I had to fight long and hard to get funding for Insulin Pump Therapy. There were a select few of people that actually believed, understood and helped me in this quest to which I am truly grateful. I may have been the more vocal of patients trying to get funding for this pump but at least I succeeded in getting the right treatment for my diabetes as well as the treatment I feel I deserve.
To summarise, insulin pump therapy enables YOU to control your diabetes. You are not longer restricted to times of meals or certain foods etc. You gain your independence and life back. After being on daily injections for 27 years and being on a pump for 6 months I can honestly say that I am converted and NEVER again would I EVER go back to injections not even for a day.
You can contact me at trisha@hyde85.fsnet.co.uk