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How To Switch From Pump To Shots

Back To Shots

Back To Shots

There are a number of reasons why switching from your insulin pump back to shots (MDI), using insulin pens or syringes, is sometimes necessary. Reasons can include Pump malfunction Losing or misplacing pump Forgetting pump or supplies at home Hospital visit or surgery Spending a day at the beach or in water Taking a break from the pump all together Short term pump breaks If you will only be disconnected from your pump for a short period of time, your doctor may provide a guideline for you to use only rapid-acting insulin (i.e.: Novalog or Humalog) incrementally, every 3 to 4 hours until you can get back on your pump. Example (off the pump for less than 24 hours) Short-acting insulin doses while off the pump are necessary every 3-4 hours. To calculate, combine a food bolus and the insulin you would normally receive as a basal rate via pump. Here’s an example for a calculating a breakfast injection while off the pump for less than 24 hours: Step 1: Calculate breakfast bolus. Morning blood sugar value = 170 mg/dL Insulin to carbohydrate ratio (ICR) = 1 unit per 15 grams of carbs Insulin sensitivity factor (ICR) / Correction factor (CF) = 50 Breakfast is 60 grams of total carbohydrates Breakfast bolus = bolus for carbs + correction bolus. Cover carbs: 60/15 = 4 units Correction: (170-120)/50 = 1 unit 4 + 1 = 5 unit breakfast bolus Step 2: Calculate amount needed to cover basal rate. Basal rate (s) MN = 0.60 10:00 a.m. = 0.85 5:00 p.m. = 0.70 Combine sum of basal rates from 8 a.m. – 11:00 a.m. = 0.6 (8:00 a.m.) + 0.6 (9:00 a.m.) + 0.85 (10 a.m.) = 2.05 units Step 3: Combine breakfast bolus and amount needed to cover basal rate – this will be your breakfast dosage! 5 units (breakfast bolus) + 2.05 units (basal coverage) = 7.05 units Dose 7 units. *Reminder – repeat th Continue reading >>

To Pump, Or Not To Pump?

To Pump, Or Not To Pump?

Your 10-year-old daughter just returned from diabetes camp. She said that everyone was using an insulin pump, and she wants one too. You are worried about having a tiny computer deliver insulin into her body. Should you ask your daughter’s health-care team about pumps? Your three-year-old son is a very picky eater and you are having a very hard time controlling his blood glucose levels, even with multiple injections every day. You have heard about insulin pumps, but is he too young for one? Your teenager has been using a pump for about three years. She is now on the cheerleading team and she does not like being connected to the pump because of how it looks on her clothes. Should she switch back to injections? These are all common scenarios for parents of children or teens with diabetes. If you’re facing a decision about whether your child should use a pump, this article may help by explaining some of the advantages and challenges of insulin pump therapy for children and teens. Pump basics An insulin pump is a small, computerized device that is programmed to continuously deliver basal, or background, insulin and that also allows bolus doses of insulin to be delivered to cover meals and snacks. The pumps currently on the market are about the size of a cell phone. An insulin pump is worn outside the body; no surgery is necessary for insulin pump therapy. Instead, an infusion set is used to connect the pump to the body. An infusion set consists of a small plastic cannula, or catheter, that is connected to a length of plastic tubing, which transports insulin from the pump reservoir to the body. The cannula is inserted into the fatty tissue just under the skin with a small needle, either manually or with an insertion device. The needle is removed after the cannula is inse Continue reading >>

Dumping My Horrible Pump - Switching Back To Injections : Diabetes

Dumping My Horrible Pump - Switching Back To Injections : Diabetes

Got a couple of requests for clarification as to why I think injecting will work better than Pump when my control right now isn't good. I literally feel like it's not delivering insulin to my system. I wish I had a better way of explaining it. I change my infusions more often than recommended, use insulin that's well within it's sell-by date and refrigerated, prime for any bubbles/issues with the delivery system multiple times daily but if I bolus for a high blood sugar the sugar DOES NOT GO DOWN. If I inject - it goes down immediately. My basal profiles are useless because I'm either running high for days on end or I'm low constantly and I have to drink juice like it's my job. I've spent hours and hours with my diabetes team and endo working on carb-insulin ratio and the various basal rates and I can't figure out why it's not working. I believe it's actually the pump model (Roche Accuchek Spirit Combo) but as I explained in my OP I can't actually change models for another 2 years for insurance purposes and I'm not willing to stick it out. Got another suggestion that it may be scar tissue. I tried to use longer canulas and I've changed infusion sets that I'm using but it's still a 1-2 weeks out of the month where everything goes to shit. I posted here a couple days ago because I have been just destroyed over my lack of control and completely unpredictable readings. Today was the last straw and I'm ready to dump my insulin pump and move back to Injections. I injected from age 5 to 21 and I had decent control - without doing much work for it. The pump was great for the first 2 years I had it but I have had it replaced with the same model 5X in the past 15 months - and the insurance will not allow me to change models for another 2 years. I'm fed up and I want to go back t Continue reading >>

Conversion Back Onto Insulin Injections

Conversion Back Onto Insulin Injections

Thanks for our wonderful support group, GNO, and Sharon Roberson, here is a great guide for converting back to insulin shots from being on an insulin pump. This comes from a British site called Salford Diabetes Care (www.salforddiabetescare.co.uk) Why would you want to switch from a pump to injections? In an emergency situation, such as a pump failure, it may be necessary for you to convert back onto insulin injections. In case you are unable to recall information from your pump it is recommended that you should always keep a written record of your current basal rate and average total daily insulin usage. You are going on vacation and don’t want to be sporting an insulin pump at the beach or while scuba diving. You are just plain TIRED of managing the insulin pump. Your skin is sore, needs a break or you are simply running out of skin geography. How to Calculate Your Starting Dose Calculate using your average total daily dose (TTD) of insulin. TTD is all the insulin you have i.e. the basal and every bolus. Obtain this information by: Accessing the history of daily insulin totals in the memory of the pump or: From your records add together the daily set basal rate and the bolus doses together. Add 20% onto your average daily total of insulin then divide this in two equal parts. 50% is now your background insulin eg Lantus or Levemir. You should continue with your usual insulin to CHO ratio at mealtimes and give your usual correction dose. This formula provide a starting dose, further adjustments may be necessary depending on your blood sugar results Working example Daily average insulin total via the insulin pump = 36 units Add on 20% (36 x 20% extra insulin = 7 units) 36 units + 7 units= 43 units Divide into two equal parts = 43 units/2 = 22 units You would administer Continue reading >>

A Day In The Life: Mdi Vs. Insulin Pump Therapy With Cgm

A Day In The Life: Mdi Vs. Insulin Pump Therapy With Cgm

As someone who has lived with diabetes for over 11 years, I have experienced life with multiple daily injections (MDI), as well as an insulin pump therapy and continuous glucose monitor (CGM). Either way, I am still living with diabetes, but these two lifestyles are fairly different in the way I manage my disease, and also my day. Let’s go through my typical day, from waking up to going to sleep, on MDI versus an integrated insulin pump with CGM. Morning My first alarm goes off, typically followed by a few snooze buttons. MDI: Wake up, check blood glucose (BG) to see how well my basal insulin worked overnight. Pump: Wake up, view my sensor glucose (SG) on my pump, and check my BG to see how well my basal settings on my pump worked overnight. Meals and Snacks MDI: Check BG, count the carbs I’m about to eat, do the math to determine how much insulin is needed, draw up a syringe of insulin (or the proper amount in an insulin pen), and take the shot. Pump: Check BG, count the carbs I’m about to eat, input my BG and grams of carbs into the Bolus Wizard, and press ACT. Throughout the day, I’ll often pull my insulin pump out of my pocket to glance at my SG levels. I look for trends on the graphs provided by the CGM to determine if I need to wait a little longer to eat or if I need to take a BG and have some sugar sooner rather than later. Post Meal/Snack BG Tests MDI: Take a BG. If I’m high, I draw up a syringe of insulin, and take the shot. Pump: Check my sensor glucose (SG) on my pump, and if I’m high, check my BG. If my BG is high, I put my BG into my Bolus Wizard, review the Bolus Wizard recommendation, and press ACT. Mid-Day MDI: Do nothing until I start to feel my BG levels dropping, so I test my BG and am low, so I have a snack. Pump: The Predictive Low aler Continue reading >>

Pens Vs. Pumps – Why I Choose Daily Injections Over An Insulin Pump

Pens Vs. Pumps – Why I Choose Daily Injections Over An Insulin Pump

There are several methods for delivering daily insulin doses to manage type 1 diabetes. The most often prescribed being an insulin pump. While this method is widely considered the most efficient for managing Type 1, I opt for “old school” insulin pens. When I was first diagnosed two years ago my health care team and family insisted I get on a pump immediately. They presumed it would be the most effective way for me to manage my blood sugar while carrying on with my already busy lifestyle. After six months with the Omnipod insulin pump system I decided to go back to the traditional daily injection method and have stuck with it ever since. Before I get into my decision for ditching my Omnipod I’ll share my opinion on the pros and cons of using a pump. The following is taken from my experience with the Omnipod which is a widely prescribed system. I have not tried other pump systems but much will apply to the variety of available models. Insulin pumps are extremely accurate, capable of delivering doses in increments of 0.01 units. These devices are currently the closest available thing to an artificial pancreas. This precision greatly decreases the chances of hypo and hyperglycemic episodes and improves hemoglobin A1C levels in diabetics. The onboard computer calculates dosages based on settings input by an endocrinologist, eliminating much human error (as long as the user is efficiently counting carbohydrates). With a pump there is no need for multiple daily injections, just a single inset insertion every few days, diminishing the frequency of pain experienced. The device also gives warnings and reminders to check blood glucose levels, great for a newly diagnosed patient learning to cope with type 1. Pumps eliminate the need for two different types of insulin. With t Continue reading >>

The Art Of The Pump Break

The Art Of The Pump Break

Memorial Day weekend was a good reminder to me that bathing suit season is coming up, and along with the obligatory five pounds I try to lose every year for this season, I also started thinking aboutsummertime pump breaks. I dont mind wearing my pump at the beach people tend to take a look, raise an eyebrow, and move on. My OmniPod looks medical, so most folks assume it does something important, and thats it. Occasionally, someone will ask what it is, to which I usually respond Im the bionic woman, its mybattery pack. More raised eyebrows. Ahem. Moving on. There are times however, when I just want to be pump free for a weekend. I think most people with diabetes that wear a device or two relish a day without a plastic and metal device stuck to their skin. Aside from not having to deal with any questions or looks, it just feelsgood. Although we get used to our gear, it doesnt mean we dont like a little break now and then. For me, living in Southern California, summer weekends can mean lots of time in a bathing suit, which are the times when Im most tempted to take a day off from the hardware (I actually have a CGM sensor tanline right now from a few weekends ago. My dermatologist busted up laughing when he saw the oval shape on my hip. Then he chided me for not using sunscreen. Hes right. Digression). Although we are lucky enough to live in a time where we even have the option of taking a break, Ive found that going back to a basal-bolus regimen of multiple daily injections (MDI) is tougher than it sounds. Youd think you just take a shot of Lantus, remove your pump, and voila, inject your rapid-acting as needed. No dice. For one thing, I was on a split dose of Lantus before my pump. Although it claims 24 hour control, I did better when I took half the Lantus I needed for Continue reading >>

Going From Pump Back To Injections

Going From Pump Back To Injections

Hi all - apologising in advance for a long post! I was wondering if any of you have made the decision to stop using an insulin pump and to go back to regular injections (MDI)? I have been thinking a lot about this recently- I have had some issues with infections at cannula sites upon removal, some odd high blood sugars from not being able to pump much more than 6 units through my cannula, as well as some bumpy scar tissue and leaky cannula sites. (Using accu chek spirit wit plastic cannula) I know I am incredibly lucky as I am in the UK and do not have to pay upfront for any of my healthcare, so I know I have the fortune to make this decision of my own free will and not because of funding. I have been pumping since 2012 and started off very positive. My hba1c has never been above 60 and my pump and I have had a pretty good relationship for a number of years. Recently, however, I have completely fallen out of love with my pump. It feels cumbersome, it puts me in serious pain with these infections, I am constantly checking for leaky sites, and I feel like I am relying on my Bluetooth handset rather than actually thinking about my dosages. Its also partly got me into a bad routine as I am not eating as well as I should, and upon thinking about this I think it might be because there isnt that physical requirement to inject and be conscious of it. I am aware that Im incredibly stressed at work etc which is making this worse. Anyway- the long and short of it is that I know I need to go and see my diabetic specialist before making a decision, especially as I dont have much in the way of in-date insulin! But I would love to hear your thoughts on this. I used a pump for many years and decided to switch back to injections about 6 to 7 years ago. The main reason for the switch wa Continue reading >>

Taking A Pump Vacation

Taking A Pump Vacation

Right now, I'm on vacation. To be more specific, I'm on an insulin pump vacation. Which, to be honest, it's not much of a vacation (still have the ole diabetes to contend with!). What is a pump vacation? It's taking a break from wearing an insulin pump for short period of time. I'm not switching back to shots permanently, although I do know of people who have done so after taking a pump vacation. Sometimes it's done because absorption isn't working well due to overused skin "real estate"; sometimes it's done seasonally (the freedom to wear dresses and skimpy bathing suits, for example); and sometimes it's done in advance to prevent damage to an insulin pump, like for a rafting trip. Some people even do it every weekend! My pump vacation started kind of by accident. When we last left off, my insulin pump had spontaneously combusted in Arizona while at a family wedding. As it turns out, the exact same weekend that my insulin pump broke, the insulin pump of my friend, Katie Clark, also broke! She signed up for a pump vacation, taking a respite from technology in favor of injections. When my new insulin pump arrived, I decided to take a cue from Katie and delay my pump hook-up a little longer in favor of a pump vacation. With the summer season around the corner, I started thinking that others might be considering a pump vacation and I want to share my experiences thus far. I should note that this is not my first pump vacation. In 2007, I spent four months attempting to do Dr. Steve Edelman's "untethered" regime, but it didn't work as well for me. Going "untethered" means using Lantus and using the insulin pump only for corrections and meal boluses. It's good for people who don't want to wear a "tethered" insulin pump, and who aren't sold on the patch pump either (at the tim Continue reading >>

Why You Don’t Need An Insulin Pump

Why You Don’t Need An Insulin Pump

Tags: Perhaps my most controversial post ever, let me begin by saying this is not about bashing insulin pumps. I think they are a nice tool and a great piece of technology. They’re just not great enough for me to use. Nothing can compare to a fully functioning pancreas (duh) but, I find it interesting that most people I have talked to who have insulin pumps say they couldn’t live without it. They mean it, too! I understand. I used to feel this way. Yet, now that I’ve been off of the pump for a few years I realize I felt that way because of fear. I can assure you there is nothing to be afraid of. Please read on to find out what exactly I’m making a fuss about. I recently heard someone say, “if you aren’t on the pump you must be crazy!” Oh really? Let’s be more open minded here. First of all, why does it matter to me that people out there feel this strongly about having a pump? Well, because of the negative power these words might have on an individual who cannot afford a pump or who for some reason or other cannot get access to one. People should know it is very possible to manage their diabetes without one if that is the hand they are dealt at the moment. I would hate to think some people out there feel they don’t have good control over their diabetes because they can’t get a pump. This isn’t true but, they might be lead to believe it is. They need empowerment and those of us who feel strongly about using all that modern technology has to offer should think twice before speaking. Even my own doctor (I refer to him as my ex-doctor) laughed at me when I told him I wanted to get off of the pump. He said, “nobody goes backwards, people always want to seek to improve their blood sugars, not disturb them”. He disturbed me! What ignorance! (Its ok, he Continue reading >>

5 Reasons People Ditch The Pump

5 Reasons People Ditch The Pump

We hear a lot about the pros of insulin pump therapy. A diabetes educator shares some of the cons. Integrated Diabetes Services (IDS) provides detailed advice and coaching on diabetes management from certified diabetes educators and dieticians. Insulin Nation hosts a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community. Q – I see studies show that people with Type 1 do better on insulin pump therapy, but I sometimes hear of people stopping pump therapy to return to multiple daily injections. Can you tell me why it might be better for some people to stop using a pump? A – There are many more choices for insulin pumps than in the past, and many of these new pumps come with new and powerful technological options to help you with blood sugar management. Many clinicians promote pump use as the best way to achieve optimal control. But is it really the end-all-be-all of diabetes management? As with everything in life, it comes down to personal choice and what works for you. It’s best to do your homework to evaluate if a pump is best for your lifestyle and blood sugar management needs. There are plenty of articles discussing the pros of pump therapy, but few that discuss the cons. To offer some balance, here are some downsides to pump use that have caused people to switch back to multiple daily injections: 1) Mechanical Failure Insulin pens and syringes don’t have mechanical parts – they will not malfunction or have errors. The more technology that is used to deliver insulin, the higher the chance that something can go wrong in a mechanical sense. It doesn’t happen often, but it does happen. I have had several pump failures in 15 years of pump use; all were detected by the pump. Pump problems can include internal errors in Continue reading >>

Guidelines For Temporary Removal Of The Insulin Pump

Guidelines For Temporary Removal Of The Insulin Pump

correction factor (insulin sensitivity factor) is 4.0 the basal rate is 0.60 units/hr until noon correction bolus: 14.8 – 6.0/4.0 = 2.2 units Total dose: 2.4 + 2.7 + 2.2 = 7.3 units, rounded off to 7.0 2- Long term off pump (24 hrs or more): There are 3 options Give long-acting insulin (Lantus or Levemir) as basal, and rapid insulin for boluses Give intermediate-acting insulin (NPH or N) ** call the doctor on-call for this dose Give rapid-acting insulin every 4 hours including overnight, as per the “short term” example Calculate the total daily basal amount of insulin and give as a single dose of Lantus or Levemir. It can be given as soon as convenient. Then continue every 24 hours thereafter. These insulins cannot be mixed with other insulins in a syringe Take rapid insulin for meal, snack and correction boluses The carb ratio’s and correction factors remain the same as for the pump Children who are too young to give their own insulin may need to have a parent go to school to give the lunchtime dose. The basal rate is 0.50 units from midnight to 6:00 a.m., and 0.40 units for the rest of the day until midnight. The total basal is 10.2 units. The dose of Lantus or Levemir will be rounded off to 10.0 units, given once every 24 hours until the insulin pump is resumed. Since Lantus and Levemir are basal insulins, you cannot have a basal rate running when you restart the pump or severe hypoglycemia may result! Restart your basal approximately 18 hours after the last Levemir dose; 22 hours after the last Lantus dose.    If you want to re-start the pump earlier, set the basal rate at 0.00 units/hr until all the Lantus or Levemir has worn off. Extra blood sugar checks will be needed to see how your adjustments are working, especially after the first inj Continue reading >>

Switching From Multiple Daily Injections To Csii Pump Therapy: Insulin Expenditures In Type 2 Diabetes.

Switching From Multiple Daily Injections To Csii Pump Therapy: Insulin Expenditures In Type 2 Diabetes.

Switching from multiple daily injections to CSII pump therapy: insulin expenditures in type 2 diabetes. CTI Clinical Trial and Consulting Service, 1775 Lexington Ave, Ste 200, Cincinnati, OH 45212. E-mail: [email protected] To identify variations in expenditures and utilization of insulin and other antidiabetes medications by comparing patients with type 2 diabetes mellitus using continuous subcutaneous insulin infusion (CSII) pump therapy versus multiple daily injection (MDI) therapy. Truven Health Analytics MarketScan Commercial Claims and Encounters Database and Medicare Supplemental Database for 2006 to 2010 were used in a difference-in-differences approach that took advantage of variation in the timing of the switch from MDI therapy to CSII pump therapy. Continuous users of MDI therapy throughout the study period were compared with those who switched to the CSII pump therapy during this period. Specifications included: coefficient estimates from cross-sectional ordinary least squares (OLS) regressions with: 1) no additional controls, 2) controls for patient demographics and comorbidities, and 3) patient fixed effects. Propensity score matching at baseline mitigated concerns regarding patient selection bias. While insulin expenditures rose during the study period, switching to CSII pump therapy led to sizable reductions in insulin expenditures. This reduction in insulin expenditures due to switching varied between $657 (standard error [SE] $126; P<.01) and $1011 (SE $250.60; P<.01) per year. This study demonstrated a significant reduction in insulin expenditures among MDI patients who switched to CSII pump therapy at various times throughout the study period. Continue reading >>

Coming Off My Pump | Diabetes Forum The Global Diabetes Community

Coming Off My Pump | Diabetes Forum The Global Diabetes Community

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community I have made the difficult decision to come off my animas vibe pump. I have been pumping almost 3 years now, and while things were fine in the beginning, the last six months have been very stressful. At least once a month, I get ketones, high readings, and no idea why. My tubing isn't twisted, cant find any evidence of air bubbles, and my sites don't look infected. I am fed up with it, I have exhausted all the possibilities, and I can't keep doing this. It is causing me more anxiety and stress than I need in my life. Just this morning, woke again with readings of 15.6, and ketones. I have done a set change, and all is fine at the moment, but I never know how long it will last. I can go several weeks with no problems, at all, and fantastic reading, to suddenly out the blue, readings really high, and evidence of ketones. I phoned my diabetic nurse at the hospital today, and she was lovely, very kind and supportive. I said I want to go back to mdi. She totally understood, and agreed. I did say I am not giving up on my pump, but I need a break from the constant worry of whether my pump is working properly. I have an appointment on the 25 November to return back to injections. Feeling quite apprehensive about going back, but feel I have been left with no choice. Would appreciate any feedback, and if anyone else has experienced similar problems, if I had a pump without tubing, I would feel more confident about wearing it, but Animas don't do them. Hope I am making the right decision, any advice gratefully received. Don't feel bad about what you are going to do.... high bg levels with keytones to boot are not good for anyone and not a good advert for pumps. T Continue reading >>

Insulin Injections Vs. Insulin Pump

Insulin Injections Vs. Insulin Pump

Are you considering switching from insulin injections to insulin pump therapy? Stacy O’Donnell, RN, BS, CDE, and Andrea Penney, RN, CDE, at Joslin Diabetes Center, give the pros and cons of each method. Insulin Injections Injections require less education and training than pump therapy. “Many people don’t realize the amount of work involved with pumps,” Penney says. “Using a pump requires professional training and close diabetes management.” Injection therapy is cheaper than pump therapy. Cons Low blood glucose levels can occur because you may be using different types of insulin. Frequent injections mean you may develop resistant areas of the body where insulin will not absorb properly. Insulin Pump Pros The pump delivers insulin continuously throughout the day, causing fewer sudden highs and lows in blood glucose levels. Insulin delivery is more accurate and precise. There will be less needle sticks. You may have one injection (hook up) every three days versus 15-18 injections in a three-day period with injection therapy, according to O’Donnell. Adjusting your own insulin allows a more flexible lifestyle. Cons There is a greater risk of developing diabetic ketoacidosis (DKA), however, O’Donnell believes this can be prevented. “Patients are testing blood glucose levels frequently and are also well-educated on what to do if this occurs.” It is attached to your body all day, reminding you and others that you have diabetes. Pump supplies are expensive. Continue reading >>

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