[acb-diabetics] Insulin Pump: To do or not to do.

Fri Nov 11 17:52:35 EST 2011

I am sorry for expressing my opinion as fact. At first, being on the pump is 
more work since one must check his/her blood sugar often so that basal rates 
may be adjusted. I had better control when I was taking injections--probably 
because I had strict parents. However, I have gotten my a1c down recently. 
One thing I struggle with in using the pump is remembering whether or not I 
have given a bolus. I am trying to be better about giving a bolus before 
meals. That can be tricky since I don't know if I will eat all of my meal; 
however, my doctor has told me to just give insulin for half of the carbs at 
the beginning of the meal and then more insulin when I know that I am going 
to eat more. Being on the pump allows one greater flexibility with meal 
times and exercise. This was at least true when I was taking injections, but 
I don't know the case now. The basal rates are to be set in a manner which 
allows blood sugars to remain at a good level, which is often why doctors 
require one to fast during certain periods of the day in order to measure 
basal rate effectiveness. In short, the pump if set properly should prevent 
extremes in blood glucose levels therefore allowing more flexibility in 
one's schedule. As I previously mentioned, it is also possible to set a 
temporary basal rate (i.e., 80 percent of normal basal rate for so many 
hours). This is useful for exercise when you know that blood sugars will 
drop or when being less active since they would tend to go higher.
I didn't count carbs when I was taking injections (my doctor had me on a 
sliding scale), but this is especially important with a pump. It requires a 
little more work for someone who is blind since we can't read product 
labels. I have an ID mate, which is a bar code reader, or look up nutrition 
info on site such as calorieking.com. Sometimes I have taken advantage of 
the fact that I can be more flexible with the pump in eating sweets and junk 
food for which I don't know the carb amounts. It is especially difficult to 
determine carbohydrates in recipes. Maybe others on the list have more 
suggestions for carb counting. Some people talk about foods based on their 
glycemic index, but I don't think that there is a way to calculate insulin 
amounts for GL or GI.
I forgot to mention that Diagnostic Devices, the company which manufactures 
the Prodigy Voice, is working on a talking insulin pump. Unfortunately, it 
may not be released for a long while due to the time it takes to be tested 
by the FDA.

Chanelle

-----Original Message----- 
From: Mike Freeman
Sent: Friday, November 11, 2011 8:41 AM
To: 'Discussion list for diabetics and/or ACB issues'
Subject: Re: [acb-diabetics] Insulin Pump: To do or not to do.

Nefertiti:

Chanelle gives excellent descriptions and advice below. Not being a pumper,
I have nothing to add and even were I sufficiently presumptive to try, it
would be in the FWIW department.

My only observation is that Chanelle's observation that it's better to be on
a pump than to inject several times a day is a matter of opinion. To my way
of thinking, wearing a pump and futzing with it all the time is far more
work than simply calculating one's dose, injecting and forgetting about it.
And yes, I'm on intensive management and my last A1C was 6.8 and I usually
stay between 6.5 and 6.8.

Peace!

Mike Freeman

-----Original Message-----
From: acb-diabetics-bounces at acb.org [mailto:acb-diabetics-bounces at acb.org]
On Behalf Of Chanelle Allen
Sent: Friday, November 11, 2011 5:11 AM
To: Discussion list for diabetics and/or ACB issues
Subject: Re: [acb-diabetics] Insulin Pump: To do or not to do.

Dear Nefertiti and list,
Many people who are blind have successfully used insulin pumps.
Unfortunately, most features are inaccessible, but it is possible to perform

basic functions without the aid of sighted assistance. It takes some time to

be trained in how to fill reservoirs, change infusion sets, and learn button

pushing sequences. I have used the Minimed Paradigm pumps, so I can only
speak from my experience with Minimed. The pump has three horizontal buttons

and two vertical buttons which are the up and down arrows. My pump is set to

beep for each press of the up arrow so long as I am in the main screen. This

is called easy bolus, and for me, one beep equals 0.1 units of insulin.
Everyone has their pumps customized differently (1 beep = 0.5 or 1 units of
insulin etc.). The pump will beep back to me again (10 beeps = 1 unit of
insulin) to confirm that I want the insulin. The maximum amount of insulin
that can be given at one time is ten units. The key closest to the arrow
keys is the activate button, which also goes into menus. The button in the
middle is the escape key, and I am not quite sure what the other button
does. Priming the pump is simply a matter of pressing the activate button
and down arrow a few times activate, and down arrow again. When the
reservoir and infusion set are inserted, continually holding down the
activate button until you feel wetness lets you know that the insulin is
going through the tubing properly. After inserting some infusion sets, the
pump must be primed again; since that feature is inaccessible however, I
just press escape and activate several times until I come back to the main
menu indicated by three beeps and give 0.4 units of insulin (about the
amount given when going into the menus to prime the pump). The Minimed pumps

have something called a bolus wizard where users may input their blood
glucose level along with the amount of carbohydrates eaten and the pump will

calculate the amount of insulin needed. Unfortunately, this is inaccessible.

The pump gives a certain amount of insulin each hour called the basal rate.
Doctors may from time to time want to change the basal rate, and since there

is no audio feedback to do this, I have needed assistance. The button
pushing sequence is simple enough to set a temporary basal rate. The pump
emits a sequence of three beeps, which could mean several things: the
battery is low, the reservoir only has a certain amount of units left, the
pump is not connected or able to give insulin, and many others. Usually, I
am able to take a guess as to what the pump wants. For example, after three
days, it probably wants more insulin; after two or three weeks, it wants a
new battery; after an infusion set is inserted, their may be a problem with
the cannula being bent, etc. Doctors are able to download settings and
history from the pump on to a computer in order to analyze trends. Minimed
produces a meter that works with the pump in transferring readings
wirelessly; however, this is inaccessible. At one time, the software for a
pump user to view settings and history was accessible, but I don't know what

the case may be now. Overall, being on a pump is better than having to give
injections several times a day. It is best to try to be patient with the
process as many adjustments to basal rates and boluses will need to be made
in the first several weeks. There are several different types of infusion
sets from which to use, so you will need to find the one that works best for

you. Usually, pump users are first trained in filling the reservoir with
saline, inserting the infusion set and wearing the pump for a few times.
I hope that I am not overwhelming you with too much information and that
this explanation helps. Please feel free to ask more questions.

Chanelle

-----Original Message----- 
From: Nef
Sent: Thursday, November 10, 2011 4:43 PM
To: acb-diabetics at acb.org
Subject: [acb-diabetics] Insulin Pump: To do or not to do.

Hi everyone,
My doctor and I began discussing the possibility of putting me on an
Insulin pump during my last visit. Both she and I are ignorant as to
the accessibility challenges one might face as a visually-impaired
individual. In hopes of remedying this, we agreed to do our due
diligence by way of research, and reconvening in 2 weeks time.
So far, the information I have read online is grossly out of date, and
this has hampered any true progress on my part.
Recently, I read a message posted to this list by a lady (Patricia?)
who mentioned her pump use.
Are there any other users here? Would any of you be willing to share
your experiences and/or advice? Perhaps there are resources I've yet
to tap into that someone might be kind enough to impart?
Hoping all are well,
Nefertiti
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