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Re: [IP] To be or not to be


It is good to see that you are giving this decision such serious thought.
Pumping is not to be taken lightly, nor is it a cure-all for all
insulin-infusion issues.  Let me add a few comments, I've been pumping for
almost two years.

>This is a thinking person's question. These are authentic questions
>and are not meant to shake the foundations of insulin pump therapy.
>I've been reading and contributing to this list for about 25 hours while 
>I wait to see how much the pump will cost me. 
>There are three benefits to wearing a pump:
>1. Flexibility
>2. Accuracy
>3. Predictability of insulin peaking 

<much snipping to save bandwidth>

>Now my question:
>How is the pump better?
>Is it only as follows:
>I can set more than two basal rates.
>I can change the basal rate on the semi-fly.

This is an important point to consider.  Most people require more than one
rate, many require more than two.  Often the duration of a basal rate
"difference" is only for a few hours.  Blood sugars can go "out the window"
if these rates aren't set properly.  

>I cannot include accuracy as a pump forte because
>while the pump ejects at a greater than 2% accuracy
>other factors affect the amount injected. For instance
>if I take 8 units in 12 hours basal then in one hour I get 
>6 pulses.  If I remove the pump for any reason for any
>length of time there is a chance of missing a pulse with 
>a 17% error that hour. That error spread out over three hours
>is 5.5%. Many pumpers wait until the transfusion site absorption
>becomes a problem before changing the site this causes
>a huge accuracy error. And finaly it is not benefit to go 
>from 2% accuracy to 0.02% accuracy.

You are only looking at one side of the coin here.  Yes, if you disconnect,
you do lose some basal insulin.  Many pumpers choose to do a small bolus to
make up the difference.  But the other side of the coin is the BOLUS
accuracy.  I count carbs as accurately as possible and more often than not,
calculate a bolus that is a fraction of a unit.  I also use relatively
little insulin, about 25 units a day.  That means that my boluses are often
under 3 units.  With an amount this small, each tenth of a unit represents
a fairly significant portion of my bolus.  If I'm off by a tenth of a unit,
it can have a great effect on my blood sugar.  This is what drew me to
pumping in the first place. There is no way to get that level of accuracy
with a standard syringe, or even an insulin pen.

Also, you may have read about people waiting until they start seeing
increasing  blood sugars before they change sites.  Some do, but I wouldn't
say that most do.  Many pumpers change their sites on a set schedule and
have consistent bg readings throughout the life of their sets.  The key is
knowing what to expect from your body.  One person here "knows" that he
needs to change every two and a half days, no matter what.  Others "know"
that they can expect a set to last 4 or more days.  With pumping, you
change the routine of timed meals for a routine of timed infusion set
changes.  It's a tradeoff I'm more than happy to make!

>I cannot include Predictability of insulin peaking as a pump forte because
>There are unpredictable factors that effect insulin sensitivity.
>There are unknowns about insulin absorption rate and sensitivity fluctuations
>that make a scientific analysis impossible.

Yes, but these factors are present even without the pump.  At least with
the pump, you can make an attempt to come closer, by using various basal
rates to match your body's needs.  If you are only using one type of
insulin you have far less variation than if you are trying to match the
curves of two or more insulins.

The bottom line is that most pumpers experience greater control and overall
lower A1c's than before they pumped.  There are some pretty interesting
charts on this on our website in the "about insulin pumpers" area. 

Only you can decide if the pump is right for you.  Please keep asking
questions about your concerns.  There are people here with a vast amount of
knowlege and experience.  


Insulin-Pumpers website http://www.insulin-pumpers.org/