As with all big decisions there are positive and negative aspects that need to be considered. But with every decision there is always a balance between the 2 and hopefully with sound judgement the right decision is made.
I have spoken in part of my decision about pumping and even the decision to have my 2 year old daughter on a pump but I suppose I haven't gone through the consideration process.
First to consider is what stage are you at -
- Are you a long standing or well experienced T1D and you have been giving so many injections over the years that your tired of the routine, the feeling of being a pin cushion, the inflexibility and to a degree the blindness that can come with MDI?
- Are you a long standing or well experienced T1D with control and a view to maintain the control and avoid complications well into the future?
- Are you new to T1D and looking for a management method that will be as like to normal function?
- Are you a parent trying to work out what is going to suit your little one the best to ensure that they can minimise the risk of complications?
For me some 8 years ago I was 16 years in to my journey. I was living on 5 injections a day and calculating my food intake by exchanges. I was a slave to feeding my insulin rather than have my insulin to what my body requires. I was tired of the needles, I was tired of managing my intake by knowing what I had to have hours before hand so that I could have my insulin 30 minutes prior to eating.
All of the above stages have elements to them that will have a dramatic effect on what decision will be made.
As with all methods of controlling T1D pumping can in fact be a method that can be stable and also have quick change if not paid attention to. By using short acting insulin only, you can have something go wrong and it can change your BSL in minutes. This is not to say that on MDI with a long acting insulin this won't happen and to tell you the truth the worst hypo's that I have had is when I was on MDI with a long acting insulin. I suppose that with the short acting insulin you can make changes and have them applied within minutes and hours rather than days.
If you have gotten to this point and you think pumping, which is the most advanced method of T1D management, is something that should be considered (which I completely agree with) then you need to take the following into account -
- What type of pumps are there? Well in our market there are 3 on the market that can be prescribed. All of which do the same basic job however, and this is where you need to do the research and understand about the support and company behind them. A pump is only as good as the support that goes along with them. Do not expect that each of the companies are the same. Do your homework.
- What functions do you and your health team think are important? Is it small dosage ability for your basal rates, is it the ability to connect a CGM to the pump to help with a little bit of automation and reassurance through out the day or is it a combination of all the little things that make up the pump.
- How do you work with your Team? Do you wait until your 3 monthly appointment before you review your BSL's and rates or do you expect the information to be available to you and your team no matter the day or even where you are in the world. For me this is a big thing, I download my pump and that data is available for my team to review whether I am there with them or I am in the other side if the world. This allows me the speak to my team and tweak my settings to ensure a maintainable range is kept.
- Is it more about the aesthetics? Can you read the screen, can you navigate through the screens in an easy manner and would it be in user friendly terminology?
- Does your endocrinologist have a vested interest in understanding how your pump can work for you to ensure your life immediately and in the future will be better. Even though I was on a Medtronic pump for nearly 8 years prior to my daughter being diagnosed and knowing that I wanted her on a pump I still asked her medical team for their professional opinion on what they thought was best. Of course I could have argued with them if they didn't agree me as to the best but that wasn't to happen.
- Is it a concern that you will have a device attached to you 24 hours a day, 7 days a week? Well this is an interesting question as there are many like situations. My wife is not a T1D however she has a device that I would say is attached to her 24x7 and is rarely more than a meter away from her. The difference is that I think she can live with out her phone compared to me not living with out my pump. It is a change to have a device attached however the pro's quickly outweigh the con's and within days you live like it isn't there. My daughter, since seeing me with mine her whole life never second guessed her pump and to her now it is normal.
- Can you teach old dogs new tricks? It's never too late to make a change and if you have gotten through 10's of years on MDI and have little to no complications then pumping could be a management style to get you through the next 10's of years minimising the possibility through hard work of complications.
- The pump is not a cure! This was one of the first things my endo told me. It is a management tool that if abused can be dangerousness but used in the purpose of why it was made, have awareness of your body and have the drive to always want the best for yourself and the pump will be a shimmer of normality back in your life.
For me and my daughter the pump has been a welcome addition to life. It has put flexibility and control back in our hands. It was the best decision I could have ever made in my years so far as a T1D. I understand that people could be adverse to the change but if there is an incling that any one point above has made you think then at least ask the question and investigate. Do not be afraid to make a change for the good.
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