Because I have been on the pump for 18 years, I have used several different brands - Travenol, Nordisk, MiniMed 504-S, MiniMed 506 and as of December 2000, a MiniMed 508. I like the MiniMed's best by far but all the pumps have helped me a lot. I went off the pump for 2 months in 1994 just to see what would happen if I went back to needles. I never got my blood sugars into control and finally went back on the pump when my average hit 250 mg/dl (14 mmol/l). I will never ever willingly go off my pump again!
Questions I get asked and answer below:
How do you take a shower?
Can you go swimming?
What about... sex?
How did you find out you had diabetes?
How many people in your family have diabetes?
How did you get the pump?
Why do people assume I am sick, just because I am on/thinking about the pump?
Can you rent pumps to try them out?
How did you make insurance cover the pump?
Is there an adjustment period?
I am worried about gaining weight...
Can I wear a bikini?
How do you get the tape to stay stuck during exercise or hot weather?
You say you go for at least six days between site changes - is this normal??
Which pump is better?
What can you tell me about Dahedi or Animas pumps?
Is there a book specifically for insulin pump users?
The first three questions I always get asked:
How do you take a shower?
For showers, the pump can go in a ShowerPak, which is basically a high-tech baggie or a special case like a travel soap dish. Or it can be disconnected using infusion sets from MiniMed called QR (Quick Release) and Silhouette, that disconnect at the junction of the site and the tubing. These sets that disconnect are very convenient and popular, from what I hear. I am used to always wearing my pump, so I don't find it annoying during showers.
The site is waterproof, depending on what tape you use. Most are water-resistant. For a bath, I keep the site above water. I don't have to, but I figure if it gets wet, it may get infected so why bother. The ShowerPak or case are easier to use if you have the longer length infusion sets.
My pump is water resistant, which I field tested by dragging it off the side of a Jacuzzi tub into the water. Some sixth sense alerted me to the fact that my pump was in the tub with us, and I pulled it out and dried it very carefully. Now I always protect it, because while it was fine, I was a mess! {back to questions}
Can you go swimming?
For swimming, the pump can either come off, be disconnected or be put in the waterproof Sportguard container from MiniMed. The site is supposed to be okay as long as you aren't in dirty water. I have not tried this because I don't swim much, but if I am near or out on the water, I would definitely use the Sportguard. I have also received feedback from people reading this site, who say the Sportguard works very well.
Taking off or disconnecting from the pump means that you need to make sure that you have enough insulin to cover the time you aren't getting any. In some instances, like intense exercise, I can take off the pump and not take insulin to compensate. However, this really depends on what you are doing and how your body reacts to this activity. The main thing to remember is to be aware of how much leeway you have (for example, I took off the pump for 2 hours and took enough insulin to cover that time. After 2 hours, my pump needs to be back on or I need to take more insulin) and to put the pump back on when you are done. Yes, I have forgotten! Doing bloodsugars is the best way to figure out how you are doing. {back to questions}
What about... sex?
By far the most popular question! Sex with the pump on is the same for me as sex without the pump. Unless the site is infected, there is no pain or sensation at all using Sof-sets. Direct pressure has not been a problem. If your site is fine, nothing should bother you.
You will have to move the pump around if you move a lot but I found that becomes a habit really quickly. I used to keep it close to the site so I didn't pull it out accidentally when I might be thinking of other things but found that the sets are hard to pull out if they are taped properly. My dogs have wrapped themselves in the infusion tubing and run away, and it has not come out. Well, you have to catch them before they get too far, but it can withstand hard jerks fairly well. If a Sof-set does get pulled out, it does not hurt, unless you have lots of hair under the tape.
So sex is not a problem at all and hey, you could always find new and interesting uses for tubing that could actually enhance your sex life. Oh, and if you have the urge to cover yourself and/or your partner in oil, maybe put the pump in a baggie and keep in mind that your tape may come up! {back to questions}
Other questions - from my feedback form
How did you find out you had diabetes?
In January of 1979, when I was 13, I was on a sled hill and a guy went off the course and ran into me. I landed on my shoulder and broke my collarbone. After that, my health seemed to slowly decline. In May, I remember going camping with friends and having to urinate every hour. I found it hugely embarrassing and knew something was wrong, but didn't tell anyone. My parents realized something was wrong on a trip from Vancouver home. Over that 6-7 hour car ride, we had to stop repeatedly and I drank huge amounts of water. I was taken to the doctor and had blood tests. The next day, we were told I had diabetes, which meant nothing to me. I remember stopping at the grocery store and having a chocolate milk, knowing that for some reason this would be my last one.
I was in the hospital for about a week and they taught me how to inject and do urine tests. Yuck. Needles are fine but urine tests were awful. The day after I was put on insulin, I got out of bed without my glasses on and I could see over the town perfectly. I thought maybe this wasn't so bad if I could stop wearing glasses! But that didn't last, I had to wear my glasses again and I soon realized that I would rather wear glasses than have diabetes any day. {back to questions}
How many people in your family have diabetes?
No one does. {back to questions}
How did you get the pump?
In 1984, after having diabetes for 5 years, I moved to Victoria, BC, to go to university. I had problems with blood in my urine (which totally freaked me out) that ended up with me being sent to a nephrologist (kidney specialist). Nothing was wrong with my kidneys, but my lack of control was a concern. The guy told me that unless I shaped up, I would have serious problems (kidney damage, blindness, death, plagues of locusts) in the near future. Frankly, this blunt and tactless reality check was a bad move, although I know he was going on the familiar line of "scare them straight". For me, it made me sink farther into denial, but it also got a further referral to an endocrinologist.
The endo was very pump friendly and basically put most of his patients on pumps. It was discussed with my parents and I agreed to do regular blood sugars (yeah, right, anything to get out of the conversation). So I was hospitalized for several days and started the pump. {back to questions}
Why do people always ask if I am really ill, just because I am on/thinking about the pump?
It does seem to be a common assumption for people who don't understand pumps or diabetes very well. People who are candidates for pumps can be in need of greater control for immediate health reasons, but many other people have diabetes that is already well controlled. Currently, many doctors expect proof of good control before they are willing to put people on pumps. Going on the pump doesn't necessarily mean that you are out of control or brittle, it just means that you want a better standard of health care regardless of your current status. I get this question a lot, generally from people who think pumps are new and experimental (and are shocked when I say I have had one for over 16 years), and take the opportunity to educate them about pumps. {back to questions}
Can you rent pumps to try them out?
This is a service that I used initially and found quite helpful, both to see if you might like the pump and to try both out if you don't know which would be better. Check with the pump companies, MiniMed and Disetronic, and find out if this program is offered in your area. {back to questions}
How did you make insurance cover the pump?
Good question! Personally, my first pump was covered by my father's health plan, but in British Columbia, pumps are not covered by BC Medical and I do not have private insurance so we have paid for the last couple ourselves. I just bought a new pump and we had to pay for that one too.
Insurance differs from country to country, province to province, state to state, company to company. I think in Washington State there is a law that if your doctor says you need a pump, the insurance is legally required to cover all expenses. But for many of us, things are not so progressive and usually you have to fight. And fight. A good resource is the Insulin Pumper's mailing list. There are lots of people on the list who have fought for coverage and hopefully someone will have hints and resources that will work for you specifically. {back to questions}
Is there an adjustment period?
Yes, there is for most people. Going on the pump will not mean that suddenly you have perfect control and you feel great. It will take a while for your body to get used to having a steadier level of insulin and for your basal rates and boluses to be customized. People report that they feel tired and out of sorts for the first week or so, but usually after 2-3 weeks they feel better. Once the rates are all set properly, the advantages of pumping become clearer and people talk about increased energy, feeling happier and having a sense of actually being in control of their lives. {back to questions}
I am worried about gaining weight...
Usually, your insulin requirement goes down a bit, you feel more energy and you have better blood sugar control. This often leads to more exercise and less need for snacks and some people do lose weight. However, you also find out that you can actually eat that cookie and just bolus a bit, eat that milkshake and bolus, eat that ice cream and bolus, and still have great blood sugars. BUT you will also gain weight, due to all that extra insulin you are bolusing. So the freedom of the pump is great, but if you find yourself bolusing to cover extras, you might also find yourself gaining weight because your body is working efficiently. {back to questions}
Can I wear a bikini?
Well, that is a personal preference and depends a lot on how big your bikini is and how self-conscious you are about wearing a pump. The pump site and the pump itself could be hard to hide, if that is important to you. You could take the pump off for a while but you have to account for insulin you need in that time. Pumps/insulin and sand and hot weather are not a great combination, and tape hates sweat and humidity. It obviously can be done, since Miss America managed the swimsuit competition (I can't remember if it was a bikini, though). If anyone has any suggestions, e-mail me. {back to questions}
How do you get the tape to stay stuck during exercise or hot weather?
Tape can be a big problem, since even a little slippage can let the canula disconnect. And infection is a possibility. And people are allergic to some tape, but not others. It took me a while to find a tape I can use, which for me is Tegaderm or IV3000. I used Polyskin but it didn't work well for me.
It is important in humid conditions to make sure the tape is sticking. Carrying extra pieces for a quick fix is a good idea. I make sure that I am totally dry after a shower or bath (give about 15 minutes air drying to really dry), and in hot weather/for exercise I use Smith and Nephew SkinPrep. It disinfects and seems to make the tape adhere better. I know of people who use deodorant under the tape (not right over the housing) and they say it works. I would be careful about infection and would not use the same one you use for underarms, since it might have bacteria on it. Trying different tapes and SkinPrep or a similar product (talk to a pharmacist in a surgical supply store), would be better, in my opinion, just because of potential problems messing with what really is an open wound. {back to questions}
You say you go for at least six days between site changes - is this normal??
Not from what I hear from other pumpers. I do know several people who do the same thing I do and have no problem. However, most people get 2-3 days or less out of a site and if you are one of them, please don't feel like you are doing something wrong! Pushing yourself to get more time could lead to insulin delivery problems, due to lack of absorption, and potential site infections, which can be nasty and hard to get rid of. Basically, you should change the site when it works for you. If you are new to pumping, follow the recommended procedures until you have a good feel for your body in relation to the pump. {back to questions}
Which pump is better?
This is based on personal preference, more than anything. I think both pumps are good and that we are lucky to have choice! I do know people who have tried both and like one better and it is about 50/50. The best way to choose is get their videos, watch them and see how each system seems to you. Are there particular options that you want? Then talk to your rep and find out who seems helpful and willing to work with you. Often people don't care which pump they get, and the attitude of the rep makes the difference.
A good page that compares pumps is the Insulin Pump Comparison at Diabetesnet. I know people who have had problems with all types of pumps. Sometimes the problem is a "lemon" pump, more often problems with the pump rep. {back to questions}
What can you tell me about Dahedi or Animas pumps?
Nothing, really. I have no experience with either pump. I talked to someone who has an Animas after having a MiniMed, and she really likes it. Disetronic owns Dahedi now. Their web pages are Dahedi and Animas Corporation. {back to questions}
Is there a book specifically for insulin pump users?
Okay, no one has asked me that but Yes there is!!! If you are thinking about getting a pump, if you have had a pump for years, for whatever reason - get this book:
Pumping Insulin, 2nd Edition: John Walsh, and Ruth Roberts. It is basically a "how to" book and is essential to understanding the process of refining pump/diabetes management. It is often referred to as the "pumper's bible" and it is a great troubleshooting manual. It is available via the internet (amazon.com, etc). {back to questions}
As you can no doubt tell, I am pro-pump. But I do have days when I want to chuck the thing out a window (I have thrown it at someone once. That was a cheaper version.) For a list of the good and bad things I have encountered while pumping, check out Pros and Cons .
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