The Big One - To Pump Or Not To Pump

So I now get to the biggest question of my recent delve into the online community.  

Firstly a bit of background for my non-local readers - hello by the way, I still love the fact I'm discussing something very personal to me with people from around the world when for the last 30 years I've not really discussed it with anyone outside my very close family. And, I even know some of your 'real' names. - Anyway as I was saying; funding for pumps in the UK is very much down to luck. Firstly you need to live in an area (Local Health Authority) that provides pumps and then you need a Consultant, or Endo, that agrees with your justification for having one. As ongoing costs are free to the user (if NHS approved) this cost is significant. Just like the rest of the world, money is in short supply at the moment, so everything is short-term rather than appreciating saved costs from ongoing care etc. I am extremely fortunate to live in a LHA that provides pumps and indications so far are that the Endo will support my request, if I make one.  So the decision for me is a lot simpler than for a lot of the DOC and I must be thankful for that.

I really sympathise for those less fortunate where the battle for funding/supply is constant, but, this is my story so thankfully, that’s not part of my challenge.

However, the decision to make is still a big one. For me, pumps seem to have been around for a long time developing from the size and convenience of bricks to something a lot more discreet.  I'm going to try and break it down into good and bad points.  However, I'm certain the end decision will be made by the heart rather than the head.

I'll start with the good bits (the pros):

• Better control - For everyone selling the pump concept, and yes I'll include a significant chunk of the DOC here, I'm told frequently that A1cs improve dramatically and without fail. I can believe testimony but is this because of the pump or because of the amount of control needed to ensure the pumps 'works'?If I do as much testing and carb counting as is required on the pump but without the pump can I achieve similarly fantastic results????

• Public dosage - The biggest problem I have with MDI is the publicness of shooting up.  Pumping would give the chance to subtly administer my dose without the need to hunch shoulders or visit the bathroom. 

• Closer to natural - there's no escaping that a continual supply of bolus is a lot closer to the non-Ds norm than basal once a day with boosts whenever I eat.  This has to be better for the body, or that might just be my flawed logic.

• Less injections - I'll admit the contraption for inserting the needle looks a little scary but it has to be better than injecting at least four times a day. Every day.  My skin wants a rest but I guess I've got the wrong 'thing' for that to be able to happen. 

• CGM - Although I can't get funding for a permanent CGM, the local clinic loans them out frequently to pump users and this is a big draw. If CGM was available to my current regime the decision would be even more obvious to me. 

• Tech - I'll admit to being a gadget freak so having another toy to play with does excite me a little. Sorry.  

• Long-term complications – Again I’m fortunate. After 32 years of not perfect control I still have all my limbs and eyesight.  By changing to a pump and it’s ‘better control’ do my chances of maintaining my toe count improve?

So what in my head is stopping me from signing up straight away (the cons):

• Always there - This is the biggie. For me multiple injections means I cam sometimes leave the house and just take myself. I can go out relatively clutter free. On a good day I just need my pen. If I'm being vigilant I'll also grab some sweets and if really, really conscientious I'll also take a testing kit.  That's it. Lightweight and disability free for a few hours. Going on holiday I have two pens plus a spare, a testing kit, some needles and spare insulin.  Now compare this with the swag needed by a pumper.  I’ve seen varying amounts quoted but the minimum is at least double of what I take currently.  For me double-kit means double the amount to forget also.

• Amount of kit that fails - to test my pen I do an air shot of half a unit until I see liquid. Inject. Done.  No air bubbles and I know that if I dial 8 units and feel the plunger go down I can be pretty confident I've delivered 8 units.  Tech goes wrong, and sometimes it won’t do what I tell it. If it’s a pump that fails the consequences take a while to be discovered and then resolved.  And a total pump failure means a whole regime change for 24 hours while waiting for a replacement. 

• Compulsory testing – i.e. if I want a day ‘off’ on MDI I can check my fasting BG in a morning and do normal carb counting and dosage adjustment through the day to get me to the end without feeling crap.  With pumping if I don’t do the testing how do I know everything is working OK and that I haven’t got a major problem?

• Outside opinion – I know this is shallow and I know this will vary from person to person but for me it’s quite important.  I’m ‘Dave’. Not ‘Dave the diabetic’ or ‘Dave the bloke with the medical contraption permanently attached’. Just ‘Dave’.  I like that. I like being judged by my bad hair or poor dress sense rather than a pitying look.  I also like being just me for my family.  My wife is very, very dear to me and I don’t want to be the ‘freak with the wire’ that she’s been dumped on.  And do I want to give her a constant reminder that I’m faulty goods?  When I undress at night I’m left with my body with no attachments or signs - apart from pepperpot fingers and occasional bruises.  There’s nothing ‘unnatural’ attached or showing to get in the way of a good night’s sleep. This is a really complex part of the debate and is hard to summarise but for me D is part of me, not what defines me.  By jumping to the permanent attachment am I flipping that?

So that’s it, the main meal part of my debate.  I had hoped that getting all this down would make my decision easier but I’m not sure it does.  The DOC has plenty of examples of pumping working perfectly and finding a MDIer in the mix is often not easy.  However, does that mean it’s right for me?  I’ve had a few discussions recently with some good online friends who are very positive that pumping is the way forward, and I really value their input, but the big cons listed above are holding me back at the moment.

I’m not sure how many of you will have got to the end – I apologise for the length, my head needs to dump now and again – but as you have made it, I’d really, really appreciate your input/feedback and if you can answer any of my very vague questions then all the better!  My next Endo appointment is in two weeks so my head will probably have exploded by then.

Thanks for reading.

Dave