Despite a lot of words to the contrary there is no one-size fits all solution for diabetes management. With choices about technology, different versions of similar technology, different insulins and different diets it is actually quite a complex business to decide what you’re going to do. Sadly, I think healthcare doesn’t really understand the notion of patient choice-they do in theory but practically they can’t stop themselves from knowing what’s best. (See for example this, that refers to patient preferences not to use CGM or a pump as “barriers” and assumes tech is universally beneficial!)
So this is the sort of stuff I consider before adopting a new piece of tech, I’d be interested in hearing if you have other ideas or experiences in deciding upon tech.
- What specific D problem am I trying to fix?It might sound obvious but I am often surprised that there are people who jump on a tech bandwagon without really understanding why. Sadly, neither a pump nor CGM will simply improve your control let alone be a virtual pancreas or miracle cure.I got my first pump about 14 years ago because I was having problems with overnight hypos-one night I woke up with jelly beans in my mouth and I have no idea how they got there. Reducing my night time insulin led me to be high next morning, the pump allowed me to reduce my basal insulin between midnight and 3 am-enough to stop the hypos but go back to my normal rate at 4am so I’d be (mostly close enough) to 5.5 upon waking. For others pumping allows complete flexibility with erratic schedules, ability to do micro-adjustments (a half-unit bolus) and to adjust insulin for exercise -turning off your basal for an hour or two is preferable to scoffing jelly beans.
- Will the tech fix my problem?Again this sounds like a no-brainer but can you be sure that the promises made by tech and/or HCPs will actually be delivered ?. Always go for a try before you buy, or minimal commitment period. I signed up for a free trial of CGM and decided it created more problems than it solved for me. I found the time lag between CGM alerts and what was really going on with my bsl was too great-I was feeling hypo or very hyper before I got an alert. The alarm 15 minutes after I’d used my glucometer and acted accordingly was just annoying. Furthermore, the bulkiness and discomfort of the sensor means I will be waiting for some improvements before i try CGM again. That said if I was hypo unaware I’d definitely be using CGM.
- How Much Extra Effort is Involved?Pumping means that I don’t have to do injections 2 or 3 times a day-but these would only take me about 20 seconds, quite literally and didn’t involve much effort. Pump site changes/resevoir fillups only need to be done every 3-4 days but they take at least 5 minutes and if your pump site falls out/you run out of insulin or whatever then your sugar rises VERY quickly. You need to carry pens and insulin and check your bsl about 6 times a day to ensure that you don’t end up in DKA. Numerous studies have shown that if you’re not very motivated about pump practices AND checking your sugars then pumps actually give worse results HBA1c AND ending up in hospital with DKA than traditional needles. Similarly if you’re not motivated to act upon the results of the CGM then it’s not going to help.
- Get Other OpinionsThe best and most useful information I’ve had about pumping has come from other people who have tried pumping or particular pumps before me. Social media has made getting real life experiences so easy, so ask on twitter, Facebook groups and sites like Reality Check about the pros and cons of whatever tech you’re considering.
- Taking the Plunge? What Then?
So if you decide that tech is really going to help you/solve a problem, what next? Still more homework needs to be done. There are several pumps and a few different CGM brands out there. Carefully weigh up the pros and cons. Is size important-do you want the smallest pump or site? What about tubing, is waterproofing an issue, what about reliability and customer support? The tech companies will provide lots of info-read it, decide which features matter most to you and then also check with users of the product. If you want to scuba dive with the pump-go onto social media and try to chat with somebody else who’s done exactly that.
- Can I afford it?This is a biggie, with pumping my insurance covers the cost of the actual pump but the annual outlay for pump supplies, the infusion sets and reservoirs is not inconsiderable-especially when you’re already paying for insulin and private health insurance but for me, the benefits outweigh the costs for pumping but the $ cost of CGM is too much given its small benefits (for me)-it would be totally worth it if you have hypo unawareness.I love the Libre system (flash monitoring), for me the trend arrows and the small, painless sensor site are fantastic. I would use it all the time except that at $50 a week, it’s pretty steep (on top of all the aforementioned health expenses I incur), so I save it for special occasions like travelling-when the convenience of not finger pricking and the extra info on bsl movements is most useful. So look at the ongoing cost of any tech, is there a cheaper way of getting the same result?Remember it’s your health and your decision. Doctors and DEs can make recommendations but it’s your choice.What else do you think should be factored into decisions about D management? Have you had experiences of feeling forced into or not allowed to choose particular options?