#895 Best of Juicebox: Switching to an Insulin Pump

April 21, 2023Scott Benner

Originally posted on Jan 21,2021. The Juicebox Podcast: Type 1 Diabetes social media community sent their tips for switching from MDI to pumping.

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Scott Benner 0:00
Hello friends, and welcome to episode 895 of the Juicebox Podcast

welcome back to another episode of the Best, the Juicebox Podcast. Today we're revisiting Episode 431, which originally aired on January 22 2001. This episode includes community feedback on the topic of switching from MDI to pumping. It's very informative. So if you're thinking of switching, check it out. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Are you a US resident who has type one are the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juice box join the registry complete the survey. When you complete that survey, you are helping type one diabetes research to move forward right from your sofa. You also might be helping out yourself and you're supporting the podcast T one D exchange.org. Forward slash juicebox.

This episode of The Juicebox Podcast is sponsored by us med us med is where my daughter gets her Dexcom G seven and her Omni pods from you can to us med.com forward slash juice box or call 887211514 Use the link or call the number to get started. And by the way, they don't just have Dexcom and Omnipod. That's just what we use. You got the liberi over there. 10 a bunch of stuff I'll tell you in the ad. today's podcast is also sponsored by touched by type one great organization helping people with type one diabetes. I'm going to be speaking at their big event later this year. Go find out more about it right now at touched by type one.org A couple other great ways you can save through the podcast 35% off your entire order at cozy earth.com with the offer code juice box at checkout for 10% off your first month of therapy when you go to the link betterhelp.com forward slash juice box and free years supply of vitamin D and five free travel packs with your first order of ag one from Athletic Greens when you go to athletic greens.com forward slash juice box. And while I'm plugging stuff, check out diabetes pro tip.com for one of the greatest series that this podcast has ever put together the Pro Tip series Hello friends and welcome to episode 431 of the Juicebox Podcast. Today's show is about switching from multiple daily injections to a pump. And what I've done is gone on to the Facebook page for the podcast and gotten people's feedback about what was most valuable to them when they did the switch from injections to Bombay.

Before I jump in and get started I'd like to remind you to check out T one D exchange AT T one D exchange.org. Forward slash juicebox. And here's why. You can support T one D research and the Juicebox Podcast by checking out the T one D exchange because they're looking for type one adults and caregivers who are US residents to participate in a quick survey that can be completed in just a few minutes. You can do this survey from your phone or your computer and you never have to leave your home or visit a doctor's office to make a substantial impact on type one diabetes research. This is 100% Anonymous HIPAA compliant. And every time one of you completes the process by using my link, T one D exchange.org. Forward slash juicebox. You'll be helping to support people with type one and the show. past participants just like you have helped to bring increased coverage for test trips, Medicare coverage for CGM, and they've helped to change the ADA guidelines for pediatric Awan seagulls you can give back in just a few moments

okay, I've done this a couple of times and it's incredibly popular. So we're doing it again and went on to the Facebook page Juicebox Podcast type one diabetes. It's a private page where listeners can talk about whatever they want. It has well over 8000 members at this point and it's just a hotbed of discussion. And around diabetes management. So I put the question up there. For those of you who have transitioned from MDI, to pumping, please share your tips, things to look out for and remembrance. Here's what came back that I thought was very interesting. Right off the bat, Nicole says, start with what the endo suggests, but only give them 24 hours. If you've listened to all the podcast episodes, you know what to do, if you have a Dexcom Be bold. Maryann said that, initially, it was a little difficult to get over having a device attached to her, but that she eventually did. She said, you'll probably need to adjust your dosages with the team, be prepared for that. And nothing's really permanent. So if you don't like it, she's like, just send it back. She also suggested trying to create a time for the transition, that's a less stressful time in your life. Because there is a commitment involved in understanding it. I take Mary Ann's point. But I also think sometimes there's never a perfect time. So I guess, you know, figure out what would be best for you. But I would caution against waiting for the perfect time. And I would also caution against immediately wanting to give up, because it is going to be different. And if you've been doing shots for a while, and succeeding with it, you know, you might just be used to things working. And the truth is you're gonna have to start over might not just work perfectly immediately. Jen said that she switched from MDI, to pumping over 20 years ago. And all she really remembers was being terrified. She got a quick doctor's office visit tiny bit of training, they sent her home. But she called technical support a number of times the beginning. So she wants to let you know not to be afraid to ask for help when you need it. Katie says not to forget that you're no longer using a slow acting or long acting insulin like love Amir to recibo, one of those that your pump is giving you all of your insulin, it's doing your Basal insulin, as well as your meals and corrections. So if there's a problem with your pump site, you need to be aware that DKA can set in much more quickly than is likely with MDI. So if you get up in the morning, and you're, you know, MDI and you shoot your your Letelier Lantus, let's say, it's in there, it's doing something, but if you get up in the morning and put a pump on, and there's some sort of a problem with the site, and you're not getting your Basal insulin, you may not know right away. So you know, what I would do in that situation is test more frequently or pay attention to your glucose monitor if you have one. In my opinion, it's not something to be scared of, it's just something to remember, you're getting your Basal insulin from your pump. Now, Ashley said that the first few pumps that she put on just didn't go well. And she didn't realize that she could have them replaced the infusion sets or if you haven't on the pot, the pot itself, and she was just throwing them away. But if you have a failure, especially in the beginning, when you don't know what you're doing, call the company, they very well may replace your items. That would lead me to say that it is not uncommon in the first week or so of using a pump to have user error with the insertion or wearing of the pump, that it's important to, you know, keep trying get information, don't just think that the first experience you have is how this is going to be now because there are a lot of people who use insulin pumps of all different kinds very successfully all day every day. So when you're starting at the beginning, and it's not working, if it's not working, maybe look inward before you look outward is my best advice from what I've seen people talking about online all these years. Josh says that his remembrance for the beginning was that he just immediately felt more in control. And he started tweaking his Basal insulin and extending his boluses that that made him comfortable. Amy brings something up that I see a lot. They had fairly good control with MDI and then move to a pump and recognize the transition, that it's not just a flick of the wrist, and everything's okay. Again. What I would say that I notice is that sometimes doctors offices can be careful when they set up Basal insulin. I guess they think of it as careful when they set up Basal insulin for the first time. So say you've been doing MDI forever and you get 24 units a day. What I would do there is the quick math and say, Well, maybe I'm about a unit an hour then. But sometimes doctors offices are scared to send you out. dollar for dollar from the way you did it to the pump. And they kind of go without better high than low theory, and a lot of them will take back some. But if it was me, if Arden was using 24 units a day of Basal insulin, I'd start by saying Adding her Basal at one unit per hour, and I'd see what happens and make my adjustments from there. I guess the problem comes in where the doctors don't want you to touch the Basal insulin. So they set it low to show where the highs are, so they can come back in later and add insulin. Being a person, the way we are here that makes those changes on our own, I would start about where I thought, because here's what I see happen. Those ratios are kind of lost in the moment for people often. And what happens is, instead of thinking, Oh, I used to use 24 units a day MDI, and now I'm only using 19, or something like that, I'm probably not using enough Basal insulin, they think pumps don't work. So your brain makes this illogical leap that feels logical. And then you get caught in a little bit of a, you know, a shitstorm. And if you don't have a doctor's office that quickly gets back with you and makes adjustments, which a lot of them don't do sometimes, then you start blaming the pump, and you start having these feelings like oh, it was better on shots, you know, and you could lose faith pretty quickly. I've seen that happen a lot. So that is definitely something to look out for. So Mara warns that once you're on a pump, it's not a free for all of food, just because it's easy to Bolus, so you know, do your best to stay on track with how you eat. She also mentions that it's possible your insulin usage might go up, and that that's okay. I would say it's also possible that people lose track of the fact that they were taking 30 units of Basal insulin of one kind. And using, I don't know, let's say they use 20 units or 25 units of, of, you know, Novolog, fast acting insulin for meals and corrections. So in their head, they're only using like 25 or 30 units of insulin a day because people just generally don't think of Basal as insulin for some reason, they think of it when they're on MDI, like, I inject this once during the day. And then my fast acting insulin is for meals and corrections, somehow the two don't go together. To me, that might be where some of that comes in is then you move over to a pump. And instead of using 30, and 30, you're using 60 of all one insulin. And I guess I'll just say here in case people don't understand that a fast acting insulin like a nova lager humor, log art and uses a PG or there's fiasco, those kinds of insolence. Go into the pump, and you get little bits of it, you know, spaced out all day long to act as basil. And then you get more of it to act as a Bolus. So you're used to using to insulins on MDI. Going forward with a pump, you'll only be using one. Bob says have backup supplies, things will fail from time to time and you need some backup supplies. He's talking about MDI stuff, don't give away all your needles. I still have syringes from when Arden was four years old, and we still use them once in a while. Bob's 100%, right? He says and if you're using an omni pod have a paperclip around. So if a nominee so different pumps have different situations where they're going to all fail at some point, something will happen to the flow of insulin. The pump will recognize it and shut itself down for safety reasons. They all do it. When on the pod does it it beeps and sometimes the beeping doesn't stop and you have to flip it over. There's a little hole in the back and you stuck a paperclip in there, and it stops the alarm. So a paperclip is definitely something to have around. Bob. You're 100% right. I seem to remember one time when Arden was young and it happened at a baseball game we use the post of Kelly's earring to stop it. That was a desperate moment. Janelle says you're not going to learn everything in one day. It's trial and error. Pay attention to your CGM. If you have one adjust accordingly. small bumps and nudges. She says I have anxiety and was freaking out when I didn't have good numbers at first, but I had to just keep adjusting, and now she's in range 80% of the time and she's happy with her pump. Tara says that patience is key. It can take a few days or even weeks to get all the settings correct. She said they started without a Dexcom so it initially took longer for her son. Since then they've changed pumps twice with a CGM and with being bold and the transition went much faster and smoother.

What she's saying is is that when you can see the blood sugar and you feel the reading into what she's saying, but I feel like what she's saying is when you can see the blood sugar in real time and you have that faith in yourself to make changes. It will go much easier. Some of you will use pumps that offer soft cannulas or steel cannulas She said that they had great success with the steel ones. And that you can get your endo to write prescriptions for changes more frequently, if you need it to, to avoid absorption issues. And that's with any pump. Misty says it may get worse before it gets better. It takes time to dial in your settings. She's saying again, your rates from MDI will change and change again, but it's worth pushing through. And she suggests that Basal testing is definitely necessary. She found pick a timeframe at a time like I think that to start with overnight, then, you know, pick pick segments of the day to get I have to tell you, too, and I say in other parts of the podcast, I'm a fan of as few basil programs as possible. Like I don't think you're outsmarting diabetes by having like a different Basal program every hour, you know, it's point three, five at three o'clock and point four or five at four o'clock and point to like, Yeah, I think there's a balance in there you find you can find eventually, where maybe you'll have one, two, maybe three standard Basal settings throughout the day. I think if you start having more than that, there are other things you could be looking at. So let's go says start with the endo settings. But keep in mind they keep it on the safer side. I said this earlier, we give it a week to see they gave it a week to see how the body was adjusting. But she didn't want to keep things high too long. After a week, they started to make slow adjustments after talking to the Endo. And once she was confident and she understood how the body was reacting to the insulin, started making the insulin adjustments on her own. She says you can be as bold as necessary as long as you're paying attention. Joanne said what I said earlier, which is don't panic right away and just decide this is a bad idea if it doesn't go exactly right. A lot of people came in to agree with her about that. And Jessica wanted to offer that she loves using the extended Bolus features and Temp Basal is that pumping allows a different Jessica says listen to the pro tip episodes. Thank you, Jessica. Don't rely solely on your endo to make adjustments, watch the Dexcom keep track of your trends and make adjustments when it's necessary. I'm going to tell you about one of the better decisions I made last year I switched Arden's delivery of her diabetes supplies from where we were getting them to us Med and US med is more than edging out the service that we were getting from that previous company. right from the comfort of your home or office, you can join over 1 million satisfied customers who rely on us med for courteous, knowledgeable and trained customer care and their representatives are going to keep you up to date with your medical and diabetic supplies. All delivered right to your door. Us med.com forward slash juice box or call 888-721-1514 To get your free benefits check right now. US med features a litany of things that you're going to love. How about an A plus rating with the Better Business Bureau. They accept Medicare nationwide and over 800 private insurers. They carry everything from insulin pumps and diabetes testing supplies to the latest CGM like the FreeStyle Libre three, the Dexcom G six and a little bird told me the Dexcom G seven coming very soon. They always provide you with 90 days worth of supplies, and fast and free shipping. better service and better care is what you're going to get when you go to us med.com forward slash juice box on top of all of this US med is now dispensing Novolog insulin aspart and human log insulin lispro through their pharmacy benefits. What are you waiting for us med.com forward slash juice box 888721151 For us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omni pod dash. They are the place we got our hands on the pod fives from us med provides Arden with her Dexcom supplies and are the number one fastest growing tandem distributor nationwide. I mean, I guess I could say it again. But are you just already online getting it done? Are you even listening to me anymore? Wherever you already called 888-721-1514 don't like the phone us med.com forward slash juice box. The other day I got an email from us Med and it said are you You want some more supplies? I guess it was time and I said yes. Click the button and then they just showed up. You want to do it like that. It's pretty damn easy. Us med.com forward slash juice box

when you leave the house, it's more than 20 minutes away take an insulin pen as a backup because in case you have a bad site, so I have to say we don't bring extra insulin with Arden. If we're in what I think of driving distance. Like if it's an amount of time I wouldn't care If I had to go back, if I'm going to try to spend the afternoon at someone's house for a picnic, and it's a half an hour from my house, we take extra insulin and some pumps with us. I don't bring needles, I have to admit. But her point is valid and worth considering having backups is not a bad idea. Brent makes what I think is a great point. He said that it's just the new ballgame when you start over. And this is something I find myself telling people privately as well. Well, let's see how to put this. You might be doing terrific on MDI. But what what comes with a pump, you know, maybe you just don't want injections, or you want more control over Basal insulin or something like that. Anyway, it took you a long time to figure out injections. And it's going to take you a little bit of time to figure out pumping, it is a different game. But at the same time, it's really exactly the same. It's the mechanics of the pump, the nuts and bolts, how it works that you have to get accustomed to. And while you're getting accustomed to it, you will feel like where you could feel like I should say that you don't know what you're doing, which might lead you to have that feeling like why did I do this, I knew what I was doing. And now I don't again, but trust me, it's worth the effort. If it's something you're looking for. Amy makes a great point here. She said that after you're up and running and things are working, take a step back and look at the pump data, right look at what it's doing. Especially she says if you're using an algorithm based pump, because you'll be able to see the increases and decreases in Basal when corrections go in and stuff like that. And it'll give you an insight into what's happening. Heather says that she felt like every new step was scary for her son, who was just diagnosed recently, and eight years old. They got their demo on the pod and just left it on the table for a few days until he was ready to try it on. She also figured out things about how to remove adhesive and overlay patches that help hold things on. So there's a little bit of a new world in there. Some people use patches, Arden doesn't we never put a patch on Ardens Omnipod. It stays on fine for three days. But I liked that she didn't rush here, she went out and got the on the pod demo. And just was like, alright, let's just leave it here till we're ready. It gets a good vibe. Even though this episode doesn't have a sponsor, it's a great place to say, I really do believe when I say during the app in the ads for on the pod, one of the greatest things about Omnipod is you can get a free, no obligation demo, you can actually try it on and where the other pumps just don't lend themselves to that. But on the pods tubeless nature makes that accessible to you. My on the pod.com forward slash juicebox to get that free demo. And you're helping out the podcast if you use the link. Allen's recommending the book pumping insulin which I've never read, but I've heard so many good things about I'm absolutely happy to say it here. He also wants to point out that the information that's available in doctors offices can often be lacking. And that's what led him to pumping insulin. He said back in. Let's see back in 2007. My doctor at the time told me they'd write a prescription for a pump. But if I needed help with it, I'd have to get it somewhere else. He said he appreciated the honesty but finds that a little frightening. Lauren says Keep in mind that you are probably rounding up your insulin amounts of MDI. So the same ratio on a pump might not work. So this is the exact opposite of what I was talking about earlier. But it's still really valuable to say that you might what she's saying, Laurie, I'm Lauren, I'm sorry, Lauren, I'm speaking for you here. But what I'm saying is you might have been using a unit or a half a unit because that's what you could measure with a syringe when maybe point four or point six or 1.1 was more like what you needed. Brianna says to do your research to decide what pump is right for you. She spent a long time looking at the pros and cons of all the pumps that are on the market. She says that she eventually found that her body responded differently to insulin going in through MDI and through a pump that there was a big learning curve for she had to end for 19 years and was previously on a pump years ago as a child but didn't use insulin correctly then it eventually transitioned to MDI, having been well controlled with MDI. She just thought the transition to a pump would be seamless. And it wasn't. Kristen says try not to put too much pressure on yourself when you make this switch. She found it stressful to learn to use a new piece of equipment, and says give yourself or your child some time to adjust. And you may hate it at first, but give it time. She said it can be strange to wear something on your body at first, but one day, you'll probably barely notice it. I must say that I've worn a couple of Dexcom and some Omnipod demos on my time. And I have to agree with that. I've obviously never used them for insulin or for actually taking care of diabetes. But when I've worn the things myself, I have forgotten that they were there eventually they do become pretty seamless. And that's probably hard to imagine especially for parents who are looking at their kids and thinking Oh they're so small on this thing, but I do think you just get accustomed to it. I know Arden did. Kristen continues on that for her switching to pumping was life changing, it just took time to adjust. She says as far as management goes, you already know how to use insulin and pumps to the same. This is a great point that I really want to echo. You're just delivering the insulin a different way. That's it, the basil is going in a different way. The boluses are going in a different way. Instead of pushing in a needle and pushing on a plunger, you're pushing a button, and it's going through a tube, she finishes by saying, take your time. And if you need help, come back to this Facebook group, we'll help you Kaylee's saying something that I've heard people say before, a pump is not a cure for diabetes. And while it makes life much easier with type one, or type two, I guess if you need insulin, it still sucks, you still have diabetes, it's going to be work to learn a new method for both you or if you have a child for your child, too. Don't forget to write down your settings, she said. So you're not scampering around trying to remember things. And remember that technology can fail at times. So you're going to want to not just rely on that programming to remember all your settings forever, write them down somewhere. But what she's saying is valid, that sometimes you can hear people outside of diabetes say, Oh, do you have one of those pumps, and they say it like oh, you must have if you have a pump, it's probably just super simple, right? Probably makes the whole thing go away. If you're feeling that way, like a pump is just going to make diabetes disappear. That's not going to you're still gonna have diabetes, you're still gonna need a Bolus, your meals Pre-Bolus You know, understand your settings, just the delivery of insulin is going to be different, easier, in my opinion, and you're not gonna get stuck as much, which is a big deal to me, Arden also being on the pod user, I really enjoy the fact that she does not have to take her pump off to bathe or to swim, which means we can get a nice stable Basal setting and use it 24/7 Kate just jumped in and thanked me for doing the episode and said that they've been MDI for three and a half years and the idea of pumping scares everyone in her family. And I'm, I've got to tell you, Kate, that is unfounded fear, you really don't need to be afraid you're just delivering the insulin a little differently. You get rid of the shots, and you're picking up your ability to manipulate your Basal insulin and create extended boluses. It's not scary. I know you're scared, but trust me, it's not actually scary. Christy said she wished that someone would have told her that her on the pod beeps to let you know when it's done. She was in a board meeting the first time it went off and she had no idea what to do. Christy, I would tell you that the on the pod came with a book and it would have explained all that in there. But I get your point, it would be nice if someone would just go over it real quickly with you. That's one of the great things about I don't know about other pumps, but on the pod for certain. Let you know when your reservoirs getting low, let you know when it's coming time to change it. It's good stuff. Linda says they got a pump quickly and not had and at that time had not known about the podcast. So they were very reliant on their endo team for help. She said her diabetes educator was awesome and called several times after we placed the pump. In the days and weeks that followed. They were calling to make sure everything was going good to help with adjustments. See, this is great if you've got this kind of Endo. Good knock on some wood good for you. She still says she remembers being overwhelmed at first by all the steps that it took to replace the site and being afraid that she'd forget something. That's just the I get that but that's the not knowing right? It's like you don't know what you don't know. So you're worried about everything. She has a T slim pump. She said it's user friendly, told her exactly what to do. Her biggest advice would be to just know that there will need to be adjustments made. Julia says something I've heard a lot of as well. She remembers feeling like she had just been diagnosed all over again. We kind of touched on it earlier, but it could give you that feeling. Heather says take your time. Listen to the instructions on how to change your sight. And if you're getting persistent highs, it could be that your cannulas bent or something like that happened while you were changing your infusion set. We've only ever had that once where Arden got a bent cannula. And it took a couple of hours to figure out because we were swimming and she was away from her CGM. Had she been right with her CGM. At the time we would have noticed the rise right away.

And he says I remember being in high school and pumped started really being used that her endo was all about it. Her mom really wanted her to get it and she didn't want anything to do with it. She didn't want the tubing, the pumping attached to her all the time, the newness of it. She just didn't want it. She got a two pump and had it less than a year and hated it. She'd get it caught on doorknobs drop it never had a pocket to put it in. She was in private school. She wore skirts sounds like everything was not going well. It wasn't until her sophomore or junior year of college that she got an omni pod and it was a game changer. Oh, well. Thank you, Miami bah Calm forward slash juice box. That was nice for you to say any Thank you Carmen figuring out how to adjust the Basal rates on time of day was a huge advantage. So, you know, my daughter, you guys hear me talk about all the time but Arden needs less insulin from basil overnight and she does during the day. And you have the ability to make those changes. You can say from midnight to seven, I want it to be point nine, five but from seven to, you know, midnight, I want it to be 1.2. Sara says she's a type one she's had it for 29 years, she used the pump for about 13 years got tired of it went back then di was never super comfortable with extended Bolus and stuff. But she says however, I am now trying to regain better control. And I'm about to switch back to a pump. She's got a Dexcom G six now, for about six months. She loves it and she's eager to get going with a pump again. And she's hopeful to lower her one season to the sixes Sarah, I definitely think you can do that. Christine is talking about the power of temp basals and extended boluses. There's things that I think a lot of people don't think about. I talked about them pretty extensively with Jenny in the diabetes pro tip episodes. I think these things are amazing tools that pumping offers. And please take a look at those episodes and try to figure it out. Dee says that when they started on on the pod, she had a couple of errors in the beginning. And it all seemed like a pretty big mess, but she stuck with it. Just remember Basil is not going to be right right away. And the need to make changes. It's obviously you're hearing a lot of people say the same things. It's because it's just what happens. Meghan basil testing and patience is huge, especially if you're moving to an algorithm based pump. Like the Medtronic 670 G, for example. Both of these systems should be started with the algorithm off until basil testing is complete. So if you're thinking about doing that, she's 100%. Right? If you're starting with an algorithm, you start with the algorithm not working so that you can get the basil right before you start expecting the algorithm to do something. She said juice box listeners know the importance of Basal testing. However, it seems there's not enough follow up in the transition from MDI. long acting insulin to pumping Basal rates I very much agree magnets. We do not talk about Basal insulin the right way overall. Tara says if you have a younger child, this is a good point that on the pod like ticks as it's getting ready to go in and she said it made her daughter anxious. They gave her headphones and an iPad so she wouldn't hear it. It's click click click. I have to tell you Arden has been wearing it on the pod for 13 Maybe years. And she still counts the clicks as they go in. So I hear you I think everybody within Omnipod knows about the clicking. But the clicking is it's part of the game. It's how it makes tension to put the insert. It's not important. It's just you know, tout works, but the headphones to eliminate you being able to hear the clicking smart coordinates reminding us that the pump is only as smart as the settings that are in it. She had to remind yourself that the pump was only going to do its job once she did hers. Here's a fun story from Danielle. She said my daughter was six years old when we told her how she wasn't going to have to get shots anymore because she was getting in on the pod. So she was very excited. The first time they put on the pump. The clicking and insertion scared her but they told her Don't worry because you're not going to feel it anymore. No more shots than it came time to give her her first Bolus. They explained it again no more shots that her daughter ran from the house down the street to avoid the Bolus. She said when they finally got her to calm down and gave her the insulin. Her eyes went very big and she suddenly realized no more shots. She thought she was going to feel the insertion every time she got insulin. That was the one thing they didn't think to explain to her. That's a great little piece of advice and an amusing anecdote. Sara just says please everyone share your tips so we can get this episode up. I need it for making the transition soon. Big smiley face. That's really great. People here we're waiting for insurance approval. A lot of people in the thread are just talking about we're getting a pump. Laura, I would say that the fear of making the move from MDI to pumping at least for her fear of change. Yeah, what's worked we already doing something it's working. And then she said we should have they were worried about and then she says they were worried about cost. Is this really something everyone would like? So a lot of those concerns. Okay, good. I was hoping this one came up with. Okay, good. I was hoping this one would come up. Marta says that her total Basal insulin went down, that the initial formulas for pump therapy starting with about 80% of original Basal dose had to be dramatically reduced. She went from injecting 18 units of Toujeo to 12 units on the pump. See, everyone's not the same. And I'm not saying this happened to this specific person. But you There are many people on MDI who are using way too much Basal and find themselves feeding their insulin constantly. So as long as they eat on a certain schedule, they don't notice that they're using too much Basal insulin. And it mimics really great control because you're being held low and steady. And as you try to drop you add food. I hope that makes sense. So there's a lot of different scenarios people find themselves in with their Basal. Some people don't have enough some people have too much, you know, etc. You'll find out who you are. When you change your pump. Jennifer says, if you're using a tube pump, remember that you're going to disconnect it for, you know, bathing, for example, she says, Be aware that your child may take the pump off for a shower and forget to put it back on. Of course, whether you're a child or an adult for getting to hook back up to your pump, you know, you don't have insulin, and you will be surprised how quickly your blood sugar will rise to a dangerous level without any insulin. Tommy asks for me to talk about transitioning during the honeymoon period. Tell me what I would say there is if someone's honeymooning, and they maybe don't need very much insulin or at times it feels like they don't need any for 15 or 20 minutes at a time. Your ability to shut basil down or to tamp it back is going to be amazing for you. Here I'll bring this up. Never turn your Basal insulin off, so you don't suspend your pump. When you want your Basal to go away. You always do a Temp Basal decrease, because when they end, you go back to your regular Basal rate. Suspending insulin and again, maybe forgetting to turn it back on is another quick way to get into DKA always Temp Basal never suspend. Now I hope all of you find the diabetes pro tip episodes that are here in the podcast, they begin at episode 210. With an episode called diabetes pro tip newly diagnosed we're starting over, but if you've been through them, and just want to get back to some things that might be specific to this to 19 is about insulin pumping to 26 about the perfect Bolus setting Basal insulin to 37 Pre-Bolus ng 217. These are all things that might have more stuff for you about using a pump like episode 218 Temp Basal. There's also one here about fat and protein rises, which we'll talk a little bit about using extended boluses. And that's episode 263. You can find them all in your podcast app or at diabetes pro tip.com. All right back to the list. Kyle says Don't forget to rotate your sites, that's a great one. Don't always put your pump in the same exact place. Oh, he also says you can do a Temp Basal like 0% type Temp Basal off when you first start pumping until your old injected Basal insulin get through your system and then boom, pop it right back on again. You can just sort of match them up as close as possible, so you don't have an overlap of your injected Basal insulin, and your pump Basal insulin on your first day. Eva says that for her pumping was the first time she had any concept of insulin onboard, since it was now being displayed right there on her pump and sometimes scared her away from being as bold with insulin as she was with MDI. It was only once she pushed that out of her head that she was able to add insulin when she knew she needed more. So we talked about insulin on board through the Pro Tip series, I hope you've heard them. There's a lot about how your settings get set up on your pump, your doctor chooses an amount of time that they think the insulin stays in your system. If that number is not accurate, then the pumpkin imagine that there's insulin that's still active when there's not. In other words, imagine that the pump thinks that the insulin stays in your system for four hours. But really, you use up the insulin most times in three hours. Then between that third and fourth hour. The pumps gonna still think there's insulin active in there working and say you go to have like three or four carbs. The pump might say no, you don't need any insulin. You still have some active, but he may not. It's you'll figure it out. But don't just maybe I'll do an episode of insulin on board with Jenny sometime might be a good idea.

Alright, let's see what's next. Abby says I need this episode now. very forceful IV it's coming. Carrie remembers being excited that she would not wait. I remember being excited that I would not be as lazy of a diabetic since I would not have to get all the paraphernalia out just to give myself a single shot. But I wish I had a provider that once we had all the settings in would have done the little small tests with me to really hone in the settings. Also remember that it's a tool not a savior or cure. We've gone over that you're still responsible for understanding. Absolutely true have a backup plan for are failures with your pump. It is an electronic device it could fail to and describes learning about a pump as an elephant that's charging at you. I think she's mixing her metaphors she'll join. I think you're mixing your metaphors, but I love it. I'm just starting this week. So I'm super new. But here's what I know. It's an elephant, a giant elephant that feels like it is charging you the classes and forms the logging pump. The represent the logging, the pump reps, the saline start actually starting it more logging, it feels like you'll never see the end of the tunnel, but you get there. So an elephant one bite at a time. So worth it. So where she mixed is she said I love this. You said it's like an elephant charging eight. But I think the saying is how do you eat an elephant one bite at a time, right? I'm not sure what you did there join. But I like you kid who I like what Vicki does here. She says I can wholeheartedly say it was the worst thing I've gone through in 25 years of having diabetes. Looking back, I wish I really understood all the terms in the defining diabetes series before getting a pump. I went from MDI and basically had no knowledge of carb counting. I was diagnosed in 95. And I really didn't stay up with it. So overnight, I needed to understand Basal correction factor, insulin on board, extended Bolus, etc. Also, she says work with your diabetes educator when you're setting the Basal rates, get them to teach you when you should make the changes. I was on 14 units of Lantis on MDI, my diabetes educator who I hate her fired started me on four units. Yeah, that wasn't going to work out with a pump. And would only let me increase it if she said it was okay, they need to teach you how to use the pump. I agree. And Vicki, I appreciate you bringing up the defining diabetes series. There is a series within the podcast called defining diabetes. And this is going to be a big deal for you. Because new terms are gonna pop up with a pump. If you don't know what they mean, you might as well be reading a different language when someone's explaining it to you. You need to understand the terms that you're going to be using. And I do believe just you know, I know I made them. So I might be a little bias but those defining diabetes series are an amazing way to learn a lot of things very quickly. Hey, Katie, you have a great post here. But we covered everything that you said already, but I want to thank you for it. Oh, Jennifer says I recall being nervous about my son accidentally dosing. When he first got his pump. He had an animus ping. So I learned how to lock the pump or use the second security feature that helped ease my anxiety. Apparently there was a pin number she could use. Also, I recall being thrilled that our world got bigger once parents don't have to worry about the needles. He got invited to a lot more playdates and sleepovers. People were just more comfortable with the electronics. That's an excellent point. And leads me into the idea that I'd like to bring up which is that I know the Omni pod has limits that you can set I'm sure every other pump does as well. Max Bolus Max Basal rate so that you can't by mistake want to give one unit and give 100 units is a Bolus or so you can set it wherever you want. I think Arden's Max Basil is set at like six units or seven units an hour. So I can't mistakenly type in nine or 10 or 77, or something like that. And same with her Bolus. I don't remember where it's at at the moment, but I just took the biggest Bolus I've ever made in my life added a couple of units to it and limited it at that so that somebody doesn't end up doing, you know, 175 if they mean 17, but I'm also not in a situation where if suddenly she eats something more than usual, the pumps not stopping us from giving a couple of more units than we normally do. It's a very important safety feature. Please check it out. Kelsey, you're asking a lot of good questions here in the thread. They're all covered in the diabetes pro tip episodes. Stephen says best tips I got were in my original training from a CDE, who was also a T one D. The first was about changing sites, be sure to prime the cannula and add the appropriate amount of insulin to create the puddle of insulin. So it can able so it can enable the insulin to start the absorption, breaking the clumps of insulin into single molecules so the body can use them. Steven, I'm not following you because orange never used the to pump but I trust you as a great person on this site. So I'm going to continue reading. The second grade tip was to use skin prep as a skin barrier and adhesive enhancer been using it for over 20 years. The third was to understand that the Basal rates will change and that the insulin to carb ratio will change no matter what you do. Don't take it personally, Steven, I'm gonna say I'm guessing tube pumps get air in them you have to prime them through. It's not something I understand. Because I've never used the tube pump but I do know it's important. So if you have a tube pump, make sure you understand how to prime it. If you have an omni pod, it takes care of that automatically. And what else did I want to say here? I just had a thought in my head Stephen What the hell you made me think of something and now it's gone. Oh, Tim, what about Basal rates? I got it, but you may have lost my mind yet. Basal rates are going to change. That's whether you're MDI, or you're pumping, you're gonna gain weight become more or less sedentary. There's all kinds of reasons why the amount of insulin you'll need will change, hormonal changes. It's not ever going to be set it and forget it, you're never just going to be like, Oh, my Basal rate is point seven, five an hour. I'll never think of that again. Don't think that's gonna happen. Jenna, this is brilliant. Start your first few sites around the same place on the body. For consistency. Different locations can require different Basal rates. Like for instance, Arden's thigh needs a little more insulin than Ardens arms, very good. Her belly doesn't need as much as your thighs, etc. That could be different from every for everybody. Jenna goes on to say different locations can require different Basal rates, Pre-Bolus times and just overall insulin need and action time. Personally, when doing MDI, I recognize that I have poor arm absorption and great belly absorption. Jenna has great belly absorption. If you're ever on the podcast. Yeah, that's gonna be the title of your episode. So I started putting my pods primarily on my belly for the first few months. So I could figure out how to best use my pump. And its features without adding confusion of absorption differences. That's pretty brilliant. Also a great time to read, mind you that you can't just put the pump in the same exact spot over and over again, very similar to you just can't inject over and over in the same place, you have to have a few sites and you should rotate them often. And don't forget that please. In the same vein, Arden has times of the month where she is more easy to control and less easy to control. I don't think that was English. But when I know she's going to be harder and need more insulin, I make sure that her pumps are on her sites that work better. And times when she's going to be easier. I put it on the sites that need a little more work. So it's not that drastic, but it is significant enough to mention that you should be paying attention to it. Okay, well, that's it. I appreciate everyone jumping in the thread and leaving their thoughts remembered his and tips of switching from MDI, to pumping. I remember the time personally as not that confusing or different because I was pretty bad with MDI. So I didn't notice if I was bad at it would pop, just just move one show from this side of the room to that side of the room. You know what I mean? I can say now looking back with hindsight that everything that everyone mentioned here is well worth understanding. But in the end, you're changing insulin delivery systems, you're eliminating using two different insolence, you're using just one fast acting insulin that's being dispersed by the pump, both for basil and Bolus. You need to know the terms of the pump stuff, because otherwise you're like, I don't understand what a Temp Basal is. You learn that kind of stuff, you learn what a cannula is, that kind of thing. You start figuring out what spots on the body work better, which spots need a little more insulin, get that Basal insulin, right? Don't sit and stare at it, especially especially just do the math. If you were using 10 units a day, and now all of a sudden you're using five units a day of Basal insulin. And you're like, Oh, the blood sugar is always high. Please don't say pumps don't work. Think, why are we not using all the Basal insulin we used to? That's just such a big thing.

Just I just see it so much with people. And here's one last tip from me. When you're wearing an insulin pump, and you think this site might be bad for whatever reason, and you're pumping in insulin, you're not seeing anything happen, and you're not sure if the site's bad. Or if you just have a high blood sugar and you're not using enough insulin. Making an injection, as a correction will bypass the pump, right? So if you inject in that scenario, and your blood sugar starts to move down pretty quickly, that's a good way to figure out that the site might be bad. You say makes sense, Scott, but what I think of it in the moment, you probably would not just why I've mentioned it here. Anyway, I hope you enjoyed this. I really want to thank the people on the private Facebook group for the podcast. It's called Juicebox Podcast, type one diabetes, I hope to see you there. And that's it. They don't forget the T one D exchange. If you can go to T one D exchange.org. Forward slash juicebox. And get involved in the registry. You'll be helping people with type one diabetes, a huge amount you'll be helping the show. That by the way is for US residents who have type one diabetes or US residents who are the caregivers for someone who has type one diabetes, and because we talk so much about it. I know there are plenty of other pumps. But of course the on the pod is a sponsor of the show, and they offer a free, no obligation demo it will be sent right to your house and you can actually try it on My Omni pod.com forward slash juicebox. There's still links in the show notes, and links at juicebox podcast.com. I forgot to mention that the defining diabetes episodes are of course available, they're spread throughout the podcast. But if you go to diabetes pro tip.com, and scroll to the bottom of the page, there's, they're all there. So you can find them that way, if you just want to find out what number they are, and then listen to them in your player or you can listen to them right on the website. I really appreciate you listening. I'll be back soon with more episodes of The Juicebox Podcast.

If you think you'd be a great guest for the podcast, reach out to me by emailing me at Scott at juicebox podcast.com. I'm currently booking for the second half of 2021. I think that's August or later, I'm looking for anyone who thinks they have a good story. Somebody who really wants to share help people or just want to be involved in the podcast. Bonus if you think you have a good after dark episode and you email me. I'll wait for this. I'm Scott at juicebox podcast.com.

Want to thank you for listening today. And of course thank you s med for sponsoring this episode us med.com forward slash juice box or call 888-721-1514 You can get your diabetes supplies the way we do from us met. Of course 35% off cozy earth.com with the offer code juice box at checkout, save 10% On your first month of therapy@betterhelp.com forward slash juice box. And if you want to get started today with ag one from athletic greens, you will get five free travel packs and a year supply of vitamin D with your first order at my link. All the links are available at juicebox podcast.com. And in the show notes of the audio app you're listening in right now. When you click on these links, you're supporting the production of the podcast and I can't tell you how much that means to me keeps the thing free and plentiful. So if you're enjoying the podcast and you need one of these services or products, please consider using my link. Thank you so much for listening. Don't forget to check out the private Facebook group Juicebox Podcast type one diabetes online. That's where all this came from absolutely great community. It's absolutely free. I said absolutely twice but whatever. Still good Juicebox Podcast type one diabetes on Facebook. You don't have to have type one. You could have type two. You could have Lada you could be the caregiver of someone with diabetes. It's just a great place in general. Thanks again for listening. I'll be back very soon with another episode of The Juicebox Podcast.