HbA1c drops 1.6% after 3 months on an insulin pump (vs MDI)

I’ve heard countless stories of the benefits of using an insulin pump over multiple daily injections (MDI) and in October 2016 I took the plunge into becoming a little bit bionic.

I was diagnosed with type 1 in 2012 at the ripe age of 25 and within 24 hours I was doing injections of Lantus and NovoRapid insulin. Apart from moving onto to Levemir a year later nothing changed for 4 years despite my management not being perfect.

I can’t remember being told about pump therapy at diagnosis, but it wasn’t long before I learned about what else was available. I wasn’t interested for a few reasons:

  1. I wanted a few years of MDI experience under my belt so if I ever needed to transition back it would be familiar
  2. I liked doing a jab then putting the pen away in my (trendy) pencil case and forgetting about it
  3. I’ve never been ashamed or embarrassed about my condition but an insulin pump doesn’t really give you the option of being discreet, especially as I was single at the time.
  4. User experience and design of insulin pumps were very poor until recently (and still lagging behind the latest available tech) so didn’t want to look like I was rocking a 1980s pager on my belt. I know, very shallow.

Why did I want a pump then? Injections just weren’t working for me any more. I couldn’t get my A1c below 7.5%, no matter how much attention and effort I put into managing my levels. They were pretty erratic at times and it was exhausting to manage this while juggling everything else life throws at you – something had to give.

The journey started early 2016 with DAFNE – a structured education course through the NHS, which is mandatory if you want a pump. Once I’d completed the course and got a few holidays out the way I started the conversation with my DSN. Before I knew it I was signed up to start pumping later in the year.

Guy’s Hospital in London was where I attended my 4 week pump course (1 day a week) and the team were great. Even on day 1 I knew this style of therapy was the one for me. I love technology and this feeds my tech addiction more than my other gadgets.

The first few weeks were rocky as I got use to a new routine and established basal patterns, carb ratios and all the other amazing features that come with pumps these days. It also took a while to trust the technology, after all I was putting my life in the hands of a device running on an AA battery. It didn’t help that my very first one died within 24 hours.

Having the Freestyle Libre really helped me understand what impact little tweaks had on my blood sugars and I soon became pretty good at knowing what needed to be done. About a month after pumping I finally felt I’d started to get it right. My time in range and average levels were improving, fewer swings and therefore fewer high highs and low lows. I felt better in myself, I had more energy, improved focus and attention and fewer mood swings. Coming up to my DSN appointment I was confident I had improved.

I had dropped from 8.3% to 6.7%, which is more than the 1% I forecasted and hoped for. I was over the moon, so was my DSN and the trainee nurse observing the appointment. The cynic in me would say that A1c isn’t a true representation of good management as you can have a good A1c with erratic levels. However I also had a 24 hour profile from my Libre and regular finger prick testing that proved that my time in range over a 24 hour profile had improved from 40% to almost 70%.

I’ve purposely put off posting anything sooner as I wanted to see what I was like after achieving that first HbA1c result. To be honest, I relaxed a bit and my levels show it. I had another HbA1c test a month later (on a clinical trial) and it’s slid to 7%. I appreciate I can’t look into this too much but it shows what happens when you take your eye off the ball.

So along with changing jobs and the novelty wearing off, I took my eye off the ball and my levels wondered a bit. But that won’t be for long hopefully. My next target is to hit 6% by the end of the year and I think I can do it by upping my exercise and tweaking my diet further.

The biggest thing I learnt about this process is an insulin pump isn’t for everyone. I love my pump, it fits in with my life completely. It’s a bit of a chew on if I want to go to the Turkish bath or go surfing but I find ways to make it work. You need to be ready for quite a big change in treatment and how you do anything from exercise to taking your trousers off when it’s clipped to your belt. More importantly you need to be ready to put the time in, a pump will not produce results without making use of all the features. I probably do something on my pump 15 times a day, that’s a lot more interaction with my type 1 than I had with MDI so it’s bound to have a positive effect.

The reason I have been waffling on for a thousand or so words is to talk directly to those T1Ds who are on the fence about transitions to pump therapy. All I can say is the reservations I had previously are insignificant in comparison to the benefits I’m reaping now. Appreciate it’s still early days but I’m already a huge advocate for pump therapy and recommend everyone to give it a go.

It would be great to hear other people’s stories, throw me a bird on Twitter – @diabeticbanana

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