i’m a prediabetic, so i have no clue about this. i would assume you could handle roller coaster bg better with a pump than mdi. if so, couldn’t a person on a pump eat more carbs than they could on mdi?
Pumps have certain boluses that make eating certain foods like pizza easier (eg. square wave), but with MDI you can also eat high carb if you are smart about it. A pump is just a different method of treatment that may work better for some. Some people actually have both a pump and an insulin pen. They use the pump most of the time, but if their bloodsugar goes high, they take an injection with the pen to get their bloodsugar down faster. Its all about what works for you.
Personally, I eat at least 200carbs/day on MDI. I physically can’t eat much more than that so I see no need to eat more.
With a pump, if you have a pretty good idea of your carb-to-insulin ratio, then you can adjust your bolus (the extra dose of insulin that you give yourself before meals) to compensate for additional carbs.
You can also do this on MDI. If you have a 1:15 carb ratio, for example, it doesn’t matter if you’re using a pump or MDI. If you eat 45 carbs, you’ll take 3u of insulin either way.
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It is just a different insulin delivery system, gives a little more comfort over sticking your self multiple times. Need to use a little know how to get it done right.
The chief difference between a pump and MDI with a genuine basal insulin like Lantus or Levemir is not in the bolusing (though the pump has some refinements there) but in the basal. With MDI, you have no control over the basal once you’ve taken your shot. It’s going to do what it’s going to do. With a pump, the basal is being delivered in micro amounts throughout the day, and you have total control over that delivery–not just programming the various rates, but setting temporary rates at will or even suspending delivery entirely.
The bearing that has on your question about roller-coastering is pretty clear I think, but here’s a f’rinstance: I have a pattern of a pretty sizable post-prandial spike after midday meal, but also a tendency to go low in late-afternoon or early evening. Kind of a built-in roller-coaster, if you will, that is exacerbated because I also bike commute and that afternoon ride can cause me to plummet from 180-230 at 2pm down to the 40s by the time I get home from my evening commute. I’ve been getting better control–thanks TUDers!–by pre-bolusing for the midday meal, which of course you can do on MDI, but also by setting a temp basal down to almost zero for an hour or so starting around 3:30-4pm, that helps prevent the exercise-induced plummet. You have to do it ahead like that because the basal being administered right now isn’t actually going to start taking effect until later, and for me the lag time seems to be a bit better than an hour. This has helped me attenuate my personal roller-coaster considerably, and you can see how part of it I could do on MDI, but part of it–really the more important part–I could not. It’s almost like being able to subtract as well as add insulin, which with a basal shot is impossible.
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Well said, DrBB
As DrBB explained, you have a bit more flexibility in how your insulin is delivered with a pump so it can be more helpful in that way. However, my feeling is that the most effective tool for helping to cope with “roller coaster BG” would be a CGM which works well for you. If I had to choose between a pump and MDI I would choose the CGM.
Again, to an extent the extra flexibility of a pump can help manage carbs. But a CGM is much more of a help in doing this because instead of guessing as to when your insulin takes effect or when the carbs you ate are starting to raise your BG you can actually track that.
It’s been about a year now since I started using CGM and I am losing track of just how I felt about CGM before I started using it. But I think I assumed it was just something like a BG meter on steroids. You could probably replace a CGM with more finger sticks, but the CGM was just more convenient and less painful than doing that.
That is simply not the case unless you are capable of testing your BG 288 times a day, including the period when you are asleep.
It is a quantitatively different experience, at least in my opinion.
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And full disclosure–because T1 is nothing if not hilariously ironic–I’m having one of the worst roller-coaster days I’ve had in weeks today. My usually timing for pre-lunch bolus didn’t work, my CGM told me I was 90 but no down arrow… only where did this weakness and cone vision suddenly come from? Fingerstick, 40s!!! gasp! Got out the sandwich as the EatNowNOWNOWNOW feeling started crashing in. So no way was I going to only have half and take the other home for later… and 2 hours later, over 230 with an up arrow, better break down and do a correction, but I only took half of what Mr Medtronic suggested just in case. And an hour later I’m looking at sharp down arrows with the afternoon bike ride coming up. At least I can set the temp basal going…
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Yes a pump is better than MDI to manage roller coaster BG. Today with a CGM and a pump I can steer my BG down what would look like a crooked path kind of like driving a car from curb to curb. I watch my CGM and do small boluses turning it back toward the center of my target range. Do I run out of my target range almost every day but I can stay in range 80 to 90 percent of each day (a 24 hr. cycle)…buy doing this I can eliminate most of my really high spikes. I still have a few BG over 200mg/dL and I can make a mistake but they are no longer a common practice. There is no way for me to give myself maybe up to 6 corrections each day and each can be less than 1 unit with a syringe …I even tried pediatric pins and it just does not work, the only way is with a pump.
My BG is never stable…it’s always a roller-coaster and at night my pump program turns down my basal and lets my BG slowly drift up to my high target until early in the morning so I can safely sleep without worrying (less stressing out over nighttime hypos…works better than snacking before bedtime to feel safe…the snacking just adds more hills to your roller-coaster.
Note: If my BG gets up over 200mg/dL I will do a correction based on my pump program using a syringe in several locations to lower my BG quickly back into target range and also dump the correction insulin out of my pump so it will track my IOB.
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Three questions, just out of curiosity.
How much of a correction bolus do you take for 200 mg/dl?
Have you ever tried to quantify to what extent injecting in multiple places differs from a single injection of the same amount of insulin? (Or versus bolusing with your pump?)
How do you “dump” the correction bolus to allow the pump to track your IOB?
Note:
My Medtronic Paradigm Revel (723) and (I assume later models) have a “Capture Event” option which at first glance looks like it would be a better solution to this problem of tracking injected IOB. You can use it to enter into the pump’s data the fact that you gave yourself insulin via an injection.
But 
astonishingly (to me) I don’t think the amount of insulin logged by “Capture Event” is added to the IOB log. I guess I should ask Medtronic about this. But it seems to fit a pattern I’ve seen of Medtronic adding a potentially useful feature only to hamstring it so that it isn’t actually as useful as you had hoped. 
FWIW, you can also use “Capture Event” to add carbs to the log. I do that sometimes when I’ve given myself a correction via Easy Bolus or Manual Bolus rather than Mr Wizard. In the past I didn’t bother, but during my last visit I was asked "Why are you doing all these boluses but there is no record of any carbs? 
" To which I cleverly responded, “Oh. Yeah. That.” 
Yes a pump is much better, no comparison there imo.
In addition to the flexibility that a pump’s basal profile gives, I find the ability to deliver both an immediate meal bolus for carbs combined with an extended meal bolus for protein and fat to be an outstanding feature of the pump. Extended boluses for my meals often run 2-5 hours depending on the amount of protein that I eat. So like, the description of increasing and decreasing basal rates to compensate for exercise, I can do the same thing with an extended meal bolus. If my post meal BG numbers trend lower then I can cancel an extended bolus and put the brakes on.
I think a pump gives more flexibility when compared with MDI. I suppose if I had to make MDI work in similar fashion that I employ with my pump, I could probably make it work.
This is a persuasive argument in favor of a pump, for sure.
My opinion: if someone is very active (especially intermittently active and/or engaged in hours-long very strenuous activity such as myself), there is NO WAY to control bg’s as effectively on MDI, as there is by using a pump. Flat out. Once you get your dose of basal, you can’t “remove it” , so changing up your activity level quickly, or schedule, will put you at risk for hypos far more readily than by using just short-acting insulin and making use of the SUSPEND feature or the temporary basal rate.
How do you cancel the extended bolus without suspending the whole pump and therefore the basal? I am on a 530 MM.
I use an Animas Ping. When I deliver an extended bolus, I use the Animas “combo bolus” feature. It permits combining an immediate bolus with an extended bolus using a percentage split between the two. I split it by delivering 0% up front and 100% extended. If during the extended period, to cancel, I would just access the combo bolus screen and it offers the current status of the extended bolus (“delivered 0.5 units of 2.0 total”) and a cancel option at that point.
So you don’t have to suspend the pump to cancel a pending bolus. I’m sure the Medtronic pump has a comparable cancel feature. The cancel option may not even appear until you program and extended bolus. This is one of those situations where you’ll need to experiment.
You Suspend, then Resume. Suspend kills any special programs you’ve set and Resume just, well, resumes.
Thank you. Good information.
I am concerned for those who have owned a MM pump for years and are not yet familiar with the SUSPEND feature; or how to SUSPEND and immediately RESUME, to cancel a square wave bolus, for instance.
These are basic ways to control the pump and should have become familiar quite quickly after beginning to pump. This is not a smartphone that one can learn about as one goes along. A pump can either be your best “friend” or it can bite you in the butt if you dont know how to control it.
PLEASE, all of you who aren’t yet totally conversant with your pumps, get out your manuals! 
SUSPEND/RESUME isn’t something you should be reading about here years later, and going, “oh, wow, I didn’t know that”. There should have arisen some occasions when you have suddenly needed to stop a square wave bolus, no? And if not that, I get the feeling that are quite a few basic functions (given the comments I have read on this forum) seem unknown to some of you. I don’t want you getting hurt by misunderstanding how to use your pumps.
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