CGM or pump?

Just wondering for those of you who have experience with both pumping and using a CGM…if you HAD to make a choice, which would you use. A CGM only with MDI or a pump with multiple bs monitoring…

Hi Sylvie ,
Speaking as a Canadian ,if I had no Extended Health Plan , I would likely first need to know the ongoing cost comparison of Paradigm Real -Time versa Guardian Real -Tme ; do you have this info available ?
I believe, that the Diabetes Center( s) in my area will set up a patient with either one or the other .I recall getting a call from a CDE asking for view of the CGMS ; the patient was on MDI and using a Guardian Real- Time .
Would this " service " be available to you ?

I’ve always wanted CGM more but my basal appears to be varying and I’m having trouble controlling it via MDI so I’m starting to prefer pump more!

Pump first. CGM second.


  1. Less stuff to carry around with a pump - just the pump and the meter. With the CGM only, I’d need to carry the meter anyway, plus injectables.
  2. Easier and more accurate bolusing. Calculate, enter and you’re done. With CGM only, I’d still need to confirm the reading with fingerstick before making a bolus calculation, which I’d have to do manually, or worse, in my head.


Go with a pump first. Once you get use to that technology your blood sugars will be a lot better and make your transition to the CGM so much smoother. The pump truly does make life so much more simple, just check, eat, and bolus (or bolus and eat). You will gain so much control with the pump. I personally use animas and love it, I have stuck with them for about 8 years now after a bad experience with minimed ( a few actually). Good luck, you will love the pump.

If the question is which to get first, then I vote for CGM first because it will make fine-tuning basal settings on the pump much easier and safer

Definitely the pump. I have been using a pump for ~12 years now, and it changed my life in such a positive way. I use the Animas, which I can highly recommend. CGM, I made the mistake of getting the Medtronic Guardian, so mine sits in a drawer because it’s just not very good/accurate, and it’s extremely difficult to get it functioning properly.

Wow1 Thanks for all that input. I have things to mull over…I was really thinking of going CGM first, although the supplies’ cost are way out there for me. I just thought that maybe it would help me catch lows and highs before they get out of hand.,and that that would help me keep the bg more steady. I don’t mind carrying stuff around (like meters/strips/pen needles…) and I have pretty tight control with MDI. I would just like to have way less lows and not live in fear of lows as I am getting less symptoms as I go along!! I like to hear from people with experience cause I know they know the little details that matter… Thanks

Have you had a chance to look at the Guardian Real-Time Tutorial ??..and what are the costs ???
Sylvie, can you explain your comment " and I have pretty tight control with MDI." followed by " like to have way less lows " . Is this not contradicting ? Wonder if it would work , if Melitta can give you her Guardian ( my frugal mind at work !!) …ofcourse you still will need the sensor( s) /transmitter ( my transmitter is over 2 years old )

I have some of their litterature and I have checked out Guardian Real-TIme. The costs…I am guessing at those, and hope to get more info at my meeting with the CDE (that I have not seen in 15 years) in January…

I guess what I should write is"my constant effort at tight control". I check bg 8-15 times a day and adjust when needed, but the better my numbers, the more lows I get.

I just wonder if the CGM would be more helpful to me than the pump (although popular opinion seems to think the pump should be the first investment…) For instance, this morning I started with 6 bg but could tell from the rise (I had tested earlier) that I was going to rise quickly from that. So when I injected myself I took that into account. 2 hours later I retested and quickly realized that either I had been way wrong in my calculations or the diabetic gods were playing with me again!! I was sitting at 16!!! What I wondered at that point was whether the pump would have made a difference in this scenario OR would a CGM have alerted me quicker to the quick rise… I wonder which piece of equipment would help me keep those bg more even…

Those are the quesitons I ponder before I spend what for me would be an extraordinary amount of money… So if appropriate and anyone out there has a pump or CGM that they would like to get rid of…I would be more than happy to help with that!!!

Hope this helps to understand where I am coming from…


The choice you pose really requires pondering. I love the ability of my pump to deliver different basal rates throughout the day. I currently use 11 different basals! On the other hand I see the CGM as my metabolic “eyes.” Getting a BG update every five minutes along with the all important trend indication is something that I could not do without.

If I had to choose between the two technologies, I would select the CGM first. As long as I can “see” where I’m headed then I can compensate (food or insulin) appropriately. As I understand it, insulin pens can deliver with 1/2 unit accuracy. (Is there a pen with a memory?) Yes, I would give up my pump to keep my CGM!

If I had decide CGM or Pump first, I would have to say is would be the pump first and then get an anal understanding of that technology before adding the CGM. If the choice were pump or CGM, I would have to lean toward the CGM. I have been on a pump for ~13 years and on a CGM, with the pump, for nearly three months. The combo works well. Either way you go, you need to learn about D well beyond he numbers. My fav is “Think like a Pancreas” to get a broad and focussed understanding of D and how the whole think works.

After writing this, I think maybe the best thing would be to do a two week round on the CGM before making the decision. Do at least two sensors before giving it back. You will get lots of data you can use to decide if you need the pump or the CGM to reach your D goal.


Thanks for explaining your motivation. I am on shots and checked my bg on average 12 times a day. I was able to deal with lows but the highs drove me nuts. I follow a pretty boring routine which should result in predictable bg. This worked out most of the time. Before pricking my finger I try to predict my bg. On some days it was like someone threw a switch. I predicted low and I was high or the other way around. My best explanation is that this was caused by an unusual rate of insulin absorption. Another problem area was dining-out. Many times it took me an entire day to get back to normal. My hope was that with a CGM I could see highs and lows coming and react before things got out of hand. This is how it turned out to be in the beginning. After about 3 months with the CGM things changed. All of a sudden I had learned where highs were coming from and avoided them instead of treating them early. I now have entire weeks in which my bg does not go above 160. About 90% of the time my bg is below 130. I would have considered my CGM a success if I would have been able to rein in the occurrences of 200+ bg. Being able to be below 160 at all times is much more than I was hoping for.

One word of caution: CGMs are not all the same. Some brands don’t work at all for some people. Try them out before committing. DexCom has a 30 day money-back guarantee. If you don’t like it you are not out of any money and you have a story to tell.

Good luck.

I’m kind of where you are, Terry. I have been a pumper for a decade, but after a year with a CGM, I don’t even know how I could give it up. I love it too too much. I think that a CGM might allow me to do fine back on MDI, though insulin choices have changed so much since I was on NPH back in the 90s that I would have to re-learn some things about my body’s response to long-acting. But like you said, as long as I can see where I’m headed, I can make adjustments.

DexCom cited a study in their earnings call that found no clinical difference between pumpers with CGM and MDIers with CGM.

Thanks to everyone who has contributed to this discussion… I have lots to ponder. Llike I sayed earlier, I love to hear from people with REAL experience because you are the people who know the details that matter… Much appreciated!!

I like the idea of trying 2 weeks with a CGM, and then 2 weeks with the pump (if that is a possibility) and decideing from there… . Of course, I would love to just get the two at once…but one step at a time!!


If you are planning to get both then I recommend getting the CGM first. In preparing for my pump I read “Pumping Insulin”. The book describes the painful process of establishing the various rates for finger prickers. Each chapter also contains a short paragraph which asserts how easy the same process is for CGMers.