Many people using pumps enjoy tight control but they do have to work at it. Programming a pump to dose for dawn phenomena is definitely possible but don’t expect to discover a formula that will not require tweaking and adjustments over time. Diabetes remains a moving target that you need to pay attention to and change your settings when it changes.
This squares with my perception of glucose management. For the last four years I’ve used a do-it-yourself hybrid closed-loop system whose performance I’d have a hard time reproducing with injections. It makes dosing decisions while I sleep, something no multiple injections system can do.
The commercial hybrid systems like Tandem’s Control-IQ are reaching toward this performance and, as Laddie points out, their track record is mixed but they will get better over time.
I do believe, however, that the knowledge and dedication of the person with diabetes counts for a lot. There are people who follow Dr. Richard Bernstein’s low carb methods using injections alone who consistently over many years post A1c’s in upper 4% to lower 5% range.
Bernstein is not a fan of insulin pumps and does not use one. He’s in his mid-80s, and has lived with T1D for almost his entire life. He still sees patients in his clinic and currently posts diabetes videos to YouTube.
I’m not quite as dedicated as the most ardent Bernstein followers. My Loop system enables me to deal with the inevitable glucose variability inherent in diabetes. What I’m trying to say is that a person with diabetes can do very well using a pump or on multiple daily injections.
One of the things that I like about pump therapy is that it records your doses and you can always check the size and time of your insulin doses. You don’t have to depend on your memory or record keeping discipline when a question arises.