So I am thinking about other options/backups. What is the best MDI option off the pump? I am super squeamish with needles and have bad anxiety when changing my sites so keep that in mind. I also prefer inserters that you just push a button and it clicks for you. Thank you in advance. I need a pump vacation. Although I am thankful for it, I hate this stupid piece of crap attached to me 24/7 and it’d be nice to have a break once in a while.
I am on a pump break and life is fine. After three years on a t:slim I was having more and more trouble with failed sites. So frustrating. So I took everything I’d learned about insuin pump therapy and adapted it to MDI. I’m doing split basal doses and dual boluses as needed. So far, so good. My A1c is stable, before and after, at 6.1. One thing that is different from MDI of years ago is the new nano needles. They are 4mm and 32 guage and I can hardly tell when I’ve pierced the skin. Wishing you luck.
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Apparently Tresiba for basal and rapid-acting insulin combined with inhaled from what I’ve read. Both are probably expensive though. We don’t have either in Canada yet, so I tried a pump vacation last year with NovoRapid (Novolog) and Levemir and didn’t last more than a day. It couldn’t replace the ability to bolus discreetly everytime I want to eat (and I love to eat meals and snacks when I’m hungry and to eat out, have no interest in a regulated diabetic diet of only eating at certain times or a limited number of times in a day), and being stuck with a basal amount all day that you can’t adjust sucks far more than wearing a pump. I love being able to bolus under the table, or just push a button in my pocket to correct on the subway, when I’m in court for my job or anywhere else in public without anyone seeing. MDI can’t replace that. Good luck to you though if you try it!
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Also, for those who say their control is the same on MDI or pump, how do you mimic the ability to “superbolus”? I’ve achieved an a1c of 5 eating mostly what I want, by taking 1-2 hours of basal upfront with my boluses for many meals to prevent post-meal spikes. Not being able to do this would be a huge disadvantage to going off the pump and would mean worse control without significant diet change unless anyone can tell me different.
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Even when on a pump I never “super-bolused”. Basal was background and had nothing to do with food. When I needed to spread coverage I gave a dual wave or square bolus. I eat 100-150 grams of carbohydrate a day and my c-peptide tells me my pancreas is of no help whatsoever. Even exercise was never a challenge in terms of spikes or drops. Any of those were fleeting and didn’t require intervention to resolve. So, maybe I’m unusually stable that the technology didn’t give me a huge advantage. My numbers can still stray some but they did on a pump too. But at least I now know that the excursion is do to my choices where with occlusions and site issues - not so much. Pumps are great and I wouldn’t want to discourage anyone from giving the technology a try. But, it isn’t ALL THAT for everyone. And going back to MDI after a nice long stretch on a pump is a different experience than MDI right out of the gate.
It serves a different purpose than spreading coverage - I absolutely use square/dual wave boluses for that. What I’m talking about is for foods such as bagels or a Subway sandwich which are very fast-acting carbs and require a lot of insulin up front but not as much later on. If I just took my normal bolus using my carb ratio I would spike like crazy eating those foods. Though I agree, basal typically has nothing to do with food, the superbolus is a trick you can use where you suspend the basal for 1-2 hours and take the same amount the basal would have given you with your meal bolus. That way you have tons of insulin to work up front for a very fast-acting meal and then less later on so you don’t spike and don’t go low later. I was never able to have great control until I discovered this trick, and don’t see how it could be done on MDI.
Also, while the examples I gave are extreme, I find it useful for many meals, and it’s often the difference between going up to 9-10 mmol/L after a meal vs staying below 6 or 7.
I took four months off my pump last year. I used Tresiba basal insulin and only took one dose per day. For my meal-time insulin I used Apidra. Both Tresiba and Apidra come in pens with narrow guage needles as short as 4 mm. For most corrections I used Afrezza, the powder insulin taken by inhaling it. I sometimes added Apridra for corrections.
I found it to be a very good protocol overall for me. While it was an adequate replacement for the pump I was never able to get the right basal coverage for my prominent dawn phenomena needs.
If you want to go for the fewest injections, I think using Tresiba once per day and experimenting with Afrezza for meal-time and correction insulin. That could get you down to one injection per day. Good luck – let us know what you end up doing.
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Thank you!! And congrats on your awesome A1C lol.
Ok thank you. Yes I would love to just have one or two injections a day. I could handle that. I’ve never even heard of afrezza. That would be a dream. I did just look it up and the only thing that is a concern, is that I’m a singer in the musical theater industry. Has it messed with your breathing or throat at all?
I just had a breathing test performed after two years of using Afrezza daily. It showed some marginal effect but not enough to concern my doctor. He renewed my Afrezza prescription. You may be able to get a sample from your doctor so you can try it. Your trial would be the best indicator for you.
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