Is it crazy to consider returning to shots?

I've been on the pump for 3 years now and my a1cs through this time have still been going up. My best a1cs were right after I was first diagnosed in the first few years using novolog insulin pen / shots.

There could be many reasons why my a1cs were better then. My belief is that when I was on shots, I was much more stringent about what I ate and had less carbs in my diet. I think of carbs (particularly when it's difficult to count) as adding variability to the equation of getting my BG right. On the pump, I'm much more likely to snack or give less insulin knowing that I can make a correction later.

Do people out there have better a1cs on the pump or shots? I'm starting to think that I am just undisciplined and need to light a fire under my you know what so that I can get this better control on the pump that everyone else has...

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I have never been able to have the a1c's that I do now on shots. For me being on a pump has made a world of difference. My last 3 a1c's have been 5.5, 5.9 and 5.5, and I dont super low carb. But I think we've all discovered you have to do what works best for you. If you think you can have better control back on shots, give it a try.

sounds like you might be using the pump to cheat on your carb consumption. i only "cheat"
on occations like my birthday, anniversaries, ect. my A1c are awful (btw 7&8) but theyve always been awful. still i can correct more accurately and more quickly on the pump. and the pump gives me many more food options.

whatever works most comfortably for you is the bottom line. personally, i would never go bk unless my pump broke (which, by the way, has happened more than once)

I have been on MDI for 37 years and have only recently taken a much more active role in getting better control. I am pretty disciplined as far as carb counting goes and have cut back considerably. My last A1C was 6.1%.
My colleague at work has a paradigm medtronic pump and his A1C's are in the 8 range. He pretty much eats a lot of carbs and just boluses for them.
So not "everyone else" has great control on a pump.
I think you pretty much answered your own question as far as returning to shots. It's probably not the method of insulin delivery that is leading to higher A1C's it's the diet and lack of discipline.
I'd stick with the pump if you're comfortable with it and work at getting more disciplined using it. Baby steps...

Perfectly ok to return to MDI. But try something else before you dump the pump.
Think of the pump as strictly what you'd give yourself as a basal. Now think strictly. Do not think of it as something to press when someone at work brings in brownies with confectioner's sugar on top, or simply press for multiple snacks thru the day.
Try two days of eating a low carb diet persistently like you'd do on MDI. Press the pump for a low carb breakfast. Press it for a low carb (7g) snack. Figure out a low carb lunch & press it. If you need a snack, find a nice 5g veggie snack and press it. Do a low carb supper and press it. Get your average BG for the two days. Are you happy with the results? Are they good enough to still want MDI or can this same process be redone on the pump for another two days? Can you maintain persistence on the pump? Persistence in turning down heavy starches, etc. Do two days, get an average every two days.
Actually, maintaining persistence, you can do it either way!!! You can correct on MDI - it's just a tougher process. And correcting the correction is slower.

The A1c statistics are on the side of the pump. There are a lot of personality factors in there, such as persistence, that no one ever researches.
I maintain 5.7 on MDI. What would I do on a pump? I don't know if I could be as persistent.
Do the trial on the pump before dumping it.

I went back to MDI. I only used the pump for about 8-9 months and it was more trouble than it was worth. I do better on MDI and did not have all the bad site problems that I had with the pump.

I agree with the others here - you need to address the discipline side of things before ditching the pump (but ditching is fine, BTW). Both I and my 5 year old daughter tried the pump for a year, and we both ditched it - it wasn't worth the hassle.

According to my endo, A1Cs on the pump are no different than those on MDI. The companies that produce the pumps are generally the ones that pay for these studies to be done...

When you ditch the pump, you could try using a good bolus calculator such as managebgl.com, to calculate boluses, corrections and track IOB (Insulin on Board).

A couple of things come to mind. First, going back on MDI from a pump seems to be fairly common. People take "pump vacations" all the time for all kinds of different reasons.

Second, you are absolutely correct when you say that there are many reasons why A1Cs fluctuate. My first though was that, since you are now six years into your diagnosis and had an easier time mainining control in the beginning, maybe what you are experiencing now is a consequence of finally being completely out of that awkward Honeymoon stage. I stayed on MDI for many years. never quite understanding the the days of infintesimally small insulin doses and insane carb intake were probably well behind me. I had to get myself under control first, by any means necessary and was able to get back into the ballpark while still on MDI, before going on the pump. From there, the additional functionality of a pump allowed me to zero in on specfic issues reagrding insulin delivery to sharpen my control even more.

I would go with what others have said and stick with the pump at least until you can get some of those other factors under control.

My A1c’s on the pump aren’t lower than what I got on shots. However, my standard deviation on the pump is much lower–meaning I have fewer extreme highs and lows. That improves my quality of life and makes me feel safer because my lows are not as extreme.

Give shots a try again. Just don’t get rid of the pump in case you change your mind.

I went on a pump about 15 years ago and went off due to a systemic allergic reaction to the adhesive and the plastic. I find I do very well on injections I carry insulin in my glucometer case and always have everything with me. My latest A1C was 6.4. You need to due whatever works best for you to keep in control. Good Luck : )

My hbA isn#t great 7% at the mo. I use MDI, not entirely sure if I would like the pump. A lot of people say it is far better. Suppose you can#t really blame the pump if you are less disciplined. I think good control can be achieved with both, just takes quite a bit of work. Keep at it, you will get there.

No its not crazy.. You do what you think its best for you, Might find using MDI for a bit, to get you back into better pump habits... Seriously.. Like many have/will say.. You do what you gotta do...

Kerri's post yesterday (Oct 2) covered her opinions on the Pros and Cons of her recent pump break: http://www.sixuntilme.com/

It sounds to me, that if you are bolusing for the carbs, but your overall BG levels are going up, that the sensitivity is not calculated correctly, either for the wrong time of day or for what you are eating. Finding out what types of food and what they do to your BG is HUGE in pumping. Fatty foods, starchy carbs, eating tons of protein, lots of sugary treats, they are all going to react differently to your Bolus. Finding what happens to your BG levels to normal boluses and squarewaves and so on. The way the pump works, if you have your pump dialed in correctly and you counter act the differences of the foods you eat. You should have a great hold on your over all numbers and lower your A1C. I'm very technical and stuff like this really click in my head, but figureing out food to carb ratios should also be helped by your medical staff. Hope some or any of this helps ^^

This totally resonates with me. I find it is so easy to just hit a few buttons, suspend, up my basal, do corrections, etc. when I’m on the pump. With MDI, I think twice about getting that unhealthy snack that I know will cause me rollercoaster BG’s and I stay on track better. IMHO, good control comes down to discipline, and MDI is one tool that helps me to be more disciplined.

Best of luck to you!

Theo Pella and FHS have some really good points. The pump I feel gives you more control, you can bolus for 2 or 3 carbs so much easier, but you have to figure it out. And as a LADA the first years are way different than down the road.

I have dawn phenomenon so I skip eating or stay under 10 carbs in the am and I bolus up to 2:00 pm at 1 unit per 3 carbs, but by night I am at 1 unit per 7 carbs and sometimes that is too much! I like to drop 50 points at night and sometime in the morning I will spike anywhere from 30-100 points, usually right before 6 am. Prebolusing is also a critical management tool for me because I eat what carbs I want to.

Where else can I give myself the control of a constant different ratio of basal rates? Plus with a CGM, which is the most wonderful thing, where I can easily give 1 unit to correct a BG to be more perfect?

That being said everyone’s different on how they want to manage their diabetes, so whatever works for you is whats best> It could be you prefer shots or once you try it, you end up back on a pump because you liked it better.

But it seems like you might need to tweak your settings some and maybe pay more attention to what insulin amounts you need. If you go back to shots you will have to pay attention to that anyway!

Personally I have always done shots/pen. I don’t think I will be ready to even try a pump for years for that exact reason. Being on the pens, while infuriating at times, forces me to be more dilligent. I am adding a CGM soon, and am thinking that that combo might be a winner!

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I have been on a pump since February 2008. When I was on injections, I couldn’t get my a1c below 8.0 without having alot of lows. Now my a1cs have been between 6.5 and 7.0.

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I’ve had A1C as low as 4.8 on shots (and afrezza) with SDs at <20. I’ve never used a pump. I never intend to. In my opinion MDI technology has appreciably surpassed pump technology at this point. Many people disagree with me.

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I switched to a pump because my endocrinologist explained it could reduce low blood sugars. It has, although part of the credit goes to my learning to use the CGM alarms much more. The main reason I am still on the pump, though (after 18 months, when I had been on MDI for over 30 years) is because long-acting insulins don’t do the job for me. I could not predict where my BGL would be at 6 am. My typical A1C is 5.6, so I worked around the unpredictability, but the pump will give me a slow measured flow all night (except when a site goes bad). If they come out with better long-acting insulin, I’d be more tempted to go with MDI (or if insurance didn’t cover the pump or supplies).