Is it really the pump?

I’ve noticed a recurring theme in discussions. When people relay info about pre-pump experiences, it seems that they learned about (or more about) I:C ratios, carb counting, ISF & other nuances of control as a mandatory part of pump training. This appears to be information they didn’t have, or didn’t apply, prior to pumping. Many times we hear how pumps improved A1c. I’ve been curious for a while if the pump gets the credit when improvement is really, or partly, a result of better education. If this is true, are MDI’ers not receiving the same level of intensive training on managing BG?

In my case, I had figured out my I:C ratio but never bothered with the ISF. I was always scared of lows and didn’t particularly push for tight control. Getting the pump made it mandatory for me to learn my ISF and fine-tune my I:C ratio. And the biggest benefit is the variable basal rates that I set on my pump - impossible to do with any long-acting insulin. Couple this with a CGM (Dexcom 7+ in my case) and I feel like someone who has regained sight after many years of blindness.

You need the better education because you have to tell the pump exactly what to do. With MDI, I could kinda “eyeball” it and do pretty well “Hmm, looks like about that much food so I need about this much insulin”. I’d been trained on carb counting but after a while, you can almost do it on instinct

But to use the pump, you MUST have the education to really do well. I guess I tend to combine education and machine when I say “went on the pump”

I think it is the intensive training. I am a mentor now to a friend who just recently started pumping. In 14 years of being on MDI she NEVER counted 1 carb and just did a sliding scale. I’m not sure if it is everywhere, however, I do think the intensive training may be due credit for the improved A1C.

I’m not disputing that pumps have distinct advantages, especially for DP & for increased activity. Just find it interesting how many people have stated that they didn’t know ratios or other factors before pumping that they should know using MDI. They also didn’t test as frequently on MDIs.

The first time I noticed this was with a friend who’s had diabetes for 33 years since he was three years old. He’s my only Type 1 friend. Though he went to his endo regularly, he never got updated info. He was literarily shooting in the dark for three decades & ended up in the ER numerous times for lows. He guesstimated doses & never counted carbs. It wasn’t until he got a pump that he was taught anything. I find it really disturbing.

I also find it really disturbing. I would ask her what her A1C was and she couldn’t even tell me. I wish there was a way that those on MDI could receive the same training that the pumpers receive. I believe it would save lives.

The more I think about this… it is not the pump.

It is the person, the pumper

The pump, carb counting, etc are just tools. And tools don’t do anything by themselves without being used properly.

When I was first diagnosed, my endo basically taught me how to take care of my diabetes like I was pumping as that’s the final result that we were going to end at- me getting a pump. He figured that it would be pointless for me to learn one way, then in four months learn a completely different way. He also refused to allow me to even consider pumping without having read John Walsh’s book.

You’re right. However, the person must also have the tools needed to succeed. The knowledge could also be seen as a “tool”.

I will amit I really didn’t do a good job of carb counting prior to my working on getting the pump. I had a set bolis rate and would inject it sometime either before or after I ate. I’d also have a shot of Lantus at night before bed. Now that I’ve gone Ping I have gone back to my ways of counting carbs and figuring out what my insulin needs are from my meal. I can already see my BG’s are getting better and leveling out,

yes, knowledge is definitely a tool. A tool is anything that allows us to do a task with less effort and/or with more accuracy. If the results are not worth the effort, then a different tool should be found that will work better for you

Every so I read about pwd’s in Britain taking a required DAFNE course. Good idea, because everybody gets educated on counting carbs. I can’t imagine the roller coaster and poor A1C I would have if were not carb counting and did not know my IC or ISF ratios. Ironically a lot of people who get control with their pumps would be able to go back to MDI with fair results because of what they finally learn. I’m going on 4.5 years as T1 and recently figured still more things about the Lantus I take and how it works (or fails to work) in my body.

i think it’s 75% education and 25% the ability to control the insulin with greater precision… I know I had MUCH better results on MDI after I had been pumping for several years… because I was approaching MDI with a pumping mindset, rather than the “how can I eliminate any excess shots” mentality that many on MDI seem to have. I also wasn’t afraid to make the insulin work for me, rather than working around the insulin.

That said, there is a HUGE subset of the T1 community that sees MDI as “too much work” nevermind pumping… so doing better on a pump, vs shots, truly does have a lot to do with simply putting in more effort. There are also plenty of people on pumps with 10+ A1C’s, so clearly pumping alone isn’t the secret to good control.

Also, it’s not THAT impossible to control DP with MDI… you just can’t do it with only one basal insulin. I did reasonably well adding NPH in at night to counteract the 4am rise.

I agree… a short written test that demonstrates an understanding of the fundamentals of pumping should be essential for everyone before they start :slight_smile:

This appears to be information they didn’t have, or didn’t apply, prior to pumping.

That would be incorrect in my case. I understood all manner of insulin treatment prior to pumping, including carb counting, carb/insulin ratios, how to adjust them, how to calculate correction shots, how to calculate how much insulin I had on board, etc, and etc and etc. Despite being well educated and practiced with insulin, I was not able to obtain the A1C1’s I get with a pump. There are things a pump does that MDI will never do, for instance, variable basal rates that are programmed to increase and decrease throughout the day to match my basal trends, or being able to lower my basal rate a couple of hours before working out. Also, my pump will measure out insulin within a 10th of a unit, and that is accuracy that I can not do using pens or syringes - I can measure about a third of a unit by syringe at best. With the greater accuracy from a pump, I get better bgls, and less lows.

MDI’ers may or may not be receiving the same level of intensive training on managing their diabetes. I think the better one understands the complexities of insulin management, the better they will do with MDI or with pumping. I also think pumping can give better results over MDI.

As somone who has just begun pumping over the last year, I believe there is some absolute truth to the observation that pumpers are given more information to better fine-tune I:C ratios and even better understanding what their basal rate is. For me, it came down to having doctors who, while well intentioned, either did not know or did not want to go through the work of fine tuning with MDI. They just labeled me “brittle” and encouraged pump use. Now I am a total believer in what the tools of the pump can do, and how much easier it is to adjust for things such as minor basal rate changes. But I do wonder if I could have avoided some years of frustration and too high A1Cs if only I had doctors willing to take the time and work with the balance of all these things while I was on MDI.

Also, access to a CDE would have been helpful, and this was a requirement for getting the pump but not covered by insurance on MDI. But that’s a whole other discussion . . .

I think you are on to something Gerri:) I think doctors have a greater tendency to send patients to CDEs, RDs, etc. when they start pump therapy and as a result, the patients get a more thorough education on all these finer points of management. Docs do not have the time (education and f/u) that is required. I was on MDI since the beginning (about 30 years ago) but, it was my doctor who managed it…I do not even think there were support staff at that time. First time I saw a CDE was when I started the pump in the 1990’s…and that was because my doc at that time had no idea what to tell me! I learned CHO counting on my own and used it to calculate my MDI injections from about the early 1980’s on…it was what allowed me to toss my Exchange Booklet!:slight_smile: Not that I didn’t get looks when I told nurses…“I don’t follow an exchange diet or calorie level.” I think it is as important to MDI as pump patients and all should be referred and provided resources to manage CHO counting. I also think f/u at least yearly w/ a CDE should be available for all patients. I wonder how many patients are still taught the exchanges? if not CHO counting. There is no flexibility w/ exchanges and set doses of insulin.

Very good point Gerri! I also had some similar thoughts when I started my “pump training”. Mostly I thought “why aren’t these classes required for everyone diagnosed with diabetes?” I remember about five years ago when I was diagnosed with diabetes, my doctor’s office told me over the phone! I asked what I should do and she was like “just be careful what you eat”! She didn’t even ask me to set up another appointment until I insisted. Imagine how much easier my life would have been if I had been handed the “pumping tools” five years ago…Sometimes medical “professionals” have no idea how difficult it is to manage this disease.

There are people using exchanges & it’s still being taught. I was given info about exchanges when I was diagnosed in May 09 by the hospital dietician & the hospital diabetic educator. There was recently a discussion where a member said his ratio was 1:1. After questioning if he took 1 unit insulin for every 1 carb, he was using the exchange method. To him, 1 carb was 1 carb portion equals 15 carbs.

Like you, I learned carb counting on my own.