MDI or insulin pump -- which do you prefer?

My friend just called -- her doctor wants to put her on an insulin pump with a CGM. She's all for it because she's into gadgets and stuff, so being on an insulin pump, at least the idea of it, doesn't bother her too much. Now, it's just a question of whether or not her insurance will pay for one! She asked me why I never went on the pump, myself, and I drew a blank. It never occurred to me to ask for one because I always did so well with the injections. I'm so used to giving myself injections (my mother made certain I knew how even as a kid) I never thought about pumping. Now that I think of it, I'm curious: are there are advantages to pumping versus MDI? If you had to choose or if you had it to do over again, which would you choose: MDI or an insulin pump? I hear pumping is hard work and involves a lot of steps! Thanks in advance!

Pump gives finer control over bolusing AND basals than MDI could possibly provide. If you don't need it fine, but for those who need refined dosing its a godsend. Those who are very sensitive to insulin benefit from that feature alone.

You can always review your boluses--cant do that on MDI. ie if you thought you forgot to bolus, just look at the appropriate screen.

Varied basal rates are awesome for people who exercise or those with dawn phenomenon.

in public, it's a great way to take your bolus without anyone being the wiser (great for the shy diabetic).

i could go on and on but am busy at the moment.

Well, thank you! I guess I personally never needed any of that stuff myself, but can see how someone with poor control might need it. This is one topic I know nothing about and can't even have a proper discussion with my friend. I'm sure if she goes on the pump, she'll take classes and in time, she'll be the expert of the 2 of us! LOL

Not only does a pump allow for a highly customized basal profile, you can change that profile as often as needed. I make basal rate changes at least once per week. My basal needs are a moving target. I can also temporarily turn off/reduce/increase the basal rate when needed.

Here's a snapshot of my current basal profile. It will probably change in the next day or two.

Neither Levemir nor Lantus basal insulins, even split three times per day, can reproduce this profile.

If I were on MDI, I would probably take a minimum of five shots/day. It's inevitable that there will come a time when you forget whether you took your injection or not. Then you are faced with double dosing and going hypo or under-dosing and going hyper, both undesirable outcomes. I don't think anyone can keep track of each of 1825 shots per year (365 x 5).

If you have a pump you'll rarely leave your insulin behind and be faced with a meal without insulin.

Adding boluses when enjoying an extended browsing party is socially much easier with a pump than it is with MDI. This can be both good and bad.

The pump is not hard work per se; controlling blood glucose levels well day after day after day is hard work, whether using a pump or MDI.

The pump will take care of keeping track of IOB or insulin on board (previous doses that are still partially active). It will also do the pedestrian arithmetic of matching your carbs to the correct insulin dose. Even people with a good math facility can make simple math errors that lead to disastrous consequences.

The pump will help with computation of an accurate correction dose to bring down hyperglycemia while also keeping track of previous doses that are still active. In other words it will help prevent "stacking" insulin doses, a common error when correcting.

Good or bad control is not a function of the pump or MDI methods. It mostly relies on the work ethic, persistence, and memory of the diabetic. They are each just tools. They only render good results in the hands of a competent and knowledgable person with diabetes.

I also like that I don't have to "eat up to the insulin" I am still quite insulin sensitive (after 30+ years) and if all I need is 1.5 units for a meal, then that is all I get. I used to have to do the minimum accurate (and that's the key word) injection of 1 -2 units and then extra tests to be sure I wasn't gonna tank. Together with minimal and precise doses, the IOB function is wonderful.

Why doesn't your friend just join TuDiabetes and she can ask these questions for herself?

Yes! Good point. Especially since you characterize your friend as someone who is into tech. She should have no trouble joining in the online discussions.

Of course, right now the timing is a bit tricky. No one can actually join TuDiabetes now until April 20'th because of the migration to the new platform, Discourse. My understanding is that anyone who tries to register on/after April 6'th is supposed to get a response telling them they will get an email on April 20'th to remind them to register again after the move of the data for the migration has completed.

Still, it would be nice to hear from you friend on/after the 20'th.


My friend and I used to "cruise" the diabetes forums together on girls night out when I wasn't feeling like going out. The thing with her is, she's very busy. She has her family, the kids, the hubby, and the in-laws and she has a house full of dogs! (I know, that came out wrong!) And, she works from home and she home-schools the kids and takes them to soccer and art and computer classes basically, she's busy. She's into gadgets but for the most part, it's to stay connected to family and keep an eye on the kids. I have a lot more time for these things than she does, but I did tell her to signup -- that's when she said she "wasn't ready to be a diabetic yet." But I know she has questions, she's asking me some I can't answer, even after YEARS of being a diabetic, myself. I'm not up on all the latest stuff, like research and insulin and pumps and things; so I signed up for the both of us. Sooner or later she's going to need more support than I can offer; she'll be happy she has all you guys. Perhaps in time she'll join herself; I'm not going to push the issue. For now, it's just me. :-)

Wow! All I can say is "wow!" That's something! I never realized pumping can be so -- what's the word I'm looking for? Dizzying? Is that even a word? I always thought you took the same amount of basal and bolus as you would with MDI, at the same time but instead of giving yourself a shot, you just pushed a button on your pump. I never imagined the thing could do math! When I ate more processed carbs, I used to go by the sliding scale and never counted carbs. Basically, I kept to the standard 15 grams of carbs (dessert rather, not meals) and shot up depending on what my blood sugar was at the time. These days, I don't count carbs because I don't eat very much anymore. I wouldn't call myself a vegetarian, but thereabouts. So, no sense in counting the carbs in my cucumber salad! But the thing you said about stacking insulin and the pump keeping track of things for you, wow! Many years ago, as a kid, it was hard to keep track of my shots, as organized as I was. I wish I had something to remind me besides my dinky little Casio watch with the alarm on it! Thanks so much, I appreciate all the info! I'll pass it along to my friend, soon as she's ready to "listen!"

I can remember a time when I used to have to "chase my insulin" all day. I was taking a lot more bolus for the snacks I was eating and was always scared I'd crash. It's a lot easier now that I don't eat that kind of thing anymore, but I sure do miss Ding Dongs! (Don't tell anyone, I still sneak on once in a while. Once in a LONG while!) ;-)

It is not even close, pumping is the way to go. I was MDI for 28 years and one day I visited a HS group of type 1's. Of the 8 diabetics in the room I was the only one not on a pump. I left the room called the doctor and one week later ordered a pump.

I never looked back and never regretted that decision. I absolutely think my pump is tops. Like I said it is not even close...............rick

By the way I agree with IR, she needs to join TUDiaebtes. Discussing her issues without her is not as fun as with her here..............rick

Like I said in my comment to irrational John, she's very busy and she's just not ready to join. She just doesn't have that kind of luxury, going online in the middle of the day; and at night, she's dead tired. She uses her iPhone to stay connected with family and such. And when she does go online, it's for home-schooling stuff. If it bothers you that I ask, let me know. I only ask stuff she's asked me that I don't really have an answer to. Or, stuff she might want answers to later down the line. I can't guarantee she'll even register, it's not my place to tell her what to do. When she's ready, if she feels a need, she will. And I respect that.

Well there is just a couple things to look at. when you inject you prick yourself multiple times a day, and if you pump, it is once every 2-3 days. It is not hard, or complex, just mathematical, When you start, it is going to be a lot of testing to set up your basal, then at the same time, you will calculate and figure out your bolus. Now once you are done with that math class, the only math you have to remember is when you bolus. how much you take for what you are going to eat, or what you ate. When I first started pumping in 2000, minimed sent a nurse over to train me with water first, so I could get the feel. after about 1 month, you will have everything set up, and it is easy from there. Now the CGM (I wish I had one) I can't tell you about, because I know what and how it works, just can't get one. So it is only difficult when you start, then you will fall in Love with the pump and won't break up for anything (hahaha)

I'd be lost without my pump. started in 1996 and it was like a new lease on life. Prior to that I didn't count carbs. didn't even have a meter until 1992 and I started insulin in 1978. those were the BAD years.

And I recall not knowing anything about pumps. I had never seen one. I imagined they wre about the size of a paperback copy of Gone With the Wind!.. I couldn't figure out how I could accommodate the device in my work clothes (I was a ballet dancer). Then at my day job, I met a woman with what looked like 2 pagers or flip phones. I teased her about being so important that she had two pagers. She laughed and said it was her insulin pump. I asked (actually demanded) that she come into my office. She did a fingerstick, and then let me enter her bg and the carbs she was about to eat. I was sold. I downloaded the medical necessity form, dropped it off at my Endo's (he had been softly suggesting a pump but knew it had to be my decision). He faxed it in and I was pumping in a week. No saline trial, nothing. Got trained by a CDE and I haven't looked back.

If you are female, and concerned about dealing with the device with women's fashions, there are pump bands, pump camisoles all sorts of ways to accommodate a pump discretely.

I'm glad you're participating. Your friend will do it in her own time.

You can tell her that insulins pumps have a lot of support form many long-time users. Plus the pump will form the foundation of the so-called "artificial pancreas project," a research effort that will in the next several years hook up the pump, CGM, and an algorithm to ease the burden on living with diabetes. Early iterations of this project will require more manual interventions but they will likely safely take you through the night, a nice thing!

What I'm trying to say is that you can encourage your friend to consider getting on the pump because it will offer her some nice treatment options in the not too distant future.

Diabetes is busy too, and waits for no one. She will pay the price if she puts her treatment options on the back burner. oh well, that's what a lot of people do.