Most of the pumps are really good while you are not eating , esp at night when you are doing nothing but sleeping.
The pump will keep you in a specified range adjusting insulin on the fly. If you go low it stops insulin if u go high it increases it.
If you ate a peanutbutter snack, you would have entered it in the pump so it would know how many carbs you have on board and adjust insulin accordingly.
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I’ve been on and off pumps since 1981. I have no strong feelings either way. Last time I switched back to MDI (for 13 years) I enjoyed the freedom of not being attached to something all the time. Which may be why my next pump was the Omnipod, which is basically non-existent as far as I’m concerned.
Pumps also give me the option of (a) stopping delivery quickly if need be, (b) having customized basal deliveries for certain times of day, and (c) extending a bolus over a period of time, helpful at summer BBQs and times where a meal is stretched out. Dealing with these situations is not impossible with MDI, the tactics are just different.
MDI is certainly cheaper, but where I live, pumps and supplies are covered by the provincial government, so luckily that is not a concern for me anymore.
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Now I know I’m even more confused…
Looked up pumps…
Went into RILEYLINKS then LOOPS…
Loops is what I’ve seen on Terry4’s posts, but it didn’t make sense to me at the time…
So…
When I first started 2 years ago, my CDE said I was “stacking” my bolus insulin because it was too close together and to not do that. Only take it before meals.that means if I under counted, you go high and you deal with the high or exercise to get it lower.
Any time the shots were too close—lecture. It’s stacking and stacking is bad. (To be honest, I’m really ashamed about how much insulin I take — are you supposed to take a little or a lot to stay at your numbers?)
So, I thought the pump would do the same 3-4 shots, too? But, that doesn’t seem to be true for what I’m reading.
So—why is it bad to do multiple shots, but it’s OK for the pump to essentially do the same thing?
A pump tracks all of your insulin and timing.
If you get it set up right, and it takes a few weeks to get things going.
So when I am high, say I hit 190 I can hit the bolus button and it will show me how much insulin it thinks I should use as a correction. If it says 0 then I know I have enough working to counter it and it will come down on its own.
If I ignore it completely, my pump will give me the additional bolus a little later on anyway.
Because my pump tracks bolus and basal all the time, it makes it easier and I don’t need to calculate insulin on board.
Technically insulin still stacks but it’s managed so it works out.
You could and should be doing this calculation if you are on MDI so you don’t crash from over correcting
I was taking 8 injections a day when on MDI in order to stay in range.
You are better off using as much insulin as you need than to allow yourself to go high.
I agree too much insulin can be bad for you, and you can change that with diet and more exercise. But if you need it, you should take it in an attempt to stay in range as much as you can.
I was using nearly 60 units a day total insulin. That was going up every year a tiny bit. One day I hit 75. So I changed my diet and I learned to time exercise better and I’m down in the 40s
That’s where I have been most of my life. I really don’t know what is a normal insulin daily dose.
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Stacking insulin is taking repeated inulin doses without consideration of the cumulative glucose lowering effect of those doses. If one considers the inulin on board number, the time since the last meal, and uses the extensive experience gained from living years with insulin dependent diabetes, it is not stacking.
Stacking is vague pejorative used by many. It is not useful in today’s insulin dosing environment - especially automated insulin dosing systems. I don’t recommend that anyone take repeated insulin doses willy-nilly without considering the IOB or the important clinical context that includes the myriad factors that affect glucose levels.
The term stacking, however, is a poor way to characterize insulin dosing behavior. It is often used by ill-informed medical professionals; it may apply to people who lack the knowledge of effective insulin dosing. It does not apply to everyone.
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There is nothing wrong with doing multiple shots as long as you know what you are doing. I do up to 8 shots a day on a regular basis and stack my insulin whenever there is an unplanned for event, such as a grandchild handing me a cookie after dinner. I take insulin to cover for the carb count in the cookie even if I had just properly pre-bolused for a meal a 1/2 hour earlier.
To do this consistenly right, however, takes a CGM. It can be done with fingersticks, however, not as well and results in sore fingers due to the number of tests required.
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There is no such thing as a “normal” daily insulin dose since each person’s needs are unique to his or her own physiology. Your level of resistance to insulin may require you to have 40 or 50 units a day to stay in range while another person who is your same gender, age, height, and weight may require only 25. The number really is irrelevant as long a each individual figures out his or her own unique needs.
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I was on MDI for over 40 years, and I told my Endo that I would never go on a pump because I did not want to be hooked up to a machine with tubes running out of my clothes. As a woman, I also did not always wear a belt where I could attach a pump. Then, in 2009, my doctor’s nurse said, “What if you could have a pump without any tubes?” I switched from MDI to the OmniPod pump and have never looked back. The pump is so much easier in my opinion. I can check my blood with a glance at my watch which is connected to my Dexcom G6, press a few buttons on the controller, and take a bolus for meals in the middle of a restaurant or on an airplane with no one noticing. Others have listed other benefits, so I won’t repeat what they have said. However, being diabetic for 56 years now, I will add that placing a Pod on every three days results in much less tissue damage than taking multiple insulin injections each day. For those who are newly diagnosed, that may not matter, but as time progresses, tissue damage and scarring can and does make a huge difference in treatment options. I love the OmniPod, but you have to be comfortable in whatever you choose to use.
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I have absolutely no tissue damage after 63 yrs of multiple injections. I am beginning to think that I have just been very fortunate.
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My thought here is very simple, whatever works for you and your situation is best for you. I know many who use MDI and are very happy with their treatment plan. I also know many using a pump and are also very happy with their plan. It really is whatever works for each person.
I do get a little bent when pumpers are all in and think everyone needs one. Yes, I have been pumping since 1990 and didn’t want to but desperately wanted a child. It was the only way to get the overnight numbers in line. My five shots a day just couldn’t handle the overnight mess. That was back in the ultralente days.
My first 6 months were not fun. But I got it figured out and was able to get the blood sugars in range for two beautiful babies.
Didn’t realize after my first baby, how much I loved my pump and the freedom and flexibility I got from it.
I will say, it is work. There are possible mechanical problems, but I had those same kind of issues with injections. Each has its pros and cons.
My biggest thrill way back when was being able to sleep in and not have to get up to take an injection. Because back than timing was everything with injections. Yeah, things are different with better insulins, but I do love my Tandem IQ. I think so little about my diabetes now. My little pump just does it’s thing. I hear less alarms, I never have lows at night and in the 30+ years I have been pumping I have only had to get a loaner twice. They are pretty darn durable.
This is one of those things, where there is no right or wrong answer. Your conversation with your medical team, needs to be what are the reasons they think you should be pumping and you need to talk about what your deal breakers are for using one. Good luck and don’t let anyone talk you into something you don’t want. It’s your disease and your life.
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I switch back and forth. As many here have said, they have their respective advantages and disadvantages. I’ve found you can maintain just as good control with either method. When I pump, I use the Omnipod. Of all the pump solutions, it’s the most unobtrusive, I find. And the new Omnipod 5 is pretty slick with its ability to communicate with your dexcom cgm to automatically adjust your basal rates to your target glucose level. And you can control it directly from your Android smartphone (and Apple coming soon), making it extremely discreet. However, pumps can fail, and when they do, it’s always at the most inconvenient times. With the previous version of the Omnipod, I’d often use a hybrid solution to mitigate that - injecting basal and using the pump for bolus. And sometimes I’m just done with having stuff stuck to me, so I go back to MDI. In short, there is no “one right answer.” Use what works best for you and what you’re most comfortable with, and feel free to try different options as you see fit
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I’m amazed at how much I learn from everyone here — thank you thank you thank you — for sharing.
I like hearing the nuances from folks here versus the black and white approach from the medical folks.
My first CDE experience and Endo appointments were so bumpy—they were essentially Olympic moguls.
Lots to still learn 
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I really wouldn’t recommend looking into DIY Looping at this point in your journey, from what you’ve said. Don’t get me wrong, I think it’s an incredible option for those with pump experience and the desire/capability to learn the programming… But for someone who’s already expressing stress over the information overload and learning new tech, I think it sounds like it’d be way too much for you to take on right now.
I’ve been pumping for 5+ years, I just love learning about new technology, and recently started looking into DIY Looping myself. Even I was feeling overwhelmed with it! It’s a whole lot to take in. I’ve learned that it’s done in such a way that it eases you into things, and it’s not as daunting as it first appears, but it does require some prerequisite knowledge of pumping in general. You’re only just now learning about “insulin on board” and safe stacking, which are some of those pumping basic prerequisites.
If you do decide you’d like to try pumping for the advantages of insulin automation, or any of the other perks, I’d highly suggest you ease yourself in with one of the new commercial systems that keeps things simpler. DIY Looping Is always an option farther down the road if you want more control options than the commercial systems allow.
And given the exciting pump technology on the horizon, I see no reason to let yourself be talked into the current options if you don’t want them. I just adore my current pump (T:slim X2 w/ Control-IQ), but it’s 5 years old now and I’m due a new pump. This one is no longer under warranty, so if it breaks, I’m up a river. That’s why I’m considering DIY Looping with Omnipod Dash Pods (they’re not considered durable, so no 4 year commitment with most insurance plans) as a backup plan, because I have no intention of committing to a new pump at this time when I know there are better options coming soon. I’m personally holding out for Tandem’s next generation pump, the Mobi. Supposedly, it’s being filed with the FDA right now, and should be available next year. It’s basically going to be a T:slim X2 and Omnipod hybrid, with the best of both worlds; including Tandem’s superior Control-IQ algorithm, and Omnipod’s small size and optional tubeless delivery. In the next few years, we’re also going to see the first fully closed loop pump, where you don’t have to count carbs and bolus at all, and dual-hormone systems that can treat lows with glucagon.
If a medical professional is pushing you to consider pumping, I think it’s fully acceptable to tell them you’re not satisfied with the current options and waiting for new ones.
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Yes, you are! Count your blessings, Marilyn6, and keep on going in your wonderful care and treatment.
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After 45 years of MDI, I started using a CGM 4 months ago and a pump 3.
If you had asked me during my first two weeks of using either, I would have said that using a BGM and syringes were easier. I resisted both for a long time because the cost/benefit ratio was questionable, and I only reconsidered when my control started deteriorating, Then I read study reports about children getting better control with minimal supervision during the day.
I was determined to get my BG under better control and got really POd when it seemed to be harder to do with “better” equipment. I was aggravated and frustrated that “no fingersticks required” was a lie, that my body wasn’t cooperating with the equipment.
I had a lot of problems with finding good sites for CGM and pump. I had a big problem getting the pharmacy to coordinate with my doctor to get Medicare approval for the insulin. I had a learning curve that I would estimate was 10x what it took for me to use MDI with 2 insulins. I spent a LOT of time thinking about what I was doing and prepping for the unexpected. To top it off, I started with a pump in a Friday and started having problems during the weekend when I couldn’t reach my endo’s group for advice, just their voice mail.
But after 2 week of using a CGM my average glucose level had dropped from ~150 to ~130, my lows weren’t as low , my highs not as high. Similarly after 2 weeks of using a t:slim with Basal IQ, my average glucose had dropped enough for my lab A1C to be down from 6.7 to 5.9 - while my TDD dropped by more than half from Novolins to Novolog.
Now I’m using Control IQ software. I just got back from trip out of town. To prep for it, I had Tandem send me a backup pump - 1 hour. I got a second FRIO to keep my worst case scenario backup basal insulin (Lantus) cool and a larger case to hold twice my expected suppies for a week - another hour.
During the trip, despite changes in schedule, diet activity and stress, my time in range only dropped by 3%. On similar previous trips with MDI I carried about 1/2 cu ft less diabetes stuff, but my BG was all over the place and it took me days to get back to my normal. With the pump I was back to normal the day after I returned home.
With the startup problems and the practical learning curve behind me I would say that using a pump with a CGM is no easier than MDI with a CGM, but it’s not any harder, and the difference in results and stress are worth the initial extra effort and the slight awkwardness in having another small box with me nearly all the time.
Being able to have a high level of confidence that a meal bolus or an activity isn’t going to put me high or low out of control, being able to check my BG a half hour before bed and be confident where it will be all night is worth the awkwardness. Being able to head off a problem in seconds with a few clicks, anywhere, without attracting attention, without washing my hands, imo is the most obvious immediate benefit.
If I could go back in time, the only things I would change would be to start using the pump on a Monday AND have a cellphone number to reach a diabetes educator 24x7 that week. It was satisfying to solve the predictable-but-unanticipated-by-me problems without assistance. But the stress made it hard to control my BG, BP and temper.
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I’ve had really good control on MDI with a Dexcom.
I could get a pump but so far I’m not too interested. I already know if I did I’d want a Tandem because of the integration with the Dexcom.
While I feel the Dexcom has been extremely helpful I still don’t like wearing a device all the time. So I feel the pump is more a burden then the Dexcom from a physical point of view. (site change, tubes, extra supplies etc…)
Also it might be rare but I have some concern about pump site failures sending me into DKA randomly. With MDI I don’t think that specific issue is possible. (I don’t think an injected shot can “fail”)
If I did use a pump I was planning to take 50% of my basal via MDI and let the pump do the other 50% to help avoid DKA/Site failure even being possible.
Last thing is I don’t love trusting a device with my life. Thinking “what if the pump has a serious issue and gives me 10 units and I don’t know about it.”
I’m a professional programmer and very aware how even well tested code can have bugs or edge cases. I’m sure these pumps are very well tested but it’s still something on my mind.
All that said if I didn’t have such good control with MDI I would definitely get a pump because having good long term health is important to me.
One downside of MDI is when you take shots all the time for years and years you may one day double dose by accident. I’ve only done that once that I know of and it was OK only because right after I took the second duplicate shot I was thinking “did I take a shot already?” So 30 minutes later seeing what was happening with my blood sugar I started drinking juice to counter act the double insulin dose. I still got down to the high 40’s but everything was OK and I recovered quickly.
My “rule” is type into the Dexcom app my insulin the moment I take the shot. Once in a while I’m doing something or someone interrupts my routine and I don’t write it down till a couple minutes later. This one time I guess I forgot to write it down and double dosed.
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Use a digital pen that records each dose and date and time of dose for last 200 shots taken and that won’t happen
My doctor offered me one but I never tried it. I do have some questions.
With my non-digital MDI pen I put on a new needle each morning. I use the same needle 4-5 times before replacing it. Before each injection I let out 1 unit to clear out the needle (no one told me too, just seems cleaner to me).
If using a digital needler will it count that as me taking 1 unit every time I do that?
My digital pen primes 0.5 units before each injection as standard. More can be primed if wanted, but I have never primed more than 0.5 units. I leave the needle on the pen for at least 40 injections before changing it as long as I don’t inject through clothing and am careful. I only change the needle when it starts tugging on the skin when I pull the needle out. My pen doses in 0.1 Units with a minimum of 0.5 for the prime.
I use BD 31G 3/16" (5mm) needles
I forgot the digital pens can dose less then 1 unit, thats nice sometimes I would do a half unit.
I’m totally fine with doing a 0.5 prime, I only do 1 because thats the minimum my pens can do.
Seems like I need to spend a little time reviewing that option, I’m satisfied with the pens but not having to type in my injections would be an improvement.