My doctors have been pushing for the pump since I was diagnosed in december 2010 at 18 years old. I’m not sure if it’s the best way to go or not, my mother is adamant on not wanting it because I’ll be to dependent on it. Could anyone tell me the pros and cons to having a pump and weather shots were a more convenient way to do it?
Hi Syd,
When it comes to all things diabetic, there isn’t really a “best” way to do anything. The only best way to do it is whatever works best for you.
Having said that, there are a number of advantages to the pump that might help you manage better in the long run. In general, it is easier to create basal profiles that work with your daily routine when on a pump, and sometimes this leads to tighter control. Taking insulin boluses with food is also easier, as well as correcting for highs. Pumps aren’t all sunshine and rainbows, however, because there are drawbacks. Pumping is more expensive (depending on your insurance situation). It also carries a somewhat higher risk of DKA if you have a problem since you don’t use any long acting insulin while on a pump. Like everything in life, it’s a give and take.
As to the comment about becoming too dependent on the pump, I think that’s a bit ridiculous (sorry mom!). You’re already dependent on insulin, syringes or pens, test strips, and other diabetes stuff. The pump would simply replace some of that stuff with other things that you needed on a daily basis.
Overall, I’m glad I switched to a pump. Keep in mind that it’s not a life changing event. If you try out a pump and it doesn’t work for you, you can always go back to MDI without any trouble. Many pumpers (myself included) will take a short “pump vacation” and go on MDI for a couple of days at a time. This can be handy if you just need a break.
Brett
Let’s see, real quick:
PROs: Can be more discrete when taking insulin, can’t forget to take it with you (mostly), stabbing yourself every 3 days instead of 3+ times a day (not counting fingersticks or CGM), can adjust rates for periods of high exercise… fewer lows, can adjust rates for periods of low activity … fewer highs, not tied down to any particular schedule (stay up late, dinner at 11pm, sleep til 2pm is OK!), don’t need to do math in your head, pump keeps track of all activity - no forgetting if you took insulin or not, no long-acting insulin makes overnight hypos a rare occurence, FREEDOM, BETTER CONTROL!
CONs: Cost, needle size during insertion (though you get over that quickly), education/technical skills to use it properly, being tethered (get over that quickly too, except swimming/beach days are a pain), selecting infusion sites that are covered by clothing (as a woman in a warm climate it might be an issue?), finding a place on your body to keep the actual pump. dependence/abuse of freedom (yes, it exists… “I’ll eat that cookie and bolus for 10 carbs” because it’s just so easy), residual marks/infections on body from leaving infusion set on too long, snagging tubing on the kitchen cabinet handles (or maybe that’s just me), may be hard to protect/stabilize during intense contact sports
I resisted a pump for years, but then decided to try it when my first son was about to be born. I decided that I want to be in better control so I can be a good, healthy father to him for a long time. Despite some difficulties at times (mostly related to playing hockey and swimming), I wouldn’t dream of going back to MDI.
Good luck with whatever you decide!
I have a question on “overnight hypos are rare” we just switched over to the pump for my daughter (2 months ago) and we are still trying to figure out the night basal. First, if we give her a snack at night (like we did on the levemir) do we need to bolas her for that now. My thought is yes since the basal is suppose to be constant without highs and lows.
What we were doing was giving her a snack at 9 pm without a bolus so that would cause her to to up at night…to cover for that we increased her basal to 0.3 units per hour. Is this bad?
Sorry, I got off track from the original post : so far on the pump we have found life to be easier for us. I have a friend who is 18 and still on shots. He likes them but he also does not mind giving himself 5 or 6 shots a day.
Unless she just really wants a little snack before bed, you should be able to set up the basal to where she doesn’t need it at all. The reason for the snack before bed when she was on levemir was to avoid overnight lows. If she is still having lows overnight without the snack, you should lower her basal insulin overnight a bit. Once you have the basals dialed in correctly, you will just bolus for whatever she eats regardless of the time.
Setting the basal higher to cover for the snack is not the correct idea. You need to get the basal set correctly first (based on not eating anything), and then the bolus will cover any food.
Well put. I agree with all of what you said. I too resisted the pump for years and have never been sorry I gave in.
Another one for the pump. I have been a diabetic for 31 years but only pumping since January. I love my omnipod pump and find it is so much easier to control my everyday life. I dont have to find a discrete area to take the shots - I can just program my carbs and away I go. It is so freeing.
Whatever is best for YOU is what you need to remember. I thought that shots were not a big deal until I investigated the pumps and found how great they were.
I wish you luck in finding your best way.
I actually found my pump to be pretty much “sunshine and rainbows” (or maybe "sunshine daydream…"heh heh heh…).
A big plus for me that I don’t see in the literature is that the reports do a much better job than I do logging stuff. The assumption of health care professionals seems to be that if they tell you to log stuff, you will log stuff but I loathe writing stuff down and the pump does both a great job keeping track of it and putting it into useful reports that I can use to make adjustments. I find that the pump makes it easier to see “hmm, a little bit off…I’ll give it a nudge over yonder…” and things really fall into place without getting out of whack. The data stream also made it easier for me to see when things are off as I was checking and inputting stuff that would be logged by the pump and counting carbs more accurately than I was before. In the long run, to me, that made diabetes a lot less work which was a big “W” for the pump.
The pump is the best thing to happen to my diabetic life, hands down, for basically the reasons that everyone else has stated. The benefits have far outweighed the risks for me so far, and the pump has so to speak set me free from the rigor and annoyance that is having to take shots at the exact same time every day. It does your long-acting for you, when you need fast-acting, pop in what you ate and your blood sugar, press the button and forget it.
Shots are a pain in the ■■■ compared to the pump. It’s annoying to have to find a bathroom when I have to take a shot or not be able to eat because you didn’t realize your pen is almost empty or carry a whole bunch of stuff around.
Syd, your mom may not realize that either way you will be dependent on any type of insulin delivery system. Whether it is a pump or needle. Both have pros and cons. With the pump you have get access to smaller doses when need. It helps when you only need a unit or two. With MDI smaller doses were always a problem with me.
Every long-acting insulin has some sort of peak, even the “flattest” of insulins (Lantus, Levemir) and when they peak overnight, they can cause lows. Thus, what you have been doing was “feeding the insulin”. With only fast-acting insulin, there is no peak, so there’s no need for a snack to cover it. I’d suggest going without the snack to get basal rates in check before mixing in the element of extra carbs. Then, if your daughter wants to snack before bed, bolus for it. I’ve found, in my own experience, that I often wake up high after a bedtime snack, as if the bolus insulin stops working when I sleep and resumes when I wake up (weird, I know. YMMV). But there’s definitely no need to snack before bed unless the basal rates are wrong.
You have to do what is best for you. Your mom’s logic really doesn’t make any sense (not to me, anyway). You are insulin dependent which means that you’re dependent on exogenous insulin to survive. A pump is just one method of delivery, albeit a more precise one (IMO).
Here are some of my thoughts based on lots of experience:
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First, make sure you are comfortable with multiple daily injections (MDI) before going on the pump. I recommend this because the pump is a device and, like any device, it will fail from time to time. You need to have MDI relatively mastered (IMO) before transitioning to the pump. That way, when (not if!) your pump breaks, you have a back-up plan.
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The pumps delivery very small amounts of fast acting insulin throughout the day, and then you bolus for your meals. I like this because I can change my basal rates throughout the day based on my schedule and activity level. For me, this is WAY safer than MDI because I have fewer “scary” lows. I think many people find the pump “safer” in this regard. You’re less likely to have a bad low while driving, for example, which can be really dangerous.
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I like that with the pump, I can bolus more discretely. When I’m out eating with friends or coworkers, no one even notices that I’m bolusing usually. That is really nice.
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With a pump, you can correct much more accurately than you can with MDI. I’m fairly insulin sensitive, so correcting with MDI wasn’t possible unless I was over 180. With my pump, I can delivery really small correction doses, and this has helped my control tremendously.
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My pump has brought down my A1C considerably. I just wasn’t able to get good control on MDI.
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A pump is NOT permanent! Many of us pumpers will take pump vacations. I sometimes do this if I want to wear or do something that isn’t “pump friendly.” Also, if you don’t like the pump, you can switch back to MDI whenever you want. There are people who prefer MDI and that’s fine.
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A pump definitely gives you more freedom in terms of what you eat and when you eat. On MDI, I had to wake up at the same time every day. On the pump, I can sleep in.
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The pump really helps me with logging and keeping track of thinkgs. I use the Revel and I also use Minimed’s Carelink system. It keeps all my data in once place and ensures that I’m consistent about logging BGs, carbs, exercise, etc (something I’ve always been sort of bad about).
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One con of pumping is the cost. You have to consider the initial cost of the pump as well as the infusion supplies. Depending on your insurance, these are not insignificant.
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The pump requires “maintenance” in that you have to make sure to change that infusion site every 3 days and keep an eye out for infections and poor absorbtion.
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You have to really be committed to testing on a regular basis, logging all your data, and staying on top of your D if you use a pump. Things can go wrong quickly when pumping because you don’t have any basal insulin in your system. DKA can happen fast if your site fails.
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There is a significant learning curve with a pump. You have to be committed to taking classes, doing online tutorials, and spending time just playing with your pump.
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Setting basal rates can be frustrating; however, the pay off is good control once they are set properly.
I will say that I often resisted the idea of being “attached” to something all the time, but after awhile, my pump just started to feel like a part of my body. I feel absolutely naked without my “plastic pancreas.” In addition, I find that it keeps me much sharper with regard to my D and more on top of things. Concealing today’s pumps is pretty easy because they are all relatively small. I keep mine clipped inside the waistband of my pants or down my bra when wearing a dress. No one ever notices it’s there (at least, they have never said anything). I like tubed pumps because I like to be able to SEE the insulin going into me. It’s just reassuring. The tubing is not that bothersome.
Provided cost isn’t a barrier, I would HIGHLY recommend trying the pump. Again, if you don’t like it, you can always go back to MDI. But be committed to having a few months of bad BGs while you get everything fine tuned. Once you’re over that initial hump, though, I am pretty sure you will find it much better for your health.
Just curious, but can you say more about what your mom’s resistance is about?
+1 for the benefits of pump logging!!! I have tried so many logging methods over the years and have failed at all of them. The pump is the only method that has been a success for me. Because it’s always there and I have to use it anyway to give myself insulin or change my basal rate, it’s so much easier to log what I need to log. I use Carelink and really like it. I just wish they would make the logging capabilities within the pump more robust (i.e., to specify the type of exercise you’re doing or to log things retroactively).
My endo started pushing for me to get on the pump about 6 weeks after diagnosis.
I came home and cried. I didn’t want to be a cyborg! With a tube! And the omnipods are too big!
Within a week after getting it, I LOVED it. So much more freedom, so much more discreet. So much better for an unpredictable and active lifestyle. Fractional doses make a huge difference – I can bolus for 2 carbs, or 5, as well as meal-size amounts, and my basals are way more fine-tuned.
Admittedly, 18 was a long time ago for me, and I’m married. I would definitely have been extra squicked out by the thought of dating new people, and um, intimacy stuff. But anyone you get involved with is going to have to know about your D anyway, and disconnecting from the pump is easier than taking a bra off.
I started pumping a few weeks after my Type 1 diagnosis 3 years ago. I was very worried about being attached to something that would constantly deliver insulin, even when I was sleeping. It took a bit of time to get used to it, but I cannot imagine my diabetes life without it.
A huge advantage if you are still in the honeymoon phase is that the pump allows for much smaller doses and boluses. You can bolus in 1/10ths of a unit, so you can bolus for a small snack, and bolus more accurately for a meal. You can accurately do correnction boluses when you are just a bit above you target with much less worry about going too low. You can adjust your basal rates to match your activiy levels, so you don’t have to eat more simply because you decided to go for a bike ride, etc. You also don’t have to remember to bring anything with you or worry about storage in hot weather.
I am a mom of 3 kids in your age range. You know we moms tend to worry about a lot of things because we want the best for our kids. That being said, unless your mom has Type 1 or has very closely managed someone’s Type 1 care with and without a pump, she may not have a realistic view of the pros and cons of pumping. As people with type 1 diabetes, we are all dependent on insulin anyway. That will not change until there is a cure. She may not understand that the pump is a tool that can help us be more flexible in planning our days and managing our care.
Best of luck with your decision.
Hi Syd: I started pumping 13 years ago, 3 years after I was diagnosed. I would never go back to MDI. For me, the pump was a life-changer for the better–it offers better control, fewer nighttime hypos, easier to eat. Also, it’s the best technology out there for insulin delivery–if possible, we should have the best for ourselves. Most people have a psychological resistance to pumping–I certainly did not want a machine strapped to my body 24/7. For most people, that resistance evaporates in a week or less. It does take work initially to get your basals set correctly, etc. (John Walsh’s Pumping Insulin is my go-to resource), but once you are through the experimentation phase it makes life so much better. Also, it’s great for dealing with dawn phenomenon and PMS insulin resistance.
What I can assure you is that pumping does not guarantee any improvement in glucose control. You often find stories where people had really bad control with MDI and then with the pump this was all solved. The quick conclusion: it must be the pump right? In reality it is more that the potential of MDI was not explored the way it is supposed to. Just a small fraction of pumpers really need to have the pump to overcome something like the dawn phenomen. Often the type of insulin used and the correct pattern of application makes a huge difference. So if the potential of MDI is explored thoroughly and the mechanics of D are well known the level of control between pumping and injecting should be comparable. Quite possibly some advantages in favour of pumping will remain: the convenience in handling, the automated logging, the adjustability to different levels of physical activity or work shifts. On the other hand it can have a severe impact on self image to be attached to a device 24 hours. Site infections, scar tissue around sites and recurring absorbtion problems are very real problems to deal with as a pumper. It is a very personal choice to balance the pros and cons. I just needed to wear a pump site for three days to know that pumping is not my cup of tea. This is why I have developed the Glucosurfer project to integrate many of the advantages of pumping into my smartphone (bolus wizard, IOB calculation, documentation). This made MDI much easier for me. At the end it really is the attitude and the right application of tools that makes one type of management superior to the other. If the pump still seems attractive you really should try to wear a dummy pump that is pumping saline. Most pump companies will offer these trial runs.
like it or not, you’ll be “dependent” on whichever form of insulin delivery you choose. The pump is a bit easier for tight control, in my opinion, but you can do the same on MDI. The key to being successful with the pump or MDI is carb counting. Get that down and you will be able to dose your insulin better for your needs.
Pump: It’s always attached to you. People will ask why you have a pager in this day and age. Sometimes the tubing can get snagged on things, or rip out, or bleed alot when you take it out. I’ve experienced all of these things and none of it was so bad at all. You can fine tune basal rates to fit your activity and even give a “combo” bolus… where you take a portion right away and the rest is released more slowly, like if you eat a high fat meal. Another con for the pump is cost-- depending on if you have insurance and what they pay for, the out of pocket expenses can be quite hefty!
Shots: having to inject any time you need to eat… which can be quite often. Can’t fine tune your basal insulin, which would sometimes give me terrible lows, which I had to treat, which meant eating more carbs/calories when I was trying to lose weight. But you are not attached to anything, and other than some marks on your tummy and tips of your fingers, there’s nothing on you that marks that you have diabetes.
When you have a pump, it’s still important that you carry around stuff for shots in the event that your pump breaks. Right now, I’ve gone back to MDI because it’s taken Animas/insurance company FOREVER to send me more infusion sets. Going back on shots has really made me think even more how it was such a good choice to finally get a pump.
Hey Syd,
If you are not ready to pump then do not do it. Doctors have always pressured me to get on the pump also but its not a concept I am ready for. I have heard about the pro’s and cons of having the pump and with my lifestyle I just decided its not for me. I am not a forgetfull person and taking my shots is not that big of a deal. I take them in front of people all the time and no one cares. I like to wear what I want to wear without having to think about where to put my pump, I mean its hard enough trying to pick out clothes with out that to worry about. I also feel like your mother,I feel very confident on controlling it without depending on a machine. Not to mention the possibility of the pump not working without me knowing and I get sick as a result, no thanks. If the only overall pro of a pump is that its easier thats not a good enough reason for ME to plug in…
Of course these are only reasons why I do not to pump. Do it if and when you are ready 
i was 19 when i got diagnosed. ive been on shots ever since. thought about the pump but the expense is what was really putting me at a stand still. this is year 5 ive had diabetes and im perfectly fine with shots. its all i know. you have to be very diligent with it. its sometimes a hassle if you dont want to carry your purse around because you need your needles. i got on the pens recently and highly recommend it! its much easier than the vials. my A1c was a 6.2 on shots. it can be done just takes alot of self discipline. let me just say if i can do it anyone can do it. i tend to be lazy. good luck! feel free to message me if you want!
–brea