I am a fairly new pump user (almost three years now) and I’ve heard people talk about taking a “pump vacation” here on TuDiabetes and other places on the web. After the past month of a bunch of occlusions, loading issues and other failed technology I’m ready to take a break and go back to some retro insulin pens.
I was hoping people here might help me gather some PROs and CONs (I’m genuinely looking for both) to taking a vacation. I don’t currently have a prescription for a long-acting insulin so doing this would require an endo visit as well as a strong case for why I want to do this.
Would love your advice. I feel like I know what I want to do but…
I can tell you that I’ve taken a permanent pump vacation. I pumped for 15 years and always wanted to take a pump vacation but was hesitant to because I didn’t believe I could achieve the same control on MDI. My recent experience with Tresiba has completely made me do a 180 on this. I take Tresiba one time a day when I wake up and that’s it. I had multiple profiles on my pump and was worried this would be difficult to replicate on Tresiba and my fasting blood sugars have been outstanding. I’ve tried Apidra, Humalog and now I’m trying Novolog for my meal and correction bolus’ and I’ve found injecting myself a couple times a day is really no big deal at all.
No more beeping, no more pump attached, no more occlusions (although I didn’t have a ton of them) no more worrying to carry my PDM (was on Omnipod) and just as good, if not better control so far. Also, no more of my wife yelling at me in the middle of the night when my pump was beeping because it was about to expire.
Mike - I went on an MDI trial starting almost two weeks ago. That is after 29 years on a pump continuously. I didn’t mind the pump, at all. I really had the settings dialed in and was enjoying good results, great time in range, low time hypo, and low BG variability. I also enjoyed a relatively low total daily dose of around 30 units/day.
My primary reason for trying MDI was the glowing reports others made about the basal insulin, Tresiba combined with my interest in gaining proficiency with MDI in case I ever was forced off of my pump. I’m up in the air whether I will go back to the pump or not. I don’t feel that pump therapy is a burden. I had been doing it for so long that habit just put me on auto-pilot. The biggest drawback of MDI for me is losing the automatic electronic recording of my dosing and insulin on board. I could mitigate that negative by a Timesulin dose pen accessory.
If you go back to MDI for a while, I strongly encourage you to try the Tresiba. I’ve only needed to take it once per day and I’ve learned that you don’t have to even take it the same time every day. It’s only requirement is that you space the 24-hour doses at least 8 hours apart. This is my first experience with pens and I find them very convenient, way better than the last MDI I did with NPH and Regular delivered with syringe and vials. The pen needle gauge is tiny and very short. I barely feel them and dosing at a restaurant table is discreet. Click, click, click, lift shirt, inject and done.
My pump basal had many settings and every meal I dosed with both an immediate and extended bolus. I’ve been able to replicate that dosing fairly well with MDI. Good luck.
considering that you can go back to a pump the very second your heart desires, I really can’t come up with any real legitimate cons regarding taking a pump vacation… I think technology has come so far in the past few years that you may never look back. I too would wholeheartedly recommend tresiba as the best place to start.
Would recommend you just ask for a free sample of a couple pens to start with… So that it can’t/won’t throw a big monkey wrench into your prescriptions, and with any luck might be able to avoid the endo visit if not otherwise necessary…
I think it depends so much on what you’re used to—and, of course, whatever gives you the control you want. I started (recently, compared to everyone else here) with vials and syringes, and it has become so second nature that it commands hardly any of my attention. Whatever works.
JMO, but every T1 should have a long-acting insulin RX “on file” - if your pump dies over a weekend, or even worse, over a holiday weekend, you could need to go back to MDI for a few days. It’s better to have easy access to long-acting insulin than to have to scramble to figure something out (since odds are good if you can’t get a new pump next day, reaching your doctor won’t be possible either)
Your desire to go back on MDI for a pump break has little to do with this… it’s really a safety concern. If you have seen your endo relatively recently, you can just ask them to call in an RX for you - I really can’t see why they wouldn’t. You can even say that you had an issue with your pump that made you nervous about NOT having any long-acting, and they probably won’t even question it. If it’s been a while since you’ve been and you don’t want to deal with going to see them, urgent care will also give you an RX as well. albeit at probably a higher co-pay than seeing your endo, but they will write it for you (probably for only for one month though).
Personally, as a pumper, I love having the flexibility to do whatever I want - if that’s MDI, great, if that’s POLI, also great, and if that’s 100% pumped insulin, again, also great - it’s all my choice. Not great is not having access to the insulin you need.
Short of that, check your local Craigslist… I’ve been able to find Lantus for FAR less than my RX co-pay would be (because it’s Tier 3 and my insurance only covers Levemir at Teir 1, which I am allergic to). I’ll only accept unopened boxes (vials or pens) from strangers though - it’s never a good idea to accept a single pen since they can’t be guaranteed sterile/unused.
I still have every pump I have every used. If my current one becomes unusable, I’d most likely just switch back to the (out of warranty) pump I used previously.
I also have a vial of Lantus in my fridge which is dying on me. I’ve never, ever used Lantus, but at some point one of the VA doctors filed a prescription for me because she felt I needed to have it on hand. Seems like a complete waste of a few hundred dollars to me, but no one bothered to ask me. It just showed up a few days after that appointment.
They are also always throwing glucagon at me. Yeah. As if. So I also “collect” expired glucagon kits.
Hey Mike,
I’m a little one sided here so take my view points with a grain of salt. I have been pumping for around 25 years (really should try and get a hard date on that). Went on it to try and get control before having children. It took about 2 years before we got the ok to try.mit helped us have 2 beautiful children. Now even with pregnancy times done with, I still would not give it up. I love the flexibility it gives me. In my 25 years I have had 4 different pumps.
First 3 from Minimed/Medtronic and Tandem a few years ago. Pretty good success rate I think with how well they work. In all those years I had one pump problem due to a drop on tile floor. Again pretty good succes rate. I also have probably only had a handful of bent/occlusion problems over the years. I’m not a huge technology person but they sure have been my friend.
I think pumps are like doctors, you need to find one that works well for you. Maybe whatever pump you have been using is not the right one for you. Most companies will let you try them out before you buy ( I think and hope).
I love the fact that I can go 12 hours without eating if I want to. I love being able to sleep in until 10 if able. I love that I can take under 18 units on work days and 22 units on off days. I love that I can program late start or early start days at work. The freedom of my pump is so great.
I remember when I first got my pump and did miss lunch one day ( which before I could never do) and than started having that weird feeling in my stomach. Hard to believe but it was hunger pains. Something I had never felt before because I always ate whether I was hungry or not because I had to eat because of whatever injection was on board.
So 25 years and no vacation, well actually it’s been 45 years with no vacation, but no pump vacation. Not sure if you need one but many PWD do very, very well with MDI. And there is probably many pros for going that way, but for me it’s been so long I couldn’t help you on that one.
Sorry so long winded but you can tell I love my pump. And yes the company change was a huge one for me as I was very happy with my first company. Hope you can find what works for you and hopefully no more occlusion alarms.
I had to do a “pump vacation”–slightly exaggerated term for what it was–a few weeks ago when I forgot I needed to swap in a new reservoir and set before heading to my granddaughter’s b’day several hours away. Medtronic “empty” beeper went off while on the drive–oops–and I didn’t have the wherewithal with me, so I had to get some novolog and syringes at a pharmacy when we arrived. I’ve only been on a pump for three years so I was rather surprised at how much I’d forgotten about the old way, particularly having the pump do my carb-bolus calculations for me. I had my pump along, so I just put the numbers in because: lazy. But there are a lot of little things like that. Having it keep track of IOB is also pretty huge, something you take for granted until you don’t have it.
I am curious about the Tresiba thing though. Really different from Lantus, huh? Definitely going to bring that up with my endo when I see her in April.
Everyone seems to interpret the idea to mean that if you stop using a pump for a week or two that you can never go back? I don’t get it. You can go back the second you decide to— there is absolutely nothing to lose. Why do people seem to project that it’s a lifelong decision to try something different? You’re not asking MDI to marry you… There seems to be an emotional connection between pumpers and their pump that I truly can’t understand.
My pharmaceutical coverage provides for one box of Lantus pens and one of Novologs per year explicitly as pump backup. But I’m not sure how they’d respond if I wanted to go off the pump and start getting those supplies regularly. I’m sure they’d want to cut off the pump supplies. I expect I’d be allowed to do it once but I’d definitely not be allowed to switch back for another year.
Which is why you should only use free samples for a trial, so there is no interference with or involvement of your pharmacy or insurance at all… Most doctors offices have a fridge overflowing with insulin samples, they’d be happy to offload a couple
Right now it’s not an issue for me as I hardly ever use the things–I only just noticed that my current box of novologs went past its use-by last September–but it’s good advice in general.
That’s not how I’ve been reading it. I took previous “Not for me” comments as simply saying they just don’t have that itch to switch back to MDI. Nada. ничего. Not at all.
I know I don’t. The only time the thought of trying a “Pump Vacation” ever enters my mind is when I read a post here or there about it. For me the pump is like getting dressed; it is just one of those things one does as a regular part of life.
Asking if I would want to go back to MDI is … for me … somewhat like asking why I don’t go shopping for groceries naked. The question itself just doesn’t make sense to me. It puzzles me so much that I’m not really sure how to respond.
Still, when I do read threads such as this I tend to reflect on reasons why I prefer the pump. DrBB’s points about the bolus calculator and Insulin On Board tracking are certainly part of it. But the biggest part has to be the logging. Without the pump the chances of me having any usable log of my insulin usage that paired up with my BG tests are extremely low. Maybe things have changed enough that I could now track it with an app on my iPad mini. But I’m not optimistic.
The other aspect of why a pump is the right thing for me is a pump’s unflagging diligence. I’ve had too many days lately when if I had to get up to take my regularly scheduled shot of whatever basal insulin, I would not have done it. But as it is when those times come my pump steps up and says, “No problem. I’ve got this.”
I think could turn my back in it quite easily when the technology has been surpassed. I think it’s a fair debate if we’re at that point yet or not-- though of course the answer would be very individualized. But the only way to know if it has been for an individual or not is for them to try it.
Seems to me that most pumpers are still clinging to their superiority because they were superior 25 years ago. The other technologies have come an awful long way since then— insulin pumps really haven’t. Imo.
But the real point is that there’s no harm in trying something else, it’s not a one-way street. Or, if one has no interest in other options then there’s no need for them to… Clearly the OP is interested in trying an MDI trial and was asking about the drawbacks. I submit that there aren’t any inherent, and if any are encountered, he can always go right back to the pump.
