Pump Vs. MDI - What are your experiences?

Hi all,
I have been an insulin pump user for 23 years. In the last few years, I’ve had increasing issues with bad sites/infusion sets. Overall, I have very good control, but I get really frustrated when my control is blown when I have a number of bad sites in a row. It’s happening more and more to the point that each site feels like a gamble. I’ve tried various types of infusion sets and all possible sites.

I’m considering going back to multiple daily injections. The thought of taking a dose and it working consistently is very appealing. Also, traveling with far less supplies is really appealing. Going on trips with pump supplies is ridiculous! The thought of the awkwardness of injecting in work and social istuations is intimidating. What do you all do in these situations? I also worry my control may not be as tightly controlled on MDI, especially with the limitations of dosage size for boluses etc.

Can you share your experiences with pum vs. MDI? Has anyone transitioned from pump to MDI?

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First, I suggest you start using MDI while you are on a pump. That way it will give you a good idea of how you handle it.

I have a lot more problems with site/pod issues, but I love my patch pump so I am trying to make it work. But I do not have nearly as good of control on MDI shots. I started trying to get my pods to work and not fail by giving larger doses by shots and here are some of the things I found I do…

I have a tendency to round up dosing
I have a tendency to add an extra unit or two to cover grabbing a piece of chocolate
I have a tendency to not give a shot for smaller doses, I don’t mind shots, I just don’t
want to bother getting it out and giving a shot
I have a tendency to forget when I gave it, not paying attention to the time, and then
trying to guess it’s been about ??? I could solve that by a better pen, and if I stay
on any MDI, I will probably get one.
Not a biggy for me, but since my pod is always on my abdomen, I give shots on my
legs, I have a bunch of little bruises
I trend lower more because of those little extra doses

I’m sure there are a few more bad habits and I am trying to break myself of them. I actually am trying to use my pump for any doses under 5 units so I don’t mess with a shot as much. But I decided I suck at MDI. I still have the same A1c and I still am 96% TIR, so I really am doing okay. But I’m pretty sure I have been using more insulin. I also use Afrezza some, but I try to use that sparingly because my system seems to go a little nutty if I use it a lot.

That’s the thing, the pump keeps track of how much when. And I always have kept track of my daily use. If I track higher for a day, I don’t care, but if it is for a few days, it means weight gain for me so I always keep an eye on it.

So I suggest you first start giving yourself shots for dosing. It will give you a good idea of how you handle it and if you like it.


I suspect that most people have gone the other way — multiple injections to pump. As I did, about a year and a half ago.

I was giving myself 6-8 injections a day towards the end, especially after getting the Dexcom that alerted me to real-time glucose levels. I didn’t give a damn about people seeing me inject, at work, at a restaurant, at a movie — their worry wasn’t my problem.

I could go back if I had to, but I’m pretty happy with improved glycemic control especially at night. Always waking up to a normal glucose and hours long flat line is awesome!

I like being able to reduce basal rates for a few hours of exercise. Rather than my long acting insulin having to be considered always. I like being able to give extended boluses over two hours that the pump allows. I like Auto- adjust basal rates and auto bolus if I’m distracted and things are going haywire. I like not having to remember to bring my pen with me everywhere.

I’m not thrilled about the amount of stuff I need to pack for a trip. I don’t like all the trash I produce. I don’t like unexplained trending upwards that requires me to change and reload everything but that is fortunately uncommon.

I don’t like the cost of the pump and supplies, although fortunately it is mostly covered for me. I don’t like wasting insulin as I do with each set change.

On balance, I’m comfortable with these trade offs: I’ll be sticking with Tandem pump assisted by Dexcom.


I’ve been a T1D about 4 years now only MDI with a Dexcom. I have good control A1C 5.6 95% in range on dexcom.

At first when out at work I would go to the bathroom for shots. Then with close co-workers I would take my shot at the table. Now no matter where I am I take it right there. I’ve never had anyone really look at me or say anything. If someone at my table looks like they are wondering what I’m doing I’ll tell them but thats it. In general most people around me are aware by now so explanation is almost never required.

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Hello Devon,

I have never tried a pump, but thought I would answer some of your questions about MDI. Also I have been following the Mastering Diabetes plan for 6 yrs now.

I have been a type 1 for 64 yrs. I started out with glass syringes which had to be sterilized. I was taking 1 shot a day. Now I use pens and find them to be so easy. I give 4 to 6 shots a day. I inject right through my clothing so it takes less than a minute to get a pen and give a shot. I have never worried about whether someone sees me give an injection. I rarely ever forget to inject. Some of the newer pens keep track of injections.

My A1c is 4.5 but since I am a vegan I do take B12. My TIR averages 95. I usually stay between 60 and 120. Sometimes I will have a bad week for some unknown reason and find that keeping between these numbers is somewhat difficult, but usually it is quite easy. Sometimes my nights are interrupted and sometimes I flat line the entire night. My morning glucose level is usually around 80. My SD is around 22. I take a total of 17-19 units of insulin daily. 5’ tall 107 lbs.

I would try a pump, but I have never wanted to be attached to one and I feel MDI to be terribly easy especially with a CGM. Following the Mastering Diabetes way of eating simplifies everything too.

I am retired, so I can devote time to staying in excellent control.

Just want to add that all of my skin is in great shape. I rarely bruise and I have no compromised areas.


That’s about where I’ve been the past year with A1c in mid 5s and upper range 89% TIR. Any tips on how you keep things so level in MDI?

This is really exciting for me to read Marilyn! I started Mastering Diabetes 8 months ago, and it has changed my life. I’m now in mid 5 A1c range, which I never had the 25 years previous of being diabetic. It has also helped me reverse diabetic retinopathy. I’m so encouraged to read you’re able to keep such tight control on MDI! I know Robby and Cyrus both use MDI, so I figured it can be done, but so few people are on it anymore. What size pen needles do you use? I’m pretty slender person also, but I wondered if I should get longer needles if I may be injecting through my clothes.


I think the Mastering Diabetes guys are great. I took my training long enough ago that Robby and Cyrus trained me along with a small group of people. Maybe they still offer that, I don’t know. Previously I had been following the Bernstein 30 carbs daily way of eating. It was great for giving me a low Alc, but it was terrible for my body. I ate this way for 11 yrs, and it almost killed me. I ended up with heart stents, passing out and landing on my head several times and it gave me horrible migraines. Because it worked so well for Dr Bernstein I was very stubborn about changing my diet, but finally I really was forced to.

Now I am so much healthier. I am glad that your eyes are great once again! Lowering fat really does work! My level of insulin resistance is very low now. I am trying very hard not to get diabetic neuropathy. I have a little in my feet from a statin that I tried and I hate it. I still have full feeling in my feet, so I have been very fortunate.

I use 4mm pen needles. Those will go through thin jeans, and almost all of my other clothing. I think I remember Dr. Bernstein saying that he also injects through clothes.

I have to exercise after my oats groats and fruit in the morning unless I give myself 1 1/2 units more of insulin. I ride my exercise bike for 20 to 30 minutes. I tend to eat the same thing for lunch everyday although I do change my dinner. If my glucose level starts to rise I get on the bike again or walk. I check my CGM very frequently and adjust with exercise, insulin or glucose whenever needed.

Of course I would rather not have diabetes, but I manage quite well.


I eat a lot of the same things for breakfast/lunch so I know how much insulin to take. Also I take Fiasp for my fast acting so around 1 hour after taking a shot I will see where my blood sugar is. If its under 160 I’m probably OK if its still trending up I might take 1-3 more units.

Also I try to walk a mile a couple times a day. Or if after dinner I’m going high I might take a walk instead of only adding insulin.

Walks don’t replace insulin but sometimes I can make the insulin I’ve already taken work better if I add a well timed walk.


It really depends what specific equipment you are using now and how much you rely on its autmation, if any. MDI requires more work than a well- working pump augmented pump but not more than a oumom with bad infusion sites.

I used MDI with a BGM for 45 years and switched to pump and CMG last spring. I believe most if the gains I’ve made were from the CGM and my lifestyle adjustments, not the pump itself. I’ve temporarily switched back to MDI - and Novolins - when there have been delays getting my Novolog orders filled. My variability worsened but not by much.

I think that I could return to using MDI with a CGM, and maintain pretty good control but not with a MDI and a BGM.

Are you using a CGM and if so, you having trouble also with CGM sites? What kind if cannulas are you using currently?

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I have been using the Tslim X2 for about 6 to 7 years. I added the Dexcom about 3 years ago. I usd the autosoft 90 for most of that time. I lost some weight and now I’m quite lean and muscular, and I think I was hitting muscle more and more. I switched to the autosoft 30, but I still get a lot of bad sites. They are never bent when I remove them, they just don’t seem to absorb right. The Dexcom gives me no issues. I can use it anywhere on my body, and I get pretty accurate readings. It’s just the infusion sites. They are so frustrting. It’s not uncommon for me to get two to three bad sites in a week, then my averages are blown. I have talked twice with a nurse from Tandem, but I continue to have the same issues.

Walking does wonders for me too. Unfortunately I have a job where I spend a lot of time in the car so I don’t walk enough during the day. I need to be more intentional about scheduling 10 minute walking breaks and walking over lunch to help theinsulin work better.

It sounds like you’re doing really well! Thanks for being such a positive example. I’m really glad to hear you found the Mastering Diabetes method and that it helped you achieve much better overall health. It’s truly changed my life in all kinds of positive ways.

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Have you tried using TruSteel infusion sets? If you have no problems with the Dexcom, then whereever you use it should work with TruSteel

I was on MDI +4x for 45 years. I had a lot of problems when they started me with Autosoft. I have had very few issues since I switched. Unlike Autosoft, if a site doesn’t work, I can remove and reinsert a TruSteel cannula to an nearby site. I also have the option of leaving a canulla inserted until I know the next sites is good, and moving back rapidly.


I’ve never tried TruSteel. I may need to give it a shot.

It’s definitely worth trying. Best wishes and good luck. If you try it let us know how it works out.

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“Pump vacation” is—I wouldn’t say common—but it’s definitely a thing people post about fairly regularly. Pretty sure you’ll find quite a few of those if you use the site search.

Big advantages of a pump over MDI:

  1. Adjustable basal rate vs one long flat-wave shot (or two in some cases) that you can’t modify for circumstances later on. If DP is a problem for you, as it is for me, I don’t think there’s any other solution than a pump, unless you want to set an alarm to wake up for an injection at 4am.
  2. Record of what insulin you have on board, what you dosed and when. Avoids all those moments like “Wait, did I bolus ten minutes ago or was I just thinking of it before my puppy started trying to urinate on the carpet?” “Oh dang, was that my Novolog injector I just gave myself my Lantus dose with???” Keeps track of things like daily insulin use, all your correction factors, DIA etc etc.

As far as bolusing for meals goes it’s pretty much a wash unless using an injector in public is a big problem for you. I never had anyone notice me doing it in the ten years I was using 'em. OTOH I have had people ask me “Is that a pager???” when I’ve been bolusing from my pump, so there’s that.

The case against a pump is that it’s more complicated with way more failure points. You’re never going to get that “Non Delivery” alert with MDI. Your infusion set or pod isn’t going to get yanked off by your clothes or close contact with a door jamb, your AID system isn’t going to wake you up complaining about needing a CGM calibration, and there’s no sophisticated hardware involved unless you’re using some kind of memory-enabled injector (which also helps with #2 above). And scarring from infusion sites is a definite problem, the more so the longer you’re at it. Especially with a tubed pump the available real estate is far more limited than for injections.

I think it basically comes down to a tradeoff between flexibility and simplicity. Pumps are much better at matching your actual basal requirements, but there’s a cost in terms of stuff that can go wrong and bits and pieces you need to keep the whole system going.


If you transition, I would definitely make that change before travel so you have a period of time to see any problems pop up.

One thing about travel and MI might be that you are walking more, and so having large insulin dosages onboard getting absorbed at variable rates could be an issue. On the upside, you don’t have to worry about resetting your pump to deal with time changes.

I transitioned last August. I changed to MI for several weeks prior to travel. I was on MI for one week during travel to Vegas. I was walking ten miles per day on travel and not eating much because food was very expensive in Vegas. I bought a loaf of bread at a grocery store and made sandwiches in my hotel room. I lost some weight during travel, so it might have been nice to have my sensor, but I went ‘no medical devices’ for the whole week and had absolutely no problems. My sugars were excellent, despite all the behavior change (swimming in pools and walking around).

One caution is that if you travel overseas, your diet can change dramatically, so the pump might provide better meal control. You could always pack your pump in your carry on incase you need it. Then you have an option. I usually bring enough supplies overseas so that I could go MI or pump for the duration of travel. Once, during travel to China, I ate nothing but white rice during travel because I just wanted to know what I was consuming, and the language barrier made that tough.


Very good points and advice. Thank you. You’ve given me a lot to think about in regards to travel.

You bring up a lot of good points. Overnight basal is my primary concern. I anticipate more lows for sure, because I’m on control IQ, and it does adjust my basal at night. I do almost all the bolusing with my pump though, and do not rely on it to do that for me. There’s no perfect system. At this point, I’m looking for reliability with receiving insulin, but the tradeoffs may be more than it’s worth. I guess I’ll find out.