Pump vs. MDI

ok so here's the backstory,
I was diagnosed type 1 on June 20, 2011. I tried to get a pump right away because everyone just told me that's what you should do. I learned after meeting with an Animas rep. that my insurance didn't cover pumps until 6 months after diagnosis. Since then I've been using pens and I really like them. They aren't EXTREMELY expensive, and easy to use. However, my blood sugars have been nowhere close to good which is my fault. I find it really difficult to get the motivation to bolus every time I eat, especially when it's something small and I almost never remember my basil. I'm very ashamed that I don't try harder but every time I try to commit to staying focused I just forget about it a couple days later. I attribute some of this to that fact that I'm 20 and I'm just not ready to be responsible yet. Anyway, on Dec. 20th I became eligible for a pump. Because I'd been to the hospital after my diagnosis, I had met my $1,500 deductible for the year. If I got a pump between the 20th and New Years it would be covered in full and if I waited till 2012 I would have to pay $1,500 out of pocket. I got a pump pretty much just because it was free and now I'm not sure if I should use it.
I have the Animas Ping.
My concerns:
I work at an animal hospital and I'm worried about the tubing being caught by animal claws. I had a CGM and I used it for a week and never again because it was too much of a pain to do all the insertion and the calibrating. I will admit that I am just lazy. The idea of refilling and re applying the inset things makes me cringe. I like how easy the pens are, but then again I'm not really using them as intended. Maybe a pump will force me to get better control....

If there's anyone that has dealt with very poor motivation and has seen a change when switching from MDI's to a pump, I would love to hear. I'm also interested in the price differences for insulin and supplies. Any other advice would also be greatly appreciated.

Thank you,

I have to honestly say, and I'm not trying to be mean, but as you admit you are "lazy", the pump might not be the best bet for you at this time. Simply due to the fact being on the pump is not some magical fix, it really does require even more commitment to testing and staying on top of things than MDI does. Yes you can get really good control with it, BUT you have to be willing to put the work into it. I can understand you theory if you already met your deductible that it would be a good time to get one if interested, but my personal opinion, I think I'd set it aside for now, and work on developing good habits and getting my BG under a bit better control. Being on the pump really does require a LOT of commitment, you still have to bolus for what you eat, stop test your BG, input the information etc. And the fact that you do not have long acting insulin on board, you CAN go into DKA very rapidly if you are not keeping on top of it.

I think at some point you can and will get better control on a pump, but I really think you'd be better off first developing better habits, and getting your BG in better control and just realizing you CAN'T be lazy with this disease OR a pump and expect good control.

Good luck.

Condolences on joining the T1 club. Your poor motivation is completely understandable. It took me a long time to accept that
I have to do everything I can to keep bg as normal as possible. The long-term damage from high bg is no joke, so as angry as I am about the effort and money it takes to manage it, I make myself do it. As for your pump, you might want to leave it in the box for a while until you are ready.

One suggestion I would have is you may try to change your thinking on managing your diabetes. Why day to day management is important, what you are really managing for is 10, 20, 30 and 40 years from now and for all those goals and aspirations that you want to achieve in your life.

It makes me sad when I hear stories like yours of just not caring. It will make your like 10 years from now so much more difficult. Good luck in figuring it out .

PS. I would wait on the pump until your ready.

Emily, you must be proactive in your care. Nobody can help you but you. Just six months with D. A lot to learn still. You have to bolus every time, regardless if on a pump or pen. I can tell you being on a pump will require much more attention and fingersticks. And you will learn how to hide a pump and keep it out of the way at work. You're just 20, and if you don't take care of yourself you won't see 50, or grandchildren. Tough lesson. Now is the time to get moving..........

The pump means commitment to testing and making the effort to assess what is happing at all times. Leaving it to the pump to take care of you D is a BIG mistake and can create a real dangerous situation.

Mike S. is on the mark, pumping needs a lot understanding and commitment so you may not be ready. MDI if you commit to managing the D can be as affective as the pump if the commit is made and the learning is accepted as a part of taking care of yourself.

Successful T1D management means commitment and continuous learning, for life. The result is living to the max w/o letting the D take anything away for you, and you can be what ever you want.

Afte 42 years after being diagnosed in late teens I have been able to avoid the negative physical hazards of not successfully managing the damn T1D and had a pretty good life so far with many more years to go.

Keep the faith and take control, no one else can, thats part of living with this T1D thing, there is no magic to it.

I have a somewhat different perspective from what everyone else has posted, and I've been thinking about it for awhile before committing myself. So you can always assign me to the old weirdo class and get on with it! :-)

The issue that everyone addresses is the fact that you HAVE to pay attention when you have diabetes. It's cut and dried, and if you slip up, you pay the consequences. It seems to me that you probably haven't had so much of a problem because you are probably still in your honeymoon, when control is a LOT easier. So denial is not really hurting you so much right now. And I suspect that being "lazy" actually has something to do with denial -- it's a royal pain to have to pay so much attention to stuff you never had to think about in the past. And mind you, after 20 years, I'm STILL the QUEEN of De Nial and I almost died on account of it. The emotional part of diabetes is NOT to be underestimated!

But once Type 1 hits full-on, you have to be equally as responsible whether you use a pen or a pump. Neither one is an ideal solution, because management depends on YOU, not your tools. The issue is, whatever your emotional state, you HAVE to pay attention, and you CAN'T be lazy, or you will get quite sick very fast. And I don't think dying of diabetes should be part of your life plan! :-(

I was diagnosed with diabetes in the old vial and syringe days, and THAT was a hassle! Plus it was R and NPH, and I was still working at the time, and there was no way to time shots and meals well enough to prevent horrendous highs and lows. And the meter required a huge hanging drop of blood, which you had to time for 60 seconds, and then wipe off, insert in the meter, and time for another 60 seconds. Inconvenient, messy and embarrassing to say the least!

When pens came along, it was a relief, BUT I still had to remember to bring my stuff WITH me, and many were the times when I forgot. And sometimes I JUST DIDN'T WANNA!! It wasn't that I didn't know what I should be doing, but it was really hard to FORCE myself sometimes (still is).

When I got the pump, it was a relief. First advantage: it's attached to me all the time, so there is no such thing as forgetting to bring along my insulin, no matter how spontaneous I want to be. It's true that it takes a bit of time to remove old set, fill new reservoir, insert new set, prime and make sure it's all taped down. But that's just the same time I would have spent fiddling with vials and syringes, or pens. 6 of one, half dozen of the other. Getting the pump out of my pocket, and discreetly pushing buttons to bolus is SO much easier on my poor demented brain! Plus the boluses can be very small increments that are impossible on syringes or pens. It just somehow doesn't bother me nearly so much to whip out the pump than it did to scramble in my purse for the pen that I had probably forgotten to put there anyway.

Second advantage: you're not tied into giving basal shots at specific hours, and you can vary basals as needed. I remember being at a movie, and the time for my basal shot came and went, and I hadn't brought it along with me -- NOW what do I do? The pump eliminated a LOT of the pre-planning that used to drive me crazy. And being able to vary basals has eliminated my formerly rather pronounced dawn phenomenon.

Most everyone else has talked about the learning curve, and being in your honeymoon means things ARE going to change. Most people with Type 1 experience a lot of change anyway -- it never stops. I don't see much difference between dealing with change while on a pump from dealing with it on shots, except that I think the pump is much more flexible and responsive to your own individual needs. The proviso, however, is that you get good guidance, preferably from an endo or a CDE with lots of pump experience, or if necessary, from books, like Pumping Insulin by John Walsh or Think Like a Pancreas by Gary Scheiner.

About tubing -- I have 7 cats (used to have MORE!!), and the only issue I have ever had is letting my tubing hang out while I was asleep, and as you may know, cats LOVE long tubular things (maybe they think they're rat tails?) So I've had my tubing bitten through at night a couple of times. So now, I'm really careful to coil up and tuck my tubing into my waistband, and to clip my pump to the front of my PJs when I sleep. I'm a side sleeper, so it works for me, but other people handle the situation differently. During the daytime, my tubing is ALWAYS tucked in, and I have NEVER caught it on anything. And I'm going on 13 years with the pump. And I handle my cats a LOT! :-)

So the net result of what I'm saying is why not try the pump, as long as you have adequate guidance. You're going to be fussing with basals and boluses anyway, and you're going to have to learn how to count carbs and figure out insulin:carb ratios anyway, and insulin sensitivity factors, too, and it's really NOT different from the pen to the pump, except that the pump is more flexible. The pump WILL alarm you when your reservoir is going low, and it's hard to ignore that thing screaming at you, whereas the pen will not tell you it's low, and then you're out to eat, and guess what -- not enough insulin! You can also look up whether or when you gave your last bolus on the pump, so you don't bolus twice, or not bolus at all -- a VERY good feature for people like me, who could never remember 2 seconds after a shot whether I'd taken it or not.

I mean, if an airhead like ME can get a very distinct improvement, not so much in A1c, but in "compliance" by using a pump, why can't you?

If you're lazy, the pump is NOT a good idea. Being on a pump is a huge responsibility. There are site changes to worry about, properly filling up your reservoirs, etc. You have to really stay on top of your BGs because without that long-acting insulin, you can go into DKA fast if your pump should fail.

I do, however, think the pump can sometimes "force" people to take better control of things. For me, the technology made it much easier for me to log all my data and really examine those numbers and determine how to best administer insulin. This was not something I was doing consistently on MDI, partly because of laziness and partly because it was so difficult to log all my info appropriately without the assistance of some device. That said, I am very much on top of checking my BG, changing my sites, etc. Pens are definitely a little easier than a pump in terms of carrying stuff around, but once you get used to it (and get a large enough purse), toting around the necessary back-up pump supplies is not that big of a deal (at least, not for me).

In terms of cost - a pump is definitely more expensive. You won't need long-acting insulin, but you will need all the infusion sets, reservoirs, and other site-change supplies (tegaderm, skintac, etc).

You need to get to the bottom of where your lack of motivation is coming from. You may find that your motivation improves simply because you have a tool that, once you learn how to use it correctly, will give you more freedom and control over your diabetes. Or you may find that it's too much of a hassle.

The bottom line is that you may just need to try it and see how things go. You may find that being on a pump makes you feel better and thus improves your motivation. Or you may not. The good thing is that it's very easy to switch back to MDI if the pump simply isn't working for you.