Pumping vs MDI - A Case for Both

I am flip flopping on Pumping or using MDI to manage my diabetes. I can argue for both.

Pump: Mentally better, once it is set right.

MDI: Mentally easier get it going.

I explain it on my blog Pumping vs MDI- A Case for Both

What do you all think? Why do you pump or use Multiple Injections?

It’s a personal decision. For us pumping offers more flexibility because we aren’t locked into a 24 hour dose of a long acting insulin. If DD is running higher or lower than normal, we can adjust her rates on the fly. Pumps are also very helpful for doing extended boluses for high fat/high protein foods. Also a great calculator :slight_smile:

MDI, because theres no way I can afford $2500 for a pump

It seems like you are suggesting that the big issue w/ the pump is that it’s more work but I found the pump to be a lot less work. I may not be the best example as my MDI regimen was not remotely scientific, very much seat of my pants and also used N/R (this until April 2008…but I was stubborn…) including IV R shots to make it work faster. I wish I had saved the “logs” I did to get the pump b/c the scribbling was a total cluster$%@# but, whatever, it worked. To me, the pump made sense almost immediately. It is certainly not “easy” but to me, once it’s set, it’s pretty easy to tell when stuff is off. If a ratio changes, which seems to happen maybe every 6 months or so, it’s not as pronounced as a bad site or whatever and seems to be much less work to fix but I’m not 100% sure if 'Log/ Lantus regimens might be easier to use? To me it was like night and day how much easier it is to maintain relatively decent numbers most of the time enough to get an A1C that makes me happy. Even when it’s off, I don’t think that it’s as much work.

On MDI because developing scar tissue is a concern along with pump/set failures… I’ve never had an injection fail that resulted in soaring BG. The expense & waste factor of pump supplies (or the entirely disposable Omipod) are problematic. Life is easier for me by keeping things low tech. Simplify is my goal:) I don’t need a dozen basal settings, but being able to adjust basal is an advantage for some people.

The argument for pump - better once it is set right doesn’t hold for me. I’ve used a pump for 5 years, but I continually tweak it as seasons change, my fitness waxes and wanes, and my diet changes.

But I couldn’t live like I do on MDI. Endurance sports would be very difficult on MDI.

I’ve been pumping for 12 years; was on shots for 5 years before that. I started shots with N and R before the pens came out (in the US, at least), and really hated fumbling with the syringes and vials. The pens were an improvement, but I still didn’t like messing around with getting them ready. Plus I didn’t like trying to calculate in my head the amounts for meals – pure laziness! I also hated the necessity of snacking on N.

I went on the pump before Lantus and Levemir came out, so I’m not making a fair comparison, but I can say that in the week and a half between getting out of the hospital after my coma, where they discharged me on shots of Lantus and Novolog, and when I saw my new endo and got back on the pump, I had 2 lows, whereas on the pump, they’re rare. I attribute that to the fact that the pump won’t let me stack insulin, and because it has more precise dosing than pens do, althougn I never had the 1/2 unit pens.

I really find the pump to be less work than the shots, because it calculates boluses for me, and it’s just a couple of button pushes, and I can bolus as often if I like if I’m grazing, without having to mess with shots. And I can skip meals or have small ones, no sweat. I’ve been losing weight, and find that I have to adjust the basals, but I don’t find it hard to do.

I’ve only had 2 site infections in 12 years, and they were minor, and went away on their own. I HAVE had sets fall out, and no delivery alarms, and kinked cannulas, and yes, that’s a pain, but while it was a frustration at the time it was happening, it really hasn’t bothered me much in the long term. I’ve also run out of insulin at inconvenient times, but with pens, I forgot them, too, so it’s a wash.

I’m due to go on Medicare in 2 years, and I’m terrified that I won’t pass their C-peptide limits, and I will lose my pump, and if that happens, I will be devastated.

But in the end, I think it’s really a personal choice – I know that some people have just hated the pump, and it’s better that they should go with what seems better to them. There are no standard answers!

For some, it can be personal choice. But personal choice is like what you do when you choose between wearing blue earrings and wearing green ones.
For a young and middle aged person, the pump does an infinitely better job as long as the person running it is intellectually competent. It keeps one’s blood glucose consistently in the target zone, a BG which would be going up and down on MDI. Staying consistent is certainly a way to prevent complications.
The problem is always scar tissue. It’s the biggie against the pump. Healing of scar tissue is a reason for multiple injections. More sites to use.
It’s seldom I find a person using a pump, however, who is not well controlled, well informed, and well able to heal from surgeries, dental extractions, flu, etc.! I argue for the pump. I cannot argue for MDI.

I’ve seen many people with pumps who don’t have good control. For anyone it’s a personal preference & pumps don’t “keep one’s BG in the target zone” any more or less than injections.

If I saw evidence that pumps lowered A1c’s and lowered standard deviation, I’d get one tomorrow if I could afford it. Pump training teacjhes people about careful carb counting & doses. MDI’ers rarely get near that level of education. Most people receive no help on dosing appropriately when using injections. No denying that variable basal settings are beneficial for exercise & other situations, but for me it’s not worth the problems that come with pumps.

I used MDI for 16 years. It was never very effective for me; I’ve always had horrible dawn phenomenon. When I hit puberty I discovered I have crazy needs during my menstrual cycle that made things even more unpredictable and difficult.

Since August 2008 I’ve been pumping, and I never want to go back to MDI. I personally need the ability to change my basal throughout the day and from day to day depending on what I’m doing/feeling, etc. This just can’t happen with MDI. In addition, I like the convenience of the pump remembering that my morning I:C ratio is 1:13 until 10am, then 1:10 the rest of the day, while my ISF is 1 unit:50 mg/dl midnight to 6am, 1 unit:70 mg/dl 6am-9am, and 1 unit:40 mg.dl 9am to midnight. Remembering all that and balancing the math with MDI is just something I DON’T want to go back to! I also like being able to use my glucose meter to give myself insulin - so if I am around people I don’t know well, no one has to know and ask questions or give weird looks or whatever.

I agree also. I only pumped for 8 months and my pump did me a favor when it decided to break. I just got the results back yesterday from my last A1c and it went up to 6.1 – I haven’t had an A1c in the 6s in over 3 years.

I guess I build up scar tissue easily because I had tons of site problems. Sometimes a site would actually last 48 hours and other times it would break down 4-5 hours before and my BS would shoot up. Even when I started pumping last summer, every set I put on the right side of my stomach failed so I quit even trying. I rotated between the left side of my stomach and both right & left love handles. I know I was not re-using areas because I had red dots everywhere I put a site in for a couple weeks. I started having problems on the left side of my stomach. When I went back to MDI and tried to use my stomach, I heard crunching when the needles went in and actually broke about 4 different needles trying. In 26 ½ years on MDI, I never had that happen before. I would wake up high in the middle of the night if I rolled over and slept on the site. I was literally seeing 200 every other day with the pump – that was not something that happened with MDI.

In the summer I had problems with Apidra breaking down and I had to change my cartridge every day and a half. In December I started having problems with Apidra going bad about 10 days into the vial. When insulin goes bad in a pump, your BS goes higher than bad insulin on MDI because on MDI you have at least one kind of working insulin.

The last week I was on the pump, my average BS was 119 with a standard deviation of 46. The first week back on MDI, my average BS was 109 with a standard deviation of 35. Pre-pump my average was in the 90s with the SD being upper 20s. I never came close to that on the pump because of all the problems. My Dexcom uses 12 readings per hour to come up with a SD number and unless I have a bad sensor, I look at that number instead of 18 readings a day with a meter.

The first time I mentioned basal testing to an endo while on MDI, he was surprised I kenw what it was let alone had done it.

I think that a pump gives you better data, in one place, for less work than MDI. I had an UltraSmart meter but still sucked at logging pretty much anything such as food/ exercise. I was able to run in the high 5s and 6s w/ that but went up into the 7s when I started working out a lot, not what I would consider “crap” but not where I wanted to be either. I was eating less food and taking less insulin and was happy to lose weight but knew I didn’t want my control to go to hell either.

W/ the pump I was back to 5.8 3 months after starting it and then stayed at 5.8 for two years. Not “4.5” but not “crap” either. I subsequently acquired a CGM which seems to have helped push me to 5.4 and more recently 5.2 and prompted my doctor to say “I don’t think there’s anything I can tell you” which is nice except, of course, for having paid her to say that? I think that the fine gradations of control with a pump are useful to make improvements as you run into the law of diminishing returns.

Re the “problems”, I hate to say it and make smoke and/or flames come out of my pump but I have had one instance where the pump did something strange, it was about 2 years ago and, given the lack of subsequent problems, must have been something to do w/ an infusion set (which crapped out mid-bolus at a restaurant after ordering a huge heap of breakfast…so I had to bolus about 10X, in .7U chunks before I got the whole load ‘on board’)? Other than that, no problems whatsoever. I am not sure since, as I mentioned, I am averse to logging but in retrospect, I think that a lot of the variability in insulin experiences I ran into with MDI was due to taking large shots. I had some decent results splitting 25-35U N injections into 7U chunks but only did that for a couple of weeks.

I’d like to know if ANY Type 1 diabetics have a 4.5 A1c! Early-stage Type 2’s who are low-glycators and work hard for meticulous control, maybe, but even there, I think it would be rare. A 4.5 is no piece of cake for ANYONE!

You only get out of a pump what you’re willing to put into it.

Depending on how complex your body’s insulin needs are, though, there really are some people who cannot get good control with shots. I have a basal rate which varies significantly throughout the day and there was just no way Lantus could provide proper coverage. I was never able to get an A1c below 7% on Lantus even when I was doing things like splitting my Lantus into two doses and waking up every morning at 3 AM to take a shot of Humalog to counteract the dawn phenomenon. I also find my insulin needs change considerably based on activity level, hormones, illness, my schedule, and so on. With Lantus there was also no way to keep up with those kinds of adjustments like I can with the pump.

With the pump I am able to stay below 7% but ONLY if I put in the consistent effort needed. If I slack off in the least, then forget it. I would disagree that the pump is easier, though. It’s more flexible, but it’s just as much work, and record-keeping with a pump is MUCH harder than with injections just because of the number of variables that can be adjusted. Plus, with a pump there are more variable to consider when trying to figure out highs which you don’t have while on shots.

One misconception lots of people have (even lots of pumpers) is that you can only use your stomach for infusion sets. In reality, you don’t have “more sites” with shots, because you can put an infusion set anywhere you can do a shot. Right now I have my infusion set in my left arm, and I could also use my legs, hips, butt, etc. if I wanted to.

I had equally good A1cs on MDI as I did on the pump, but for me it was the convenience (and laziness) factor – for example, I used to be embarrassed to shoot in public, and didn’t want to go to the restroom. And I didn’t want to go hunting for my pen at home when I wanted to eat. I just really like having my insulin WITH me all the time. And, having a CGM, I like being able to have an approximate idea where I am whenever I want to take a peek.

I don’t know what my standard deviation is, but I’m sure it’s much less on the pump than it was on MDI, because I used to go up into the 200’s regularly, and had lows, maybe once a week, and with the pump, I’m pretty consistently staying under 140, and almost never have lows, unless I misestimate carbs. And since I’m not eating much in the way of carbs, that’s not really a problem.

Now I have to convince my emotional self that I’m having such good numbers BECAUSE I’m being really good with my insulin, and not because the diabetes went away!

The nurse who did my pump training said I was the first person she’d ever heard say that I wanted to go on the pump for better control, rather than for more convenience.

I still have highs and lows regularly on the pump but the swing from high to low is not nearly as dramatic. The change in A1c has not bee huge (maybe 0.5% or so during times that I’m really putting in the effort), but the stability of my numbers is much better. This has also made me aware of tons of things that affect my blood sugars that I had no idea about on MDI because my numbers were too crazy, things like how huge of an impact activity level, monthly hormones, and even different daily schedules have.

I never realized, for example, that when I was substitute teaching I would go low when subbing in unfamiliar classes but not in familiar ones, and I’d go sky-high if the class happened to be stressful regardless of whether it was familiar or unfamiliar to me. So when I got the pump I was able to lower or raise my basal rates for the morning or afternoon or full day that I was subbing, which helped immensely! It also wasn’t until after getting the pump that I was able to pick out a specific pattern I follow each month as hormones change. Then all the little things like lowering basal rates overnight if I exercise in the evening, being able to start and finish exercise in range (more often, at least; haven’t quite figured this out yet), and so on.

Kelly, I think that you are right and that you are one of those people that can do better on MDI’s. I think that the A1c is telling you just that. You had far too many problems with the pump and the sets and sites. You have the Dex, and you don’t mind all of the shots that it takes to keep in good control. I feel the same way about Michael, I doubt that he will ever be a pumper, and that is ok with me. We just got through a rough time with Melissa, she seemed to be either high or low, never just right. Alarms at night, mostly lows and then lots of corrections. After a whole lot of tweaking basals and ratios, she is doing much better. But then this afternoon she went over 200, for no darned reason at all. Just when we were seeing lots of my favorite numbers, which is anything that starts with a 9, lol.