Pumping vs MDI - A Case for Both

You guys are really paying that much for a pump? That sucks. My policy caps out-of-pocket hardware expenditures at $1,000. I know I have a great policy, but I'm surprised the device isn't more accessible, especially because of how many type 2s I've notice wearing them. Is CGM the same? Still terribly inaccessible to people? That's bad.

My A1C was 4.6 on MDI mostly because of lows, I'm on a pump for the moderatio

I used a pump from 1992 - 1999. I got off of it because I could not afford the supplies, but what a relief to be off of it! My stomach is still covered in tiny scarred potmarks all these years later.

For me, the psychological impact of having the pump on my body 24/7 was terrible. Not to mention how quickly everything spirals out of control if you have a problem with the tubing or the spot that it goes in. The itchiness under the tape, the tube constantly getting caught on drawer handles or rolling over in bed, it was a constant grating annoyance. I swam a lot in those days and the water under the tape - so gross! And to have that on you during sex? Ugh. To this day I still stand in the shower and rub my hands over my belly feeling thankful I am not on the pump anymore.

My pump years were also my teen years - so I have had consistently better A1c with injections than I did with the pump but I suspect that has more to do with hormones than the differences in treatment.

If my control seriously deteriorates I might reconsider, but for me injections are best!

For me, pumping for 10+ years, my management is much better - A1C's 5.3-5.5 during my pumping years. Caveat: I am one of those people who aim for non-D labs. The tubing never bothered me, and I have yet to get "pump bumps" but then I have always had tough non-sensitive skin. If I have the choice, I will never go back to MDI. I'd be injecting 10-15 times a day - I micro correct and micro bolus, and the IOB is very valuable to me. I take the IOB and my CGM trending info into account when blousing. It takes such little time to check and correct/eat/adjust basal that I don't feel at all like I am "constantly managing my D. I suppose it would be wise pumping. My only issue is callouses on my fingertips from checking bg 10-15x a day. But that is resolved with good emollient handcream.

Hi gabarito....so, I debate back and forth about pump vs. MDI, too. i've never stayed on a pump long enough to see if I like it, (for all the reasons you suggested)..so not sure I can be objective. however, i'm wondering if you have DP...if so, how do you manage it on MDI...I find it very very difficult to get stable with levemir. thanks!

I should add that I was MDI for 20 years, and now pumping for 10 years+.

@ gabarito -Yea, I had a competitive swimmer friend who also really hated her pumpy. Real bummer about the side effects. Do you think that had anything to do with having a small body mass - being a teenager? I wonder if some people just dont have the body mass for good rotation of the site. Can you inject insulin into your tummy today? Or is the site ruined for injection?

I've been pumping for almost 4 years now. I prefer the conveinence over MDI, but my A1C is n't that much better on the pump. It stays in the low 7s for the most part, and that's the way it was for most of my MDI years. That's ok with me. I do best when my pre-meal BS is in the low 100s. I treat anything in the 70s as a low. If I try to "hang out in the 80s" my sugar invariably crashes. I'm not low carb, but at 150-200g per day, I guess that's moderate.

In summary with the pump...

Better A1C? No
Less Lows? Yes
Better stability? Yes

With all the closed-loop systems coming online, I don’t see the case for MDI.

With all that extra hardware to deal with along with their issues, + I can keep my A1C in the high 4’s to low 5’s with a digital pen that delivers insulin in 01.Units combined with a cgm, I really don’t see the case for a pump. Each to his/her own. My endo has stated emphatically that my control would not be any better with a pump and frequently traveling internationally with a pump is infinitely more challenging than mdi.

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My A1c is always excellent and has been for years. My last one was 4.8. My time in range is very good.

I have no desire to give up the simplicity of MDI. I am not saying that I will never try a pump, but I am in no hurry to do so.

Dx 1959

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Pumps fail. Sensors fail. Sensors can be inaccurate. Occlusions can happen. Absorption varies site to site. If you want a bulletproof (or as much as possible) regiment there closed loops could be WORSE than a dumb pump and I’ve used dumb pumps, OpenAPS, Loop, X2, and AndroidAPS.

I have a 5.1 A1C with minimal efforts (and I eat rice and potatoes!) on MDI (Does I include Afrezza?) and failures are minimal if non existent.

I was on Tandem pumps for 7 years before starting a pump break ten months ago. I’m still on that break. It feels freeing to not have to babysit an algorithm or tend to hardware. I’m using an InPen. My A1c is 6 and I eat 150-200 carbs a day. My endo got on board when I showed her I could maintain the same average, TIR and standard deviation on or off the pump.

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That’s true… that you won’t get better control… in fact, high 4’s is too low. My point is that the closed-loop pump takes over much of the decision making for you. Granted that it will never be as aggressive as you are but will lower and maintain a1C’s at a very healthy level.

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So how many injections are you giving per day?

2 for Tresiba
5 for Regular at meals
3 for Afrezza at meals

Total times I interact my my diabetes, as in take action, 6 times a day (my last tresiba shot happens at the same time as my last R). I might do 1 correction at most if I go over 130.

Mid to high 4% range for A1c is a normal blood glucose level. What’s your reasoning behind this assertion?

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While I’m satisfied with pumping, it does have its drawbacks. I woke up this morning with a CGM reading of 155, an uncommon elevation for me. I changed my infusion set because it was due and found a kinked cannula right at the tip.

If I used MDI, this would not have happened. Or if I used steel cannulas, I could have prevented it as well. Every system has its weaknesses.

But I do favor the pump systems since I believe that when automated these systems can shoulder a lot of cognitive burden. As I get older, I appreciate that.

I am fighting with an infection which has put my glucose levels on a rollercoaster. More than twice today I have asked myself if this would be any easier with a pump!

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I think dosing insulin in the midst of an infection is tough on any system. I don’t think a pump would do any better than MDI. Good luck with that, Marilyn.

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