The insulin pump evangelists drive me crazy.
My A1C is 7.0? Go on the pump. I had a low this morning? Go on the pump. My big toe hurts? Go on the pump. I’m being facetious, but the evangelists are baffled why anyone would be on injections when a pump will apparently solve any diabetes issues one might encounter.
I totally understand the reasons why people would want a pump. Not liking injections, variable basal requirements, inconsistent absorption of long-acting insulins such as NPH, etc. But what the evangelists should realize is that the pump is not the best choice for everyone and it should not be a knee-jerk recommendation for all people with diabetes.
There was a good overview of the pump versus MDI debate in a recent Diabetes Care editorial, which provided an estimate that 20% of Type 1 patients in the US were using a pump. In my opinion, the most interesting part of the discussion pertained to the A1C and which patients might benefit the most from a pump. “… the best improvement [in A1C] is seen in the worst-controlled subjects (who are the likely candidates for pump therapy), a fact that was obscured in previous trials of unselected, general type 1 diabetic patients without clinical problems. When, for example, the starting A1C is 10% on MDI, the fall in A1C on switching to CSII is likely to be 2% but, in a relatively well-controlled subject with an A1C of 7%, the difference in A1C could be <0.5%.”
I’m happy that you’re thrilled with your pump. Really. But can you back off a little? Plenty of diabetics have good control without one.