I have a question for all you pumpers. I am T1 on MDI’s. I am seriously considering either an Omnipod or a Tslim. One thing I keep coming across is people on pumps do not seem to be getting as good of numbers as I am on injections. My time in range (Dexcom G6) is usually around 90% and my last A1c was 5.6. Of course to get this takes many injections a day (up to 10), which is one reason I’m considering a pump. Will I be able to get the same control and numbers with a pump?
Why does it take up to 10 injections a day? What insulins are you using? How many of your injections are for basal versus bolus?
It can help to have context when trying to respond. Usually folks are so familiar with their routine that they forget that other people don’t know jack about them or their life.
My A1C improved with getting my pump. (and the help of my first CGM 30 days before) I had a tendency to take a dose to cover what I might end up eating and maybe even a snack. My insulin dropped to less than half of what I had been using. With a pump it’s easy to give that 1/2 unit adjustment to cover a snack and I would have never bothered doing that with MDI shots. I eat a cracker, give some insulin, eat a cracker before and ignored I ate 2 carbs. Plus with meals I give some as a prebolus and then the rest when I eat to end up with the more correct amount and maybe a delayed amount later.
I think this comes down to people post when they need help, have a question trying to solve something or have a problem. Generally you don’t post that everything is running along smoothly. So it makes it look like people are unhappy.
It still comes down to the fact that it is easier to do small doses, more doses and to adjust your basal rates during the day. A pump can have it’s downsides, but proper dosing to me is much easier.
Personally, I think you can obtain BETTER control with a pump. It opens up new options such as extended boluses, super boluses, and varied basal rates. You can do everything you do with injections, without the stabbing discomfort, plus more.
You, like many here, are not the “average” diabetic. Welcome to the high achievers club! You’ve clearly obtained an excellent relationship with your food and insulin. You’ve learned how much and when to bolus for food to obtain much better than the “average” 56% TIR.
I strongly believe a lot of diabetes management comes down to intrinsic behaviors. It’s all about accumulating knowledge and experiences and then being able to reference it subconsciously so you just “know” how to deal with the day-to-day challenges of dosing.
That knowledge will still be with you if you choose to switch to a pump. Your personal management style won’t change, just the mechanism in which you deliver the insulin. There is zero reason you should see your TIR decline, aside from possibly the first month or so while you and/or your medical team dial in your pump settings.
Many have never been able to achieve your 90% TIR, with or without a pump. The trending goal is still to get most of us up to 70% TIR. That so many achieve less than that has less to do with technology than it has to do with education, support, and attitude of the individual.
Personally, 31 years of stabbing myself and I’m still needle-phobic. I don’t enjoy any part of it, and I admit I lied through my teeth every time I shrugged and told someone “you get used to it.” Only having to inject (sorta, kinda, in a way) once every 3 days is a massive mental relief to me. I don’t hesitate to bolus anymore. I don’t have to stop and debate whether it’s worth it for a small amount. I don’t have the anxiety that comes with every injection anymore.
There’s still a big trade off to choosing a pump that you have to consider, but I don’t think it’s your control. It’s more the burden of being tethered. Of essentially being on a 23-inch leash eternally. I’m not quite 4 years into my experience with the T:slim X2, so I’m still fascinated by the technology and happy to have it, but I can see how many more years with it might become mentally fatiguing. Depending on your insurance, it might also cost more money. No matter what pump you choose, there will be insulin wasted to the reservoir/cartridge/pod, and maybe the tubing. The consumables cost more than pen needles or syringes, too.
Almost certainly. I think the attitude and personality of the person is the biggest influence on glucose management success. MDI and pump therapy are two different tools, both with their own characteristics, strengths and weaknesses.
Your willingness to take up to 10 injections per day tells me that you pay attention and you like to actively manage your glucose levels.
I prefer to use a pump since it’s part of an automated insulin dosing system. Most pump companies are busy developing hybrid and full closed loop systems and people on MDI will not be able to access that tech. My system makes 288 insulin dosing decisions every day and even does it while I’m sleeping.
My 14-day time in range is 92%, 65-130 mg/dL. I think I could do this on MDI but I’m sure it would take more time and attention.
I’ve been on insulin pumps almost continuously since 1987. I think they provide a flexible way to deliver insulin but also come with a host of fastidious maintenance requirements. You need to pay close attention to infusion site health and absorption, change your sites at least every 72 hours, and be quick to swap a site out upon pain or unexpected glucose rises.
In return you can deliver extended meal boluses customized for high protein or fat consumption. You are able to fine tune and segment your basal rates to counter dawn phenomena and other circadian rhythms. The convenience of discreetly delivering a meal bolus when dining out with friends (can’t wait till we can do that again!) is really nice. On top of all that, the electronic brains on your pump will never forget whether you gave yourself your last meal dose.
Pumps are not for everyone and you are doing quite well without one. I think if you choose to adopt pump therapy, you will make it work for you and enjoy its many conveniences despite some of its neediness.
Thanks everyone for the detailed responses, it certainly has made my decision easier. DP is another problem I have so I am looking forward to not waking up at 5 in the morning to make a correction.
I think that you can get a good a1c with MI OR a pump.
I don’t think that a pump is required for good a1c.
But, there will be a learning curve and you will have to setup your basals correctly.
That will take some time and effort.
It will definitely help the DP.