So I haven’t read through everyone else’s comments, but here’s my two cents (which often runs contrary to the others, given that I’ve gone back and forth between MDI and pump and am generally happy with MDI, so spoiler alert for that!)
Out of order answers…
I am planning to get a CGM before the trip (have never used one). Does anybody think that maintaining the CGM will be a problem and not worth the hassle? My endo is skeptical that a CGM will be of much help, she advocates bringing hundreds of test strips and lots of extra testing.
A CGM is worth its weight in gold, and also worth paying out of pocket for in my experience (which I have done in the past with no regrets). Yes, still bring lots of strips and test as needed as your endo suggests, but a CGM brings so much piece of mind, not just for yourself but also the others around you, that its worth getting tomorrow! I use the Dexcom CGM (because it works lightyears better than the other) and regularly have about… zero problems with it. I use extra tape to help it stick longer, and even swimming laps a few times a week I regularly get 20+ days out of a single sensor, so its a low a hassle thing as any I’ve ever used, and the piece of mind it brings is worth even more than the potential for better control, at least in my opinion.What does your endo think a CGM is to be used for if not for this sort of activity???
**Corrected after the fact… I suppose keeping a CGM receiver charged could be seen as a hassle, but there are several solar chargeable battery packs available that work fine, and I’ve even seen (but not tried yet) a motion-powered charger that would be pretty slick if it worked, so there are options even if your version of “remote” includes no power outlets for weeks on end. (That being said, I regularly get 5-6 days on my receiver between charges, so its not like a phone that needs re-powering every night.)
Would it be easier to adjust on the fly, make corrections, etc if I switch to a pump (compared to staying with MDI)?
If you want daily or hourly basal rate changes, YES to a pump. But, you specifically mentioned concern regarding guessing carb counts on high carb meals and having to correct afterwards, and to that aspect I say MDI and pumps are equal IF YOU USE A BOLUS CALCULATOR. If you do injection math in your head and don’t account for IOB, a pump will give you better answers. However, there are several IOB calculators that do a fabulous job (my favorite is RapidCalc, available via iTunes and runs fine on a iTouch, no wifi/data connection required so good even “out in the woods”). If you don’t account for IOB in your current bolus calculations, shame on your endo for not bringing that up! Correcting by 2 units two hours after a meal is either a quick 30seconds with a pen or syringe, or a 30-second round of button pushing on a pump. While a pump can fine tune and give tinier doses (.05 units in many cases), most adults don’t see a benefit from using such minuscule increments in bolus/correction dosing. For what its worth, I speak of actual experience on this one: my last backpacking trip I did with a CGM and MDI with RapidCalc on my iTouch and was a pretty happy camper (except for the weather, but a pump wouldn’t have helped on that front!).
Or would the hassles of a pump up in the mountains outweigh the benefits? I will be many days away from a pharmacy most of the time. I’m pretty confident I can keep my insulin pens from spoiling but have no idea if insulin spoilage would be a hassle with a pump.
Pens and vials need the same treatment, so if you’d protect one, you should protect the other; but the rest of the pump supplies are not temperature sensitive so that makes that part easy at least. The harder question though, “would the hassles of a pump outweigh the benefits?” My first answer is that if you are happy in your regular life with MDI, then stick with that, but if you’re already considering switching to a pump for various other reasons, go for it with the following thoughts in mind: The decision to pump and ultimate happiness doing so will depend entirely on… well, YOU, with a side note that not all pump trainers are created equal, and your first month or two is largely dependent on your trainers training, and how comfortable you are making changes without orders. (I know people who after 15 years still make a doctor appt to adjust their basal rates, and others who are continuously tweaking on their own; both methods have their pros and cons). A pump comes with a lot of parts and pieces and while they can work wonderfully, they can also fail dramatically. And if you’ve never used one before, I’d caution you that there is a pretty steep learning curve, and I would get at least 2-3 months of pumping under your belt before taking it on a trip. Sure, some of your ability to catch on quick will be due to the training you receive, but I don’t think anyone has ever started pumping and felt like they had it under control in just a few weeks. Also, there are many different makes and models of pumps, and so if you were primarily shopping for one to take “adventuring”, you’d want to make sure to shop for one that would hold up to what you were going to throw at it. Because I have a penchant for water, its more important that I look for one that is at least watertight which might not be as big a concern for others: and whether or not there is tubing will affect where you can put it and you’ll want to make sure that jives with how you wear your backpack. I like my pack’s waistband low around my hips, which means (when wearing a pack) I am generally limited to infusion sites on my upper belly or thighs, but someone who wears a waistband higher up could gain real estate on the lower belly and maybe backside and some of that will be affected by the infusion set of pump you choose. FYI, I have yet to go through a pump training course where they start you out with anything but belly sites, so if you go that route, know that pump trainers are generally a conservative bunch and they have to suggest only FDA-approved sites, which aren’t always where “real life users” put infusion sites (or CGM sites, for that matter). Also to be considered would be the pump’s power source- and for remote adventures the ones that take AAA batteries are probably easier, otherwise you need to bring a power source to keep it charged up.
It sounds like a fun adventure either way though, you will come back and tell us how it worked out?!