The pump vs needles

My doc wants me to get on the pump…I have been refusing due to not being able to be so tech savy and I am horrible with carb ratios. The nurse told me if I ever wanted to get in control, I would start trying harder…like carry that book (calorie, carbohydrate counting). I don’t think the doc understands me very well, I am 59 years old, I have been MDI for 29 years, I am not savy to programming a pump. I hate things attached to me (CGM is enough!) Am I being stubborn and pig headed? I think the doc just wants to be able to talk to me about what I am doing and that is why he wants me on the pump…I know he is very frustrated with me (I can tell in his voice) I have been looking for a new doc but I live in an area where there aren’t many endos.

A pump will not help you if you don’t know how to count carbohydrates. Are you not doing this already on MDI? Part of the basis of MDI is supposed to be taking insulin based on the number of carbohydrates eaten. A pump is simply a different method of delivering insulin. It can be a very powerful tool, and has been life-changing for some (myself included), but only if one puts in the effort to learn and use all its features.

In my experience, carbohydrate counting is not hard, but it is something you need to find a method that works for you (book, app, memorizing, measuring food, weighing food, estimating) and then build the habit of doing it. I’m only 35, but I don’t think 59 years is too old to learn a new habit.

I think if you don’t want a pump and if what you’ve been doing is working for you, then you shouldn’t be forced to get one. It sounds like you may want to better your diabetes control, though. Have you thought about using the services of a Certified Diabetes Educator? Companies like Integrated Diabetes Services offer remote CDE appointments online, so you don’t have to be in their local area.

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I will be 59! in 2017. I am not too old a dog to learn new tricks, and unless you have dementia, neither are you. That being said, as Jen stated, carb counting is mandatory if you want anything but crap control of your D. Your endo may have recommended an insulin pump because they (at least every insulin pump I’ve seen) calculate your dosage for you after you enter the grams of carbs you will be consuming. Carb counting is an inescapable “must” if you use insulin. Not carb counting (unless you use Afrezza) is like driving a car while blindfolded. How the heck do you know how much insulin you should pre-bolus before eating unless you count carbs? Dosing insulin should not be based on a wild guess. It does not take a genius IQ or an advanced degree to master carb counting. A skilled CDE can assist you with pump settings, but with even a modicum of intelligence and diligence, you can learn this on your own with Gary Scheiner’s Think Like a Pancreas and/or John Walsh’s Pumping Insulin. Plus you have the knowledge and experience of a huge pool of actual real PWD on this Forum that you can tap into any time you need. Anything important involves learning, hard work, and diligence (barring dumb luck and/or independent wealth).

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Do YOU want to improve your control ? What do you think are the key things that would help you improve ?

You should be able to tell your endo/CDE that you prefer MDI, and ask for their help to improve your control using MDI. Since you have CGMS, that would be very beneficial to show your patterns of highs/lows and what areas to work on. If you are willing to log your foods/quantity/bolus insulin, and align with your CGMS download, it would be easy to see if there are patterns that would show what to concentrate on.

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I love using MDI. I use the RapidCalc app to help me count and track carbs and determine how much to bolus. My doc pressed for a few years for me to be on a pump, but my numbers are good and she finally decided to quit pressing.

If your endo is frustrated with you because you won’t put enough effort into achieving tighter control of your BG (and I’m not saying that this is actually the case), this is a positive thing IMO. I would not want my daughter to have an endo who was OK with poor management. On the other hand, if your endo is frustrated with you just because you won’t switch to a pump just for the sake of pumping, then this is a different matter entirely.

you sound like a great candidate for the newest meditronic pump offering which is the “artificial pancreas” technology - that one has glucogen on board as well as insulin and it takes constant readings dosing you with whichever hormone is needed to keep you in your target BG. It seeks to maintain your average HBA1C at no lower than 6.5…your doc could put you in touch with a Certified Diabetes Educator who would go over this pump program with you to explain how little you have to worry about the technology if you’d rather have it set up for you by the CDE…

New medtronic pump does NOT have glucagon. Only insulin. And while it is a hybrid closed loop and awesome, you still need to count carbs and bolus for food, as the closed loop only works with basal rates

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You are mistaken about the new Medtronic hybrid closed loop pump. It is not bihormonal and is not a “set it and forget it” pump. No bihormonal pumps are commercially available currently. As swisschocolate said, you still need to count carbs and bolus for them. Additionally, you need to determine reasonably accurate settings when starting to use this closed loop pump the same as a “traditional” pump. You need to read up on closed loop pumps.

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I’ve only ever been on MDI. A pump can help, but it doesn’t just automagically fix things. I am convinced that at least in my case I can achieve control that is just as good with MDI and a CGM. As others have said, properly dosing your mealtime insulin to something that can really reduce mealtime blood sugar swings. You can do that both on MDI and a pump. But it isn’t the only thing you can do. If you are willing to adopt a low carb high fat diet you can dramatically reduce your mealtime blood sugar swings and make precise carb counting much less of a problem. You can use your CGM and meter to set your basal levels more precisely and that can help. And you can do things like pre-bolusing to further reduce your blood sugar swings.

You don’t get anything for free, but there are probably some things you could do with MDI to improve your blood sugar control and better satisfy you doctor and nurse.

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Whats your A1C now? The pump wont give you any better control, all it is is a different way to take insulin, it’s not a magic pill.

Has the Dr gave you all your options instead of just “get on a pump”? What do you use for basal insulin? Have you considered Afrezza at all? I was MDI for 30 years (minus a few years for pumping) and until I got on my CGM, Tresiba, and then Afrezza i had high A1C’s no matter what I did. But the thing is I didnt really try that hard now that I look back. The CGM tells you exactly whats causing your high A1C (which I assume you have) and then you can determine the best solution for solving that problem. Night time fluctutions… Tresiba. Spikes after meals… Afrezza. Need different basals during the day… Pump.

If you dont want to count carbs then Afrezza would be a good option to look into. I never count carbs, ever. I went from a 8.1 A1C to a 5.9 in a few months with very little effort. You just need the right tools for the job.

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And as many others mention, a lower carb diet works wonders in helping manage things. For me though, i can go out to eat and eat anything I want and just take Afrezza every couple hours and/or added Novolog for the long meal time coverage.

I’m starting to sound like an Afrezza ad like Sam19 but I cant help it, it has allowed me to forget about my diabetes and be totally lazy like I am by nature. :slight_smile: And to think I almost gave up on it.

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You can (and most likely will) get trained on how to use the pump. It’s not that bad at all really. Once you understand the general concepts, you just program it and let it do it’s thing. As you get better you can begin experimenting with advanced functions of the pump. I guess the question is whether there is real value in it for you. As I understand it, some people on these forums are MDI only, have been, always will be, and have very good control of their diabetes. And if that works for them (and you) then go for it! Diabetes is very much YDMV. If; however, your A1C, your “numbers” are very high and you WANT to get them under control, then I would say go for it. But don’t be afraid of the technology…it’s just buttons and information and everything can be learned, and mastered, over time.

Good luck on your journey. Whatever you decide!

Hi. I was using the vial and syringe until last November. I’ve had diabetes since 1965. I wasn’t counting carbohydrates until October of last year. You can do insulin by not counting carbohydrates if you know how to do it. Obviously I was doing it since my A1C is as good now on the pump as it was when I wasn’t on the pump.

But it’s not that difficult to learn. I’m not a big fan of the carbohydrate book everyone seems to like, so I created my own. Plus I found a web site that will break down recipes into calories, carbohydrates, proteins, sodium, etc https://www.caloriecount.com/cc/recipe_analysis.php This has helped me a great deal in creating my listing of carbohydrates. I have a spreadsheet on my tablet that I carry with me. I just open it up and look for items.

The Animas Vibe has the Dexcom G4 integrated into it AND an In-pump food database (up to 500 food items). This was the pump I wanted but for some reason my endo was against it, so I ended up getting the Tandem T:Slim G4. I don’t have a smart phone, nor do I want to share my Dexcom readings with anyone, so I haven’t switched to the G5 yet.

I wasn’t for pumps, I was against them. My endo suggested I get one. I knew before I got one, I’d have to do the carbohydrate counting. She wasn’t keen on how I was doing my insulin. She couldn’t believe my A1C was as good as it was. So I started learning how to count carbohydrates before I got the pump.

But whatever you decide, YOU have to make the decision. You are in control of your body. YOU are. Your endo is just there to help you along the way. If I didn’t really like my endo, I wouldn’t have made as many changes as I have.

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thank you, Tatty…I am definitely going to try this. It may be the answer to all my problems!

As has been said, counting carbs is not rocket science. Here is an excellent book on the subject:

Gary Scheiner, The Ultimate Guide To Accurate Carb Counting (Boston: Da Capo Press, 2011)

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I got my pump one year ago at the age of 63. Like you, I was apprehensive about learning a new technology and concerned about rocking the boat of my “system” that I used for 32 years… it wasn’t a perfect system as my blood sugars and a1C evidenced, but it was MY system… if you know what I mean:wink:

One year later, I say with confidence that getting an insulin pump was the best decision I’ve made yet for my health. My A1c has been 6.0 for every lab I’ve had, and I no longer experience high highs or low lows. Yes, it was a learning curve. But SO worth it, imho.

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I hesitated getting a pump for years, mostly because I was scared about being able to manage the technology aspect of it, and I was a teenager at the time. I finally got a pump in college, after watching a number of promotional pump videos where they had a really young kid (like 4 or 5) say, “it’s so easy!” and an older grandparent say, “it’s so easy!” I figured, if they can both figure it out, I probably can, too. It’s a lot of work at the outside - with the help and guidance of your doctor, CDEs, and pump trainers - but once you get your settings settled, the rest of it is fairly routine. I agree with the comments about carb counting…that is key.

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You’re not stuck with the pump if you try it. You can decide its not for you and return it. Most companies will let you try it out.

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My thoughts are if your used to doing it your way then carry on. but bare in mind the lasting effects, I feel that is good to have a knowledge of what carbs to intake at each meal. The book looked really tricky to me when I first looked at it and at times it still does. I was crap at maths and it took a while to learn the basics. I will always say that pumping is better, I suppose its like wearing a watch, you get used to it. The handset is like using a mobile phone and there are lots of differnt types to choose from.
However like you say your doc should not pressure you if it’s really not in your mind rather advice on the good points and benifits it could bring. ;:wink: Try aproaching it from a different angle maybe.