Type 1s - If You Don't Pump, Why?

I am curious as to why people who are T1s don't use the pump and instead stick with MDI. Is it cost? Ease of use? Being attached to something 24/7? This is just a question I was pondering.

Basically everything you said is why I have no interest in the pump. People that don't know think it regulates your sugar for you. WRONG! The only way I'd use a pump is if I couldn't inject more then three times a day for whatever reason. The way I eat in general I inject on average 6 times per day. I think I can get virtually the same control and close to the same flexibility as people on the pump get. I don't see what the big deal is to load a syringe and take the shot? It's really the easiest part by far of diabetes IMO. Would I rather pop a pill, yeah but its the control problem that is the nightmare not the way the medication is obtained.I will say that I have on occasion loaded my needle up with air so its not foolproof.

I think the people who find the pump most beneficial are those who have a) variable basal needs throughout the day (one "flat" dose of Lantus/Levemir doesn't cover it properly), b) a need to dose in fractions of a unit (you can only get as low as 0.5 unit with half-unit pens), and c) people who have variable insulin needs due to activity level, hormones, etc. (you can easily adjust a pump's basal rate over a matter of hours, while adjusting Lantus/Levemir can take several days).

The pump does NOT make diabetes any "easier" or require any less work than shots (I'd argue it requires more), but I do think there are some people (me included) who are able to achieve much better control on the pump due to the above factors. Of course, there's also people (perhaps the majority) who go on the pump so that they don't have to do shots, so that doses are easier to calculate, and so on. Then, there are the people who don't find it makes much difference in their control and end up either never pursuing a pump or going back to MDI. I would guess these are people who have relatively flat basal needs throughout the day and also don't have things like hormonal variations or changes in activity from day to day that make their insulin requirements change rapidly.

You know I don't even use a basil throughout the day although sometimes I use R for my bolus which stays in your bloodstream about 5 hrs anyway. I notice Humalog is virtually out of my system at about 2 to 2.5 hrs at the most. When I first went on MDI my therapist who was also diabetic said when he was on shots what worked best for him was one shot of Lantus though I use (NPH) and just humalog throughout the day. I kind of did the same thing and it seems fairly consistent most of the time. I would bet the majority of the time levels run haywire are miscalculating carbs, insulin not loading correctly, stress and exercise. With all that into play the fact that your basil dosage is correct won't have much relevance anyway. I mean just an extra 10 carb grams for some people can be 30 to 40 points higher.

My interpretation, much like Gary's, is that it is just another way to dose and not much more (my new CGM on the other hand is such a cool device!!!). I was also put off by all the 'stuff' associated with pumping. Too muchy! Seems to me that pumping involves lots of waste product. This from a guy who uses each syringe until the numbers are wearing off or I bend the point -- about three weeks or so, so dozens of injections with a single needle (keeps my diabetic waste level way down below the norm).

I do a shot of 27u Lantus in the AM each day, followed by a sliding scale 4-9u bolus of Huma-/Novo-log (whatever's handy at the time) with each meal. And sometimes a correction or two. Works fine for me.


The waste issue is one thing that has always bothered me about pumping (probably the only thing, outside of the cost). All the packaging just makes me sick!! I try to reuse things and recycle whatever I can, but it's still a lot. I wish pump manufacturers would look at that. Hey Minimed, NO, I don't need a 100-page booklet with EACH box of infusion sets.

It's hard to explain how much better I found the delivery of basal insulin w/ a pump without having the opportunity to try it. I found it much easier to control things and run very smooth numbers. I guess it's not guaranteed to be that way but having a basal "gas pedal" you can stomp on or let up on is very useful.

I found it to be less work than shots because there are less messes, unexpected highs or lows, to clean up and the cleaning is easier.

Mike we have something in common. I use one syringe a day for as many shots as I take. Usually 5-6 on average. Other then a cure the upcoming Non Invasive meters will be a huge help for most. I spoke to a person working at a company involved with the one I have my eye on and she said It will likely be a few more years because of the FDA guidelines. They are finalizing the unit as we speak and it will be nice and small, give the reading in one second and have no waste or ongoing expense other then the cost of the machine itself. Seriously I don't get how people don't mind walking around with crap hanging all over their body. I carry a vial of insulin in my pocket and a syringe and am prepared equal to a pump. Don't think the pump manufacturers hate people like us. It's a multi-million dollar business those things.

I also get bothered by the waste and recycle everything I can. In fact, pretty much the only parts I don't recycle are the "medical waste" parts like used tubing, cartridges, test strips, lancets, and infusion sets. All other cardboard and plastic packaging and other little bits (the little blue piece that you use to fill a cartridge and then just discard, for example) get recycled.

I think this depends a lot on the types of recycling facilities around your areas. I pay extra to recycle odd things (like foil, plastic packaging not marked with a number, etc.), but these are available in some areas for free and/or curb-side pickup.

Also, I think it's possible with pumping to reuse tubing/cartridges to a certain extent. I've never done it, but I've of heard people who do. Some people can also stretch their infusion sets out to three or four days, but I personally have to change mine every two days due to allergy issues.

I think that the "new" pumps are completely outdated in their technology and ridiculously overpriced. I looked into getting one and had to laugh as they were telling me about the new "design" and "features". We're a family of engineers and can't believe how behind the medical industry is. My reasons for not using one are many 1) they are way too costly and usually not covered by insurance 2) you still have to prick your finger to test your BG because they are often not accurate (i still can't believe this?!) 3) it's not really like a pancreas, you must still figure out your dosages 4) they need to be replaced more often than i think is acceptable and 5) they are bulky and won't fit well under nice clothes (a little silly, I know but I don't want to have diabetes AND have to wear sweatshirts all the time).

My A1C is very much under control just with background and meal insulins. I don't think I will ever consider the pump unless Apple makes one that connects to my iPhone ;P

I can't wait for non-evasive meters!!! What is the company that's producing them? I test so often in a day, it makes things so much easier :)

I hate the pump industry too, it makes me sick that there are so few options :(

My reason is cost. I've had 3 straight years of sizable premium increases along with (this year) an increase of DME copay to 50%.

have you ever actually tried one...? it's great for people who need small basal adjustments, different basal adjustments throughout the day (especially at night and for working out, etc..), it's great for small increments for bolus - corrections. Most insurance companies do cover a pump for a type 1, depending on, of course, insurance. Actually, they typically do not need to replaced...they're actually very reliable and have a warranty. Most people love their pump and wouldn't go back to MDI's unless they HAD to.

Its the invasiveness of it all. Although from the outside, it looks like the waterproof omnipod would be ok. Since being involved in triathlons i think they would be a pain in the ■■■ with a wetsuit. Im only newly diagnosed, so maybe a few years down the track its something ill look at. But while im honeymooning its easier to just needle myself. I wouldnt mind a CGM but they arent covered here in Australia and are rather thing on the ground. I would love a dexcom. I wish the NDSS here in oz would cover them :(

My main objection is scar tissue, followed by mechanical & site failures, cost & waste. I don't need multiple basal settings, but can see that's a benefit. I usually know ahead when I'm going to be active enough to need a basal reduction. (I use two Levemir doses.) Don't mind injections & easier than hauling a bunch of pump supplies along.

1) they are way too costly and usually not covered by insurance

They are expensive, but if you look at ANY device for medical/disability purposes, they are all ridiculously expensive and often not covered by insurance and/or provincial health coverage. So this is not really a "pump" problem but a more general problem of companies charging ridiculous prices for technology that people need. I have a braille-tablet-computer type device on loan for school which costs $7,000 for, essentially, an iPad (and yes, it's just as feature limited!). Which is ridiculous but, well, I need to be able to read, and all such devices with refreshable braille displays are just as expensive.

2) you still have to prick your finger to test your BG because they are often not accurate (i still can't believe this?!)

This is not a problem with pumps. This is a problem with CGM devices which are completely different. Pumps are starting to have CGMs integrated into them, but pumps came out LONG before CGMs did, and there are many people who use a pump without using a CGM.

it's not really like a pancreas, you must still figure out your dosages

Pump aren't like an "artificial pancreas" but, then, they have never purported to be automatic like that ... Overall, pumps offer way more flexibility than you can get with injections, although not everyone needs that flexibility. It's not possible to do temporary basal rates, extended boluses, "super" boluses, or stop delivery completely with injections.

4) they need to be replaced more often than i think is acceptable

Pump companies and insurance companies "recommend" that pumps be replaced every four years, but this doesn't mean they have to be (with the exception of the Spirit which is set to stop working at four years). I have a Cozmo from five years ago that is still working fine and that I would still be using if not for the fact that it's not covered under warranty anymore and I can't see the screen at all (compared to the Ping). So the problem is not with the pumps and/or their design, it's with the companies wanting to make extra money by having people upgrade to the newest model.

5) they are bulky and won't fit well under nice clothes

I actually think the main problem here is not that the PUMP is bulky but that the INSULIN and the BATTERY are bulky. Pumps these days are not much bigger than meters. Both pumps I've had have had a majority of their space dedicated to a cartridge and a battery. If they could find a way to make insulin "smaller" and use a small watch battery, then that would go a LONG way towards being able to design smaller pumps.

For us it was 2 things:
1) fear of 'starting over' after getting a handle on MDI
2) cost
Happily, cost has been addressed by our medicare system and our daughter's pump and most of her supplies are covered. It was a ton of work at the beginning to learn a new system but I'm glad we took the plunge and started on the pump. I thought being 'tethered' would bother my daughter but she adapted remarkably quickly. The ability to change basal rates has been very useful for us and the pump has allowed for more flexibility with eating. Also have seen an improvement in A1C. This week we are going to work in a very short pump break and use shots to cover a sporting event - nice to have that additional flexibility.

The only issue with MDI (as compared to pumping) is the small dosing amounts you can delivery with a pump that you can't do with MDI. For some this probably isn't an issue, but for someone like me (small, insulin sensitive, TDD averages around 22 units), a pump can be a lifesaver. On MDI, I just wasn't correcting anything under 220 or so because I couldn't be sure I wasn't going to drop like a rock with just a unit of humalog.

LOL...I have always said that I'm just not sure why pumps cost so much when my iPhone is WAY more advanced. I am sure a lot of the cost has to do with FDA clearance, legal costs, customer support, etc as opposed to the actual cost of the device itself. I love my pump, but yeah, it's not that fancy when it really comes down to it. Granted, it does seem way more durable than my iPhone. But an Apple-designed insulin pump would just be....awesome.

With the analog insulins like NovoLog and Levemir I can have good control on MDI. My basal coverage is always good and I do not have to deal with site problems. I tried different catheters and my skin does not like adhesives very much - especially Teflon showed some mild allergic reactions. Steel would work but this felt rather uncomfortable. I am also skeptical about scar tissue. The catheter will induce a local low blood glucose for several days. With MDI in comparison this does only happen for a much shorter period of time. This local low, the permanent flow of preservatives and the permanent needle are responsible for the build-up of scar tissue. Long term I am convinced that this will lead to more severe problems - especially for the patch pumps that have only limited areas to be applied to (higher repetitive use of sites). With the pen needle I see little to no damage and right now I have only one bruise on my body from hitting a blood vessel. A permanent catheter would remind me 24/7 on being type 1 - something I would really dislike but maybe this is something to adjust to over time. One major advantage of pumps is the flexible adjustment of the basal profile to physical activity. This I have to manage with additional carbohydrates. On the other hand for sports the combination of insulin and carbs is even recommended so it is no big deal to me. So far I do not see that the adjust-ability of the pump will outweigh the negative aspects I see. This can change of course as I am not fundamental about it. In the Glucosurfer project I was just surprised to see that the link between good control and pumping is rather weak. This impression might be biased because in Germany hard to control diabetics are more likely to get a pump.