Mine’s a minority opinion because I don’t want a pump. Developing scar tissue is my major objection. I don’t mind injections, don’t find them inconvenient or imprecise. I don’t want to be tethered & the expense & waste is a consideration also. Having read of pump problems makes me even less inclined to want one. With injections I don’t worry about site issues, insertion problems & failures. Admit I would freak having highs because of lack of delivery. I don’t believe a pump necessarily means better control.
The size of the Omnipod & having remotes to lug around doesn’t seem terribly convenient compared to carrying around a few syringes & a vial in my meter case.
The greatest advantage is being able to adjust different basal rates, which helps depending on your situation.
I think it’s more about control of your lifestyle, and how diabetes management affects the things you do each day, than it is about numbers. I was on MDI for several years, and was able to achieve good control, just like I can on the pump.
But, my pump makes my lifestyle easier for me for a few reasons:
Spontaneity! I can exercise, and fine tune my basal accordingly. If it's intense morning exercise, I know I need more insulin during and right after, then much less later in the day. If it's an evening run/walk, then I know I need much less during and right before. I found it much trickier to fine tune a lantus shot, that I may have taken the night before, or in the morning.
Easier to eat in public, and again, I can be more spontaneous when I eat. If I feel like having an extra roll at my meal, I don't have to pull out a pen/needle, or if I'm at a business lunch or something, I wouldn't have to excuse myself to the bathroom to do a shot. I could just press a few buttons on my pump and no one notices.
I was like you and had great numbers after I was first diagnosed, and did not see the benefit of having some awful thing attached to me all the time. And, back then, perhaps it wasn't right for me to have a pump. Type 1 is a big enough life change, I didn't want to turn part robot at the same time.
But after a few years, maintaining that level of control can change. And for me, the pump gave me more freedom and control because easier. And really, the clunky thing isn't so bad to have on you. It's by far the biggest negative, but the positives outweigh it by a million for me.
If your range is good right now, you may not have issues like dawn phenomena, night lows, and all the other annoying BG control nuisances. But if you do, the pump can make it easier to control these as well. At least for me!
I would say, if you're comfortable with how your current diabetes management affects your life and your numbers are great, you're okay on MDI!
If presented with the choice go on pump or go on cgm (if not both at same time), in hindsight I would vote for cgm.
Then, a few months later, I’d likely sign up for a pump because the cgm would reveal all the ups and downs that a semi-disciplined life with diabetes encounters—a pump allows fancy-schmancy basal-rate and temp basal-rate changes that I just couldn’t achieve with MDI. The monthly female cycle alone makes a pump well worth the added expense and effort.
Best wishes as you figure out what tools are for you. I’ve found that after several decades with type 1, my treatment needs and my tools change. When I’ve been stubborn about changing are the times I’ve later said, “Why didn’t I try that earlier?”
For someone in your shoes, it’s more a question of convenience than control. If you don’t think MDI is a big deal at this point, then maybe now isn’t the time for you to switch. BUT, at least consider…
…I love being able to bolus on the fly. At the movies, on a plane, at dinner, it’s just less hassle than pulling out a pen.
…I also love being able to cut my basal when I’m running or more active so that I don’t need to munch on glucose tablets to keep off the low.
…I also love being able to set longer duration wave boluses for high protein or slow absorbing carbs.
Like you, I was 100% opposed to being tethered to a machine before I tried the pump. Now I wouldn’t go back. After a few months adjustment, the benefits of the pump will dwarf the inconveniences. I wouldn’t let that be the only reason that you don’t give it a shot.
Financially, it can be a strain if your insurance has a high co-pay or one year decides to add a high co-pay. That would be a real deal-breaker for me. Right now, I pay less on the pump than I would pay on MDI b/c needles have a co-pay and pump supplies don’t. But if that was 75-80% or worse, then I might have to re-consider my options. I love it, but I wouldn’t go bankrupt for it!
It really is a tough decision. When you’re ready, you’re ready. You’ll know it. If now isn’t the time, now isn’t the time. But keep yourself open for the future. I do think that you have to be ready to let the pump into your life for it to work for you. And part of that is being frustrated with the amount of effort you put into MDI.
Arshag: I was on shots for 28 of my 29 years living with Type 1. I was never able to get an A1C below 7.0, until now. Assuming you are able to get an A1C in the 5-6 range on shots, then I would think personal preference would be the only factor to consider. On the pump, you can bolus as you go, as someone mentioned below, without ever leaving the dining table. You only have to stick yourself once every 4 days instead of at every meal and then some. You will never have to worry about skipping a meal because you forgot your pen at home, as your insulin is always on you. On the flip side, it is an annoyance to have the pump on you all of the time…it is not a natural extremity, and I do not find it comfortable sleeping at night, as I am always turning onto it, no matter where I put it. Plus, people ask questions…what is that? If you are a private person, it is not always possible to hide it. Having said that, I will never go back to shots…not even on a holiday. I have too much control now that I never had before, and I like sleeping really late on the weekends without having to get up to take my insulin!
I was recently diagnosed this fall and got my pump as soon as my insurance would allow me! I hated that my pens were in whole units and I don’t have the space/availability for syringes. My main benefits to the pump: not having to remember so many injections (I had two daily Lantus ones) and not having to excuse myself everytime I eat. I have a busy/stressful life and the pump has made it easier. I also love the IOB function. If I am 160 and want to give myself insulin, my pump reminds me that I have some on board, how much is still working, and how much if any is needed. Also I hated eating before I worked out. Now, I turn down my Basal 30 mins-1 hr before I work out and don’t need to eat.
This is just me. I have not had it long enough for scar tissue. It may be attached to you at all times but it’s less of a burden then carrying around the rest of the my supplies.
I am sure that I am in my honeymoon phase as well but my HA1C is under 6 and I don’t get as many draining lows.
Good luck with your decision! I am sure whatever you chose will be just fine
After 26 ½ years on MDI, I just started pumping this summer. My A1cs were in the 5s on MDI and I was not expecting much change in that respect. One of the main reasons for me was to have better variability in basal rates. I did really well on Levemir but I had to take it every 8 hours. I also have DP so with the pump, I can actually sleep more than 6 hours without hearing alarms going off reminding me to take insulin.
There are also downsides also. If you have a bad site, your BS goes up. I worry about scar tissue because I already have a lot on one side of my stomach even pre-pump and I never had any kind of stomach surgery. My pump malfunctioned at the beginning of the month and was putting a lot of air in the tubes. I was not getting insulin & my BS would go up. If you give yourself a shot, at least you know you got that shot. You don’t know that with a pump until your BS is out of whack.
This year I was given a $2500 Diabetic DME max. That did not cover 6 months of the pods for my omnipod. Hense, I have just started on MDI for the first time in 12 years.
Being on the pump allowed me to gain all this extra weight I carry around. I have gotten down to 179 as of today, but at 5’4" that is still way to large.
Now I am panicky because I am having to learn how to do the actual calculation with the I:C factor - the pump did it all. Having to learn how to calculate the correction factor - the pump did it all. Having to calculate IOB - again the pump did it all. Still have not figured out how to handle exercising on MDI - I am reading articles and books. Much easier on the pump.
I got lazy with the calculations because I never had to do them. My control slipped toward the end before I switched over to MDI - alot to do with the skin issues I was having. Over the years having to first put the skin prep on, then later having the skin prep and the IV3000 or the tegaderm, finally ended up getting skin reactions around the canula - leaving large (greater than a 50 cent piece) red hard induration which made the pod not as effective.
I am happy not to be on the pump - but I just have to relearn to eat at more designated times so I will not go low due to the Lantus being higher than the amount I need (in the afternoons), etc.
It would also be a shame for Arshag to mar what I have to say is a classically sculpted physique, at least in the profile pics, w/ a bunch of gizmos and tape and stuff! If I looked like that, I would have to at least consider that angle!
The pump was good for me from a lifestyle perspective. It affords me more discretion in more formal professional settings. Personally I seem better able to manage my bg with the pump, But I truly believe others may do just as well with MDIs. (I never heard the only bolus every three hour rule). Personally, I would think if MDIs work for you on a control and lifestyle perspective why change?
That’s a pretty weird routine. I was told that you bolus only when you’re going to eat, because that’s how a pancreas responds – there’s basal insulin all the time, and a big secretion of insulin occurs when Brain tells Pancreas it’s time to eat. Seems bizarre to disconnect the bolus from the intention to have food!
“fast-acting” insulins like novolog/humalog have a duration of 3-4 hours, but the peak action occurs within 1-2 hours. you don’t want to take doses too close together for fear of “stacking” your insulin and having a compounding blood sugar drop, but spacing out doses by 2 hours is safe according to everyone i’ve spoken to. 3 hours strikes me as overly conservative and unnecessary for most type 1s.
my understanding is that the insulin provided by the pump is faster-acting. i’m not sure if this is because of the chemical properties of the insulin itself or because the cannula goes deeper than a subcutaneous insulin injection into adipose tissue, which absorbs insulin more slowly.
Unless, of course, one is engaged in some sort of debauchery. I don’t mind stacking my way through Christmas parties when there’s lots of food around. It usually works out ok?
I hate to poke a hole in your balloon, but (in my case), my insulin take up to 3 hrs to get into my system. It is Humulin 500, which is more concentrated than others. My conclusion (in my case) is that it is the insuliin.
One way to avoid this “stacking” dilemma is to use the Medtronic Minimed 722 with the Bolus Wizard. When I enter that program, it asks for the BG reading, then the carb intake. From there it is programmed to calculate how much it needs to cover the carbs and just how long and how much your last bolus was taken. This all depends on how your meter is programmed to your personal needs. If needed, it subtracts any insulin that may be left in your body so that you can’t overdose. Sometimes it doesn’t allow another dose. Sssssswwwwwweeeeeeeeeeeeeeeeetttttttt!!! LOL
Getting the pump for pump’s sake! I like that one!! Actually one trap to look out for is that some people tend to gain weight when they go on the pump. WHY? Because we get very casual about what and when we eat. Want a hot fudge sundae?.. then give yourself a dose. Want another serving of pasta? … then give yourself some more insulin. Be very aware and wary of what you’re putting in your mouth!!!
Actually, every point you can shave that doesn’t get low is valuable to conserving your health. They find that a constant number of, say, 130 over the years is consistent but bad for your health. Better to be lower without going “low.”
