Choose one: CGM or Pump?

[SamElliott1997]

So, I know both CGMs and pumps can be indispensable in fine control of type 1 diabetes, but just a thought, if you have both and had to lose one, or have neither and had to gain one, or have one or the other (I currently have a Libre with a Nightrider linked up to xDrip and Nightscout), and had the ability to switch, what would you do?

For me, if I HAD to choose between the two, CGM. It takes a lot of worry out with hypos, especially overnight. It's also great for timing doses and adjusting basal, and a whole host of other things.

A pump is also fantastic to use, as far as I see it's most useful is the adjustable basal rates, which is great to use depending on activities or if you suffer from dawn phenomenon. Also much easier to bolus, especially when you're out in public. And the ability to suspend your basal.

However, I feel that to operate a pump effectively, you need a CGM. Looking at the overnight trend to adjust basal and counter the dawn phenomenon. And the only way you're going to suspend a low is if you feel it, or if you happen to test when hypo.

I could be wrong about the pump, as I don't have one. But I feel if I HAD to choose between these two pieces of life changing technology, I'd go for a CGM.

What would you all choose and what are your reasons why? Include negatives if you want too, I didn't include negatives because a lot of them are obvious like inaccuracies for CGMs, and pump blockages/failures, the fact that with both, something is attached to you 24/7 etc...

I look forward to reading your opinions

 

[Nicola M]

That's a tough one and I'm glad that I'm fortunate enough to be in a position where I'd never have to make that choice.

I've had my pump for almost 3 years now and it's helped me immensely in getting rid of the dawn phenomenon effect I have in the morning and I feel it gives me more independence and control throughout the day. It also takes the worry out of having to do insulin injections in public.

But if I had to choose I'd go for the CGM any day. I currently use the Libre and for a few months I've been struggling mentally and haven't been doing my blood sugar testing like I should have and without the CGM I wouldn't honestly still be doing any now. So for me, the CGM is the much better option. Before my insulin pump, I also used injections for 17 years so I think I'd be ok going back to them.

 

[Deleted Account]

Easy peasy for me. I would choose the pump.

I occasionally use a CGM but find it so inaccurate I sometimes feel I am wasting my money. I have tried both Libre and Dexcom and found both to be randomly inaccurate. For example, the last time I had a Dexcom it kept waking me in the middle of the night telling me my BG was under 3.9. It suggested values like 2.5 (so not on the boarder). At first I GlucoTabbed up but it still kept waking me so I checked with a finger prick to find my BG was actually 6.5. The Libre would tell me I was very high (14.5) when I was actually around 9.5 (and had enough IOB to handle it).
Over the last few months, I have decided a CGM or Libre has some use to work out trends such as taking my insulin earlier when eating pasta and reducing my basal a lot (40%) 90 minutes before the gym but I only need to check these trends 5 or 6 times a year. I am far more comfortable pricking my finger and getting a number I trust.
I know many people find CGM and Libre invaluable. I have also spoken to people who, like me, find them wildly inaccurate. I guess there is something about the way our bodies work which result in fast BG changes which current CGM technology cannot keep up with.

 

[donnellysdogs]

Had all of them. For me loss of pump is my choice (because I so prefer being back on injections now).
My Cgm though is my preferred choice to keep as it enables management better and my living better.

Being out in cold or heat and with my dog with cgm I know I'm safe all the time...
When training to be an instructor, again I can see and hear if I'm ok..same with my other activities. So long as I have meter to test before I'm driving then it is life enabling for me.

No worry over pump, cannulas working etc that I had.

Have enhanced my eating and range of foods because I can see how my colon/stomach is reacting.

We are all different and individual and this is what I wish CCGs and NICE etc would realise.

 

[Grumpy ole thing]

Hi @SamElliott1997, good question but sorry, but I would not like to use either. I cant imagine anything stuck to the outside of me, connecting to the inside (*teeth throbbing symbol here*). I'm also really clumsy so suspect I would come a cropper fairly early on. I'm hoping one of the non-invasive CGMs will become available shortly, mind you we were on the brink of a cure 45 years ago so I'm not holding my breath... ;-)

 

[LooperCat]

I’ll have my Libre any day of the week and twice on Sundays. I’m not keen on a pump being attached all the time (the sensor is ok though) and I don’t mind injecting.

 

[DunePlodder]

CGM

 

[Proto]

CGM

I was thinking about this the other day and would stick with the CGM in a heartbeat for all the reasons you mentioned. The pumps great but its just another method of delivering insulin. I would probably use pens with a self funded iPort just because the reason I went on the pump originally is the single 'shot' every 3 days. The CGM has no other comparable alternative however.

 

[donnellysdogs]

I wish I could properly relate to people how much my funded CGM has chsnged my life for the better.

I have just submitted information to my CCG panel for further funding (as an exceptional case).

I sent in 8 written pages of positives and a stack of my log books as evidence.

I hope that they will regard this evidence as good for otgers in the future. This hasnt just helped my levels, but has helped me with eating and finally being able to get back to trying some different foods and getting a much needed 21lb back on me and a size 10 again (without worry) and no hospitalisations and finally being signed off by my gastroenterologist for an annual review instead of 3 monthly ones.

As my skin decided it was not liking cannulas, the pump was causing me to be hyper vigilant. My cancer screwed me up and my stomach/colon was on top.

Now, I can manage my own colon/stomach/food/diabetes and am getting back to health again.

On the guidelines for decision making with cgms by the panel it states that alarms can be intrusive and negative to people wearing CGM's...
For me, well, I am so, so grateful for alarms. Hugely better than having to set an alarm clock every night at 1am etc just to check. I have to take first injection(s) at 3.30am anyway and that was having a negative on me.. but like last night (got a virus currently) I went to sleep early at 11pm and it alarmed at 1am and I had to inject. However, I've had 9 months of not having to wake at 1am or at extra times due to the CGM... it is empowering...

I did a photoshoot a couple weeks ago though... and some photos had clothes, some didnt. Except nobody until a while in to shooting photos actuslly realised the cgm was stuck on my bum!! Nobody noticed it! And I forgot about it... so its hardly invasive or intrusive physically either.

Hoping when get the photos to send my consultant a photo!! And if no further funding sllowed, will send a photo to the Panel too!!

I do think you have to care about your levels and health to get benefit from cgm.. I do know a particular T1 like me who just doesnt give a **** and funding would be wasted as that person says that she will never change anything as she doesnt see the point...

For me the CGM has been the most empowering gadget for MDI usage.

 

[jackois]

cgm for me.... every time

 

[Scott-C]

I'd go for the CGM, without a doubt.

We're dealing with an unpredictable constantly moving target here: bg levels.

Cgm lets us see and monitor and gently steer that target in a way that strip snapshots, useful though they are for calibration, corroboration, checking against askew cgm output etc. can never do on their own.

Seeing what we're dealing with in more or less real time via cgm seems to me to come before any issues of whether mdi or pumps are better.

Cgm improves the management of both, so it must come first in the list of new toys we've got to play with.

You can have the best platinum plated pump on the planet, but you'll still be kinda blind without cgm.

This thread is a bit like Desert Island Discs! In that scenario, I'd be binning both the cgm and pump - there's no plugs on a desert island - and stocking up on colour-changing strips and some papers from the post-Banting days about how to make insulin from scratch from pancreata of rabbits!

 

[kev-w]

The CGM or Libre without any doubt whatsoever.

Though I'm scared of the idea of a pump being quite clumsy, and the only person I know who's had one went back to mdi and their HbA1c was a fair bit higher than mine (although this is a kid still in their honeymoon period). I would have thought a CGN would be a necessity for a pump user..

I found the Libre trial pretty eye opening after 33 years, I finger prick 10x+ and don't always catch hypos until I'm under 3 and it mostly fixed that, and even though I'm not using one have got rid of a few hypos from what I've learned and haven't had a blood of over 15 since either,

 

[becca59]

Very interesting thread. Thanks! Oh and definitely the CGM for me. I eat less as you can see the trends and have less hypos. Amazing bit of kit.

 

[iHs]

I love using a pump even though they demand frequent bg testing to get the settings correct but, I love cgm on a mobile phone screen even more, especially now that predictive alerts can be used and the rise or drop in the data dots enable me to keep on the straight and narrow. Team that with a smartwatch and there's not too much more needed except an AP and that's not too far away now