MDI or insulin pump -- which do you prefer?

Alicia R said:

My friend just called -- her doctor wants to put her on an insulin pump with a CGM. She's all for it because she's into gadgets and stuff, so being on an insulin pump, at least the idea of it, doesn't bother her too much. Now, it's just a question of whether or not her insurance will pay for one! She asked me why I never went on the pump, myself, and I drew a blank. It never occurred to me to ask for one because I always did so well with the injections. I'm so used to giving myself injections (my mother made certain I knew how even as a kid) I never thought about pumping. Now that I think of it, I'm curious: are there any advantages to pumping versus MDI? If you had to choose or if you had it to do over again, which would you choose: MDI or an insulin pump? I hear pumping is hard work and involves a lot of steps! Thanks in advance!

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I will be interested in any replies you get on your very thought provoking post. I have just decided not to go on to the pump for reasons very personal to me. I am coping fine with MDI, I've done the New Deal Carb counting course (I live in Scotland I believe this course is called Dafne in England) did this about 3 years ago and it has made a huge difference to my life in so many ways. I look forward to reading any replies - but as far as I can see - whatever suits you is the best thing. People with pumps talk about flexibility but I have found MDI to be just as flexible for me. I am on Levemir twice daily, total of 14 units per day, and NovoRapid when I eat. I adjust my NovoRapid depending on the carb count, and most times I do the NovoRapid after I have eaten, which was recommended to me by both by DSN and dietitian. And this seems to work fine. Nothing is ever perfect but I would rather be on MDI than be attached to a pump. Again, it's personal. I've been diabetic type 1 since 1972 and I have good control. IMHO if it's not broke, don't fix it!

To me this is going to be a very interesting ,I am about to go on a pump.I have been injecting insulin since 1963 and managed for the majority of the time to have good control of my diabetes but unfortunately over the past 2 years have lost my Hypo awareness and no matter what I do I appear to be unable to get it back.i have managed to avoid any hospital admissions,by the skin of my teeth,and my lovely wife who able to spot my signs of hypo.To me it's a no brainier,it's a pump and CGM is my only way forward,but another challenge in the life of a diabetic and I am up for it. This is the only diabetic complication I have so I don't have to many complaints.Thats not to say that diabetes is not a pain in the ass and a lot of hard work.

Now pumping, wouldn't change back to mdi. Much better control and easier to change basal rates when needed anytime. Only downside is having to be attached to it 24\7 but, there are many pros to the one con of pumping. yes its hard work initially learning about different cannulas, getting basal rates correct, but worth the initial effort.

I am on the waiting list for a pump -- i have been approved by the dietician and my appointment with the endocrinologist is in July.
I have impaired hypo awareness and have been approved on that basis as currently my HBA1c's are around 38 or 39
i have been doing MDI for about 18 years.

I am hoping to smooth out the lows being on a pump and from everything I have read these are the sorts of things to be expected if the hard work is put in to the pump. The actual injections I do currently don't really bother me.

I do have the niggling if it's not broke why fix it going around in my head but the lows are a worry and reducing those is an important factor.

Okay - an ignorant question. Do the pumps inject basal and quick-acting? Or do they just inject micro amounts of quick-acting as needed so you don't really need a basal?

LucySW said:

Okay - an ignorant question. Do the pumps inject basal and quick-acting? Or do they just inject micro amounts of quick-acting as needed so you don't really need a basal?

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Pumps act more like a pancreas. Humans don't have long and short acting insulin, just short acting insulin with a tap. When you need background, it just drips. When you eat, the tap is turned on.

A pump is similar. It simply provides a constant drip feed of fast acting insulin at low levels, then you turn on the tap (bolus) for food.

Thanks Tim.

LucySW said:

Okay - an ignorant question. Do the pumps inject basal and quick-acting? Or do they just inject micro amounts of quick-acting as needed so you don't really need a basal?

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You use just the one insulin in a pump, I use Novorapid and this acts as both basal and bolus. The advantage over a MDI is you can set different basal rates for different times of the day, the pump I use (Omnipod) you can have up to 7 different basal rates, so you can deal with things like DP more easily than on injections.

Pumps mean you attach more clutter to your body. You have to think about "which side will I sleep on? Can I wear that tight shirt?" On holiday you can't strip off at the beach so easily. CGM will eat up areas of your skin, and, really it's not too pretty.
Those are the down-sides.
The good things are that it's REALLY easy to do correction doses with a wireless controller (A MUST, don't want to fish the pump out and twiddle buttons unless you REALLY have to). It's REALLY easy to sort out extra basal for sniffles and colds (you also can diagnose a day ahead you're getting a cold, basal requirements zoom up). Nibbling anything any time is REALLY easy, and if you want to lie-in and do nothing all day? Sure go ahead. Just take the basal. CGM is a definite plus, but it's very expensive - definite luxury territory ;-)
When I look back, I don't think I would have wanted a pump in my 20s, a pen was fine. As I've slowed down a bit in my 40s, a pump & CGM is really really nice.

Interesting reading. I've been type one for 36 years, now at the age if 46 I'm fed up and control is becoming more difficult. I never considered a pump, just the thought of being attached to something 24/7 was not for me. I'm now thinking seriously about making the change. I'm struggling with depression due to my diabetes at the moment and due to the work involved in changing to a pump I doubt my consultant would make the change until my 'head' is sorted out. But I am very keen and have read a lot about using a pump. Here's hoping x

I found a pump grest to have in the first 12 months, then the next 12 months, i wasnt so sure as i had problems with infusion sets etc and needing to bg test frequently to make sure the pump was working and to keep on top of changing basal rates due to weightgain, changing weather temps. The good thing about pumping is basal control overnight which can tackle high and low bg so for that alone, they are excellent.

How are you doing with your new pump Noblehead?

LucySW said:

How are you doing with your new pump Noblehead?

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Thank you for asking Lucy

It's going really well and better than I thought, it takes time and effort to get the basal rates right but its worth it in the end, need to tweak them again this week as I've had a couple of lowish bg readings in the last week so need to do some basal checks, but love pumping insulin and wish I'd changed over several years ago, injections never really bothered me too much but now I'm not doing them I couldn't go back.