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Please help me understand MDI

Do you experience more hypos on mdi or the pump?

  • More on mdi

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  • More on the pump

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Marmar00

Member
Messages
5
Hey guys!
So ,I was thinking, What are the main day to day differences between the pump and MDI? For example , would I be safer all around while on mdi as far as malfunctions go? (I always have an somewhat irrational thought that my pump while break down and start giving wrong doses)Is blood sugar relatively equally stable on mdi coupled with a low carb diet compared to the pump?Also (and that is my main concern)do you notice more or less hypos with mdi ?are they more serious when they occurre dew to the irreversibility of the basal dose for 24 hours? The reason I am asking is because I am about to go to my first overseas trip and I am scared.I want to have the most reliable insulin delivery method .
I am really looking forward to reading your personal opinions in any of the above (sorry for bombarding you aswell)
Best of luck
 
Hi @Marmar00
I think the first question to ask is what insulin delivery method are you using at the moment. There are pros and cons for both methods and different people will have different answers as to what is the most reliable.

Also, what is your hypo awareness like and do you have a continuous glucose monitor of any sort?

As a long term (forty years?) MDI user I know and have experienced a number of potential causes for hypos, some more serious than others. But on the flip side I've never experienced a DKA, probably because I've always had some background insulin available to keep me going.

But I'm used to mild hypos and not bothered by them (just treat and go). My most serious hypos have been partly user error (eg mix up of basal and bolus pens, over zealous application of bolus for a high reading), and carelessness when I've had low hypo awareness. I've also had a couple of lantus lows (prpbably caused by injecting lantus into a blood vesse) which were definitely scary.

But I've traveled overseas quite a lot on MDI and never been hospitalised for a hypo while overseas (though navigating airport security while hypo and scoffing glucose tablets is no fun). And make sure some glucose is in your pockets if you are flying. There is no point having it in your hand luggage if said luggage is packed in the overhead locker when the seatbelt signs are on.

Are you travelling overseas alone, or with friends or colleagues. It's easier with others as you can get them to help you if you go hypo, but I've travelled alone as well.
 
Welcome @Marmar00
I assume you are newly diagnosed.
Most of us started with MDI and have done lots of travel with MDI with little problem - there is no reason why you should hypo more when overseas than you do at home. I have travelled to some pretty out of the way places (Nepal, Uganda, Venezuela, ...) with MDI and not had any major issues.
At pump is not something that is given out easily in the UK - it is an expensive piece of kit so they are limited, needing justification that a pump would resolve known issues.
The advantage of the pump is that it is possible to vary the basal dose every 30 minutes to match when the body needs more or less. This is great IF you understand how, when and why to make the adjustments.
Pumps rarely fail but, as you say, there is a risk so you always need to be able to revert to MDI if that happens, But if they were always failing they would not be fit for use. Bear in mind, when a pump fails it stops - it does not give the wrong dose.

Whether MDI or pump gives a more stable blood sugar depends on the person. I use a pump because my basal needs vary greatly, especially when I exercise. But most people use MDI and travel.

If you are interested in a pump, I advise doing some further research and talk to your diabetes team. I would recommend having some well thought out justification why you think a pump would assist your diabetes management. "I'm going overseas" is not sufficient justification especially when you consider the large bag of pump paraphernalia you will need to take with you as well as the back up MDI.
 
In Response said:
"I'm going overseas" is not sufficient justification especially when you consider the large bag of pump paraphernalia you will need to take with you as well as the back up MDI.
Click to expand...

Plus I wouldn't want to change to a new system at the same time as going overseas
 
Thank you so much for taking the time to respond! I have been on the pump since the start so I am wondering if the grass is greener on the Mdi side.The hypo problem is more of a fear from previous dangerous episodes.I end up keeping my bg very higher than I would want to avoid worrying about hypos when I am out and about,so I rarely get low anymore.I am traveling alone and I will be very uncomfortable if I know I am even a little far away from a hospital.I don't feel that I have much confidence even having planed and overthought almost everything.
 
Marmar00 said:
Thank you so much for taking the time to respond! I have been on the pump since the start so I am wondering if the grass is greener on the Mdi side.T
Click to expand...

As a pump user, you presumably carry spare syringes or insulin pens so that if the pump fails you can use MDI???
In your position, I would keep with the system I know so that I could concentrate on the experiences of the overseas trip.
A dexcom or a libre might help you manage your hypo fear.... (It's certainly helped me.)

Anyway, most important, enjoy your trip...
 

Hi,

From what I can gather you have been diagnosed for nearly 20 years?

A trip abroad is a great opportunity. Sounds like your first time…
Stick with what you know. Your pump.. Now I’m not a pumper. But I wouldn’t wish to faff with a new regime on the eve of a holiday..
However, to belay any initial anxiety. Carry & plan gear for a “pump break?”

plan for the worst, & it never happens…

Have a fantastic trip.
 
In Response said:
Do you have evidence of this?
My understanding is that as a safety critical device this should not be possible.
Click to expand...
Unfortunately all technology can fail and can also fail in ways which are unexpected. Insulin pumps and the control devices are not exempt - neither for that matter is mdi technology. Too little or too much insulin are both potentially dangerous so there is not really a true fail safe state - and even if there was it is not possible to design something as complex as an insulin pump to always fail in one direction.
You may find the majority of insulin pump failures to result in low insulin delivery but that does not mean all insulin pump failures result in low insulin delivery.

If you look on the net for fda insulin pump failures you will find some reports - most are old and technology has improved but there will still be failures ...

ed: example product recall here
 
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