Pumping vs. MDI

Insulin pens and insulin pumpWhen I decided to stick with MDI in March after my pump broke, I said I would write more about the comparisons between MDI and pumping. I never did that so thought I would do that now.

One big plus of pumping is the multiple basal rates. Most people take one or two shots of Lantus or Levemir. Some people need more variety and they can have more basal rates with a pump. I take three shots of Levemir per day. I was always able to get fairly flat coverage with the three shots, but lately, my basal needs have changed. If I take enough Levemir to stay flat in the mornings, I end up going low after lunch. If I were on a pump, I could just set the pump to change basals rates when my body needs more or less basal.

You can also change your basals or suspend them on the fly with a pump. If your plans change for the day once you take Lantus or Levemir, that insulin is floating around in your body and you can’t take it back. You can change your basals with a pump or suspend them altogether.

Another advantage of pumping is no alarm clocks to remind you take to your basal insulin. I take my Levemir at 7 AM, 3 PM and 11 PM. If I want to sleep in late, I still have to set an alarm to go off so I can take my Levemir. I didn’t have to do that with a pump and actually slept in a few times. If I sleep in while taking Levemir, then I would wake up high.

Another nice thing about pumping is you can dose very precisely. If you want to take 0.15 units of insulin, you can. That is hard to do with a syringe.

You can also do extended boluses with a pump. You tell the pump how much insulin you want and spread it out over a certain period of time. You don’t have to remember to keep taking multiple shots after your meal, the pump will do all the work.

A lot of people are concerned about having something attached to them 24/7. That was a concern of mine before I started pumping but it really wasn’t a problem. Other than a few times I got the tubing stuck on something, I didn’t really notice it was there.

So if pumping is so great, why did I decide to stick with MDI? I had two pumps break in 8 months. I knew that any piece of equipment has the potential to break, but I thought a pump would be more durable. I also did not know that when the pump breaks, it gets replaced with a refurbished one. That is something that really bothered me. To me, using a pump that someone else used is like using someone else’s toothbrush.

The first pump caused a lot of problems and I did not even realize it was the pump until Animas replaced it. Right after it broke, a new Ping user in the Animas Group on TuDiabetes complained about the 16 extra units of insulin left in the cartridge when the pump said the cartridge was empty. I almost told him that he was wrong because my cartridge was always empty. When the replacement pump came, I deliberately ran the pump out of insulin to see and there was insulin left in the cartridge. I didn’t get a syringe to measure it but it looked like about 16 units. That makes sense because if you actually fill the cartridge up, the pump says you have 184 units of insulin, not 200. In the very beginning, I filled it up the whole way because I wasted so much during priming and didn’t know what my needs would be. When Animas replaced that first pump, my TDD went up by about 10 units a day and my levels were higher than they had been.

A lot of people say that you don’t have as many lows with a pump but I actually had more with that first pump. When I would go shopping, I always ended up low even if I turned the basal way back. I rarely go low with Levemir when shopping. I am guessing that movement helped speed up the insulin but I don’t know that for sure. I just know something wasn’t right. To be clear here, that only happened with the first pump not the second one.

Apidra is my insulin of choice and it is very heat sensitive. I had a lot of problems with it in the pump. In the summer, I had to change my cartridge every day and a half or I would end up high. I did read other people had that same problem so I know it wasn’t just me.

I also seem to build up scar tissue very easily. I properly rotated sites so I know that wasn’t the cause. I had little red marks for about 2 weeks after I pulled a site so I know I was not reusing sites too soon. When I went back to MDI, my skin was actually crunchy when I would stick a needle in. In 27 years of taking insulin, I never had crunchy skin before.

It was rare that I ever had a site last 48 hours. Between the site problems and the Apidra problems, I was seeing 200s every other day. Yes, I see 200s with MDI, but not every other day.

I can get better control with MDI than I did with a pump, so I am going to stick with that. I have no regrets trying the pump – you won’t know if you like something or not until you actually try it.

Comments

  1. Thanks for sharing this, Kelly. I’m always interested in hearing about others’ experiences in MDI v. pumping. As you likely know, I took my own hiatus back in 2010 and then briefly this year. For me, pumping has always been the preferred method (in the decade I’ve been pumping) and I’ve loved it (still do). It’s never been the connection 24-7 for me. But I’m not the best in proper site rotation and slack on that way too often, and I think that’s caused more scar tissue and site problems over time. I’ve become less enthused and actually have sometimes dreaded changing my sites, to the point I have needed mental and emotional breaks from pumping. That’s helped a lot. For me, it seems like it’s not necessary the method of D-Management, but the focus on doing what’s needed and the discipline to maintain that management. When I do that, I’m in pretty good waters. But being lazy, I run into issues more often than I probably should. Oh well. Like you said, it’s about doing what’s best for you – whatever works, go for it!

    • Thanks Mike. I knew you had taken some pump breaks. I think we all need a mini-vacation once in awhile and just ease up on the stuff we do on a daily basis – I don’t mean quit taking insulin, but just not worrying about what will happen if we eat something. I think if I could find a solution to the site problems, I would have stuck with pumping. There really are a lot of advantages to it. I forgot to mention in this article that I got hives from the Teflon sets so that really narrowed down my choice of sets.

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