I’ve lived with sort 1 diabetes since 1997, and I’ve been managing my diabetes with insulin injections (a number of each day injections – MDI) since day one. I briefly tried an insulin pump, and it was not for me, so I’m again to being completely satisfied and thriving doing MDI.
On this publish, I’ll stroll you thru my journey and why I select to make use of insulin pens over an insulin pump.
My purpose with this text is to not sway you both method, however to inform you my expertise and to provide the rundown of the professionals and the cons of insulin pumps and insulin pens respectively.
With the appropriate information, we are able to make knowledgeable selections, and it is going to be as much as you to decide on what appears best for you. There’s no one-size-fits-all with something in the case of diabetes.
My machine journey
Once I was identified with sort 1 diabetes in 1997, I used to be handed a blood glucose meter and a prescription for prefilled insulin pens. Prefilled signifies that the insulin was already within the pens, all I needed to do was screw on the needle and draw up the variety of items I wished to dose. When empty, I simply tossed the pens within the trash.
As with anybody on MDI, I used to be prescribed a short-acting insulin to cowl meals (bolus) and long-acting insulin to behave as background insulin (basal).
I don’t keep in mind precisely what sort of insulin I used to be prescribed but it surely required me to eat sure instances — it was in all probability NPH insulin. This basal insulin had just a little ball within the combination (like some bottles of nail polish do), and I needed to gently transfer the ball by the liquid to combine it earlier than use. Not precisely optimum, but it surely labored.
As newer insulins got here to the market, I switched to utilizing Levemir as my basal insulin and Humalog as my rapid-acting insulin, protecting meals and corrections for highs.
The one factor that has modified for me since is switching from a prefilled Humalog pen to a sturdy pen, after which from a traditional sturdy pen to a sturdy Smartpen. A sturdy pen merely signifies that the pen is reused and solely the insulin cartridge is tossed when empty.
The upside of a sturdy pen is that it may give ½ items of insulin (the prefilled used to solely be capable to do 1-unit increments). And the upside of a Smartpen (I exploit an InPen) is that it helps hold observe of my energetic insulin on board (IOB), helps me in calculating my doses, jogs my memory after I must take my basal insulin, and routinely information (by Bluetooth to my cellphone) all of the injections I take.
I’ve additionally added a steady glucose monitor (CGM) to my diabetes toolbox, and that has been an actual recreation changer. (Learn extra in regards to the execs and cons of CGM HERE).
Once I tried rocking a pump and why it didn’t work for me
In December 2017, 20 years into my life with diabetes, I made a decision to attempt an insulin pump. I wished the very best care, so I made a decision to attempt Looping. Looping is a DIY (Do It Your self) model of the factitious pancreas know-how.
A regular insulin pump will routinely (based mostly on what it’s programmed to do) ship small quantities of rapid-acting insulin, equivalent to Novolog, Humalog or Apidra, 24/7. Some use the newer insulin, Fiasp (one other fast-acting insulin) of their pump, nevertheless, Fiasp is just not FDA permitted to be used in insulin pumps in the USA.
You continue to must immediate the pump to provide you a bolus for meals or correction, however the background insulin is programmed and automated.
With Looping (the DIY system) and the latest Medtronic 670G system, the pump takes it one step additional by adjusting your basal insulin doses based mostly in your CGM readings.
If the system thinks your blood sugars will go too low, it’s going to droop administering insulin till it determines that your blood sugar is at a protected and steady stage. If it thinks your blood sugar is rising, it gives you extra insulin.
That is sensible, and I’m such an enormous fan of the know-how, however there’s a downside. And that downside, and in the end why an insulin pump didn’t work for me, is that the pumps are pumping rapid-acting insulin 24/7.
The drawbacks of rapid-acting insulin
Speedy-acting insulins equivalent to Novolog, Humalog or Apidra takes 15 to twenty minutes to succeed in the bloodstream as soon as injected. It doesn’t peak till 1 to three hours after it’s injected, and it’ll keep within the physique for 3 to five hours whole.
The brand new child on the block, Fiasp, hits the bloodstream and peaks a couple of minutes quicker, however just like the opposite rapid-acting insulins, it stays energetic within the physique for 4 to five hours.
The chance of DKA
So, if you happen to’re on a pump, you’ll want rapid-acting insulin to be circulating always to stop Diabetic ketoacidosis (DKA) from taking place (assuming you don’t have any insulin manufacturing in any way). Ought to the pump malfunction and cease delivering insulin, you’re at a heightened threat of going into DKA and ending up within the hospital.
When you take your insulin through MDI, which suggests you at all times have background insulin on board, the danger of DKA is way decrease (this, in fact, assumes you don’t neglect to take your each day background insulin dose.)
Low blood sugars & train
Since rapid-acting insulin lasts 3 to five hours, these utilizing an insulin pump must be very proactive in planning train or any motion in any respect. When exercising, going for a stroll or doing on a regular basis duties like vacuuming, you’re prone to experiencing low blood sugar when you have an excessive amount of rapid-acting insulin onboard. Since an insulin pump is delivering rapid-acting insulin on a regular basis, you probably may have an excessive amount of insulin in your system for any sort of spontaneous motion nearly all of the time.
Whether or not or not we use an insulin pump or MDI, all of us want to regulate our rapid-acting insulin if we wish to train or transfer round with out going low. Nevertheless, on MDI I solely have to fret about any bolus injections I’ve taken the final 4 hours since my basal insulin hardly get impacted by exercise.
When utilizing an insulin pump, I additionally needed to fear in regards to the insulin I’d obtained as basal for the final 4 hours. In fact, that may be executed, and I can train you ways (HERE). However for me, all that basal adjusting was simply way more of a trouble in comparison with utilizing MDI to handle my insulin.
Pumps have advantages however not sufficient for me
As talked about, I used to be Looping so the pump would modify my insulin when it estimated that I used to be about to have a low or excessive blood sugar. And it did, simply not successfully sufficient.
Since rapid-acting insulin lasts for 4 to five hours within the physique, there was no method the Loop system might sustain with my exercise stage. Sure, it received smarter, however my days are not often the identical and I’m a really energetic particular person. I used to be dropping low method too continuously until I disconnected and micromanaged your entire program.
For a lot of, the system is life-changing. If we had entry to insulin that labored quicker and had a shorter length, I’d in all probability be utilizing an insulin pump.
The upside of basal (long-acting) insulin
Basal insulin doesn’t get impacted by exercise in the identical method as rapid-acting insulin. That signifies that I (and my diabetes teaching shoppers who do MDI) solely have to consider adjusting my mealtime and correction boluses if I intend to train or simply be energetic. That signifies that if I resolve to train proper off the bed, there isn’t a adjusting insulin. I simply go. Identical take care of afternoon train, so long as it’s greater than 4 hours after the final bolus.
Some tips say to scale back long-acting basal insulin on days the place train is deliberate, and I generally try this. However all I modify is my nighttime basal. My endo recommended splitting my basal right into a morning and a night dose, and it has labored wonders for me.
I hold my daytime dose the identical (apart from days the place I’ll be sitting all day, like throughout an extended flight, then I’ll enhance it) and modify my nighttime basal relying on my exercise stage. That signifies that I don’t must plan forward in the case of my dose. I modify it after the day is over.
Professionals and cons
In terms of selecting whether or not to handle your insulin with injections or an insulin pump, the selection may be very private — and the selection is yours! Each strategies have their execs and cons.
Professionals of utilizing an insulin pump
- Potential to set a wide range of basal charges to match your private wants, with the choice to set small dosing increments
- Some built-in methods can modify insulin based mostly on CGM readings
- Pumps hold observe of IOB, assist calculate doses, and have detailed reporting out there
Cons of utilizing an insulin pump
- Being disconnected for greater than 4 hours or pump failures can shortly result in DKA
- The fashionable insulins final too lengthy within the physique for the trendy pump methods to essentially make sense
- Having to be hooked up to a tool 24/7
Professionals of a number of each day injections
- Lengthy-acting basal insulin hardly wants adjustment for exercise
- Not having one other machine hooked up to you
- Much less threat of DKA as a result of basal insulin and no machine failure
Cons of a number of each day injections
- ½ unit is the smallest unit increment you may dose
- Basal can solely be adjusted 1 to 2 instances each day (relying on whether or not you break up your dose) and the affect of that adjustment isn’t speedy
- Common pens (not Smartpens) don’t have a bolus calculator or observe IOB
What’s best for you: injections or a pump?
So possibly you’re keen on your insulin pump or your insulin pens, or possibly you’re prepared for a change. Perhaps you’re questioning if the grass is greener on the opposite aspect and switching to a distinct insulin supply methodology would enhance your diabetes administration and make life simpler?
In my view, you may obtain actually wholesome blood sugar ranges with each strategies. What determines your success is how that methodology of insulin supply suits along with your way of life, your character, and your willingness to take care of the cons of both methodology.
For some, the danger of DKA with a pump doesn’t outweigh the stress of getting to take not less than 4 to six insulin injections day-after-day.
Once I requested the Diabetes Robust neighborhood on Instagram in the event that they used an insulin pump or MDI, the responses got here again at 50/50, which appears to point that my concept of there not being a “one-size-fits-all” is true.
I hope this publish helped provide you with a extra nuanced image of the “Pump versus MDI” dialogue. And if nothing else, you bought to know me just a little higher.