Opinions wanted -pump versus Lantus
Posted 03 August 2007 - 07:28 PM
I know a lot of you have used pumps for a long time & never used Lantus, or may have only used Lantus for a short time after diagnosis before pumping.
So I am wondering if there are some people who have used Lantus for 2+ years & then switched to a pump.
I like Lantus & it suits me, but would be interested in hearing comparisons from those with experience of both. Both in terms of results & anything else else you think might interest me.
Pumps are not funded where I live so the decisionis a bit more critical as it involves a big financial committment.
Posted 03 August 2007 - 09:40 PM
For me, Lantus did not even compare to the control possible with the pump. I realize the expense is high without insurance, but your eyesight, limbs and life are worth every penny...
Posted 03 August 2007 - 10:38 PM
Just my opinion.
Posted 04 August 2007 - 12:13 AM
On MDI and doing well. A1Cs range from 5.6 to 6.4. December 2016 was 6.1. 12 911's in my career; a few highs; lots of shots. Diagnosed Oct 19th, 1975.
Proliferative retinopathy March 1994, 4,000 laser, vitrectomy Oct. 2006. Vision 20/25 in right, 20/40 in left (slight cataract).
Posted 04 August 2007 - 12:40 AM
While individual experiences vary, the research suggests that control improvement with CSSI over Lants based MDI is fairly marginal. Below is a summary of the research taken from the Medscape website:
Log In Problems
New Data on Glargine and CSII?
An earlier "Ask the Expert" question this year dealt with insulin pumps. At the time, there were significant advantages to using insulin glargine and insulin pumps for the treatment of diabetes, but there were no head-to-head studies. Are there any new data?
Response from M. James Lenhard, MD
Medical Director, Weight Management Program, Preventative Medicine and Rehabilitation Institute and Chief, Section of Endocrinology, Christiana Care Health Systems, Wilmington, Delaware.
Continuous subcutaneous insulin infusion (CSII), or insulin pump therapy, represents an increasingly popular method of treating diabetes. Several studies were presented at the 63rd Scientific Sessions of the American Diabetes Association that examined CSII compared with glargine.
Glargine is a long-acting basal insulin, with little or no peak over its 24-hour profile. When used with rapid-acting insulin analogs such as aspart or lispro, it has been called the "poor man's pump" because the basal and bolus regimen is similar to that obtained with an insulin pump. A randomized, prospective comparison between CSII and glargine in children was conducted at Yale University. Twenty-six children (39% male, 79% white) with a mean age of 12.7 ± 2.7 years completed the 16-week study. The study is ongoing, and after 16 weeks the subjects are allowed to choose the therapy they desire. The children who were randomized to multiple daily injections (MDI) with glargine and aspart had no significant change in their hemoglobin A1C (HbA1c), with values declining minimally from 8.4% to 8.1%. The children on CSII with aspart had a significant decline, from 8.1% to 7.2%. There were 4 severe hypoglycemic events in the group treated with MDI, and 2 severe events in the group treated with CSII. In addition, subjects randomized to the group with CSII were able to decrease their total daily dose of insulin, while the subjects in the MDI group had no change. The study authors concluded that CSII was more effective at controlling type 1 diabetes in children than was MDI.
A retrospective chart review of 103 patients with type 1 diabetes compared CSII (58 patients) with MDI (45 patients) consisting of glargine plus a rapid-acting insulin analog. This study used a longer duration of treatment than the Yale study described above, with 16 months of treatment for the CSII group and 11.6 months for the MDI group. The authors found no difference in HbA1c levels between the 2 groups (6.79% vs 6.84%), nor was there a difference in severe hypoglycemic events.
A third study looked at patients who wanted to take a break from CSII and go on a pump holiday. Thirty patients with CSII-treated type 1 diabetes were randomized to either 4 months of continuing CSII or MDI with glargine and an analog. There was no significant change in the HbA1c levels in either group, nor was there a change in the incidence of hypoglycemia.
Also presented was a multicenter, open-label, randomized crossover study of adults with type 1 diabetes. This study involved 100 subjects with CSII-treated diabetes. Subjects were randomized to either continuing CSII or MDI with glargine and aspart. After 5 weeks the patients were switched to the alternative therapy for 5 additional weeks. During the last week of each treatment period, subjects wore a continuous glucose monitoring system (CGMS; Medtronic MiniMed) for 2-3 days. Glycemic control was superior with CSII as measured by fructosamine (343 vs 355 micromol/L for CSII and MDI, respectively) or by area under the curve glucose from the CGMS. There was no change in hypoglycemia.
These 4 studies are interesting but probably are not the final chapter in the comparison between CSII and MDI. They confirm some of the things that we already know about CSII. CSII is usually at least as effective as MDI in both achieving glycemic control and preventing hypoglycemia, and may be superior. The skill, training, and patience of the healthcare team providing the treatment directly affect success with CSII as well as MDI. The proper selection of the patients who use CSII plays a significant role in the successful outcome. It is possible that studies that fail to show an improvement in outcome from using CSII suffer from excessively talented healthcare providers that are capable of achieving excellent outcomes with MDI.
In addition, these studies raise some additional questions: What is the optimal length of time to compare outcomes between CSII and MDI? Do outcomes differ between children and adults? How much of the observed differences can be explained by patient preference and motivation? Hopefully the answers to these questions and others will be addressed with ongoing research.
It is hard to know how much benefit you might get from a pump without actually using one. Most of the pump companies offer a free trial, during which you only have to cover the cost of supplies. I will probably do this at some stage, but I can't get enthusiastic about it as the value proposition is far from compelling. Essentially, whatever improvement in control can be achieved through CSII will cost NZ$3,500 per annum. That is based on the amortisation of a $6,000 pump (Accu Chek Spirit - the other pumps are more expensive) over it's 6 year life and NZ$2,500 per annum for supplies. That comes to $52,500 over a 15 year period.... If I saved that amount and invested it, I would have a very nice retirement nest egg!
In my humble opinion :wink:
Type1 since 1977
now using a pump
Posted 04 August 2007 - 12:51 AM
Posted 04 August 2007 - 10:52 PM
The similar A1cs was pretty much what I suspected.
I am still interested in hearing other opinions if anyone out there would like to respond.
Posted 04 August 2007 - 11:03 PM
Posted 04 August 2007 - 11:50 PM
Also Lantus doesn't work for everyone in 1 shot/day, and in some it has caused phsycological side effects (pop only 2). I don't think this kills my hypothesis of the length of time in the first paragraph eathier, but I think that those who are on 2 shots of lanus per day (and there are quite a few on here) could better answer as to how that works for them.
I personally just can't use a pump. I had a tube that stuck out from my belly into my stomach (peritenal cavity actually) for dialysis and ever since being healed (jesus was there, no doubt) and having any kind of tube connected to me to sustain life like that is just a horse I want to shoot.
To me the fact that pretty much EVERY diabetic loves their pump and wouldn't want to go back to MDI is a very powerful testimony for how great it is to control diabetes. There also those who fall under the sides of the bell shaped curve.
Posted 05 August 2007 - 10:22 AM
I am convinced that how well MDI works is an individual thing. For me, taking the whole dose of lantus in one shot left me with dangerous lows 4 hours after the injections, and highs 2-4 hours before I took the injection again 24 hours later.
Taking it twice daily has given me much more consistant coverage, and the ability to match my own personal needs for the two seperate 12 hour stretches of a day. I do not doubt for a moment that I could tweak my basal's to within a gnat's eyebrow on the pump, and I personally would think that is the major benefit of pumping.
By learning how to chart out how much basal insulin I am getting every hour of the day (thanks, Duck!) I was able to make some adjustments to my humalog and gain what I consider to be good control without perpetual hypo's.
I considered the pump very strongly last year, and I personally am not convinced that there would be that significant enough of a change in my A1c to warrent the expense, and to me, the hassle. That's just my opinion, though.
Incorrectly dx'ed type 2 7/00
Correctly dx'ed type 1 5/01
Lantus 2x daily & Humalog
Posted 05 August 2007 - 02:33 PM
My basal rates have multiple cycles with significant variations throughout a 24 hour period from 0.5 u/hr to 0.8 u/hr. My basal pattern on the pump would be hard to match on MDI. In 16 mos with the pump, my A1C went from 9.4 to 7.5, with far fewer extreme highs and lows. Adding the CGMS in May provided even more insight into my patterns (288 readings a day being better than 12 finger sticks), and I have managed to drop my A1C to 6.8. I plan on dropping it further still, with the help of these two tools.
For some people, the pump may not make much difference, and certainly when you average the results across a population, it doesn't appear like much difference - but the "average" family with 2.3 kids includes those with 1, 3, 4 and 17(!) kids, as well as those with none. For me, pumping made a world of difference.
I think it comes down to a personal decision. If you are able to achieve your personal health goals (low deviations from target BG range, desired A1C, lack of complications, adequate flexibility and ease with MDI, etc.), the pump may not add much to your quality of life. It is possible however, that the pump could make a big difference in your life, whether or not it did so for any other 10 people. It all depends on your reasons for wanting (or not wanting) a pump.
All the best whatever decision you make,
The above is my personal opinion, and Your Mileage May Vary.
- May 2 1995 - "D" Day
- Feb 2006 - Animas 1250 (Silver)
- May 2007 - Animas 2020 (Silver) - Guardian REAL-Time (MiniLink)
- Sep 2011 - Animas Ping (Silver) - Dexcom 7+
- Dec 2012 - DexCom G4 (Pink)
- Feb 2015 - Animas Vibe Upgrade (Pink)
- Apr 2016 - DexCom G5
Posted 06 August 2007 - 05:18 AM
Just sometimes I am sick of jabbing myself all the time for the bolus, & if I want an extra snack the thought of one more shot is a deterant. I'm often hungry late afternoon, which means either snacking & ending up high before dinner, or getting home from work hungry & grumpy! Also it would be great to be able to top up when needed rather than think "I"ll just wait till the next meal as it's only an hour"
I know I can have extra jabs for those times, but I figure 4 per day is enough!!!!
Posted 06 August 2007 - 04:11 PM
I'll respond as one who takes lantus in two shots a day.
I am convinced that how well MDI works is an individual thing.
I tips muh hat to yore keen observational
Each of us has to do what works best for that indiviual------------------------PERIOD.
If that means kissing Toads on the third eclipse of each alternate month, then that's what you have to do.
CDE I work with wanted me on pump from day ONE-------thbbpt---------my average A1c is 5.4, at first she kept saying I was still on honeymoon, but after 3 years, she gave up and now lets me manage my injections, boluses, and corrections as it suits me.
Ya gotta do what ya gotta do when it comes to Diabetes
Frodo to Samwise