[betty inquirer]

Hi Guys,

I am trying to find out a little bit of information about the types of medication that people use. I am not diabetic but i am doing some research into what issues stem from using insulin pumps as apposed to insulin injections.

Can anyone help me out?

[shiftzor]

Well I am an MDI user, on Novorapid (fast acting) and Lantus (long term). “Issues” is quite a broad term when talking about diabetes and MDI. I have "issues" from injection sites to finger pricking to simply trying to control my bg level and A1c. I can't help you with pumping as I’ve not used one, although I believe the basic advantages are that you get a steady stream of insulin that matches your body better than Lantus can. Despite Lantus supposedly having a flat absorption rate many people claim it peaks and runs out before its time to inject the next dose.

[betty inquirer]

Thanks Shiftzor,

I know that there are probably a million issues when talking about diabetes.I am, however really interested in problems specifically concerned with injection and finger pricking. Can you give me anymore details?

[BlueSky]

I think the biggest issue I have with injecting is remembering to take my insulin pen with me wherever I go. I always keep my pen and testing kit together as one is not much use without the other. Mislaying them is another issue. It doesn't happen often, but causes major inconvenience when it does. Some people are self-concious about injecting in public, but I got over that many years ago. Sometimes the injection hurts, which is annoying. I guess changing the needle every time must be a bind too, but also stopped doing that a long time ago. I can't think of any other "issues" with injecting insulin. Finger pricking has always been a nuisance and I am sure we all look forward to the day when monitors are non-invasive. But a new system needs to be cheap, non-invasive and to provide real-time monitoring to be an improvement on the current finger-pricking modus operandi.

[Subby]

Hi betty, I injected for 15 years and now on pump for 4 months.

Finger prickng - there is no difference between the two therapies here. In fact I probably take more finger tests now on the pump becuase I can effect change more easily (eg, corrective dosage with a few button presses, making a mid-afternoon test more actionable). I take between 8 and 14 tests per day. As Bluesky says it is a nuisance and non invasive forms will be great - but I think many diabetics agree that having out of control BG levels are a much bigger nuisance.

If you are talking about pumps with CGMS systems you might need to do some more hunting - people with both are around but it certainly isn't common yet due to cost and dificulty getting medical coverage. Such systems require multiple daily finger tests to calibrate the sensor, so do not negate finger pricking.

Injections:
Again talking for myself injections are a nuisance but not much more than that. I used to, and still do, hate shaving more than injecting. I never felt a stigma either. Of course for many other people injections are far worse and hopefully one of them will comment! Unfortunately, now I've been on the pump I would not see it as much better physically, but of course the stigma and most of the actual injections are removed.

With multiple injections you have the need to keep rotating sites to avoid scarification buildup under the skin. This is a bit like a war of attrition: if you are winning and managing it's ok, but if lots of useful sites get affected it can become a bigger problem. I really started to run out of effective sites as I seem to get lumpy quickly.

With pumps you put a new infusion set every 2 or 3 days. This is a large-needle guided cannula which I have to say is much more imposing than the typical MDI pen or syringe. You still have these "site" issues to contend with, although the rate of injection is much less. However, with a cannula stuck in you constantly, as you can imagine the sites can be a bigger deal. Problem infections don't seem to be an issue if you stick to 2 or 3 days maximum - but sites are often sore like a nasty pimple for a day or so after, for me. I havn't been going long enough to have a real estate problem, as it were.

With pumps there is a whole new range of livability issues that come in. Wearing it constantly, can be physical and psychological challenges. There is so much variation between people here: some people of course can't stand it, its a hindrance, reminder of their condition, etc etc. Others, like me, don't mind it because they "love" their pump - it's a burden gladly worn. Others of course fall in the middle.

One last thing I would say here - being on the pump does require being intimate with it on a daily basis.... it needs to be part of your life, mainly because many of us do find our needs change rapidly and we are need to be in a state ready to adjust settings, regularly. It is by no means "set and forget"... over a week or two for me, it's more like "set, keep an eye on, enjoy, adjust, enjoy, adjust, keep an eye on, enjoy..." Pump infusion systems have more complexity, more potential points to go wrong, to troubleshoot, etc. You need to be just as if not more patient with them! But my experience so far is that on balance they bring more ability to interact with your blood sugars, provide fine tuning, and make progress, that outweigh the negatives.

[Gary_W]

I don't pump yet, but am hoping to change that. In addition to what others have written, I would add the following bits that make pumping attractive vs MDI.

The newer-style basal insulins (Lantus and Levemir) are generally thought of as better than the older style as they have a much flatter response. The flatter response makes them more predictable and the lack of a peak does make management of BG easier.

There are problems with this, though. For a start, the length of time they last varies from patient to patient. Also, they DO peak. Not as violently as the older NPH but they are not 100% flat by any stretch of the imagination. Next problem is that the amount you inject seems to affect the absorbsion charactersistics. And the final problem is that, even if it did manage to stay 100% flat throughout the day and night, we all vary in our needs for basal insulin through the day and night so a flat response is a long way from what we actually need.

With a pump, you can (with experimentation) get it to match your basal needs in a far more accurate manner. If your basal insulin matches your basal needs, all of the other calculations that you must do on a daily basis have a much better chance of coming right.

You also have a far better chance of matching carbs to insulin due to the smaller delivery units. 1u of insulin drops me by around 2.5 UK numbers (47 US). If I start off with perfect blood glucose and eat a decent sized orange which has 24g of carbs. If my ratio is 1:10, I actually need 2.4U of insulin. I can do this on a pump. With MDI, I am left with a choice of injecting 2u of insulin and having a slightly raised BG as a result of too little insulin or I can whack in 3u and accept that I'll go a little low.

Gary

[ant hill]

Originally Posted by BlueSky

I think the biggest issue I have with injecting is remembering to take my insulin pen with me wherever I go. I always keep my pen and testing kit together as one is not much use without the other. Mislaying them is another issue. It doesn't happen often, but causes major inconvenience when it does.

I have been rather good with my diabetes but there are times that we do run in to problems that is inconvenient to bolus weather it is forgetful, Loss, Or damage is the stumbling block for us.

[Eddy]

Originally Posted by Gary_W

You also have a far better chance of matching carbs to insulin due to the smaller delivery units. 1u of insulin drops me by around 2.5 UK numbers (47 US). If I start off with perfect blood glucose and eat a decent sized orange which has 24g of carbs. If my ratio is 1:10, I actually need 2.4U of insulin. I can do this on a pump. With MDI, I am left with a choice of injecting 2u of insulin and having a slightly raised BG as a result of too little insulin or I can whack in 3u and accept that I'll go a little low.

Anybody mind if I hijack that thought, and x-ref another thread that I started?

Diluent? I wish to dilute...

U-100 annoys me, and evidently is even worse for Gary. And then there are children who are something like 1U:100mg/dL. U-100 is just too <insert favorite expletive> strong for some people. Type 2s might need it; many type 1s would be better off with a weaker mix.

[shiftzor]

Problems with finger prickers: small amounts of pain(sometimes), infections, loss of feeling in fingers, constantly having to find a side of my finger isn't saw or overused and lots of red/black marks.

Problems with Injections: quantities of insulin i.e “how much to inject?”, small amounts of pain(sometimes), drawing blood from poor selection of site, infections, bruises, red marks and changing sites to avoid this (thighs/stomach).

Problems with insulins: too strong/too weak, cannot mimic pancreas, side effects i.e depression (unproven) and can cause weight gain.

lol this is a miserable post, but through all of this we suffer and still lead normal lives. It’s not all doom and gloom, there are lots of things that can be done to improve these "problems" and are experienced by some but not by others. I am sure there are other problems, I just can’t think of anything else at the moment.

[ant hill]

Originally Posted by Eddy

Anybody mind if I hijack that thought, and x-ref another thread that I started?

Diluent? I wish to dilute...

U-100 annoys me, and evidently is even worse for Gary. And then there are children who are something like 1U:100mg/dL. U-100 is just too <insert favorite expletive> strong for some people. Type 2s might need it; many type 1s would be better off with a weaker mix.

Eddy, Have you looked at U40 insulin? This is used in animals like your dog or cat as you can inject larger doses without the stronger U100 insulin and, May I add that it is less of a jump from one unit to another.

Also to have an alarm on the pens too as this will help "Wake the brain to inject" as this can be of some help.

[SGT Shoutmore]

Pumping or MDI? Why do I want a pump? For starters, 5 injections a day SUCKS!

A narrower BG range, ROCKS. MDI does not give **ME** a narrower range means a hue difference in my qualiy of life.

Every insulin dependent diabetic should get the VERY best and latest means of BG control available. IMHO, at present time, that is a PUMP. MDI IMHO is an atiquated means of BG control of insulin dependent diabetes and should be left archived with I love Lucy re-runs. Again, this is MY opinion.

[squidsdc]

I'm surprised that no one has mentioned this yet, as all the posts above are well thought out and very true. I've been on MDI for many, many yrs, most recently with Lantus+Humalog for 4-5 injections per day and I have been pumping for 3 yrs. I was opposed to the pump originally because I didn't want something "attached" to me all the time. And if it wasn't going to do any better than what I was getting with MDI, why switch? Well, I think the advances in pump therapy finally swung my vote over. And now that I am on the pump (you just try to take it away from me--hah!) the biggest plus is the fact that I no longer have to design my life around the peaks and valleys of my insulin. As others have mentioned, even though there are no supposed peaks with Lantus, there is still the effect of it combined with the boluses of Humalog. For example, on a daily basis I would have to make sure I ate something before 11:50 am, or else I'd start to really plummet. If for some reason lunch was delayed, I was in big trouble. And then when my sugar dropped, I would have to eat more to get it back in line. With the pump, I can always suspend my basal if I need to, or reduce the amount of basal insulin if I will be exercising. The control over one's life is so much better. And the thought process does become second nature. I am definitely doing more finger sticks now that I am on the pump, but it is not something I fear or detest...it is a great tool to help me know what is happening in my body so I can do the best I can to try to have consistent blood sugars. But that's a whole different thread!

[mooredge]

Hey this is my first post.

I've been using the pump for about 9 years now, i was diagnosed about 14 years ago, so my opinion may be a little biased. Personally, i never felt that the pump hindered my ability to do anything. It took a few months to get used to it, but after that it was easy. Overall though the pump has made living with diabetes much easier. I never have to worry about remembering needles and insulin, and i can take exact doses down to 0.1U of insulin, consequently my blood sugar management had been much better. My A1C's are consistently less than 7.

Additionally, the pump mimics the pancreas much more efficiently. By continusouly delivering small doses of insulin throughout the day, greater blood sugar control can also be achieved.

[betty inquirer]

thanks guys!

i would love to hear from anyone if there is anyone who prefers injecting to Pumping. also does anyone have difficulty wearing their pump day and night?

[rzrbks]

Not to be snotty, but I would like to know the reason you're after this information.

Are you connected with some company?

Are you doing research for class/work?