[Funnygrl]

It's funny, but the way my insurance is set up, it's far cheeper to pump than do MDI.

MDI was:
$10 Lantus
$10 Novolog
$25 strips
$10 syringes
per month
=$165/three months

Pumping:
$15 for strips, cartridges, sets, wipes, lancets, and IV 3000 for 3 months
$10 for insulin per month

=$45 for three months

[Scratch]

Originally Posted by Blibbit784

Yes it is also subcutaneous, injected into the fluid between the cells.
She said when you put a large amount of insulin, say, your twelve hour dose by injection it pools in your system. The amount actually used can be lower because of pooling. A basal rate allows small doses just like the pancreas so it is absorbed better. She said there were other factors like hormones that could affect your insulin absorbtion, and that insulin injections are mostly guesswork because you don't really know how much you absorb.

I think she's a bit full of it. I didn't guesswork my way to 5.6 and 5.7 on my last 2 A1cs.

[Blibbit784]

That's possible, but I have to say that in my case I have issues with absorbtion anyway, I never really now what I'm getting. I can take a large dose, not have my sugar change much, then a couple hours later all of the sudden that insulin hits me.

[BlueSky]

Originally Posted by Blibbit784

.... She said when you put a large amount of insulin, say, your twelve hour dose by injection it pools in your system. The amount actually used can be lower because of pooling. ... She said ... that insulin injections are mostly guesswork because you don't really know how much you absorb.

I think that first bit is true enough. The bigger the injection, the more unpredictable absorption becomes. But it works pretty well if injection sizes are kept below 10 units. It is another good reason to spilt the Lantus dose between 2 or more shots.

[Alice]

I currently prefer MDI...but not for any reasons against the pump. In my eyes, they are near identical insulin treatments...just with a different delivery method and the pump is based on using fast-acting insulin 24/7.

I've never understood why people think eating on a pump is more "flexible" such as for grazing. The bolus is still the same. I split boluses...although I guess a "square-wave" is something a pump can do. I rarely hear people talking about those options.

I just don't like dealing with the pump. I like the freedom of taking my bolus, putting my pen away in my purse and I'm done with it. Same with my once a day Lantus pen.

I like the knowledge that my Lantus is working (very well, in my case) at all times. I can adjust that dose up or down every 24 hours....although not hourly as some people choose. Personally, I don't know that working out those frequent bolus changes would be accurate for me...as they change all the time anyway. So, whether you are changing them hourly or daily...the important thing is that you monitor your basal changes overall. Yes, it can be argued that a pump is more precise here...but you'd have to test constantly to know if a basal is truely that accurate.

One question I have for pump users that I've always forgotten to ask...since you are trickling droplets of 3-4 hour insulin...is there a slight delay in changing basal amounts anyway? Or, is it such a constant trickle that it becomes a stable number...

One day, I expect a realtime insulin to be formulated which is great for pumps. But currently, a meal-based insulin is used. This never comes up in discussions, so I'm probably curious about a non-issue. I'm not against pumps...they are wonderful. I just don't see one side pitted against the other. I think both options are great. But, I do think MDI can be just as successful. They both take work and frequent testing.

[BlueSky]

The key advantage of a pump, IMO, is the ability to to customise the basal rate. If you have a flat basal rate, you don't really need a pump. Lantus will do the job. But if the basal requirement is highly variable over the 24 hour cycle, you can't easily do what the pump does with shots. NPH and/or Regular can be added into the mix, but it is far from ideal.

Originally Posted by Alice

.... One question I have for pump users that I've always forgotten to ask...since you are trickling droplets of 3-4 hour insulin...is there a slight delay in changing basal amounts anyway? Or, is it such a constant trickle that it becomes a stable number.......

There is lag effect of about an hour - the time it takes for rapid acting insulin to peak. So if the basal requirement increases from , say, 0.4 units an hour to 0.7 units an hour between 4am and 5am, the pump would be programed to increase the basal rate at 3am.

[firoz]

I am just as active, if not slightly more and that is why I haven't gone the way of the pump. I noticed some people said that it doesn't get in the way because you can get harnesses or disconnect it, but I think that kind of defeats the point of having it in the first place no? I windsurf so if I hit the water really hard and had a pump, something bad would probably happen.

If you're playing basketball and someone rushes you or it gets caught or if you eat it on your motorcycle...it's probably going to cause trouble yeah?

I try to stay as close to natural as possible so I say if you're healthy and don't mind the slight inconveniences that come with injections, then stay off the pump. The alternative is of course to do a trial period thing like someone suggested and see how it fits your lifestyle.

Personally, I don't like the idea of having anything inside my body that could be ripped out, but I'm irrationally paranoid and haven't really researched the pumps because I'm quite content as is.

Let us know what you do though eh? ^_^

[RLK]

I've been pumping for 9 years now, and pump #3 is being delivered today (eee!). I wouldn't be this far into pumping if I hadn't seen a huge difference in my quality of life since I started pumping.

I'm rather insulin sensitive, with total daily doses in the ~25 unit range, and very active. I ride my bikes (road, mountain, and commuting) without trouble, used to run, and was even playing soccer for awhile. The pump was removed for soccer- those girls are pretty ferocious!- but it stays on for all other activities without any troubles. At any rate, the key benefit for me is the flexible basal rates. I can set temporary, lower basal rates to allow me to mountain bike all day and not have major hypos or spend all evening eating to keep the BG up.

I've never broken a pump from physical activity, but Minimed has been awesome about overnighting me a replacement whenever there's been any question about the pump's functionality. I've never ripped a set out, but keep extras on hand just to be safe (good practice no matter what your lifestyle).

Hope that this helps- feel free to PM if you want more info and good luck making your decision!

[fgummett]

I had heard that the large single dose long acting insulin could have a large variability in absorption from day to day... even from something as simple as putting it in your thigh and exercising one day but not the next.

I also believe the real advantage of the pump is in managing the basal requirement(s), which to me is key to the whole day... in my case I use multiple basal rates for different times of the day when insulin resistance is also different. And yes, I can turn my basal down or off for exercise... I don't see how you can do that "on the fly" with MDI.

In terms of boluses I don't think there is that much difference but when it comes to multiple correction doses I'd sure rather use the pump and press a couple of buttons... possibly also easier for youngsters where only a very small bolus is required.

[fgummett]

Originally Posted by RLK

I've been pumping for 9 years now, and pump ... I've never ripped a set out

You have never ripped a set out in 9 years of pumping... that to me is truly amazing... now I feel like a total klutz

[thomaca77]

I was concerned about ripping out infusion sets, and resisted going on the pump at first. I'm not that active, I am just a real klutz!

I decided to try the Omnipod because it has no tubing. In other words, nothing to catch on and rip out. I have only ripped it off once, (I think I ran into a table really hard...or was it when I dropped that twenty pound box on my stomach? anyway....) The really nice thing is, if I do rip it out, bang it up, smack into something, or totally wipe out.....I am only out the cost of the disposable "infusion set"...the expensive part is safely tucked away in a padded case in a pocket or my purse.

And, if I REALLY REALLY wipe out, the remote control unit is only $700 to replace, as opposed to $7,000. (the first one is $1,000, a second one is $700)

-Carisa

[Cyborg]

In over 2 years of pumping, I've only ripped out 2 sets. One getting up from a table at a restuarant when the set itself snagged the table top. And the second time last week, I woke up and it was out (teaches me for trying to stretch them 4 days).

[RLK]

Originally Posted by fgummett

You have never ripped a set out in 9 years of pumping... that to me is truly amazing... now I feel like a total klutz

I've had plenty of close calls (door knobs!), but there's generally enough of a yank on the tape to stop me in my tracks.

[Cyborg]

Wearing my pump in my shirt pocket is the reason why the tubing doesn't get snatched onto anything. Very convenient location also...

[qtrchicken]

Thanks to all for responding, discussing different things, etc. Keep it coming. I have read the posts and am kind of on the fence now. I had left the Mini-Med rep a call and I think I'm going to try it out (at least a test version). The MDI method has been good to me overall, but after almost 19 years it's getting a bit tiring.

I can always go back to MDI, if I find it a complete hassle or want a break. I think the thing that is giving me some reservation is the CGM. I was really interested in that feature, but it seems like that might be the most expensive part of the whole system. If I don't have that, then I don't see it as much different than MDI. It's just a different delivery device. I rarely ever change my Lantus amount, so it's all about bolus for me.

That being said, someone asked about activities and damage to the pump/system. I agree that it's risky in high impact sports, but I would never go anywhere without a backup plan. I've eaten it on the bike and playing b-ball. I play inside, so there's a lot of pushing, elbows, grabbing, etc. Big concern, but putting it inside my shorts mike make that a non-issue.

This decision just doesn't get any easier.