FUDiabetes

Study: Insulin Pumps Decrease Quality of Life and Increase A1c in CGM Users

mdi
pump

#41

I’ve seen people using tresiba
for the vast majority of the basal needs, often all the way down to the pumps minimum basal setting just to keep it from occluding…


#42

Can’t say it’s that interesting when I’ve used mdi for most of the 5 years of my life I’ve had diabetes (Always lantus or basaglar for basal but I’ve used novolog and humalog/admelog entirely depending on insurance coverage haven’t tried apidra or any other basal insulins) . First few months I was misdiagnosed as a type 2 , then I used a pump for less than a month for sure (I tried to use it a lot for one month,but only consistently for maybe 2 weeks) and I haven’t had kids or anything so I have no idea how that’s gonna go yet , no birth control (I’ve wanted to try it for 3 years though lol, just a bit nervous due to really bad experiences with that too before I was diabetic) , so I don’t know what to really add to the survey other than sometimes my period throws an itty bitty wrench into my diabetes control. My diabetes is so consistent and predictable too though where I feel like that’s where I have good luck with MDI. I’ve only really avoided huge desserts and buffets and had good luck at all times. Clearly a type 1, no debate on that , the pump made it more obvious actually than mdi does I think :confused: . I just do better with the long acting injectable insulin. SO far Lantus has done me good all these years.

@Carol Also on the tresiba thing, it has the benefit of lasting longer in your system where it can cover you up to 42 hours where if somehow you sleep in and forget or go to bed earlier it won’t screw you up, you can take it any time of the day as long as you take it every day. It has a huge benefit over something like Lantus where it only lasts for sure at most 24 hours and you have to take it the same time every day. Lantus seems to not be as flat acting as Tresiba either, I think it’d be flatter like an accurately set pump?


#43

Some people may do that (I actually did it for a portion of my Tresiba trial), but that is not really the untethered regimen as it’s described by its inventor. Most people I read of doing this use it only very temporarily, such as if they are going to the beach, or a sports tournament, or for some other reason need to be disconnected from their pump for a few days but still want to be able to use the bolus features (bolus calculations, insulin on board, extended boluses, etc.).


#44

I feel like untethered is the only way I would really want to try a pump again but it’s kind of a silly regimen for me personally, there’s people out there it works great for, but I’ve found that that the few times my pump worked right (literally one day, and the infusion set was like oddly placed and awkward and it only lasted one day anyway, what a bunch of fun that was) and gave me one day of hope that it’d work right…I found I was still having to really use full unit doses anyway because the half and smaller ones weren’t doing AS MUCH as they could. This was also at a time I was sensitive to insulin (may of been honeymooning but it all ended with the pump ending, once I got on mdi again I wasn’t that sensitive?) and I was hoping it’d be the solution. Turns out I just had some sort of anxiety maybe or something? that 1 unit would kill me or something? But now I take 1 unit for corrections (or more , like that time I made the buffet mistake… that was a rage correction) and I don’t go low.

Lately I’ve found I rarely go low, I’ve maybe gone low once this year, highs are more likely but that’s because I’m trying new foods ( since I’ve had diabetes a while and know how it works now, why not? all but 2 things were successful!) , and a pump would likely make no difference in that , at least I don’t think it would when I’d still be taking the same amount, as I don’t eat much fatty stuff (I have a history of many episodes of pancreatitis related to bile duct stones, fat makes me feel pancreas pain like if I eat at buffets or those grilled cheese sandwiches at red robin…aka my only 2 food adventure failures in the past year) and the special boluses wouldn’t mean much for me when on the regular when I wouldn’t wanna eat those foods regularly or ever again.


#45

It’s also possible the profile of Lantus wasn’t meeting your basal needs and Tresiba does a better job. It doesn’t prove basal needs aren’t variable. My profile is the same whether I use a pump or MDI. I can meet them better on Levemir because I can make adjustments on a 12-hour basis. I don’t find much difference between this and pumping, other than site issues. Tresiba on the other hand is useless because I have different needs during the day than at night and so one 24-hr dose can’t address this. It also can’t be varied for anticipated stress and unexplainable periods of change, which are a constant phenomenon for me whether on MDI or pump. I agree not everyone needs a pump but not everyone will benefit from Tresiba either. It’s because I somewhat agree with you about pumps that I don’t think it’s a good idea to just push Tresiba, because people who don’t have a good experience with it will think pumping is the only option, when in fact other older basal insulins may actually work for them.


#46

Tresiba was a miserable failure for me. If I ever did MDI for some reason, I would do it using Levemir, NPH, Regular, and Fiasp (maybe NovoRapid, too). But one of my main problems with MDI is that I end up using 10 or more shots a day just for baseline basal and boluses, not including fine-tuning, and that just gets extremely annoying having to do a shot every hour or so during daylight hours plus a few overnight, and using four types of insulin would just compound that immensely. And then the other issue for me was being unable to rapidly adjust basal doses up or down for hormones or other things. That would be somewhat solved if I used Levemir and NPH instead of Tresiba.

I think in the end it all comes down to an individual’s insulin needs and lifestyle. Everything else about diabetes differs, it doesn’t make any sense whatsoever that everyone has identical, flat basal needs. I’ve just raised my basal rates by 10 units and added in a sixth basal segment over the past few days (the first because of hormones, the second at the suggestion of my endocrinologist). Other people may not experience this type of variability but it does NOT mean that it doesn’t exist for me or that it’s a problem that’s somehow been created by using a pump. Ask any endocrinologist out there and they will confirm that hormones absolutely do affect blood sugar. Some people don’t even really need the features of a pump, but just find being able to bolus while doing anything and not having to take a half dozen or more shots a day really convenient.

I personally have never seen anyone on this site push pumps. I do see some coments in other sites about suggestions involving pumps for problems people are having, but I see that sort of thing far less often today than I did 10-15 years ago when pump use was rising rapidly. No one should fell pressured into using a pump, but on the flip side, pumps need to be and should be available to everyone who needs them, which currently they are not. I have never seen an insurance company or government say, “You must use a pump, we won’t provide you with MDI.” I have seen many instances of insurance companies or governments saying (essentially), “You must use MDI, we won’t provide you with a pump.”


#47

In my opinion, people are exaggerating this risk way too much. Yes, a site might go bad once in a while, but no, that does not suddenly raise my BG to >20 mmol/l (~360 mg/dl) and even that would hardly be an emergency.

You can stop a pump. You can’t stop long-acting insulin. Once you injected your daily dose, you can’t do anything about it. So when I was on MDI and wanted to change plans for the day? More physical activity? Too bad, lantus already injected. Even if activity was planned, it wasn’t much easier. Do I inject less the night before and go high in the morning before exercising in the afternoon or inject the same and eat carbs like crazy?
On MDI I was always recommended to have a BG of ~140mg/dl before going to bed to prevent going low while asleep. A pump, on the other hand, allows me to have a lower basal rate during the night.
MDI was fine when life didn’t require much flexibility, but now I prefer pumping.
Pumping did not improve my A1c. There’s simply no room for improvement with no CGM and only 4-5 finger sticks a day. However, quality of life, as much as I detest that term, did improve, because of the flexibility.


#48

The bottom line here is…YDMV. You find what works FOR YOU, and you use that method. IF you want to experiment with other methods, you do so; otherwise, you stick with what works. One method is no better than the other…it’s all about what your preference is, what you’ve grown accustomed too.

No one is wrong. No one’s method is any better or worse than anyone elses. It’s all about “quality of life”, being “unlimited” and maintaining the level of control that YOU want for yourself…if you get the control that you’re looking for, it’s all good. If not, then you consider other alternatives.


#49

I agree, people make way too much of this. I have forgotten to take Levemir more than once on MDI, despite how diligent I am, and this has put me at much more of a risk than pumping ever has. In 10 years of pumping without a CGM, going though university, often being careless, drinking too much, leaving sites in way too long that were on the verge of falling out and being held in by a piece of tape, I never once came close to DKA. I didnt even know it was a serious risk until reading this forum honestly. I know some people are more susceptible to it and have to be more careful, but I dont think it’s really that big of a risk with pumping and a reason to consider not getting a pump.


#50

You’re saying exactly all the same things I was saying in the past… varying stress loads, varying physical activity levels, varying day/night neeeds— all these things require adjustment and therefore I need more adjustability. A flat basal can’t address those needs. That’s what I’d learned. It’s what I knew. It was my truth. It was all proven wrong in my case though, and my life has benefited and become more simple as a result… and I’ve seen the same thing happen with other people. Maybe its not for everyone but its a game changer for some, and based on my own life experience-- those for whom it is a game changer don’t even realize that it might be possible, because they think it doesn’t fit their needs based on their current understandings of their needs-- happened to me…


#51

That’s why pumps allow ‘Temp basal rates’ to be configured.


#52

that sentence was a reflection of my previous understandings which have since changed…


#53

And from this side, I keep getting sad when I think about starting back on another pump. Although it’s definitely less of a thing on the OmniPod— so maybe it’s more about being anchored down than anything else.

Such allure to MDI though. Not sure what that’s about. :thinking:


#54

Robust, simple, cheap. What more can you ask for if it works for you?

Of course, if it does not work for you it is not enough :slight_smile:


#55

Just don’t decide if it works for you before trying all the different options. There is a world of difference and the technology has come a long long way, and they have surpassed our previous understandings of how insulin works in your body for many people


#56

Thanks, @Sam and @Sensorium139. Sorry I’m slow acknowledging - time differences and life. But I really appreciate your helpful answers.


#57

Not in my case, I only had one functional day with the pump. I know it’s just one probably defective pump, but that kinda thing is so important to realize when I have not had nearly as much trouble with MDI. I could of went into dka every day when I had the pump, it almost never told me it failed until mealtime, lord knows how long that infusion set was bad ,always on day one. Most days I redid my site at least twice. I wasted so much stuff. MDI is so much easier than that BS. Scares me too much to ever use one again, why bother when mdi works? I get the pump works for you but I’m absolutely not exaggerating. If I didn’t delete all my pump related posts on tumblr I could prove it. I’ve heard of so many people having this issue with pumps, maybe in less amounts but it’s still an absolute risk you can avoid with mdi. As long as you take it, you’re safer on mdi with that alone.

Yes you stop the pump, you also 100% stop your insulin and if you forget to put it back on or the site fails while you have it on and you don’t realize it right away? DKA for you, or at least extreme damaging hyperglycemia. Going slightly low and having to correct it with a small snack is better than a pump failing on you and giving you DKA, hyperglycemia is more dangerous is permanently more damaging than a hypo. If you have to eat around your long acting YOU DO need to adjust the dose, just like with a pump. With basal testing with a pump and a long acting insulin it’s the same: fast watch for spikes/hypos and adjust it from there. With proper dosing a long acting insulin would not require eating around the clock. You can have a flexible life with a basal dose that’s correct. I would say I have a flexible life. I sleep different schedules all week because I work night shifts, my fiance works nights on different nights and that means I sleep weird, but because I have my dose right I don’t run into issues . There’s also newer long acting insulins like Tresiba and Toujeo that are flatter and easier even than lantus or levemir and more likely to be easier to use than that even. Toujeo and Tresiba seem to compare more to a pump.

This is not to say don’t use a pump if it works for you but it’s a matter of some people can absolutely have a lot of trouble with a pump and have severe hyperglycemia or even dka from a pump just by trying to use it how they are supposed to. I was one of those people who ran into extreme hyperglycemia a lot on it.


#58

You don’t have to. Reducing it by any percentage you like is also an option.

Certainly not for me. I’ve never been in DKA, not at diagnosis and also not after forgetting to resume my basal after a hypo.

I’m not sure what that means. What extreme damage does one incident of hyperglycemia do?

In general, I think hypos are acutely dangerous, but not really damaging, while hypers are generally not dangerous, but damaging on the long term.


#59

You and @Sensorium139 seem to be getting along just fine, but as I have currently been going back and forth between the two styles, MDI and pumping, I think it’s fair to say you both make valid points. If you haven’t had too much of a problem with one side or the other, it would be easy to minimize the other side of the argument, but you have both presented real concerns. In my case, the pump gave me the kind of control I needed and couldn’t get on my own in the beginning. However, it was not without the episodes sensorium139 has described. And this is not even the 670G Auto Mode of which I speak— but just a classic example of loose adhesive and dislodged cannula. As often as once a month I’d have to deal with horrendous blood sugar as a result of a kink or loose set. On the flip side, I do have to make decisions farther in advance when it comes to management on MDI. Knowing whether or not I plan on exercising within the next 3 or 4 hours might affect a current dose calculation. If I fail to consider such factors, I think I am stuck with correcting with carbs.

After maybe 12 years of pumping, I do feel like I favor the independence of MDI at this time. There certainly is a level of convenience that comes with pumping that is not true of MDI, but there’s just as much a feeling of … autonomy that is. If I’ve learned nothing else about this disease at this point though, I’ve learned that I might find it all shifting tomorrow towards some other ideal that has no priority today.


#60

But what if that makes your basal dose too low and you still get hyperglycemic from it? It’s almost as bad as not getting it at all sometimes. This entirely ydmv, much like debating this, but I personally find I SOMETIMES (rarely) go low during really intense exercise (IE actually trying to exercise with equipment or really intense jogs not a typical night at work) but if I were to use a lowered basal rate if I had a pump, I imagine I’d spike as I go back up to normal with little to no snacking after exercise is over and I’m relaxing. Once again like this debate ydmv, this whole study is ydmv honestly, but for the sake of debate it’s entirely possible that benefit may not work when some people go at least a little low and return back without a lowered insulin rate and that’s not always a benefit . I imagine with a flatter insulin like toujeo or tresiba it’d be even less of an issue than even with a pump but that’s hard to say when I haven’t exactly tried it yet due to being on medicaid and no access to tresiba or toujeo. Would be willing to test this out if I had the chance.

I’ve personally not experienced DKA either but I keep hearing too many stories of “I forgot to turn my basal back on” and way more dka related pump stories on other forums (I feel like Fudiabetes is more of a better site than most and due to a large amount of consistent cgm usage and more people willing to experiment at the same time so it’s avoided more?) where it’s definitely a prevalent thing and it seems to come after a fear of post exercise or just in general hypos not just pure forgot to turn it on situations. Moreso than mdi related issues with that.

Maybe not one case but if you’re sitting at like something over 300 because your pump failed or you turned your basal off or too low due to a hypo, there’s still likely something bad to come out of that rebound that isn’t good for just about anyone. Haven’t had too much of a rebound /rollercoaster with mdi, of course that may just be my diabetes but I wouldn’t put it past it being a correct theory in general due to the flatter action of long acting you can’t undo or reduce to put yourself at risk. There are people who regularly exercise and lower or turn off their basal and there’s some degree of risk in that if they go hyperglycemic and do that a lot. If you don’t do it a lot , maybe it’s not as damaging just when done like that ,there’s still a risk to it vs just having coverage no matter what and having a minor hypo that can be corrected. Chances are if someone’s using a cgm or frequent testing that wouldn’t be missed.

Overall I’m not trying to say it’s truly one vs the other better than the other for everyone…it’s just I think there’s potentially an advantage still with MDI in some situations where people who pump or have pumped for a long time don’t really see. I still feel of course, the best treatment is what prevents you from chasing hypos and hypers all day and keeps you as flat as sanely possible (even if it’s not perfect , no one’s perfect) and there’s absolute advantages to both. I just feel like there’s more advantages to mdi than people sometimes realize.