FUDiabetes

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

mdi
pump

#61

I think you are right there!

At the same time, I can’t help thinking your terrible experience with a pump could have been a fluke?

Of course, there is no reason for you to try again since you are doing so well on MDI.


#62

Yes , but at the same time it makes me never wanna try the thing again, especially because I never get on a plan that covers omnipod or tslim only medtronic, and it seems the 670g isn’t anything that fantastic (I’ve heard way too many automode horror stories and just overall difficulty with it) and would like me scare me just as much. The 530g is what I had and it was like the predecessor to the current idea of Medtronic’s artificial pancreas , and overall that wasn’t amazing either. Lots of people said the cgm sucked and didn’t truly help. Even if it somehow did go well , I don’t think it’d give me a better quality of life…mostly because the expense. I don’t think even if I had a pump now I could afford it and, even if I could…it’d make me feel bad. Just because it’s so expensive and I don’t like spending more than I have to on my diabetes. I want good (Such as in I really vastly prefer pens and think that helps a lot, and my bayer contour next meter which to some isn’t an easy thing to have because you need a newer phone for it afaik) , but not unnecessarily expensive. When MDI works fine, why spend more? I’m broke most the time so having expensive stuff to pay for that doesn’t add more really wouldn’t improve things for me? That’s another part of this study that isn’t really…mentioned enough, the stress of a cost of a pump and cgm vs a the cost of mdi with or without a cgm is really different and may impact how someone feels about their life.


#63

hate to double post but I think Medtronic knows I’m talking bad about them:

this happens almost every year at some random point I’ll get email, voice mails, whatever, whenever I unsubscribe it doesn’t seem to work they won’t leave me alone. I don’t think calling them even works since I called them before and got a stream of emails “TRY OUR PUMP!!!11” IT WAS INSANE!


#64

Yeah, it’s not. You’re not missing out if you skip this one. :grin:


#65

I finally just replaced my 530G and the threshold suspend feature was truly garbage, especially with the sucky Enlite sensors. I used that feature for maybe 6 months before determining that I needed to go back to Dexcom. I too was definitely turned off from Medtronic pumps by my 530G experience, and even though the Guardian sensor is apparently much better than the Enlite was I honestly just don’t trust Medtronic to make a quality pump/CGM combo anymore (YDMV, I know some people like Medtronic still).


#66

I would agree. And no one has mentioned the risk of accidentally over injecting Lantus, Triseba, or any other long acting insulin.

I’m not saying that I am totally pro-pump only, certainty not. BUT I feel like all insulin has inherent risk factors that could kill you if used incorrectly. Chances are, that is not what will wind up happening - with either the pump or MDI or inhaled insulin. But if you forget that you injected it, and happen to do it twice, or you miscalculated and over-inject, there’s nothing there telling you what is happened as there would be on a pump.

Also, being able to suspend all insulin delivery can be a boon for sporadic exercisers.

It certainly seems to be a YDMV issue. :blush:


#67

I think this thread has been an excellent debate of the pros and cons of MDI vs pumps. It makes for a very good (although sometimes quite passionate!) read, and, I think, can help those who have not always be presented all the arguments by their endo clinics make better decisions.

I can certainly see reasons to go both ways depending upon your own D issues.


#68

On MDI there’s no risk of wrongly guessing the dose of long-acting insulin? :face_with_raised_eyebrow: Dosing is never an exact science.
I’m getting confused. So on the one hand I’ve seen the argument that it’s bad that a pump keeps pumping rapid-acting insulin. But on the other hand it’s bad that you can stop that or decrease the basal rate. Which one is it??

These are anecdotes. There is simply no data to support the claim that pumping increases the risk of DKA.
https://www.journalslibrary.nihr.ac.uk/hta/hta14110/
Of course, there is a risk of hyperglycemia due to occlusions. That it is a legitimate criticism. But all this talk about DKA, rapidly headed towards an emergency and extreme damage is just scaremongering.

That may be true. I just don’t agree with the incorrect generalizations and exaggerations that people make in this topic.


#69

I think most, if not everyone in this thread, would agree with this! If you have good control with MDI, prefer to use pens over a pump, and can’t afford a pump…why on earth would you switch to a pump? It makes less than zero sense to move to a more complex and expensive system when a simple and less expensive system is already working.

I’m curious if you ever had a chance in your week or two of pumping to try different infusion sets? I’ve had major problems with infusion sets and it took me at least a year to work through those problems. For example, I’m allergic to Teflon infusion sets and can’t use those without them getting extremely irritated and dying (meaning high BG) within about 24 hours. I have much better success with steel infusion sets, but even with those, I can’t use the 9 mm sets. They bleed and hurt and I end up with high BG. The 6 mm ones are fine, as long as my allergies aren’t bad. When they are bad, those also die early. I’ve tried Skin Tac and Tegaderm as barriers, but both of those made my sites even more irritated. It’s been a lot of trial and error, but I have finally found the combination of infusion set, barrier wipe, and tape that works for me. I think this type of trial-and-error process is part of the process of good success with a pump. Just as with the type of insulin used, the type of infusion set, tape, barrier (if needed), and other pump factors varies widely.

Your pump experience sounds much like my Tresiba experience. One good day out of 30. I’m not in a hurry to try that again anytime soon.

My issue with MDI is always that I would spike and go low if I fasted through meals. I might spike for breakfast, then go low for lunch, spike again around dinner, and spike or go low overnight. It was such a pain trying to find a dose that kept me sort of in range when not eating so that I could just eat small snacks or do small corrections. And often when I found that sweet spot I’d have a day or two of good control, then hormones would kick in and my basal needs would skyrocket by 40%, and I’d spend the next week trying to re-adjust basal since it takes so long for chnages to take effect, and by the time I’d “caught up” my basal needs would be changing again… And that’s not even counting exercise days, which always drive me low even with light activity. I have very little counter-regulatory response after 27 years of diabetes, so my body never “self-corrects” lows like I read some people experience.

I sort of agree with @Boerenkool that I think the risk of DKA here is being exaggerated. Yes, DKA is a theoretical risk of using a pump. But anyone who is monitoring their diabetes properly and responding appropriately to what that monitoring shows should not be going into DKA from a simple failed infusion set. I see a lot of people on other forums calling high BG and ketones “DKA” when that is not in fact DKA. Anyone who has actual DKA will be in hospital with lots of IVs and monitoring. Anyone who is able to recover without doing that is not in DKA, though maybe they were headed in that direction if they hadn’t taken any action. Anyone with Type 1 diabetes should know the warning signs of DKA and know what to do if those warning signs happen and they can’t (for example) bring their blood sugar and ketones down on their own. I see SO many people on both pumps and MDI who don’t have ketone strips, don’t know about “sick day” guidelines, don’t know when to contact their medical team, and don’t know when to go to emergency. Anyone who is suspending their pump, forgetting about it for hours, not checking their BG (which should be checked every hour if insulin delivery is suspended or disconnected), and not responding immediately to unexpected highs is not monitoring their diabetes properly… All the studies I have read have indicated that there’s a lower rate of DKA among pumpers, not a higher rate. But really, anyone with Type 1 diabetes is at risk of DKA if they forget to deliver insulin, are not closely monitoring their diabetes, or are dealing with issues like illness, dehydration, or infection.


#70

For me, MDI was great before puberty.

I did not want to pump. But I went to diabetes camp, and a lot of people had a pump, so that made me think it would not be so bad. It took several months to figure it out completely.

When I got to puberty, though, the pump became necessary. Without it I would not be in control. Even with it, my control is way worse than it was.

I don’t think it is dangerous to pump, as long as you are not foolish. You always have to keep in mind that the pump site may be an issue: it is harder to think through than MDI. But it is not very hard to do. @Sensorium139, I think if you spent some time on a pump, you would be less concerned!

I did damage my skin in one site though (infection). I can see that, with time, I would lose more locations, due to infections etc. So I think this is definitely more of an issue.


#71

No, there’s not… because if you’re doing it right it’s the same dose every day. The “guessing” is the constant adjusting of pumps imo

It’s the difference in the duration that concerns me… a poorly estimated pumped basal rate could kill me in a matter of 2 hours because of how fast the insulin works, and in my estimation the risks of that are much higher because it’s availavle for constant tinkering.

With long acting it’s the same amount, always, and it’s of a type that metabolizes over many hours.

I would even suggest that long acting is far safer than using the pump with a perfectly flat programmed basal just simply because it’s rapid insulin being pumped.

It’s the type and speed of the insulin that introduces the risk factors…

Yes long acting can cause hypos, but it’s not continuously introducing additional rapid insulin to the equation. Yes it’s great that a pump can be turned down or off if a low trend is observed… it’s great if and only if that is recognized and that action is taken every single time in ones lifetime…


#72

The same dose every day is only “right” if that’s what your body needs. If your body needs a different dose each day, to compensate for activity or hormones or illness, that strategy is not going to work.

Your argument doesn’t make any sense to me.

You aren’t going to die in two hours from a wrong basal guess if you’re monitoring your blood sugar. Sure, if you randomly decide to set a temporary basal of 200% for no reason and then forget about it, you might go low. But no one is advocating that anyone do that.

A pump delivers basal rate every few minutes. If at any point you feel it’s not right, you can adjust it or you can stop delivery completely.

To me that is far safer than injecting 40 units of basal, discovering your body only actually wanted 25 units of basal today, and having to deal with constant lows for the next 24-48 hours.


#73

If ones body some days only wants 25u and that’s their minimum, that should be their basal dose with mdi and any additional insulin needs would be handled with bolus. As you point out, well executed mdi requires a lot of shots… hence the “M”


#74

I used a steel infusion set the only day it worked really good … And it hurt too much when I’d bend down or sleep or… Really did anything. No injections have hurt like that. Tried both sizes afaik are available and the smaller one is what I took out on the last day when screw it I had enough and never used it again. Between the frustrations of using it and the pain if it did work? No thanks. I strongly believe if I used it longer I’d legitimately go crazy.


#75

Yeah, that’s how I tried to handle MDI for several years… No thank you to giving constant corrections and still running at 16-20 mmol/L for two weeks out of every month. That’s the reason I could never get my A1c below about 7.4%. Plus having to get up every single night at 3:00 AM to do a bolus so I wouldn’t wake up high… Correcting with boluses is not as effective as having a well-set basal on a pump for me. I also don’t see how having a large amount of constant IOB is any safer than a pump using micro-boluses of rapid insulin for basal… At least the latter can be turned off at any time. A large amoutn of constant IOB from corrections would be far more dangerous, because if you suddenly have increased activity (which for me does not take much), or your hormones shift and suddenly today your insulin needs are only going to be 50% of what they were yesterday, than that large amount of IOB can drive you seriously low without warning.


#76

There is inherent risk in using insulin. Any type, any delivery method. I have had some real doozy lows (<20mg/dl) on MDI. I am sure I’d have the same lows with a pump. Because the low is caused by inattention, not the insulin delivery method.

I’m sure some people think that the variable basals afforded by their pump is the reason their Bg is in good control. But I think their control can be attributed to a well reasoned regimen closely monitored. Same with MDI.

There are some people who do terribly with a pump. It’s because they have not yet figured out the proper pump regimen for themselves. There are some people who do terribly on MDI because they have not figured out how to use it for themselves.

Like my Father told me while playing baseball. I was using a very small catchers mitt from little League when I was playing junior league. I dropped the ball in a play at the plate, and complained that it was because of the inferior mitt. My dad put his hand on my shoulder and kindly told me “son, it wasn’t the mitt.”

Just the same it’s not the insulin, it’s the person deciding how to take it.


#77

I’ve not adjusted Liam’s Basal for a year now. We’ve kept the same dose every day. :slight_smile: No severe lows to report as a result of his pump administered basal rate.


#78

Again, I don’t dispute that works for you, but don’t generalize. Injecting the same dose of long-acting after a day of exercise would have been an incredibly stupid action for me if I didn’t want to risk dangerous lows while asleep. Inactivity during vacation required more basal insulin, how much? That’s a guess.

I’m not constantly adjusting my settings, but contrary to lantus, my pump at least allows me to adjust to last-minute changes of circumstances.

That, too, is not a general problem.

I don’t share that fear of speed, but I would have to study the mechanisms of action of long-acting insulins more in depth to say more about it.

So then we’re back at using fast-acting insulin for basal, but in larger doses. No, thanks.


#79

I’d agree with this to a much larger extent with previous generation long acting. For me tresiba is nearly impervious to activity levels… which makes it pretty amazing…


#80

But that is your experience with your diabetes. Everyone is different. I certainly didn’t notice anything close to this when I tried Tresiba.