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



And I would NEVER start one.
You see, it’s all a matter of what you’ve mastered. And truly YDMV.


The difference is, PerfectHorse has tried it both ways.


There’s a lot of things I haven’t tried that I don’t need to.

My only interest in a pump is just to use one for a while so people will have to stop saying I’ve never used one.


The problem is that she had probably not mastered MDI. I’m not saying that is bad, but it certainly is possible to have a 5.3 A1c with MDI and maybe a Dexcom. I can testify to that.

But my doc told me to bump it up to 6.4. Maybe I should try a pump :wink:


I’ve had as low as 4.8 with mdi, with no dexcom


I’ve had 5.1 with MDI and a Dex, but it doesn’t really count because mine is always lower than you’d expect it to be. My average bg correlates with an A1c of 5.6-5.8.

I’m not sure if it’s MDI anymore though because most of my boluses are with Afrezza now.

I’ve used both MDI and a pump. I’d never go back to a pump again.


I’m hearing this more and more often in the doc… it’s not your grandpas MDI anymore…


I think it’s hard to compare A1c. A1c alone doesn’t say too much about day-to-day control, unless you’re just comparing your own results.

I’ve never had an A1c below 6.0% with either MDI or a pump. But, generally, my A1c on a pump runs consistently at 6.6% or below, while on MDI it was consistently 7.4% or above. So, in general, a pump seems better for me (and certainly is my preferred choice in daily life). But I’ve never been one of those ultra-tight control folks. I’m hoping I’ll get there once the hybrid closed-loop systems become available to me.


This would be difficult to impossible to achieve for most people on pump or MDI unless adhering strictly to a very low carb diet, honeymooning and/or maintaining some level of insulin production. Again, I don’t think Tresiba is amazing as you think it is, you just have very predictable basal needs that it perfectly addresses.


It’s very difficult for me to achieve. I disagree, I think it’s amazing. I work pretty hard for it… and I use all the best tools which include both tresiba and afrezza, and a lot of novolog… and I dabble with the regular insulin too. I test my bg probably 20+ times a day and often take upwards of 10 injections and multiple afrezza doses… so it’s not like I’m just blessed with some extraordinarily light affliction of T1 diabetes and can’t possibly grasp that it’s difficult… I just work very hard at it


And you have a very good brain. Both are key to success I think!


Some how I wonder if I have some extraordinarily rare easy type 1 based on what people post. It does sometimes make me question if my type 1 diagnosis is wrong , even though afaik I know it’s proven by my endo 90% at least true. I do realize that I have to still think about what I eat, I can’t just go out to eat anywhere with anyone, I do have to measure pasta, rice, carbier veggies with a cup or something and whatnot at home (and hope the carb counts are right on this sorta stuff when I go out to eat) , I still have bad days…though it’s really rare feeling for me. I mean I legit haven’t gone low since one time in like march when I had the nursing home job that I was depressed every day at and overworking myself where that’s most likely the bigger part of it vs just what I was doing with my blood sugar. I also had a huge basal increase from 11 units of lantus to 20 within a few months with really no explanation (well official at least, could be weight gain, but it was the same for a while before the bump up, could be the stress but hard to say) and I had no insurance to ask the doc about it. It was all still awful, different kind of awful (especially vs the people with kids and type 1 and all the fun that comes with that) . I also have slacked on testing a lot , which I know is bad but…with my insurance situation (where if my strips are indeed going to be covered by January, I will be limited to 3 a day no matter what, cgms are only considered under medically extreme conditions with my medicaid and it is not available to me as I do not have hypoglycemia unawareness nor am I medically fragile/disabled otherwise so they will never give me one on this plan to give me another option) and income , testing 3 times a day is about the best I can do now, 4 feels like a luxury. TO be fair, I usually don’t eat breakfast unless I work and even then that still means I don’t eat lunch , only dinner, because I work nights and sleep most the day then…so 3 tests is still before every meal I truly eat+ bed time . I only make $600 at most a month usually, or somewhere around that where I have to do what I can. AFAIK it hasn’t hurt me to test less as I’ve been doing that since right before I got fired from my last job and my a1c was 5.8% and it was like around the same this time, prolly getting another a1c on Monday so we’ll see about that. I still will always test extra if I’m higher or lower than normal and it seems to be a thing that day, but if things are going smooth and I feel great, I can’t typically justify it. Not like I’m ignoring it, but I can’t afford like …6-10 a day when I tend to have consistent bgs anyway.

I really don’t know to this day if I have it easier or not. I think the big thing is I’m past puberty, not having really any big hormonal changes or big life changes and overall life is pretty consistent.


Well you certainly have a challenging environment, and yes, your diabetes sounds easy to manage. With the A1c you have, I can see no reason why you would want to test more. I hope my son’s diabetes becomes this easy to manage as he becomes an adult, because it ain’t easy right now. I hope your job situation improves and that you are able to get access to strips. on a side note, we just buy our strips from Amazon, it is less work and about the same price really as getting them through our insurance.


I’m well past puberty, and I wish my diabetes was easy to manage. Heh. Hormones, illness, stress, food, seasons, activty, exercise, medication, and other chronic conditions all impact my blood sugar. It’s a constant balancing act, and even measuring all my food, wearing a pump and CGM, and testing 6-8x a day, I go high and low daily.


I’ll chime in after another sleepless WTH night with my partner and say it’s not easy for us either. And it’s for no lack of trying*. I think if he tested a few times a day he’d be in DKA or a coma from a low. It’s just not that stable. Which is how we found our way here. :grinning:

But I’m glad it is easier for some people! I wish it was easy for everyone. But I’m sure that there is some number of folks out there where it’s really routine and predictable. We’ve had a friend since childhood who has type one, and he rarely tests in public. I’m pretty sure he doesn’t test in private very often either. I think that he just uses the Force and is very predictable about what he eats.

*full disclosure: our life is not predictable at all, and I suppose that we could try to change that somehow – but it would probably require taking a new job, moving, resettling my mother elsewhere, and a whole host of things we are unwilling to do.


Yep, same.

I mean, I managed for over 20 years before I got the Dexcom. But I also had some really close calls.

And especially since developing thyroid issues, when my thyroid is shifting upwards or downwards (like it’s been doing recently), my blood sugar is utter chaos. A couple weeks ago I dropped by something like 7 mmol/L in 15 minutes. No exaggeration.

However, for people who rarely test, it’s sometimes hard to tell those who don’t test because they don’t need to test from those who just don’t test. I met a guy at a job training session once who was envious that I was correcting a blood sugar of 10.5 mmol/L. I considered that high, he thought it was a great number. He was like, “I haven’t tested all day, but my blood sugar is probably 25 mmol/L right now.” Meanwhile, I’m sitting there testing every hour or two to take corrective actions (this was before CGMs).


So I use and like Tresiba (way better than Lantus), but I have in no way found it to work the way @Sam describes. If I ever can get my other medical issues in check enough to start working out again, I’ll either have to do it extremely regularly or go off of Tresiba, because in my experience, it in no way adjusts for exercise (and I have to adjust my dose dramatically, which is challenging to do in the short-term, or face lows when my activity level goes up with travel or I have alcoholic drinks that reduce my liver output). I also do not think Tresiba fits my cycle changes well at all, but to be honest, my control just isn’t that tight right this minute, and so I’m just letting that go. But sometimes during the cycle I drift upward overnight, and sometimes downward, on the same dose. So for a cycling woman attempting tight control, I probably wouldn’t recommend it, nor would I for someone with highly variable activity levels. For MDI, I’d go with Levemir over Tresiba for either of those contexts, in order to facilitate changes in basal dosage. I might be on Levemir myself, if I didn’t have mast cell reactions at the injection sites.

I do like dosing once a day, but I also find the dosing timing flexibility to overstated considerably—I can usually tell if I wait more than about 4-5 hours (so at hour 28-29) to give my next dose, because my blood sugars start to rise. Still way better than Lantus or I imagine Levemir on that front.

I suspect I might get better results pumping. I just don’t have it in me to deal with it right now. I suspect if pump technology continues to improve, I might try it out eventually, depending on what happens on the insulin side of things too.


This was exactly the problem I had. There was a day or two where I thought I’d found the magic dose (after splitting the dose into two shots). But overall, I could never find a dose that held me in range overnight, much less during the day.

And I totally get what you’re saying in regards to other chronic health issues. I think that, much like female hormones, completely changes the game of diabetes management.


I’m thinking in your case it’s your thyroid and other issues, that certainly will screw everything up. I’ve known quite a few diabetics with other issues on their plate that have a way different time than me so that’s what I’m trying to say. Like I worked with a lady with lupus and a boat load of issues like with her thyroid and basically everything in her body I swear to god, and she had diabetes too (not sure what type, she said 2 but she was fairly insulin dependent and was on steroids and chemo a lot where it could of been like steroid diabetes or LADA due to her lupus and other autoimmune diseases) …and it would always be really hard for her and she always wished she had it as easy as me but didn’t mean it in an insulting way. I don’t blame anyone who feels even offended by how I’ve got it going on since I know most people don’t have it that easy, that’s why I feel awkward sometimes in type 1 diabetes communities, since most people make me feel like “Damn I have it too easy am I doing it right or am I like somehow a type 2 or someone with MODY or something strange even though neither of those fit me at all otherwise?” (I have no family history whatsoever so MODY is prolly out of the question and I don’t fit type 2 because none of those meds did anything for me but insulin does so ? :'D )

I really have no current conditions going along with it, used to have a lot of pancreatitis episodes which would make my blood sugar go haywire, used to due to my bile duct stone pancreatitis episodes , where that’d give me some weird numbers and less stability (not quite rollercoasting as I’d trend one way or another like all day either really high for me or really low) but the worst of it wasn’t enough to truly hurt me in anyway other than the month I went low a lot and it made my a1c go down to 5% even with less insulin and lots of testing to watch for lows. I learned 5% is also not the best a1c for me itself, I need to stick to the upper side of 5% because 5% itself is lots of lows for me no matter what. Like other than diabetes I’m pretty healthy. I’m overweight (15 lbs overweight, not obese at all yet and it’s not incredibly noticeably) but, I don’t have insulin resistance, hypertension, or high cholesterol to make any doctor I’ve had freak out. I do have IBS (or something like it) after all the pancreatitis episodes making my digestive system a mess , but that seems to have no relation to my blood sugar. I imagine if I was under 18 or had any hormonal , thyroid, other autoimmune stuff, really anything other than diabetes that was too much in the way it’d be a different story …but I don’t and my life’s pretty predictable so things just kinda work out somehow.


I keep considering trying this, especially with what I’ve found about the timing flexibility being much more limited (for me anyway) than advertised. I should at some point… if I do, I’ll post about it.

Definitely, it does, and it also sometimes means tight control with diabetes (vs what seems like, good enough control) just isn’t my top priority, because too many other things are more urgently needing my limited energy. So a simpler but imperfect routine is working ok enough for me at the moment.