This is a fascinating thread to have read through (and accidentally stumbled across). As someone who turned 30 years Type 1 late last year and spent many years on MDI using NPH and Regular, before Novorapid and Lantus, then Novorapid and Levemir (way better than NR and Lantus) then a pump 3.5 years ago and DIY closed loop 2.5 years ago, I’ve been there and done that with all the options. Throughout those 30 years I’ve been plenty active.
I think it’s fair to say that CGM makes it easier across the board, and I’ve used CGM with all of the above options. My typical Hba1C on MDI pre-CGM over 25 years was 6.5% to 8.0%. CGM had the instant impact of dropping me to 6% and then on lower.
One thing that hasn’t been mentioned here, and I think it’s an important point that is missing in terms of addressing comfort with pumping and MDI is how you eat and what you eat. Again, having tried most treatment approaches so far, reduced carbs makes MDI a great deal easier to live with, but if you’re not doing that, my experience is that there is a much higher level of variability in glucose levels, and as someone has already said, once the insulin is there with MDI, it’s there.
I think the biggest thing I take away from all of this is that you get out what you put in. Whether MDI, pump or hybrid closed-loop, if you don’t make decisions on top of insulin use, such as food regimen, exercise, how and when you test, etc, management of glucose levels is always much harder. Ultimately, we all have to try out the options and find what works best for us.
And that is not only the insulin delivery system, but also the insulin itself.