I’ve had sort 1 diabetes since 1997 and have managed my diabetes with insulin injections (a number of each day injections – MDI) since day one. I briefly tried an insulin pump, however it did not work for me, so I went on MDI and returned to a contented and energetic life.
On this article, I’ll clarify my journey to date and why I selected to make use of an insulin pen somewhat than an insulin pump.
My objective on this article is to not sway you by hook or by crook, however to share my expertise and description the professionals and cons of insulin pumps and insulin pens, respectively.
With the precise information, you may make knowledgeable selections. It is as much as you to decide on what appears best for you. There isn’t any one-size-fits-all panacea in terms of diabetes.
my machine journey
After I was recognized with sort 1 diabetes in 1997, I used to be given a blood glucose meter and a prescription for a pre-filled insulin pen. Prefilled means the insulin was already within the pen, and all I needed to do was screw within the needle and draw up the variety of models I wished to manage. As soon as empty, I threw the pen within the trash.
Like others on MDI, I used to be prescribed short-acting insulin to complement my meals (boluses) and long-acting insulin to behave as background insulin (basal).
I do not keep in mind precisely what sort of insulin I used to be prescribed, however it required me to eat at sure instances. I believe it was most likely NPH insulin. This basal insulin had a small ball contained in the combination (like a nail polish bottle) and I needed to gently transfer the ball round within the liquid to combine it earlier than use. It wasn’t essentially optimum, however it labored.
With new insulins coming in the marketplace, I switched to utilizing Levemir as my basal insulin and Humalog as my fast-acting insulin to cowl my eating regimen and correction of highs.
The one factor that has modified for me since then is switching from a pre-filled Humalog pen to a sturdy pen, after which from an everyday sturdy pen to a sturdy smartpen. A sturdy pen merely signifies that the pen is reused and solely the insulin cartridge is discarded when empty.
The benefit of sturdy pens is that they’ll administer 1/2 unit of insulin (pre-filled pens beforehand solely allowed 1 unit increments). The benefit of a smartpen (I take advantage of an InPen) is that it helps me observe my energetic insulin onboard (IOB), helps me calculate doses, jogs my memory once I have to take my basal insulin, and routinely logs each injection I give (by way of Bluetooth to my telephone).
I additionally added a steady glucose monitor (CGM) to my diabetes toolbox, and it was an actual recreation changer.
Why did not it work once I tried shaking the pump?
In December 2017, after 20 years of residing with diabetes, I made a decision to attempt an insulin pump. I wished the very best care so I made a decision to attempt looping. Looping is a DIY (Do It Your self) model of synthetic pancreas know-how.
a normally Insulin pumps routinely ship small quantities of fast-acting insulin, similar to Novolog, Humalog, or Apidra, 24/7 (based mostly on what you’ve got programmed).
You will need to inform the pump to ship boluses for meals and corrections, however the background insulin is programmed and occurs routinely.
With looping (DIY system) and the newest Medtronic 670G system, the pump goes a step additional by adjusting basal insulin doses based mostly on CGM readings.
If the system determines that your blood sugar stage has fallen too low, insulin can be paused till your blood sugar stage is decided to be at a secure and secure stage. If it determines that your blood sugar ranges are rising, it offers you extra insulin.
That is nice and I am a giant fan of this know-how, however there’s an issue. And the issue with that, and in the end why the insulin pump did not work for me, is that the pump pumps fast-acting insulin 24/7.
Disadvantages of fast-acting insulin
Quick-acting insulins similar to Novolog, Humalog, and Apidra take 15 to twenty minutes to succeed in the bloodstream after they’re injected. It doesn’t peak for 1-3 hours after injection and stays within the physique for a complete of 3-5 hours.
The new new product, Fiasp, reaches the bloodstream a number of minutes earlier and reaches its peak, however like different fast-acting insulins, it stays energetic within the physique for 4 to 5 hours.
DKA dangers
Due to this fact, if you’re utilizing a pump, you could have fast-acting insulin always circulating (assuming no insulin is being secreted in any respect) to forestall diabetic ketoacidosis (DKA) from occurring. In case your pump fails and your insulin provide stops, you’re at elevated danger of creating DKA and in the end ending up within the hospital.
Should you take your insulin by way of MDI, which means you’re all the time taking background insulin, your danger of DKA is way decrease (in fact, this assumes you keep in mind to take your each day background insulin doses).
hypoglycemia and train
As a result of rapid-acting insulin lasts 3 to five hours, individuals utilizing insulin pumps must be very energetic when planning their workout routines and actions. While you carry out each day actions like exercising, taking a stroll, or vacuuming, an excessive amount of fast-acting insulin could cause hypoglycemia. Insulin pumps all the time ship fast-acting insulin, so generally, any sort of voluntary train may end up in an excessive amount of insulin in your system.
Whether or not you utilize an insulin pump or an MDI, if you wish to train and transfer round with out shedding vitality, you may want to regulate your fast-acting insulin. Nonetheless, with MDI, your basal insulin is basically unaffected by exercise, so that you solely want to fret about bolus injections taken throughout the previous 4 hours.
When utilizing an insulin pump, I additionally needed to fear concerning the basal insulin given within the earlier 4 hours. In fact it’s potential. However for me, all the fundamental changes had been rather more troublesome than managing insulin utilizing an MDI.
The pump has its benefits, however it’s not sufficient for me
As I discussed, I used to be in a loop, so my pump adjusted my insulin once I was about to get hypoglycemia or hyperglycemia. And that is what occurred, though it wasn’t efficient sufficient.
Quick-acting insulin lasts 4-5 hours within the physique, so the Loop system could not sustain with my exercise stage. Sure, I am smarter, however my days are hardly ever the identical and I am a really energetic particular person. It was regularly dropping until I disconnected the complete program and micromanaged it.
For many individuals, this method is life-changing. If we had entry to faster-acting, shorter-lasting insulin, we might most likely use an insulin pump.
Advantages of basal (long-acting) insulin
Basal insulin, in contrast to fast-acting insulin, isn’t affected by exercise. This implies you solely want to consider mealtime changes and correction boluses while you train or simply get energetic. Which means that in the event you resolve to train proper after getting away from bed, you will not want to regulate your insulin. Simply go. The identical goes for a day exercise, so long as it has been not less than 4 hours since your final bowling session.
Some tips say to cut back your long-acting basal insulin on days you intend to train, which I typically do. However the one factor I am adjusting is the evening basis. My endo recommended splitting my basal consumption into morning and night, which labored wonders for me.
I hold my daytime consumption the identical (until I am sitting all day, like throughout an extended flight, through which case I improve it) and regulate my nighttime basal dose relying on my exercise stage. This implies you do not have to plan your consumption upfront. I will regulate it on the finish of the day.
Benefits and drawbacks
When selecting whether or not to manage your insulin with an injection or an insulin pump, the selection may be very private and yours to make. Each strategies have benefits and drawbacks.
Benefits of utilizing an insulin pump
- Completely different basal charges will be set to go well with particular person wants, with the choice to set small dosing increments.
- Some built-in programs can regulate insulin based mostly on CGM readings.
- The pump tracks IOBs, assists with dose calculations, and offers detailed stories.
Disadvantages of utilizing an insulin pump
- DKA can happen shortly if disconnected for greater than 4 hours or if the pump fails
- Fashionable insulin lasts so lengthy within the physique that trendy pump programs are actually pointless
- Should be related to your machine 24/7
Benefits of a number of each day injections
- Lengthy-acting basal insulin requires little adjustment of exercise
- No different gadgets related
- Basal insulin reduces danger of DKA and eliminates machine failure
Disadvantages of a number of each day injections
- 1/2 unit is the smallest unit increment that may be administered.
- The basal dose can solely be adjusted a couple of times a day (relying on whether or not cut up doses are given), and the results of these changes aren’t fast.
- Common pens (not smartpens) haven’t got bolus calculators or IOB monitoring.
Which is healthier: an injection or a pump?
Possibly you like your insulin pump or pen, or possibly you are able to make the change. Possibly you are considering that the grass is greener on the opposite facet, or that switching to a unique technique of insulin supply might enhance your diabetes administration and make your life simpler.
For my part, you’ll be able to obtain wholesome blood sugar ranges both manner. What is going to decide your success is how that technique of insulin administration matches along with your life-style, character, and willingness to deal with the shortcomings of both technique.
For some individuals, the danger of DKA from utilizing a pump outweighs the stress of getting to inject not less than 4 to 6 insulin injections every day.
After we requested the Diabetes Robust neighborhood on Instagram whether or not they use insulin pumps or MDIs, the reply was 50-50. This appears to indicate that my idea that there isn’t a “one dimension matches all” technique is true.
This publish isComparability of pumps and MDIAnd better of all, I obtained to know me a little bit higher.
