I’ve had kind 1 diabetes since 1997, and have been managing my diabetes from day one with insulin injections (a number of day by day injections – MDI). I attempted the insulin pump simply, however it wasn’t for me so I went again to doing MDI and thriving.
On this publish I’ll clarify my journey and why I select to make use of an insulin pen on an insulin pump.
My objective on this article is to not shake you up both means, however to share my experiences and offer you an outline of the professionals and cons of an insulin pump and an insulin pen, respectively.
With the best data, you may make knowledgeable selections. It is as much as you to decide on the one which fits you. In the case of diabetes, there’s nothing there isn’t any one there.
My Machine Journey
Once I was identified with kind 1 diabetes in 1997, I used to be handed my blood sugar degree and my insulin pen prescription upfront. Prefill signifies that insulin was already contained within the pen. All I needed to do was screw the needle in and create the variety of models I needed to manage. When it was empty, I simply threw a pen into the trash.
Like folks with MDI, I prescribed short-acting insulin to cowl meals (bolus) and long-acting insulin, performing as background insulin (basal).
I do not bear in mind precisely which kind of insulin was prescribed, however I needed to eat a sure period of time. It was in all probability NPH insulin. This basal insulin had a small bowl within the combination (like a bottle of nail polish), and needed to gently transfer the bowl into the liquid earlier than use. It wasn’t precisely optimum, however it labored.
When new insulin comes available on the market, I exploit Rebemir as the bottom insulin and Hamalog as my fast performing insulin, protecting prime quality meals and corrections.
The one factor that has modified for me since then is switching from pre-filled Fumallog pens to sturdy pens, then from common sturdy pens to sturdy sensible pens. A sturdy pen merely signifies that the pen is reused and solely the insulin cartridge could be thrown when it’s empty.
The benefit of sturdy pens is that they can provide 1½ models of insulin (a pretreatment used to carry out just one unit increments). The benefit of SmartPen (with INPEN) is that it tracks lively insulin monitoring (IOB), helps dose calculations, jogs my memory once I must take basal insulin, and information all injections mechanically (by way of Bluetooth on my telephone).
I additionally added a steady glucose monitor (CGM) to my diabetes toolbox, which was an actual recreation changer.
Once I was swinging the pump and why it did not work for me
In December 2017, 20 years after diabetes, I made a decision to attempt an insulin pump. I needed one of the best care so I made a decision to provide the loop a attempt. The loop is a DIY (do it your self) model of synthetic pancreatic know-how.
a often The insulin pump mechanically gives small quantities of speedy motion insulin (primarily based on programmed) Novolog, Fumalog, Apidora, 24/7.
You continue to want to induce the pump to provide you a bolus for meals and correction, however background insulin is programmed and computerized.
With the loop (DIY system) and the most recent Medtronic 670G system, the pump goes a step additional by adjusting the basal insulin dose primarily based on CGM readings.
If the system thinks your blood glucose is simply too low, cease taking insulin till it determines that your blood glucose is at a protected and steady degree. If you happen to assume your blood sugar ranges are rising, you’re going to get extra insulin.
That is nice and I am an enormous tech fan, however there’s an issue. And the issue, and finally, the explanation why insulin pumps did not work for me is that they pump insulin, which works 24/7.
Disadvantages of speedy motion insulin
Fast-acting insulin resembling Novolog, Humanlog, Apidra takes 15-20 minutes to succeed in the bloodstream after it’s injected. The height doesn’t attain 1-3 hours after injection. It stays in your physique for a complete of 3-5 hours.
The brand new little one on the block, FIASP, bumps into the bloodstream and peaks a couple of minutes quicker, however like different quickly performing insulins, it stays lively within the physique for 4-5 hours.
DKA’s dangers
Subsequently, if you’re utilizing a pump, you need to all the time flow into quickly performing insulin to stop the event of diabetic ketoacidosis (DKA) (assuming there isn’t a insulin manufacturing in any respect). If the pump malfunctions and stops supplying insulin, there’s a greater danger of getting into DKA and going to the hospital.
If you’re taking insulin by way of MDI, which implies you might be all the time on the bottom insulin, then the danger of DKA is way decrease (that is after all importantly bear in mind to take a day by day background insulin dose).
Hypoglycemia and train
As a result of quickly performing insulin lasts for 3-5 hours, these utilizing an insulin pump must be very aggressive in planning deliberate workouts and actions. When exercising, going for walks, or doing day by day duties like vacuuming, quick performing insulin on board is susceptible to experiencing hypoglycemia. Insulin pumps all the time present speedy motion insulin, so normally, there could be an excessive amount of insulin in your system resulting from all types of spontaneous actions.
Whether or not utilizing an insulin pump or MDI, all of us want to regulate the quickly performing insulin if we need to train or transfer round low. Nonetheless, with MDI, basal insulin is hardly affected by exercise, so you ought to be involved about bolus injections taken within the final 4 hours.
When utilizing an insulin pump, I needed to fear concerning the insulin I obtained as the premise for the previous 4 hours. In fact, you are able to do that. However for me, all of that primary changes had been way more laborious than utilizing MDI to handle insulin.
The pump has its benefits, however not sufficient for me
As talked about earlier than, I used to be in a loop so the pump regulates insulin once I estimate that I’m making an attempt to get hypoglycemia or hyperglycemia. And it wasn’t successfully sufficient.
The quickly performing insulin lasts for 4-5 hours within the physique, so the loop system could not sustain with my exercise degree. Sure, it is change into smarter, however my days are hardly ever the identical and I’m a really lively particular person. I used to be dropping too typically until I disconnected the complete program and micromanaged it.
For many individuals, the system is life-changing. When you’ve got entry to insulin that works quicker and shorter durations, you in all probability use an insulin pump.
Advantages of basal (long-acting) insulin
Basal insulin isn’t affected by exercise, identical to quickly performing insulin. Which means if you are going to train or change into lively, you could take into consideration adjusting meal instances and corrective bolus. Meaning I will not modify my insulin if I determine to train proper away from bed. I am going to simply go. So long as it is greater than 4 hours for the reason that final bolus, it is the identical deal because the afternoon train.
Some tips say to scale back long-acting basal insulin on the day the train is deliberate, and I do this every so often. However all I do is modify my nighttime base. My ending urged splitting my basis into morning and night doses.
I hold the daytime dosage the identical (apart from days I sit all day throughout lengthy flights, then I improve it), adjusting the nighttime base in keeping with my degree of exercise. This implies you needn’t plan forward of time in terms of doses. Regulate after the day is over.
Professionals and Cons
In the case of selecting to handle insulin with injections or with an insulin pump, the selection could be very private and the selection is yours! Each strategies have their benefits and downsides.
Professionals utilizing insulin pumps
- Means to set completely different base charges to fit your private wants.
- Some built-in techniques can modify insulin primarily based on CGM measurements
- The pump tracks the IOB, helps with dosage calculations, and gives detailed reviews obtainable
Disadvantages of utilizing an insulin pump
- If it will get minimize for greater than 4 hours or the pump fails, it may shortly result in DKA
- The most recent insulin lasts lengthy within the physique as a result of the most recent pumping techniques do not actually make sense
- Have to be put in in your gadget 24/7
A number of Every day Injection Professionals
- Lengthy-acting basal insulin requires little adjustment for exercise
- No different gadget hooked up
- Low danger of DKA resulting from basal insulin and no gadget failure
Cons of a number of day by day injections
- ½ unit is the smallest increment of unit you’ll be able to administer
- Basal can solely be adjusted a couple of times a day (relying on whether or not or not you break up the dose), however the impact of that adjustment isn’t rapid
- An everyday pen (not a wise pen) doesn’t have a bolus calculator or observe IOB
What’s best for you: injection or pump?
So you might love your insulin pump or your insulin pen, or you might be prepared for the swap. Possibly you are questioning whether or not the grass on the opposite facet is inexperienced and switching to a distinct insulin supply technique will enhance diabetes administration and make life simpler.
For my part, each methods may help you obtain wholesome blood sugar ranges. What determines your success is how that technique of insulin supply matches your life-style, your character, and your willingness to deal with the weaknesses of both technique.
For some, the danger of DKA with a pump doesn’t outweigh the stress of getting to take a minimum of 4-6 insulin injections day by day.
Once I requested on Instagram if I used to be utilizing insulin pumps or MDI in a extremely diabetic neighborhood, the responses returned on 50/50.
I hope this publish helps you offer you a “extra delicate” photograph.Pump vs MDI“dialogue. And if there was nothing else, you have come to know me slightly higher.
