“Everything passes, everything changes
Just do what you think you should do”
The decision to wear an insulin pump is a big one for diabetics. It’s widely acknowledged that there are pros and cons both to pumping and to multiple daily injections (MDIs; i.e., syringes or pens). Some would never dream of using a pump, while others can’t stand the thought of injecting several times a day. Health outcome is of course of utmost importance, and even that varies from patient to patient. Using a pump is a highly personal decision, and each diabetic has to choose what works best in their situation.
Having never used a pump myself, I don’t know much about them and don’t keep up with news. I’m of the “old school diabetic” approach; MDIs (and blood sugar test strips) work pretty well for me and when they don’t, I usually know why and can fix it in the future. To me, a pump just fixes problems that don’t exist and the idea of wearing a machine plunged into my stomach at all times, like some creepy S&M beeper, is a non-starter. (See more about why I don’t want a pump here.)
But my ignorance isn’t cool. Diabetics should be aware of technology and new approaches to care. I wanted to understand other sides of the issue so I asked some other diabetics about their experiences with and thoughts on insulin pumps.
Chad: I’ll wear a pump if…
Chad (Twitter: @Machine716) has had Type 1 for 20 years and has never used an insulin pump. He told me he likes the feeling of a direct relationship with his diabetes that MDIs give him – if his blood sugar is high he draws up some insulin, sticks the needle directly in his skin, and pushes the plunger. There is nothing between him and his veins (except the syringe – hey, it is diabetes).
Psychology is a vital factor about opting for a pump or MDIs – it’s not a purely medical decision for many diabetics. Besides the feeling of control MDIs give him, Chad hates “the idea of being attached to something 24/7”. This is important to many, while for others it’s no factor at all. Chad’s distaste for being hooked up at all times to a pump means MDIs fit with his psychology better, arguably leading to a better day-to-day life for him. And isn’t that the point?
Despite his aversion to having a pump attached to him at all times, Chad is a realist. Interestingly, he does wear a continuous glucose monitor (CGM); he began using it eight months ago. He was having frequent problems with nighttime lows and the CGM has virtually eliminated them (stress in his life led to his being unaware of hypos and he was waking up often in the 30s and 40s). He acknowledges difficulties with the CGM – he can’t sleep on that side of his body, and it was annoying when taking a shower or playing sports until he worked out a system. But overall the health benefits are stark and irresistible.
Even more interestingly, Chad isn’t totally against the idea of a pump, and says that while pumps are currently, basically, just glorified shots, he is attracted by the fact that pumps increase or decrease basal insulin as needed, and that microdosing is much more precise with a pump (try drawing up 0.1 units of insulin in a syringe!). And he says he himself might begin using a pump once two points are satisfied:
- Insulin AND glucagon. If a pump were made that could dole out both the yin and the yang of diabetes injectables, Chad would be all for it.
- A smart pump that learns about you. Chad would like to see technology that would improve its understanding of a patient’s specific dosing needs over time.
Furthermore, Chad points out that it’s inaccurate to lump CGM users in with pump users because “they are at opposite ends of the management spectrum”. He is highly suspicious of Big Pharma and doesn’t like the premature use of the term “artificial pancreas” for current technology.
Chad is focused on his numbers, and as things stand now a pump doesn’t figure into his diabetes care, though the CGM has improved his readings by leaps and bounds. “I swear by Lantus, but I wish I could manually tell it to let up or come on strong at times,” he says. “So I get why pumpers swear by their pumps.”
Ally: The pump didn’t work for me
Another diabetic, Ally (Twitter: @verylightnosuga), has had diabetes since she was two years old (!) and her experiences with a pump went great at first, but then so badly that she is happily back on MDIs now.
(Note: Ally asked me to stress that each diabetic’s approach to insulin delivery, and diabetes in general, is a personal choice and there are no hard and fast rules – do whatever fits your style and your diabetes. By the way, check out Ally’s blog Very Light No Sugar.)
Ally used animal and then synthetic insulin MDIs for years, but in high school started pumping. She loved it at first – it improved her life with its ease of use and the fluctuating basal rates seemed to smooth out her blood sugars. She called it “a whole new world of freedom,” mirroring what many happy pumpers say.
But in college it all changed.
Defective equipment, bent cannulas (the part that holds the needle in the skin), and painful and ineffective pump sites on her body added up to more-frequent-than-usual problems with the insulin actually getting into her bloodstream. This had, as you can imagine, serious and immediate effects on her diabetes care. Adding to the misery was the fact that people tended to disregard her when she brought up her pump issues.
Finally, two years ago, Ally and her doctors decided it was time to return to MDIs. Things have been much better for her since then – not perfect, but clearly better. Like Chad, Ally loves the feeling of direct control. If there’s a problem, she injects insulin and is positive that it’s going into her body, right now, unlike with her pump. (Interestingly, and also like Chad, Ally uses a CGM in conjunction with her MDIs.)
Ally too has not ruled out using an insulin pump in the future, and is excited about the promise that technology offers. But ultimately, she feels that the real goal is to just get rid of diabetes altogether.
“We need a cure,” she says. “I’ll be taking my insulin shots in the meantime.”
Cat: The pump gave me freedom
By contrast, Cat Latuszek (@PavedSilverRoad) started out with conventional needle insulin therapy in the 1990s but started using a pump on the advice of her doctor when she got pregnant. She loves the pump; it’s given her significant health benefits and she feels no stress at all about wearing it. (She’s also been wearing a CGM for the last few months.)
So happy is Cat with her pump that when she lists her personal pros and cons, the pros are many and the cons are actually more like hidden pros to her.
What Cat likes about the pump includes the fact that she can have an irregular schedule – which she often does due to her job – and the pump will take care of her fluctuating insulin needs during those times. Not only that, but she occasionally forgets to eat (as a self-described “workaholic”) and also has to deal with gastroparesis, which affects food digestion and can cause her to vomit. All of these would normally wreak havoc on her blood sugar, but her pump regulates it all much better than shots could.
An interesting benefit of the pump for Cat is that it’s smarter than some doctors. She was once hospitalized while still on MDIs, and had a doctor who didn’t understand her personal diabetes routine and ignored her endocrinologist’s input on the matter (the endo finally straightened him out with some sharp words). Such untalented doctors are unlikely to try to overrule a pump so Cat doesn’t have to object and be what she calls “a royal bitch” about it.
As for pumping cons, Cat could only admit that she has often jumped into a pool or the ocean for a swim, forgetting that she was hooked up to a pump. (She doesn’t have a waterproof pump yet, and has destroyed “a lot” of them over the years!) This can be annoying and expensive, but really points to the fact that she is not at all inconvenienced by wearing a pump.
A more plainly negative point is that the pump’s tubing gets snagged on things all the time – a relatively minor problem that in no way makes her rethink using a pump itself.
Cat’s attitude about her pump is that is just a mundane extension of her body. “It’s just as much a part of me as my arm or my toe – both of which get banged up a lot in their own right,” she reasons.
Chad, Ally, and Cat offer interesting perspectives on pumps. Chad isn’t interested in one, while Ally was until it started to go downhill. Cat doesn’t see any real problem with wearing one and is perfectly happy with it. All wear CGMs, though Chad doesn’t actually like the idea of being attached to something all the time. Chad and Ally would conceivably wear a pump in the future if the technology were compelling enough.
Ally’s initial experiences with her pump in high school basically mirror those of Cat now: it makes life easier, it make blood sugar control better, and as long as it’s smooth sailing there is no reason to go back to MDIs. Both cite the feeling of “freedom” that the opposing approaches have given them – different strokes for different folks!
These stories drive home the point that diabetics ought to experiment, be open-minded, have good health professionals in their lives, and go with whatever works for their physical and emotional health.
Personally, I’m quite happy with MDIs and a regular old finger-check glucose monitor. I’m used to them, they work well enough (6.9% A1C – good enough that the hassle of a pump isn’t worth it for me). But actually, while the idea of wearing a pump or a CGM all the time turns me off greatly, in many ways I’m temperamentally closest to Cat the pumper of the three people in this article: I too hate routine schedules and love simplicity, and have angrily bitched at doctors who are inept at dealing with diabetes.
While I wouldn’t consider a pump now, even I must admit that if the technology were impressive and reliable enough, I would have to try it out as well.
Ultimately the differences between pumps and MDIs are in the eye of the beholder. As Ally says:
[Technology] will never be a cure-all … Whether insulin pumping or injecting, diabetes is still diabetes.
That says it all!
How do you feel about MDIs vs. pumps?
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