I am curious as to why people who are T1s don't use the pump and instead stick with MDI. Is it cost? Ease of use? Being attached to something 24/7? This is just a question I was pondering.

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Basically everything you said is why I have no interest in the pump. People that don't know think it regulates your sugar for you. WRONG! The only way I'd use a pump is if I couldn't inject more then three times a day for whatever reason. The way I eat in general I inject on average 6 times per day. I think I can get virtually the same control and close to the same flexibility as people on the pump get. I don't see what the big deal is to load a syringe and take the shot? It's really the easiest part by far of diabetes IMO. Would I rather pop a pill, yeah but its the control problem that is the nightmare not the way the medication is obtained.I will say that I have on occasion loaded my needle up with air so its not foolproof.

I think the people who find the pump most beneficial are those who have a) variable basal needs throughout the day (one "flat" dose of Lantus/Levemir doesn't cover it properly), b) a need to dose in fractions of a unit (you can only get as low as 0.5 unit with half-unit pens), and c) people who have variable insulin needs due to activity level, hormones, etc. (you can easily adjust a pump's basal rate over a matter of hours, while adjusting Lantus/Levemir can take several days).

The pump does NOT make diabetes any "easier" or require any less work than shots (I'd argue it requires more), but I do think there are some people (me included) who are able to achieve much better control on the pump due to the above factors. Of course, there's also people (perhaps the majority) who go on the pump so that they don't have to do shots, so that doses are easier to calculate, and so on. Then, there are the people who don't find it makes much difference in their control and end up either never pursuing a pump or going back to MDI. I would guess these are people who have relatively flat basal needs throughout the day and also don't have things like hormonal variations or changes in activity from day to day that make their insulin requirements change rapidly.

You know I don't even use a basil throughout the day although sometimes I use R for my bolus which stays in your bloodstream about 5 hrs anyway. I notice Humalog is virtually out of my system at about 2 to 2.5 hrs at the most. When I first went on MDI my therapist who was also diabetic said when he was on shots what worked best for him was one shot of Lantus though I use (NPH) and just humalog throughout the day. I kind of did the same thing and it seems fairly consistent most of the time. I would bet the majority of the time levels run haywire are miscalculating carbs, insulin not loading correctly, stress and exercise. With all that into play the fact that your basil dosage is correct won't have much relevance anyway. I mean just an extra 10 carb grams for some people can be 30 to 40 points higher.

My interpretation, much like Gary's, is that it is just another way to dose and not much more (my new CGM on the other hand is such a cool device!!!). I was also put off by all the 'stuff' associated with pumping. Too muchy! Seems to me that pumping involves lots of waste product. This from a guy who uses each syringe until the numbers are wearing off or I bend the point -- about three weeks or so, so dozens of injections with a single needle (keeps my diabetic waste level way down below the norm).

I do a shot of 27u Lantus in the AM each day, followed by a sliding scale 4-9u bolus of Huma-/Novo-log (whatever's handy at the time) with each meal. And sometimes a correction or two. Works fine for me.

/\/\

The waste issue is one thing that has always bothered me about pumping (probably the only thing, outside of the cost). All the packaging just makes me sick!! I try to reuse things and recycle whatever I can, but it's still a lot. I wish pump manufacturers would look at that. Hey Minimed, NO, I don't need a 100-page booklet with EACH box of infusion sets.

I also get bothered by the waste and recycle everything I can. In fact, pretty much the only parts I don't recycle are the "medical waste" parts like used tubing, cartridges, test strips, lancets, and infusion sets. All other cardboard and plastic packaging and other little bits (the little blue piece that you use to fill a cartridge and then just discard, for example) get recycled.

I think this depends a lot on the types of recycling facilities around your areas. I pay extra to recycle odd things (like foil, plastic packaging not marked with a number, etc.), but these are available in some areas for free and/or curb-side pickup.

Also, I think it's possible with pumping to reuse tubing/cartridges to a certain extent. I've never done it, but I've of heard people who do. Some people can also stretch their infusion sets out to three or four days, but I personally have to change mine every two days due to allergy issues.

Mike we have something in common. I use one syringe a day for as many shots as I take. Usually 5-6 on average. Other then a cure the upcoming Non Invasive meters will be a huge help for most. I spoke to a person working at a company involved with the one I have my eye on and she said It will likely be a few more years because of the FDA guidelines. They are finalizing the unit as we speak and it will be nice and small, give the reading in one second and have no waste or ongoing expense other then the cost of the machine itself. Seriously I don't get how people don't mind walking around with crap hanging all over their body. I carry a vial of insulin in my pocket and a syringe and am prepared equal to a pump. Don't think the pump manufacturers hate people like us. It's a multi-million dollar business those things.

I can't wait for non-evasive meters!!! What is the company that's producing them? I test so often in a day, it makes things so much easier :)

I hate the pump industry too, it makes me sick that there are so few options :(

The only issue with MDI (as compared to pumping) is the small dosing amounts you can delivery with a pump that you can't do with MDI. For some this probably isn't an issue, but for someone like me (small, insulin sensitive, TDD averages around 22 units), a pump can be a lifesaver. On MDI, I just wasn't correcting anything under 220 or so because I couldn't be sure I wasn't going to drop like a rock with just a unit of humalog.

Great, Michael McClure, I love your philosophy on wastage. I should get the prize for using needles to the max...easily 60 times each. I also can hardly read the numbers. I use a separate one for each type of insulin and leave it in the 3oz juice glass on the fridge door that the insulin vial is in and take it out less than a minute just for the tiny injection. I use so little insulin that a PUMP of the tubeless model which is my dream, would require me to put in twice as much insulin as I use on the days I am active, and it would just about kill me if I gained 10 lbs every 6 months as I have done by going to a higher level. NO I need a pump for the ability to % reduce the basal as Jen mentions. I've been approved for one, but so far the one I want is not available in Canada...the SOLO.
I also agree the wastage issue is scaring me....all the tubing for 10u a day???? It would create lots crystals along the tube, so I predict it is too much trouble. That is why a tubeless one is the only type for me. At 15u TDD I don't gain weight but at 20 and above I gain fast. And if I walk 5 miles per day then I only need 5u TDD...so that is my plan for getting rid of the winter weight.
I joke that I have failed at being me all winter, as walking really is my favourite exercise and it's also my name. So I would really appreciate it if I could set up a petition and have people vote on the value in convincing the pump designers on creating a lower minimum for insulin in the tubeless models. After all, the children deserve good control without insulin wastage. What I did read is that to get good control you can't use the last drop in a pump, so I guess I would have to always try to suck out with a syringe the last amount and put it in the second. "Waste Not Want NOT" was taught to me from a very young age....and here I am 55 years old. I am using a one year old expired penfill vial of Levemir that I got for free, and it works, possibly not as well, but I'm still using 9-18u TDD. I predict I would put the old pump insulin in a separate vial and every two weeks use the old insulin, so I can be aware of whether it is new or old insulin that is the culprit for any problems. That way I would not always contaminate the new insulin. I have saved some empty Lantus 10ml vials, as Lantus is what I have to buy when I have to pay for it, as it is cheaper.

It's hard to explain how much better I found the delivery of basal insulin w/ a pump without having the opportunity to try it. I found it much easier to control things and run very smooth numbers. I guess it's not guaranteed to be that way but having a basal "gas pedal" you can stomp on or let up on is very useful.

I found it to be less work than shots because there are less messes, unexpected highs or lows, to clean up and the cleaning is easier.

I think that the "new" pumps are completely outdated in their technology and ridiculously overpriced. I looked into getting one and had to laugh as they were telling me about the new "design" and "features". We're a family of engineers and can't believe how behind the medical industry is. My reasons for not using one are many 1) they are way too costly and usually not covered by insurance 2) you still have to prick your finger to test your BG because they are often not accurate (i still can't believe this?!) 3) it's not really like a pancreas, you must still figure out your dosages 4) they need to be replaced more often than i think is acceptable and 5) they are bulky and won't fit well under nice clothes (a little silly, I know but I don't want to have diabetes AND have to wear sweatshirts all the time).

My A1C is very much under control just with background and meal insulins. I don't think I will ever consider the pump unless Apple makes one that connects to my iPhone ;P

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