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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have you ever actually tried one...? it's great for people who need small basal adjustments, different basal adjustments throughout the day (especially at night and for working out, etc..), it's great for small increments for bolus - corrections. Most insurance companies do cover a pump for a type 1, depending on, of course, insurance. Actually, they typically do not need to replaced...they're actually very reliable and have a warranty. Most people love their pump and wouldn't go back to MDI's unless they HAD to.

1) they are way too costly and usually not covered by insurance

They are expensive, but if you look at ANY device for medical/disability purposes, they are all ridiculously expensive and often not covered by insurance and/or provincial health coverage. So this is not really a "pump" problem but a more general problem of companies charging ridiculous prices for technology that people need. I have a braille-tablet-computer type device on loan for school which costs $7,000 for, essentially, an iPad (and yes, it's just as feature limited!). Which is ridiculous but, well, I need to be able to read, and all such devices with refreshable braille displays are just as expensive.

2) you still have to prick your finger to test your BG because they are often not accurate (i still can't believe this?!)

This is not a problem with pumps. This is a problem with CGM devices which are completely different. Pumps are starting to have CGMs integrated into them, but pumps came out LONG before CGMs did, and there are many people who use a pump without using a CGM.

it's not really like a pancreas, you must still figure out your dosages

Pump aren't like an "artificial pancreas" but, then, they have never purported to be automatic like that ... Overall, pumps offer way more flexibility than you can get with injections, although not everyone needs that flexibility. It's not possible to do temporary basal rates, extended boluses, "super" boluses, or stop delivery completely with injections.

4) they need to be replaced more often than i think is acceptable

Pump companies and insurance companies "recommend" that pumps be replaced every four years, but this doesn't mean they have to be (with the exception of the Spirit which is set to stop working at four years). I have a Cozmo from five years ago that is still working fine and that I would still be using if not for the fact that it's not covered under warranty anymore and I can't see the screen at all (compared to the Ping). So the problem is not with the pumps and/or their design, it's with the companies wanting to make extra money by having people upgrade to the newest model.

5) they are bulky and won't fit well under nice clothes

I actually think the main problem here is not that the PUMP is bulky but that the INSULIN and the BATTERY are bulky. Pumps these days are not much bigger than meters. Both pumps I've had have had a majority of their space dedicated to a cartridge and a battery. If they could find a way to make insulin "smaller" and use a small watch battery, then that would go a LONG way towards being able to design smaller pumps.

LOL...I have always said that I'm just not sure why pumps cost so much when my iPhone is WAY more advanced. I am sure a lot of the cost has to do with FDA clearance, legal costs, customer support, etc as opposed to the actual cost of the device itself. I love my pump, but yeah, it's not that fancy when it really comes down to it. Granted, it does seem way more durable than my iPhone. But an Apple-designed insulin pump would just be....awesome.

The pump calculates all the doses, correction with coverage, its actually an amazing device,since my daughter has been on the pump, her numbers are alot better!!!!!

My reason is cost. I've had 3 straight years of sizable premium increases along with (this year) an increase of DME copay to 50%.

Its the invasiveness of it all. Although from the outside, it looks like the waterproof omnipod would be ok. Since being involved in triathlons i think they would be a pain in the ass with a wetsuit. Im only newly diagnosed, so maybe a few years down the track its something ill look at. But while im honeymooning its easier to just needle myself. I wouldnt mind a CGM but they arent covered here in Australia and are rather thing on the ground. I would love a dexcom. I wish the NDSS here in oz would cover them :(

My main objection is scar tissue, followed by mechanical & site failures, cost & waste. I don't need multiple basal settings, but can see that's a benefit. I usually know ahead when I'm going to be active enough to need a basal reduction. (I use two Levemir doses.) Don't mind injections & easier than hauling a bunch of pump supplies along.

For us it was 2 things:
1) fear of 'starting over' after getting a handle on MDI
2) cost
Happily, cost has been addressed by our medicare system and our daughter's pump and most of her supplies are covered. It was a ton of work at the beginning to learn a new system but I'm glad we took the plunge and started on the pump. I thought being 'tethered' would bother my daughter but she adapted remarkably quickly. The ability to change basal rates has been very useful for us and the pump has allowed for more flexibility with eating. Also have seen an improvement in A1C. This week we are going to work in a very short pump break and use shots to cover a sporting event - nice to have that additional flexibility.

With the analog insulins like NovoLog and Levemir I can have good control on MDI. My basal coverage is always good and I do not have to deal with site problems. I tried different catheters and my skin does not like adhesives very much - especially Teflon showed some mild allergic reactions. Steel would work but this felt rather uncomfortable. I am also skeptical about scar tissue. The catheter will induce a local low blood glucose for several days. With MDI in comparison this does only happen for a much shorter period of time. This local low, the permanent flow of preservatives and the permanent needle are responsible for the build-up of scar tissue. Long term I am convinced that this will lead to more severe problems - especially for the patch pumps that have only limited areas to be applied to (higher repetitive use of sites). With the pen needle I see little to no damage and right now I have only one bruise on my body from hitting a blood vessel. A permanent catheter would remind me 24/7 on being type 1 - something I would really dislike but maybe this is something to adjust to over time. One major advantage of pumps is the flexible adjustment of the basal profile to physical activity. This I have to manage with additional carbohydrates. On the other hand for sports the combination of insulin and carbs is even recommended so it is no big deal to me. So far I do not see that the adjust-ability of the pump will outweigh the negative aspects I see. This can change of course as I am not fundamental about it. In the Glucosurfer project I was just surprised to see that the link between good control and pumping is rather weak. This impression might be biased because in Germany hard to control diabetics are more likely to get a pump.

I just wanted to comment on your observation from Glucosurfer. The studies that I have seen suggest that pumping can improve your blood sugar control, but not as much as some people think. For instance, a study called REAL Trend, cited by Medtronics found that patients with poorly controlled T1 diabetes (HbA1c > 8%) on MDI who switched to a pump lowered their HbA1c by 0.55%. Those who augmented the pump with a CGM were able to lower their HbA1c by just under 1%.

This data is backed up by other studies which suggest that perhaps the benefits when your A1c is already 7% or less may be minimal as shown in the chart below.

MDI have kept me in control so well that I don't really seek anything else. In the evening I fill two syringes with Lantus, one goes into a snack baggie & the frig, the other goes into me.
In the morning I inject the Lantus in the frig and I fill a few syringes with Humalog that go into a Frio ready to go out - enough that whatever I eat will be covered well.
No site problems, and I just might have those since I'm lean. I'm also lazy and happy. I'm well aware of everything with pumps and have handled great results and problems for others since about late 1980s, but this way suits my way of life. And the Endo shrugs and says, "Fine."

Being attached to something 24/7 is the main one for me. The say you get used to it and it feels natural and all, but it is something I think I would always have an issue with. I like my freedom too much lol.

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