I’m interested to know how the advantages and disadvantages of both options are presented these days. Is one being pushed or presented in an unrealistic or in any way misleading way by doctors and other advisors? Or are they each presented based on their merits and based on the individual needs and preferences of all those concerned? Any time a newer product, technology or method arrives, as with pumping in the last 20 years, these kinds of questions should be asked.
This is an excellent and very important question - which I certainly don’t need to tell you - and I’m looking forward to the responses. I switched to a pump almost 30 years ago now, and had been on injections nearly the same amount of time. It was about three years from the time my endo first suggested it, until I finally made the switch: and while it has been a very long time I do not recall any “pressure tactics” - he simply suggested I consider it as it would/could lead to better control. He did tell me he believed I would be an excellent candidate for one - at the time I think you had to document medical necessity for insurance approval.
While the medical community considers pumps the next best thing to an artificial pancreas, and it is easier and maybe more discrete to give a bolus than a shot, many people do well or even better on injections and I’m not sure (I even doubt) that’s made known in the discussions.
Can’t wait to see the replies!
David @David852, choice of method for taking the insulin we need to live, is and should be the choice of the person living with diabetes or, in instance of a child, the parent. Both infusion and injection can be equally optimal given the individual’s capabilities. I had a discussion this morning with an individual about this earlier today, and in her instance, we concluded that injections would be better for her - a mature adult. I’ve met a pediatric endocrinologist who occasionally posts who has lived with his own diabetes for 55 years who changed at least a decade ago from pump to MDI - he has documented significantly better management with injections.
Similar to Dorie @Wadawabbit, doctors first began talking WITH me about using a pump about three decades before I made the switch - personally, now I prefer the almost fully iAIDs of infusion. My decision came after 47 years of injections, and now two decades later I like the fact that I don’t need to stick myself with a needle 2,000 times a year.
The bottom line, you decide what works better for you / your child, and don’t let the doctor pressure you without her/him explaining why - and offering Pros & Cons of method for insulin. There are currently three choices for you; Injection (most common), Infusion, Inhalation (least common). The first two methods both were very effective for me, I have not yet (for good reason) experimented with the inhaled insulin - although a friend (20+ years T1D) has found inhaled provide him with better management than he had with either injection or infusion.
David, this is always an interesting topic.
As the others have said, the final choice comes down to what is best for you, which also translates to what you want.
The doctors will inevitably push you towards a pump. I’ve been T1D for 48 years and am not on a pump, by choice. But it’s difficult to explain why I choose pens over pump without sinking into clichés.
Yes, I am a bit old fashioned in my management of T1D. For example whenever I see the topic of “carb counting” come up, I am surprised that not everybody knows about it. Carb counting was one of the first things I was taught back in hospital at first diagnosis 48 years ago and I struggle to comprehend how something so simple and helpful is not still taught by default.
For me, understanding the mechanics of T1D is way more important than handing over some simple activities to a little box and tubes. So I choose to maintain more hands-on control.
Having said that, as I live in Australia and the government has recently mandated that all people living with T1D will be provided free-of-charge with a CGM, I am choosing to replace my finger pricks with a CGM. So for me that is a significant step.
But going to a pump is a step too far for my management style. I choose to remain with the pens.
Anecdotally, when I started with a new Endo some years ago, I told her that I would educate her about what it means to LIVE with T1D. She smothered a scoff at the time, but has since admitted to me that I have taught her a lot that they don’t teach the doctors at university. We now have a healthy 2 way relationship and it is the same doctor who will be moving me over to the CGM on my next visit.
You say that doctors will inevitably push you towards a pump. But I’m wondering how the process of advising new patients on shots vs pumps actually works these days. When I was diagnosed, there were no pumps, no options — the same as with everyone who has commented so far. There was no possible confusion and nothing much to decide about. New T1 diabetics are in a very different place.
I recall speaking awhile back to the parents of a recently diagnosed teenager. The parents thought injections were the way to go but their son wanted a pump. Who knows what advice they got or why they were told this or that. Apparently, the parents didn’t think the son would like or do well being hooked up to a machine virtually 24/7 but he was cool with that. At least, initially.
If I had to guess, I would say that whatever the advisory/decision process is in 2022, it’s likely somewhat haphazard with a lot of trial and error involved and not a whole lot of objective, thoughtful analysis being done upfront by the doctors (or whatever time-limited person is giving the advice). But that’s based more on my observing how healthcare works at present, not a sample of anecdotal reports by new Type 1s. Maybe some will chime in with their experiences.
I was diagnosed in 2020, my endo wanted me to do shots/use a meter for at least the first few months so that I would have the basics down. I heard about CGMs and Pumps from my aunt (a nurse) and from some of the nurses at the ER.
One of my diabetes educators at “diabetes crash course” had T1D and showed me and my parents her pump and CGM, which was awesome because it showed me “okay people actually use this stuff”.
6months post diagnosis I was done with bleeding fingers and having to poke myself, and so when my endo asked if I wanted to start on a CGM I said YES.
I was hesitant to start on a pump, my main hesitation being that I didn’t want another computer attached to me 24/7 (a receiver and phone were already annoying) and I was afraid that it might dump all the insulin into me and kill me. (Irrational, I know, but still a fear). My endo asked after a year if I wanted a pump and told me some of the pros (better control, no more shots, etc). I said no, I didn’t mind shots. But my family sails a lot and I hated giving shots on a rocking boat (or trying to give a shot in the car) so at my next appointment I asked for a pump and got it 3 months later. I love my pump and the control it gives and how easy it is to give a Bolus, but I don’t mind shots and I think once my pump dies I’ll go back to MDI for a while.
I think the big pros and cons are obvious, but the more everyday pros and cons of a pump aren’t really realized until you’re actually using it 24/7 and the pros/cons are a little different for each person. I love that I don’t have to poke myself with a needle In front of my friends all the time, or leave early from class at lunch, but boy alarm fatigue is real and sites that never want to stick for the full 3 days are a pain. No endo tells you that showering/getting dressed with a pump is going to be trickier. Can’t tell you how many sites I’ve pulled out on door handles/frames/drawers. Some of the basic stuff is 10x more complicated.
Hopefully that was the response you were looking for I’ll be watching this page for replies from other T1D newbies.
Hi @6yGodsGr . It’s extremely rare for me to pull out an infusion set - it may have happened a couple of times in my 20+ years pumping but not that I can specifically recall. I use the 9mm(? - well longer) set, which may help it stay in longer. I have been jerked a few times but that’s about it. There are products such as GrifGrips and SimPatches that can help keep your device in place. I use the SimPatch for my Dexcom - they’re great and generally last the entire 10 days of sensor life but I don’t know if they make one specifically for pumps. GrifGrips say they are for pump but I’ve never tried them. Both are available on Amazon.
Good post, yes. Especially your point about the “everyday” pros and cons that you may only discover by doing something yourself. Those are the kinds of things that can get you to change course on what methods you use in the future. Great that you’re staying flexible and keeping an open mind.
Interesting story on finger sticks: I was testing one day on the train and a woman quizzed me on why I was pricking the side of my finger, not the front. It hurts a lot less, bleeds less and that’s how you’re supposed to do it, I replied. Turns out she had never read that in the manual and nobody ever told her that. Besides that, it’s no accident that ads for CGMs go on and on about how terrible finger tip testing is. Not the whole story, not even close, but it gets people thinking about CGM vs BSM the way the advertisers want.
@wandawabbit - I use a 7mm set, and my problem is usually that the cannula stays but the adhesive doesn’t. I’m a teenager in a family that does a lot of water sports, so getting the adhesive to stick while I’m near the water/on the go is my biggest struggle.
I use the sim patches for my G6, but I don’t think they make patches for pumps. I haven’t been able to find any. I tried using simpatches for libre CGMs by stretching them to fit over my pump site which worked as long as I didn’t go swimming. Then the patches would shrink and end up peeling my site half off. I’m gonna try cutting the libre patches into different shapes to fit around my site better, maybe that will work.
I’ve tried using tape but that doesn’t work for me either. My brother has suggested using super glue
My endo/diabetes educators haven’t been much help in this area, I don’t think they get this issue very often.
I will definitely check out the grifgrips! Thanks.
@David852- one of the first questions I asked my diabetes educator was “where am I supposed to poke my finger?” The nurse in the ER poked my finger pad (that hurt for a few days!) but the educator was telling me to poke the side of my finger. That got me super confused.
I think there have been some forum discussions about adhesives and tips for keeping sets in place - try a search for “adhesive” and see if you find anything helpful.
As far as where to prick your finger, my personal, non-medical opinion is that it is personal prefence: I personally find the side more painful (although my doctor’ office uses it🙁) so I use the pad. I don’t think you’ll get a different result between the two. The important thing is to clean to prevent infection before and after.
@wadawabbit Very interesting that the sides of your fingers actually hurt more, not less. As I understand it, there are a lot more nerve endings in the front/pads than the sides (a Darwinian development, I would imagine). Might it have anything to do with the depth setting on your finger pricker?
@David852 that’s an excellent point. Since I use a Dexcom I don’t prick my fingers very often so it’s not a big deal for me. Thanks!