It was Easter Sunday in 1982, I was in my hospital room newly diagnosed with type 1 diabetes, sticking a syringe into an orange. The nurses had me practicing what was going to be a lifetime of daily insulin injections.
Manually injecting insulin through a syringe was all I knew, and I adjusted because there wasn't another insulin delivery method available on the market. In those days I used vials of insulin and needles that were thicker, and a bit longer than I use now.
When insulin pumps became commercially available, I didn't have medical insurance to cover the cost. So, I stayed on multiple daily injections (MDI) of basal and bolus insulin, and I've continued this insulin therapy for 40+ years now.
Although I am very thankful that I now have insurance coverage and access to any type of insulin delivery system, I still choose MDI. This insulin delivery method continues to support my lifestyle and A1C goals. So, "If it's not broken, don't fix it."
When it comes to diabetes care, there is no one size fits all. Each woman must consider her own lifestyle, personal needs, and the benefits she most needs to reach her health goals.
Insulin pumps and multiple daily injections (MDI) are both effective methods of delivering insulin for women with diabetes. But there are some differences to consider when choosing between the two insulin delivery methods.
The Pros and Cons of Insulin Pumps and MDI
Insulin pumps are small devices that deliver insulin continuously through a tube inserted under the skin. There are also new tubeless devices available.
Pros of using an insulin pump:
They offer more flexibility and precision in insulin dosing, as well as the ability to adjust basal rates (the amount of insulin delivered continuously throughout the day) based on individual needs.
They also allow for bolus doses (additional insulin delivered at mealtimes) to be calculated more precisely and conveniently.
Integrates with CGMs (continuous glucose monitor)
Cons of using an insulin pump:
Insulin pumps can be expensive.
Require more frequent monitoring and maintenance, which may not be suitable for everyone.
Pumps can break or tubing can become disconnected.
Scar tissue in site locations can interfere with insulin sensitivity.
Limitations on exercise, time in the water swimming, hot tub, etc.
There is also a risk of setting up the pump incorrectly. First-time users should ask their healthcare provider for setup instructions for using the insulin pump properly and continue to check their blood sugar regularly. If you don't, you might not get the insulin you need, which can be dangerous and even life-threatening.
MDI involves injecting insulin several times a day using vials with a syringe or insulin pen.
Pros of using MDI:
This method allows for more flexibility in terms of insulin type and dosing.
May be more affordable than an insulin pump.
Insulin pens can stay at room temperature and are easy to carry with you.
Cons of using MDI:
Can be more challenging to achieve optimal blood glucose control with MDI.
Requires careful timing of injections.
May not allow for as precise dosing as an insulin pump.
Ideally, you want to make your decision with confidence, as the day-to-day is difficult enough for women managing insulin-dependent diabetes. Know, if and when your insulin therapy isn't working for you, you can make a change or even switch back and forth between the two delivery methods when you need to.
Taking a Pump Break
Maybe you've had great success using an insulin pump. Or, it's been so long since you've been using MDI, you're afraid it would be a steep learning curve to take a pump break. Setting basal rates and bolus/carb ratios are just a few changes you have to adjust to with MDI, and that may never have been your strength.
But, having a pump attached to you, scar tissue and site irritations, and not feeling free can be reasons to consider switching it up.
Some of the cons of using an insulin pump listed above usually drive people to take a pump break and switch to insulin pens/injections for a while.
Whichever way you go, consider what is most important and how your confidence and emotional health will be impacted.
"I've been on a (non-automated) pump for many years, and I also use the Dexcom G6. But I'm extremely eager for a break. I have Tresiba in my fridge ready for a pump break but haven't started because, to be honest, I'm a little scared of transitioning over." S. Carter
Ultimately, the decision between insulin pump therapy and MDI should be made in consultation with a healthcare provider, taking into account your individual needs, lifestyle factors, and personal preferences.
Why I Stay With MDI
The main reason I continue using MDI as my insulin delivery method is that I don't want another device attached to me. I use a CGM (continuous glucose monitor) which I love and wear on my arm and it doesn't interfere with exercise, showers, hot tub, etc. The steady blood sugar numbers I get are worth wearing this device.
Having used multiple daily injections for 40+ years to manage my type 1 diabetes, I am excited about a new delivery system I now use which makes MDI the best choice for me.
A new smart pen on the market is the Inpen. This pen provides many of the same features as an insulin pump while allowing more freedom.
Benefits of the Inpen:
Tracks active insulin.
Reminds you to dose.
Calculates personalized doses.
Automatically logs doses.
Creates shareable reports.
Syncs with CGMs and glucose meters
Lasts a full year with no need to charge.
Delivers half-unit doses.
Compatible with Novolog®, Humalog®, and Fiasp® 3 mL (U-100) insulin cartridges.
Monitors insulin temperature.
Connects to the app via Bluetooth.
No matter what your choice is to support your routine and unique needs in managing diabetes, your insulin delivery method is a personal decision that only you can make with direction from your healthcare team.