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If you could reach your health goals (e.g., A1c, time in range) equally well with any of these insulin delivery methods, which would you prefer to use?
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I’d love to pare away as much of my pump as possible, while still keeping all of it functionality. But I don’t foresee life without a pump at my age, and I’m happy to have it.
I wear an insulin pump “looped” with a CGM. It does well but with my job I’ve damaged it. Likewise I’ve like the tubing loose in tight situations. With an insulin pen there’s less chance of damage or pulled tubing.
I honestly don’t believe I could have the same TIR I get with my pump/CGM with any MDI routine. While I would love not being attached to a pump I chose tubed pump. MDI with pens would not work for me, even though I know the questions states “If”. Can’t adjust basal hour by hour or do extended bolus with pens.
I just cannot understand who would WANT to be connected to a pump or even an OmniPOd if you don’t have to. I use syringes and my TIR is 80%+ and A1C is 6.1. I am sure I can improve both using a pod at night when TIR is not as good, but that is the tradeoff. Total freedom and convenience with very good results. I would LOVE to hear WHY people prefer pumps and PODs so much if they can get similar results with something less intrusive.
Philip,
I would love to not be connected to a pump but I have not been able to have success with MDI. My basal requirements are very different at different times of day. No amount of timing, splitting doses etc allowed me to have good overnight numbers on injections. “If” there was a basal insulin that worked perfectly I would love to try it!
LizB, have you considered injecting long acting glargine (“Lantus”) in split dose as basal? I take equal injections at 6 AM and 6 PM. (Perfectionists inject 3 doses per day eight hours apart.) Then bolus injections with fast acting lispro (Novolog) as needed guided by continuous monitor and net grams carbo consumed and exercise, or lack of exercise.
LizB, with what I know now, I would handle an overnight hike in Cascades this way: lower glargine before hike, take regular bolus fast acting before breakfast driving to trailhead. Every 30-60’ check continuous monitor and eat a handful of crunchy granola (“gorp”) as needed. Be prepared to drastically reduce fast acting insulin. After hike, do not immediately return to usual long acting insulin (basal) dose. Wait a day. There is a “carry over effect” of sustained exercise. If ignored, one can be subject to severe hypoglycemia.
In the Panglossian best of all possible worlds, I would choose the smart pens. Needles are so much thinner than in the past. They don’t rip out. And if the end results are identical, who needs all the complications of full factory added equipment I’ve worn since 1996? ٩(ȏ)۶
I feel the same ..I have been on syringe or Pen for 68 years.. from sweet charlie..
Ahh Life, I am really ignorant. Is a Novopen a “smart” pen? Isn’t it just another way of injecting? My “pen” was bigger than a syringe and could only deliver in whole units. Using syringes (and vials) I can try to deliver half or third of a unit. AND THERE ARE SYRINGES MARKED IN HALF UNITS. My pharmacist said these are only available to children! Sh*t!
What is a “smart” pen?
I dont know if I would be happier with a tubeless pump or not, looks like they have problems from what I read. I have had no problems with my tubed pump in over 20 yrs so happy to have it and be in pretty good TIR So great compared to 40 yrs ago.
I had a tubed pump for about 15 years and switched to Omnipod in 2009. I would never want to go back to the tubed pump. I had no problems whatsoever with either pump.
Me too. A pod fails maybe once a year. My only problem is rare and self-induced and coincidentally happened yesterday. Pod was on my leg and I caught it on the edge of one of those tall chairs at a restaurant and pulled the cannula out.
I think the best is option would be the Omnipod closed loop with a dexcom G6 so to be G7. I love my current pump just can’t stand the finagling with the tubing.
I’ve had Omnipod for quite a few years now. I am anxiously awaiting the release of the closed loop system that uses Dexcom CGM.
Ken, hey, me too, IF covered by Medicare AND approved by my endocrinologist and her diabetes tech team.
I would prefer not to have to use a delivery method 🙂
Nevin, what happened to stem cell cures? What happened to genetic CRISPR technology to correct our immune systems? You can transplant beta cells, but 9 years later your immune system will have destroyed them…and you’ll be in medical debt and still injecting. If I were a bizillionaire, yeah, I’d just have transplant after transplant.
This is a very hypothetical question, not based in reality. Given that, I would select the least restrictive option. I believe that would be the insulin pen. I’ve never seen an insulin pen. But, I’m guessing that they are prefilled and can be carried around like a pen? Then I’m not attached to anything and only need to think about it occasionally throughout the day. Hypothetically speaking. 😉
I am a senior with type 1 LADA for the past 24 years. Seniors like sameness without big changes, so I am still using syringes and vials which work for me. My A1Cs are excellent but time in range fluctuates. I wear the Abbott Freestyle Libre and learning how to inject the sensors and learn the system was overwhelming when it first arrived. The Walgreens pharmacist had just taken a class about the Libre and told me to bring the entire box into the store. She was great and I learned everything at Walgreens.
I believe you mean that SOME Seniors like sameness without big changes, ma’am. 😉
Mick and connie, I am one of Connies seniors [for] 68 years !!!
I’ve never tried pens. Im going to Greece for a month in September and may take pens instead of my Tandem pump. With cgm. I get tired of tubing. And having to change sites every 2 1/2 days.
chose other. have always been MDI and added a Libre2 a little over a year ago. A1C and TIR have been great but IF IF IF you could reach your goals equally, I’d go with inhaled insulin. No pumps, no shots at all?
The inhaled insulin is a big change and the effect on the lungs is unclear.
At this point I feel I will never go back to a pump. Either tubed or tubeless. Pens give me more freedom. Easily portable for travel. Do not mind injections. More expensive on Medicare for some reason that I do not understand. My TIR is 95-100%. Set at 70-150. My A1c is 5.6. Happy with my choice.
Jane, will you PUH-LEASE explain how pens are different from syringes? I just don’t get it.
If I could be in range I would much rather just have a needle once a day
How many can have great control with just one shot? Some, definitely. The majority, however, cannot.
I’m refusing to respond with ANY of options you’ve provided for such an inane question!
why is the question inane?? It is quite legit
I agree with Mick… I would say Pen or syringe if it would be once a day shot and normal BS all day.. But 68 years of D tells me that is not going to happen !!!!!
I don’t think the question is inane. It might help inform whether research should focus on better pumps and sensors, or better insulins, smart pens, etc.
Philip Bunsick
I just cannot understand who would WANT to be connected to a pump or even an OmniPOd if you don’t have to. I use syringes and my TIR is 80%+ and A1C is 6.1. I am sure I can improve both using a pod at night when TIR is not as good, but that is the tradeoff. Total freedom and convenience with very good results. I would LOVE to hear WHY people prefer pumps and PODs so much if they can get similar results with something less intrusive.
I don’t think Omnipod is more intrusive at all. I only have to mess with it once every three days. And the ability to adjust basal on the fly is amazing. I’d I overestimated carbs I can reduce basal instead of eating something. If I had a couple glasses of wine, I can turn basal down overnight. So many advantages.
I’ll tell you why. A tubeless Omnipod, which is so much easier to apply than the 670 tubed pump, can tell me exactly how much insulin I have on board in case I want to know. Or the exact time I took that bolus, not to mention the plethora of data provided so both my clinic and I can see it. Along with all of my Dexcom info. I do think about it every three days when I put it on. The other times are when I’m going to bolus or when I need to REDUCE the amount of insulin by using a temporary basal if everyday living plans or food amount is less than bolused for. I’m also looking forward to when the Dex and Omnipod will communicate and work together, sometime later this year.
That’s why.
I never minded MDI, but I love not having to carry syringes, insulin and alcohol pads with me when I go places. I generally am reasonably close to home, so back-up insulin and syringes are not things I worry about having to carry with me. I just go about my day and if I happen to meet a friend, I can say “Let’s go grab a bite to eat” without having to go home and grab my diabetes supplies. My pump is always on.
Philip, congratulations on achieving 80%+ TIR and an A1C of 6.1 on multiple daily injections. That’s great!
I was on MDI for five years before starting a pump. I had an AIC on the 5% range, BUT struggled with severe hypos.
Based on my insulin sensitivity and my unpredictable work /life schedule a pump has proven to be a much safer and better fit for me.
We’re all T1Ds, but the challenges we each face vary. Good to have options. May we all find out best fit!
I’m surprised that Omnipod is the most popular choice when, for a Medicare recipient, it’s so much more expensive to use than a tubed pump.
My choice is Other, I would prefer to have a fully functioning pancreas and not be dependent upon devices. Don’t get me wrong, I love my pump but I’d prefer not to have to use any insulin delivery device. #BeWell
I have always used MDI but the concept of tubeless pumps is very appealing!
A hypothetical answer to a hypothetical question. I picked tubeless pump even though I’ve never used one of those.
I’m using a tandem t:slim2x with a Dexcom g6 and never in my life I thought I could go to sleep through the entire night without having to worried about not waking up in the morning because a low took my life.
Im 82 years old and would not do injections even if you pay me. With all the inconvenience of being tethered to the pump it works a lot better than injections.
The question, while not invalid, is likely to be highly controversial and highly biased. People tend to respond that “their” current selection is the best unless they just can’t afford or get their method of choice. I’m fortunate that I can get whichever system I want, but I use a tubeless pump because I can’t imagine being tied to a tubed version. But, I’ve never tried a tubed version, though I think the T:Slim has more/better controls and better algorithm, with better resulting BG control. I’m over 80% TIR, 6.4 GMI, and an A1c to match; how much better would I need to be to make tubed version desirable and worthy of what I perceive as inconvenience?
We’re fortunate to have the different versions available, we’re unfortunate not to have a system that supports being able to easily “test” which version works best for us, as well as being able to afford what we’d choose.
If required to have 24 hour basal insulin and multiple injections, I would prefer a tubeless pump as long as it can be used as part of a closed-loop system. My preference, however, would be to use Glucose Responsive insulin via injection (daily or less frequently). If developed, this would be a less intrusive/time consuming option plus a safer/more reliable way to manage T1D.
The least invasive for me would be syringes however I was unable to achieve the control I want and had to resort to tubed pump with linked cgm.
I answered too quickly. lol
Definitely pens after reading other responses.
I use Dexcom and OmniPod. My control is still only so so. Last A1C 7.1
I would return to the least expensive method using a syringe. The tremendous expense of DME in addition to the constant stress of dealing with a third-party medical supply company is getting close to overwhelming.
While I love a lot about the CIQ feature and the tslim with Dexcom, if I could get such tight control using an insulin pen, I’d jump at it! Wearing the pump 24/7, changing sites, worry about whether it’s a “good” site- those all feel like sacrifices I make to stay optimally healthy.
I like my Tandem pump with it’s tubing, I can’t wear sensors or infusion sites on my arms as all the fat was burned away by early insulin 50-60 years ago. I do use my thighs, abdomen and the small of my back and these sites work great. Control IQ takes over some of the management too.
Other:Islet Cell or tubeless pump
I have never used a tubeless insulin pump. Advantages to me include, waterproof, and yes, no tubes. Disadvantage might be lack of real estate on my body to insert easily as I have some scarring in the best places due to my early years (20) of mdi.
I picked insulin pens. I feel I’m in more control and having less chance of problems. Also, not keen on having yet another device attached.
All outcomes being equal, I’d take pens because of the thinner needles available. I have lipoatrophy and it is getting quite difficult to find spots for a pump.
I am making an assumption that “reach health goals equally well” would mean I would miraculously be better at math… I’d need the pen that does the “insulin on board” calculation!
I would love to not have things attached to my body, yet still be able to achieve all health goals as they pertain to T1D! Although I am succeeding with this, currently, by using the insulin pump – I’d love not to have it attached 24/7.
Currently on T:slim and Dexcom, but would switch to MDI if I could have the same control in a heartbeat.
I can’t stand having things attached to me and it would be so much easier to shop without having to worry about where the hell I’d clip the pump.
As it is, I haven’t bought anything without pockets in years. Would rather just not have the hassle of worrying about securing it some other way.
I put that I would prefer a tubeless pump, but to tell you the truth, I don’t know if having a pod on me would be comfortable in many places on the body. If it is sticking out of my arm, it could get bumped into by doorways. If it is on my stomach, it may cause the waistband to be too tight. If on my hip, that could make it difficult to pull pants up. When I think about the problems the tubeless version of a pump can cause, I just may prefer my regular tube pump as I can put the pump where ever is most comfortable or convenient. I don’t have problems getting my tubing caught on anything so the only real problem with tubing for me is that there is a waste of insulin that is left in the tube when it is time to change my infusion set.
My other is to swallow a pill. I know not available in my area(Earth) LOL
Using 6 units long acting glargine at 6 AM and at 6 PM plus sliding scale for fast acting lispro before 3 meals and Dexcom 6 high alerts at 130 and low alerts at 70: over 14 days I had 121 mg/dL average glucose, 30 mg/dL Standard Deviation, 6.2% GMI (what is
GMI?), 94% In Range, 2% High, <1% Very High, 3% Low, <1% Very Low. That’s using multiple daily injections and low carb diet, only light exercise, no aerobics, no weight lifting or Nautilus machines, just walking a at least one mile 3 times a week. And preparing my own meals at home.
While I would prefer to use a tubeless pump the one I used, Medtrum, was disappointing. Particularly the associated sensor. Back on a tubed pump.
I chose Tubed pumps. I have no experience with tubeless pumps. Pumps are sooooo much better control than injections for me.
My choice would be a vaccine that cures type 1 diabetes. If they find a way to do it for newly diagnosed patients but not long standing, maybe I can receive a new pancreas that my body won’t reject.
I had the omnipod (tubeless) for a year and was miserable. I switched to injections for about a month while waiting on my tandem tslim. The pods were uncomfortable, I was allergic to the adhesive omnipod uses, and I never made it the full 72 hours with one pod.