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Re: [IP] The pump is better than MDI..../ my 2 cents
Gabe's (age 12.5; type I 3 years) HBA1Cs on MDI were 6, 6.2, 5.9 and 5.8; he
took 3-5 injections a day for 2.7 years (Ultralente and Humalog). He follows
a regular diet (but I do weigh and measure his food).
He has been pumping with the Paradigm for two months.
You cannot compare the pump and MDI in the precision and flexibility of
insulin delivery. The delivery of insulin with a pump is as close to
physiologic (the way the real pancreas does it) as technology can currently
More specifically, there is no insulin made in injection form that can cover
the lowered insulin resistance in the early morning hours (12 a.m. to 3 a.m.)
when there are frequent hypos from too much insulin, but then, with the same
insulin injection, provide increased insulin in the period from 3-6 am when
the dawn effect causes b.g. rise. Ultralente comes close, but its absorption
and effect depends on a shot given twelve hours earlier. NPH might come
close, but it has an unpredictable peak for many people. The pump can be
programmed in .05 increments to control basal hour by hour. So from 11p.m-12
a.m. there can be a different rate than every other hour (or half hour on the
Also, with MDI, it is difficult to cover the digestion of fat/protein meals;
with the pump, you simply give a dual bolus (bolus and extended bolus
Finally, who the hell wants to take an extra shot to a lower a slightly high
b.g. or to have a small snack? Gabe would never tolerate that. Last night
Gabe's b.g. at 9 p.m. was 98 (99 before dinner at 5 p.m. and 104 at 7p.m;
used a dual bolus with three hour square wave).
Okay, at 9p.m. everyone was snacking. He had a little something and rose to
150 by 11p.m. Bolused .3 units and he was 101 an hour and a half later. 120
at 4a.m. and 92 this morning at 6 a.m. It would have broken my heart to use
an injection to lower b.g. from 150 to 101.
Very difficult to do with MDI; it can be done, but it requires multiple extra
injections or a very limited (low carb) diet and massive numbers of b.g.s
The only advantage I see with MDI is the presence of a long-acting insulin to
cover should the pump malfunction and Gabe not be aware of it; however, the
Paradigm has a 3 unit occulsion alarm (it would alarm after about 3 hours of
missing basal) and Gabe checks fairly frequently.
My 2 cents
( a devoted MDI mom and now a committed pumping Mom).
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