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[IPk] thoughts on pumping vs. MDI

Zoe asked about people choosing not to pump, and I've been thinking about
the 'why' of pumping over the weekend, and why I've stuck to a pump.

This is something that's been at the back of my mind for a while, because I
know that my BGs are not as good as they were on MDI in 1998 (after I sorted
out my long-acting insulin schedule). There's a number of reasons for this:
I worked (picking mushrooms or doing secretarial work) for anywhere from
10 - 30 hours a week. I ate a more restricted (and healthier) diet. I was
always home for tea and I weighed my portions out exactly. Every night
before I went to bed I did a bit of math and predicted where my BGs would be
when I woke up - that's part of how I sorted out my background insulin. I
was spending a lot of time managing my diabetes, and a BG of 11 was not that
common and a cause for disappointment.

Now, I work a job that's officially 37.5 hours a week, plus commuting up to
10 hours a week. I'm doing a course on which the recommended weekly study
time is 15-20 hours. I live in a big filthy city rather than just off the
main road of a provincial town. Overall, I have a lot more responsibilities
outside myself than I did then. The trade off, unfortunately, has been less
time to pay attention to diabetes. A BG of 11 is fairly common and something
that I deal with as an aside to whatever else I happen to be doing.

If I had a very restricted diet, I could probably still do well on MDI.
However, on the same diet I would do a lot better on a pump because a pump
maintains more level overnight BGs for me than injections did.
Unfortunately, I give in easily to temptation and I've always been a nervous
eater/entertainment eater. This militates against good BGs, especially when
I'm stressed or very tired. I do think a lot of people can get good control
on MDI, but I think it probably takes a lot of work. I also think it's
probably influenced by how long you've had diabetes, what control was
achieved on previous insulin regimes (one shot a day, anyone?)and lots of
other factors, such as inheritance, that we don't have control over.

I would be loathe to go back to MDI in my present situation for one reason:
I wouldn't be able to turn my basal insulin off or down for exercise. That's
hugely important to me, even though I mess it up a lot anyway. That gives me
the freedom to not eat or to eat less before I'm exercising. There are times
when I don't want to eat! Might I have a life again where I would do well on
MDI? I hope so - that's what I'm working toward. But I fully intend keeping
my pump then and having normal BGs 90% of the time. Unfotuntately, I've
another three years, most probably, before I get there! So meanwhile, I hang
in there and don't pay enough attention to my diabetes.

So, Zoe, I think if you decide you can do as well on injections as you can
on a pump, that that's absolutely brilliant if that's what you want to do. A
pump isn't for everyone, so you shouldn't feel like something's wrong if you
decide against it. If you think you might still like a pump, you might want
to try a trial from the other pump manufacturer that supplies in the UK.
Just make sure you make the right decision for yourself.

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