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[IPk] Pump vs MDI: long term

Hi folks,

The thing that keeps me from being a proponent of MDI on a long-term basis 
is the tissue damage issue. From two years of 3x daily injections, I still 
have bits of scar tissue on my abdomen into which I can't put a pump set, 
and I've been pumping for over 6 years. When I was on MDI I rotated sites on 
my abdomen very consciously and used the tops of my thighs too (never 
injected in my arms as I found the position very awkward).

Thinking about how much tissue damage one can do with 4x daily injections 
over a period of 10 years or so makes me shiver: 14,600 injections can't be 
easy on the ol' subcutaneous tissue. A pumper would see the equivalent of 
1216 injections in the form of set insertions in the same 10 years (assuming 
that inserted sets were to last for three days each). Site rotation would 
not mitigate the damage of MDI very much either: a pumper would see the 
equivalent of 608 injections on each side of his/her abdomen, while a 4x 
daily MDIer who used the tops of both thighs and both sides of his/her 
abdomen (i.e., 4 areas) would see 3650 injections on each leg as well as on 
each side of his/her abodomen in 10 years. [I think I got that math 
right--someone please correct me if it's wrong--but I am a 
theologian/historian and not a numbers person!]

We all know how important good absorption is and that pumps cost a lot.  
Perhaps 7 or 8 injections a day would keep *anyone* who could do well with a 
pump within a good bg range--but after 7 or 8 years of fantastic bgs and no 
complications on such a regimen, where _would_ one stick that needle? I 
suppose that the bigger question here is whether maintaining good absorption 
is worth the cost of the pump if the pump, like MDI, enables someone to get 
more stable bgs and avoid complications, but it can do so on a longer-term 

IDDM 9+ years; MiniMed pumper 6+ years
Co-ordinator, Oxford University Student Union Diabetes Network

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