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MDI vs. pump

Discussion in 'Parents of Children with Type 1' started by Darryl, Nov 13, 2016.

  1. Darryl

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    It's been a long time since I posted here! Leah is now in college and coming up on 10 years with D. Still using the Dexcom, the Share, and Nightscout when the Share isn't cooperating.

    I wanted to share that a few months ago she changed her routine by supplementing her pump (omnipod) insulin (apidra) with a shot of Levemir each morning, with the idea of reducing the dependence on the pump. Around 20 units worked well in stabilizing her BG during the day. She then started taking some levemir also at bedtime that worked well. After a few weeks of this, she stopped using the pod altogether and for the past two months has been on MDI only, taking levemir morning and bedtime, and apidra as needed (using pens for both types of insulin).

    While not having the pump means that she can't make micro adjustments, overall her BG control has been great. There is less volatility during the day and night, and many nights the BG stays in the 70-120 range without corrections.

    Based on the dexcom data, if I had to guess, her a1c would still be around 6 like before. Even though she won't correct, say, a 120 down to 100 like she might with the pump, there are also fewer spikes above 250 and none of the need for the large, repeated boluses that were sometimes needed with the pump to bring down stubborn highs. Usually one apidra bolus using the pen is all that's needed.

    I recall being skeptical of MDI years ago, but am pleasantly surprised to see how well it's working for her. And of course, she enjoys not wearing the pump. The CGM remains an important part of the solution, especially on MDI where basal can't be turned off like a pump.
     
  2. mom24grlz

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    Ashleigh decided to go off the pump 16 months ago. And so far it's worked out pretty well for her too. She gave me no warning. 6AM one day she tossed her pump on my bed and said "i'm done with this stupid thing, i'm going back to shots". And she's been on them ever since then. We've also managed to keep her in the 6% A1C range. Same thing here with food spikes. She does occasionally spike to 250-300, but most of the time (according to dexcom) they're 200 or below. And sometimes no spike at all! As for correcting, no Ashleigh will only correct if she gets up to 170 or so. I'd like her to correct at 150 (and if i'm dialing up her insulin i will add a correction if she's 150+).
     
  3. dpr

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    We use Levemir whenever it will be more convenient to off the pump for the day, beach days, water parks etc. We get great numbers with it. It's a fantastic insulin. I would really like it if she would consider supplementing the pump but she HATES shots. For those who haven't tried Levemir it really is great stuff!
     
  4. blufickle

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    When I was using the syringe with N and R, my A1C was between 6.5 and 7, when I switched to Lantus and Humalog it ran between 6.2 and 6.5. Now that I'm using the T:Slim G4, my A1C is still between 6.2 and 6.5. So it doesn't matter what I use, my A1C stays where I want it to be. I'm sure this is because of how long I've had juvenile onset diabetes... I was diagnosed as a juvenile onset so that's what I say I have, I only call it type 1 when people ask me what did you say. As long as you do what you're suppose to, you can keep your A1C's under control. It's more difficult with children and teens because of growth spurts and hormones.
     
  5. quiltinmom

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    Thanks for sharing! Those are results to be proud of, for sure. It's got to be great to watch her self manage so successfully.

    I can't help but wonder how much of the settling down is due to her age, I.e being past puberty. That said, others have also reported less volatility through using a long-acting insulin p, instead of relying on the pump for all basal. Something I'd be interested in trying, if ds was on board.
     
  6. sszyszkiewicz

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    I have to tell you, although the pump lets me finesse things, I am so sick and tired of wondering "is it the set?" With MDI there is no question....that insulin is in! One less thing to consider! For now he stays on the pump, but man sometimes i wonder if the pump is worth the hassle.

    Darryl, I remember when i got here three years ago (this month!!!), and i read many of your posts, and i saw how you basically kept your daughter in a tight range as she slept. That was my inspiration! I am doing the same thing. When DS puts his head down, I get him in that tight range and i make sure he stays there. I am tired, but knowing my kid is non-diabetic as far as his body is concerned while he sleeps is very rewarding. Knowing that soon i will be able to trust a bionic/artificial pamcreas to do this job also helps because I know there is an end to the routine in sight. We too also have had great A1C's and the Dr's at the clinic thought i was either starving my child, or letting him coast in the 40's to make up for the 200's. But armed with Dex data. and his insulin usage (the kid eats us out of house and home) I have slowly won their confidence. I was "lucky" that T1D visted my home when my child was 11, and not 1. I just have to get him through puberty, which for many others is the last hurdle. In my case it is the only one. So I am doing what you did, and its working.
     
  7. Manuel

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    Hi everyone! My son is 2.5 years old, he was diagnosed 6 months ago. We are on MDI, our first A1C was 7.2 and now we are in 6.7. We managed to keep him in good control, but that means that some times he has to have up to 8 shots in a day (between basal, meal bolus and some corrections). We will start on Omnipod this month, but after reading all your experiences I am having doubts. We thought in Omnipod to reduce the shots and have a better management, because he is very sensitive to insulin (1U drops 240), and we can't correct him if he is around 150-180. Our thinking is: no shots, better management so better quality of life for him.

    Now after reading your opinions I am wondering if he is going to have a better management and a better quality of life without the shots; maybe there is no going to be shots...but we will have problems with the infusion set or something else.

    Do you think it is different for a small kid?. Do you think is better a pump than shots for him?

    Thanks
     
  8. Sprocket

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    So nice to hear these positive posts about MDI. My DD (15 and diagnosed at 12) is on Levemir and Novorapid and would never consider a pump- had no desire to be tethered to anything as a constant reminder to her and everyone around her. She loves MDI and has excellent control - now especially with her cgm. We were (and still are) asked every time we go to the clinic - "ready for a pump?".
    I am really anxious to try Tresiba which is a relative of Levemir because I think it will help her manage with a bit less hassle. I also think it's easier once they get over that adolescent hurdle, which has happened for us recently. Things become more predictable and a bit easier to manage.
    I think it's great that our kids master MDI and have a good understanding of insulins and how they respond using injections. I think it's a great foundation regardless of how they choose to manage in future.
     
  9. Just Jen

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    I think that everyone's situation is different, and what works for one person, will not necessarily work for another. For some people, the pump is the best option. For other people, MDI is the best option. For still others, a combination of a long acting insulin basal and a pump for carb and overage boluses is the way to go. I think that the most important element is that we are open to try other things if we, or our child with T1D, gets stuck in a rut. I am so thankful that there is more than one way to deal with this disease. I have no doubt that with technology and medicine moving as quickly as it is that there will continue to be more options available until a cure is found.
     
  10. forHisglory

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    This thread was intriguing to me. Would Lantus work as a replacement for the pump basal as well as Levimir? What makes Levimir superior if you need to use it twice a day? Just greater control for differing basal needs? We have a box of Lantus just sitting from the MDI days (not expired in fridge) and maybe we will try this for greater untethered ability. Can someone remind me of a good calculation to use when switching basal from pump to pens? ( I will run any advice by our endo first to make certain it's okay).
     
  11. sszyszkiewicz

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    There is no right answer. There are always different circumstances. Remember that I didn't get on this ride until my son was 11, but if I had a little one, i would want a pump because of the ability to *accurately* dose in teeny tiny amounts. Regardless, I would do what I could to get a CGM (Dexcom) going.
     
  12. Manuel

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    Thanks Jen and sszyszkiewicz, we will try Omnipod. I have hi expectations. I hope it will make it easier for him and us. We are using Dexcom G5, and it is a great, I can't imagine the day to day without it, we were only three weeks with finger sticks and it was very stressful, so Dexcom is priority number one!
     
  13. Sprocket

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  14. MomofSweetOne

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    Do you think some of the calmer BGs is simply her age? We keep getting told things REALLY calm down between 18 and 20, though they're so much easier than a few years ago.

    It's interesting to me that her spikes are lower.

    Will she be interested in going on one of the AP systems as more are released?
     
  15. Ali

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    Great to hear. Long time T1 here. Shots for years, pump and CGMS now for many many years, all different insulin types. I think managing T1 on shots with a CGMS it is much easier to get results similar to pump use. The micro dosing is hard, so depends on the person and the typical dosing they do, also spends on how variable their basal is over 24 hours. Mine is pretty extreme even as a 60 year old so shots has always meant compensating with food when on shots. I also have a really variable exercise and eating schedule so temporary basal rates are key. But I believe I could make shots and a CGMS work pretty close to a pump and CGMS but for me it would involve more work so I stick with the pump. I am going to switch to the Medtronic AP system next year.
     
  16. MEVsmom

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    When we were on MDI we had to split our Lantus dose. It did not last 24 hours and we would have highs. When we switch back to MDI for vacation, our doc says take your total daily basal dose and lower it 10-20%. What we find in reality is that it is pretty much the same. We take the total daily basal dose and then divide by two and take the Lantus injections about 12 hours apart. We actually dont' quite split it evenly, we give slightly more in the morning than at night to avoid nighttime lows.
     
  17. wilf

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    Hey Darryl, good to hear from you. Glad things are going well for your daughter. It certainly is possible to have decent control using MDI - you maybe have to work on it a little more, but it's very doable. My daughter is living in the Canadian Rockies and working in a resort town there and life is good. :)
     
  18. Darryl

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    Not sure. It seemed that when she was younger, BG usually responded predictably to boluses from the pump. In recent years, even with the pump, the fluctuations were getting more frequent and harder to control. Then she switched to Levemir and the overall picture stabilized considerably. I can't imagine having had good control in the early years without the pump, though, especially when boluses of under 1 unit were needed.
     
  19. Darryl

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    I still think that striving for the nondiabetic BG range is worth it. Over the years we achieved this a lot but not always. There are some days when BG is relatively stable and we capitalized on those opportunities to fine tune BG into the nondiabetic range. The pump was very helpful in doing this. But the pump didn't seem to do as well on those days when BG was persistently high. Shots often were necessary in those cases. I assume that the effects of BG on the body are cumulative, so the more time that can be spent in the normal BG range the better.
     
  20. Darryl

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    Lantus isn't covered by our insurance, but one advantage of levemir is that you can have different basal rates daytime and nighttime.
     

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