Insulin Pump vs. Multiple Daily Injections (MDI)

For those of us with insulin dependent diabetes, who cannot produce insulin, we have two options for continuous insulin treatment (basal/bolus therapy). We can use an insulin pump, or we can take multiple daily injections of insulin.

Insulin pumps

Insulin pumps deliver insulin into the body both continuously (basal) and immediately (bolus). There are currently two types of insulin pumps on the market–those that deliver insulin through a tube (like Medtronic, Animas, Tandem, and Accu-Chek pumps) and those that deliver insulin through a pod (like the OmniPod). Tubed insulin pumps are attached to an insertion site with plastic tubing, and the insertion site houses a cannula or steel needle that remains under the skin for multiple days at a time. Tubeless insulin pumps like the OmniPod deliver insulin through a Pod that attaches to the body and communicates with a wireless meter-remote.

Benefits

  • For both basal and bolus delivery, insulin pumps deliver fast-acting insulin which begins to affect blood glucose levels within 15 minutes of delivery. This makes it easier to determine how much insulin to deliver than with the use of multiple daily injections.
  • Insertion sites or pods are usually changed once every few days, so little time is needed to maintain continuous insulin delivery and there is less puncturing of the skin.
  • Using an insulin pump may lower the risk of nighttime hypoglycemia, since the device can be programmed to deliver insulin while you sleep.
  • Many studies show that the use of insulin pumps results in lower HbA(1c) levels than the use of insulin injection.
  • Newer pumps have incorporated an intelligent feature that shuts off the pump when blood sugar gets too low. This feature, however, requires the use of a continuous glucose monitoring system that can communicate with the pump.
  • Basal rates can be adjusted every 30 minutes to match the specific needs of the individual. Whereas injections of long-acting insulin can have unpredictable peaks and valleys.

Cons

  • Large needles are often used to insert the cannula beneath the skin, which can cause pain and puncture blood vessels. Some insertion sites use a steel needle instead of a cannula for people who are allergic to the cannula. The needle can occasionally cause discomfort if it is bumped.
  • The cannula can irritate the skin and cause itching. The longer you go without changing your site, the more likely you are to experience discomfort or infection.
  • The delivery of insulin causes scar tissue, so the same spot cannot be reused too soon. People who use insulin pumps are advised to select areas that are harder to reach while they are young, so that it will be easier to place insertion sites when they are older.
  • Unfortunately, insulin pumps do not automatically deliver bolus insulin – they must be programmed to do so. You must enter the grams of carbohydrates being consumed and the pump calculates the appropriate bolus based several factors (like your carb to insulin ratio, the amount of active insulin in your body, etc).
  • Air bubbles can easily get into the insulin, which can cause pain when delivered and can affect blood glucose levels.
  • Some pumps deliver bolus injections so quickly that it causes a sharp pain.
  • The tubing that connects the pump to the insertion site can get snagged on objects such as door handles and seat belts. This may pull the cannula out of the skin, so an extra insertion site should always be kept handy.
  • The insulin pump only uses rapid acting insulin, so if it gets disconnected, blood sugar levels will rise rapidly putting you at risk for ketoacidosis.
  • Insulin pumps are very expensive. The pump costs on average around $10,000 and the pump supplies cost around $400/month. However, if you have insurance you may only be responsible for a small copay.
  • Insulin pumps are bulking and sometimes difficult to conceal, especially in a bathing suit. They can also make some daily tasks awkward (like changing clothes, going to the bathroom, or having sex).

Multiple Daily Injections

Alternatively, people with diabetes can take injections of insulin. Depending on the type of injection used, multiple injections are required throughout the day. Insulin injections vary in onset (how quickly they begin to affect blood glucose), peak (when insulin is most active), and duration (how long they last). When using MDI you must use both long acting and short acting insulin.

Benefits

  • Injections require more care to properly manage basal rates, but are less complicated to use and maintain than insulin pumps.
  • They are less costly. you can easily manage your diabetes for around $50/month.
  • You don’t have to be connected to something 24/7. There isn’t a constant reminder that you have diabetes.
  • You don’t have to worry about disconnections or clogs, as you would with an insulin pump.
  • There is less scarring with MDI and there are more site options (like the upper thigh).
  • You can get needles over the counter in most states so you will have access to supplies without a prescription.

Cons

  • Since management of diabetes involves basal and bolus rates, multiple types of injections are required to manage blood glucose levels. Short-acting injections activate and peak quickly, and last about two to four hours—they are intended for meal-related glucose management. Long-acting injections take longer to activate and peak, and remain in the blood stream for upwards of four hours, sometimes lasting as long as 24 hours.
  • You have to stab yourself more often (typically 4-6 times daily) whereas with a pump the needle or cannula stays in you 2-3 days.
  • Since there is no bolus calculator, you must be able to calculate the amount of insulin to inject for each meal.
  • You must dose your insulin in increments of 1 unit so there is less flexibility in your insulin dose. With an insulin pump you can deliver doses in increments as small as 0.05-0.1 units depending on the pump.
  • There is less flexibility in when and how much you can eat.
  • Hypoglycemia is more common with MDI.
  • You must manually track your insulin intake.

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