Insulin Pump OR MDI?

Hi Everyone i wanted to ask other t1ds here if you prefer MDI over pump or pump over MDI. I am starting to feel like the pump may not be best for me some days. I have tried MDIs when i was diagnosed in 2012 and later found out i was type 1 around 2013 and then started on the pump in 2014. It has been going good but sometimes i feel like i may need a change. just would love to hear your thoughts. I am still learning!

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Hi @KayD . While pumps are considered the best way to manage our diabetes, the fact is many people do just as well and sometimes better on MDI. On the other hand, there are people who simply can’t prevent severe highs or lows on shots, and for them a pump is a must.
It’s really a matter of what works best for you, and there is no reason you can’t try taking a pump break to see how you do on MDI and if you might want to go back. You’ll need to get an rx and updated instructions on basal insulin etc first, and may need to tweak them once you get started, so make sure you allow some time for MDI to “settle in.” If you use a loop such as CIQ, you could also turn it off and see how you do in manual mode.

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I’ve had T1D for 3 years, MDI for 1 year, pumped for 2 of them. I find that I can get pretty equal control on the pump vs mdi, but the pump means fewer lows and it’s a lot more convenient! Pressing a few buttons vs having prep + inject an insulin pen/syringe. As a high schooler a pump also means not as many trips to the nurses office at school!
That being said I do take a lot of pump breaks every year. Being attached to a device 24/7 can be wearying, tubing can get annoying, and a pump isn’t always compatible or practical with some activities.


@KayD , I started pumping in 1998 or there abouts.

I would have day where my long acting wore off or stacked depending on my irregular activity. I am a retired nursing faculty. My endo suggested a pump & CGM even then for a titrateing control.

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Kayla @KayD, by themselves neither a pump nor MDI has been proven better; much depends on the person and that person’s desire to “think & work” at diabetes management. The “think & work” isn’t meant as derogatory; I’m using a heavily automated pimping system including a watch which vibrates with alerts. I left what is now called MDI after using that method for 25 years because I figured that 130 infusion-set pokes per year would appease my body from the beating of 8+ injections each day for up to 47 years. Note that the needles in use for the past 30 years are much less damaging than the “dull 6d nails” we had in the olden days.

My overall results with pumps are very similar to what I achieved with MDI until reliable CGM came into play. The reliable CGM has been the most important tool for diabetes management.

Will I return to MDI? Probably not because right now my system is working well without need for assistance from others and the display is easy for me to see and calculations are clearly visible and allow me to make mentally calculated adjustments; I envision in the not-to-distant future I’ll need manual/visual assistance. For you [and I’m only guessing], childcare and the need for you to be very aware of your child the automation of a pump adjusting insulin will be an advantage for you.


If you feel like you need a change there is nothing wrong with taking a break from your pump and doing MDI for a bit then going back on the pump.

A T1D diagnoses is a lot like being told you have to learn to juggle. Insulin, food, exercise, etc. Pump or MDI is is like choosing to juggle chainsaws or torches. It is equally impressive when you keep either in the air


I am old school MDI and have no plans to ever convert to pump. I tell others that for all the advancements I’ve seen in my life to help control T1D, my favorite by far was the introduction of short needles.


I was diagnosed in 1945 when I was 6. I used MDI for more than 60 years and I had many highs and lows that really made my life difficult.
I started using a pump in 2007, What a difference!!! With my pump and a CGM I have much better control. Troublesome highs and lows rarely occur now.

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Like the others have said, the decision is very personal and you need to do what you think is right for you.

This is my story: I’ve had diabetes since I was 6 but I’ve always been quite scared of needles and even more scared of IVs and infusion sets, so I rely on assistive devices (think spring-loaded needles) a lot. For a long time that meant pumps were out of the question because there weren’t devices available to insert the canulas for me. I’m also concerned that the tubing will get in the way while I’m at work, so that was another limiting factor. A few years ago I started struggling more with highs and lows while at work so I decided to give the Omnipod a try. I stuck with it for about a year and then quit because of the painful way my skin reacted to the catheters and because of how often the pods malfunctioned. My blood sugar management had actually gotten worse with Omnipod. When I went back to MDI I was relieved to not be in pain anymore, but it was also hard to give up the flexibility I’d gained with the pump and I struggled with depression for a long time afterwards. My doctors are encouraging me to try again with another pump brand, but I don’t feel ready to risk going through all that again.


Thank you @bsteingard for sharing your story, and congratulations to you for having “pushed through” for so long despite your issue with real pain.

In a way, I feel very fortunate to have a high pain tolerance to “only” need to deal with diabetes stuff.

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Thanks everyone so much for your stories, not really stories but real life experiences it means a lot and makes me feel like I am not alone in this. I guess I am frustrated because I’m on the new pump after a few months the pump was working so well I was giving my blouses and having no lows and now it’s a mad house. Every time my doctor sees me doing good (100-180 range) they want tighter control and that’s when the roller coaster starts. I’m thinking I want to change my setting for my omnipod 5 pump not to give me so many corrections, It’s like I bolus for a meal and it continues to correct. Or it sees my high for example I have 1 unit I’m like ok this will bring me down, I check a few minutes later and I have almost 2 units (whether I’m trending up or straight) Isn’t that stacking? I have a gut feeling it’s just too much too soon like it doesnt give my body enough time work with the insulin I’ve already got … I’d like for my pump to slow down on the correcting. The dexcom is already slow to the game so the insulin that’s actually working is indeed working so giving me more would eventually lead to a low. (Which it has) I did change my settings and my dr called me out but now I don’t trust the pump, I’m in manual mode a lot and I never use exercise mode I just turn my point off because I don’t have time to watch my pump AND work out. If anyone has any tips so that my pump isn’t correcting me so much that would help. I’ve changed a few settings myself that’s how I got to the smooth sailing before then at my appointment my dr said let’s make your numbers tighter, but I was so happy and I wasn’t worried I just want to get back to that. I’m at the point in my life where I know my body and what works for me and sometimes the dr just gets in the way and makes things worse by wanting regular blood sugars on a diabetic patient

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I don’t know if it’s possible on the omnipod but can you change your insulin duration in the pump settings? Insulin duration tells your pump how long the insulin lasts in your body. I’m on the tslim and the insulin duration is automatically set to 4 hours. That means that my pump will not give any corrections until after about 3-4 hours post bolus, avoiding insulin stacking. If your pump’s insulin duration is set too short it can cause insulin stacking. For example if your insulin duration is 2 hours then after 2 hours your pump will think that you’ve got 0 units IOB (insulin on board) and will start correcting.
You can’t change this setting in tandems ciq algorithm, you can only change it in manual mode.

A trick I found to keep my tubing from snagging was to run it through the waistband and leg hole of my panties a few times before tucking my pump into a pocket or clipping it to my waistband. Of course I had to detach when using the bathroom but it was only for a few minutes.
You might also try cable wraps like the ones used for charging cords. Here are a couple I found on Amazon (search for “cable wrap”):

The first one is about 3" across and the second about 2" but there may be smaller ones. I’m not sure if the hole in the second is large enough for the tubing but thought I would point it out.
Have you discussed Afrezza inhalable insulin with your doctor? You weird still need to inject basal but i it would replace shots for meals.

Those cord winders look awesome! Adding one to my Christmas list.
Recently I was asked by a younger kid at school “Do you have diabetes? I saw the pipe coming out of your pants. My dad also has a pump.” Always funny the words people come up with to describe tubing.

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Kayla, keep in mind that all settings on any pump are important and interact/integrate with each other.

Relative to automatic corrections, two settings, in addition to “goal” or “target” become most critical: (1) Insulin Duration - 5 hours rather than 3 hours will lead to a smaller correction. and (2) a greater ISF [Insulin Sensitivity Factor, Correction Ratio, &c.] 95 or 85 rather than 30 or 40 will yield a smaller correction dose. Example: Consider your desired target is 120 and your SG reading is 200 meaning you need to correct glucose level by 80 mg/dL an ISF of 80 will provide 1 unit correction - an ISF or 40 will direct a 2 unit correction. Both of these examples ignore any IOB, either from basal or bolus.

ISF needs to be estimated or calculated for various periods of the day - and for me involved much trial & error.

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Dorie, I’d be very cautious using any of these devices. Pump tubing is much lighter and thinner than the multi-wire cable for which these devices are built; I would be concerned that my tube would pinch or king and affect insulin delivery. And the 3" x 1/2" bulk???

@KayD I watched a Juicebox podcast on Omnipod 5 several months after starting on it, and found it helpful. The series might give you some things to look into:

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Hi Kayla,

I was diagnosed as T1D 2 1/2 years ago at the age of 56. I did MDI for over a year (which I didn’t mind) then I got a new endo and went on a pump. I chose the Omnipod because I didn’t want to deal with the tubing (being a middle aged woman who has to go to the bathroom NOW and deal with tubing was a recipe for disaster :wink:.) I have the same issues with you about Omnipod - too many micro boluses, double down arrows very often, chugging an entire bottle of apple juice so I wouldn’t crash, etc. I tried changing the insulin duration which worked for a bit but didn’t help me with manual corrections because it thought there was IOB. I changed my I:C - didn’t help. After that, I put myself in manual from late morning till dinner, the time when I am most active. This has worked very well for me. While I know this is not the ideal way to use this pump, it works for me and has made my life less stressful and my mental ability to deal with diabetes better. My endo understood my concerns and is supportive. She and I agree - do what is best for me and works best for me. This is a life long disease and making my life less stressful while managing to get good TIR is important.

You do what is best for you and use the tools you have in a way that work for you. No pump is perfect and no people use it the same way. You’ve got this!

This. You know, you got this. Trust yourself, follow your insights/gut feelings/knowledge/experience. It doesn’t guarantee success, but it’s what comes closest. It’s a lesson I’ve learned (or tried to) time and again. Insulin does need time, and trying to gain tighter control has sent me on a roller coaster as well, it’s exhausting and physically bad for my body. I want to avoid highs as much as possible, and it’s really tricky and hard, finding a balance between that and not being too aggressive with insulin.

I’m on MDI. I have no desire for a pump, MDI just works for me. But what you say about needing insulin to have time to do its thing really resonates–it’s my experience as well, especially b/c I seem to be pretty insulin-sensitive, and even when I do need corrections, they need to be minute amounts, otherwise lows often follow later…

Anyway, I would listen to yourself most of all—take others’ advice into account, but ultimately, you are the prime authority with the most knowledge. :slight_smile: :slight_smile:

Hi @BKN480 @MFBarry !

Thank you so much ladies I did change my settings I tried 4 hrs but i think that was a bit too slow then I tried 3.5 hrs and that seems to be working slow but at a pace that I like. (No double arrows just brings my BS down but in a more steady consistent way. (I was snacking too …that time of the month LOL)

I actually missed my lunch bolus I was so busy feeding my little one and forgot I usually never do this… but the rice I consume is very easy on my blood sugar it’s a special Indian rice that has a very low glycemic index…so anyway I stayed steady and ended up here with .80u left. So we will see how it goes. I won’t change any more settings because a little goes a long way and when I feel I may need help I’ll call my endo thanks again ladies I’m new to this forum but I love the community and have been learning so much