Tag Archives: diabetes MDI

What Diabetes Technology Can’t Replace


If successful diabetes management is based upon a multitude of decisions we make during the day, why is technology often regarded as the number one asset in our diabetes management arsenal?

It can’t possibly be.  Take some important daily decisions that all impact diabetes:

-what to eat

-when to eat

-how much to eat

-how much insulin to give

-when to give insulin

-when to exercise

-what type of exercise to do

-how much to exercise

-when to test blood sugar

-how often to test blood sugar

And on and on!

Now basic technology like a meter is huge.  But, only if we choose to use it.  And a pump, for many of us, makes it easier to eat and deliver insulin as needed and to do a wide variety of exercises, as long as we choose to use it properly.  A CGM gives us information about trends and helps us catch highs and lows before they get too high or low.  Not to mention it can help save our lives by alerting us to dramatic blood sugar levels. 

So technology is awesome!

That’s indisputable.

It would seem that those using all of this technology would always have better diabetes management than those who only use a meter and syringes, right?  And yet, in my personal experience, I’ve met many people who use a meter and syringes and do very well and people who use all the technology available and don’t do very well. 

There are other important variables that always need to be considered.  So when a person is struggling with their diabetes management, often times more questions need to be asked than what is often asked.  Most likely, a person who can do well with a pump, can do well without one.  And CGM’s are most dramatically beneficial to those who can’t feel their lows or have young children with diabetes. 

My cautioning is really about avoiding the conclusion that, “If I had a pump, my diabetes would be controlled” or “I probably just need a CGM to have controlled blood sugars” without considering other factors. This isn’t to say these tools won’t dramatically help one’s management.  There is no guarantee and the decisions a person takes throughout the day is a better indicator of how a person will do with diabetes technology.

So if you’re struggling with your diabetes management, assess the root of your individual struggle.  Some people’s issues are best addressed with technology, but many issues are addressed outside of technology and skipping this facet of diabetes management can prove extremely frustrating and detrimental. 

I know because I’ve been there, done that.  Address your personal needs and let your blood sugars be your guide.  What technology can’t begin to replace is you and your knowledgeable decisions, which require knowledge about your diabetes.  Make sure your bases are covered before relying on gadgets.

The Pump Myth

courtesy of Graur Codrin

When we say that an insulin pump provides better control, I think we should think about that statement.  Are we telling others who don’t have a pump that they would have tighter control with one?  Pretty much, right?  That’s not necessarily true though, is it?  If it were, I’d be on a pump according to my A1c and standard deviation results.  And in the past while I was on a pump, it would not have made sense to say I was on a pump.

It’s one thing to say that “For me, an insulin pump provides better control”  because then you’re talking about your own experience.  It is my hope that people on pumps everywhere will realize that many people are achieving very tight control without a pump and therefore it’s more helpful to stay away from comments like, “An insulin pump provides better control”.  Do you know what I mean?  It’s a general statement that might give someone without a pump the wrong impression about what is possible in their own lives.  I’m all for everyone having access to a pump, I wish everyone could at least have the chance to try it out, but what if someone doesn’t have access to one?  We should avoid giving them the idea that their multiple daily injections (MDI) are not enough.  If that is all they can get right now, don’t we want them to feel empowered to make MDI work?  For their own well being?

In some cases if someone can only get access to the older, slower insulin, then it still serves them better in the meantime if they believe that with a disciplined schedule, they can achieve good glucose management.  Yes, they deserve the opportunity for the flexibility a pump can give but if they don’t have access to that opportunity, isn’t it best they feel empowered to do what they need to do for their health?  And flexibility or no flexibility, I still think better glucose is more valuable-but maybe that’s because I’ve felt what unmanaged blood sugars can do.  I also endured the rigorous eating, snacking, sleeping, and waking schedule of R and N insulin of the past and in the end it wasn’t as bad as the unmanaged blood sugars.  I say this because of the complications that arise from high blood sugars.

A pump doesn’t provide better control or worse control anyway, it’s really up to the user.  Same goes for syringes and vials of insulin.

Does the pump add convenience in particular scenarios?  Totally!  Do syringes or pens?  I’d say so.

An unfortunate side effect of all this is people giving me pity or assuming I’m poor because they learn I don’t use a pump.  Or they assume I don’t use one because I’ve never tried it and fallen in love with it.  I get emails from very sweet people trying to convince me to use a pump.  But I did use one for seven years and so I know the pros and cons. While on the pump I literally felt I would die if it was taken away from me.  Then I tried to be without it and realized that what made diabetes difficult was not the shots, it was the variable nature of blood sugars and that with or without a pump, I was still being challenged to control them.  And after five years of the best blood sugars I’ve ever experienced, a wedding, a honeymoon at the beach, and a twin pregnancy, I really don’t miss the pump at all.

So let’s be accurate and supportive of better control, however one achieves it, because a pump being synonymous with great diabetes management is another one of those myths circulating out there.  And it’s a harmful one.