Friday, April 1, 2011

Pumping vs MDI - A Case for Both

I have just recently reintroduced my "External Pancreas" back into my life. Well,  at least on a more permanent basis then before. We now have 100 coverage for pump supplies. Need I say more.

So, as you all know, my last A1C was, not desirable, at 8% which means my numbers were running in the double digits over the last 3 months(Canadian values eh) 

I really have been a bad diabetic, well, lets just say I needed to improve my record keeping and do some serious analysis. I need to measure more frequently and stop eating crap when ever I feel like it, I feel like a big hypocrite some days when I am telling people to do the opposite of what I am doing or "Do as I say not what I do"

In any event, here I am analyzing my numbers, and now I understand why my A1C sucked!!  Okay, too dramatic, but let's just say I did not meet the recommended target of 7%.

My fastings are above 8 mmol(multiply by 18 for US)---Not good.

So I analyse:  Why are they high? (Glimpse into my mind)

-Too much fatty food for evening snack or meal?
-Not enough insulin to cover the food?
-Inadequate Ratios?
-Inadequate Basal?
-Am I sick? Nope.
-Am I stressed? No more then usual
-Am I exercising? Yup, didn't last night.
-Dawn effect, rebound from a low?  Don't know. 
-Am I due for a site change?  Is the site a good one?

Man, these are a lot of variables to consider. "Pumping is sometimes more work then it's worth" --- to quote my direct thought.

-Switch back to the MDI(Levemir/Apidra) or Stay on the Pump? This is a Rhetorical question, just typing out loud so to speak?

My argument for the Pump:
-Once I do the work, skip breakfast, test the basals, analyse ratios, eat properly, tweak, test, works, less lows, more of a match to my physiologic profile.
-On the negative it is a whole lot of work, I am not sure if I am up for it.
-Obtain some CGM sensor sets for my pump and really figure out my basals.
-Freedom from Multiple daily injections, once it's(pumps) settings are accurate it is a major time saver in calculating corrections and ratio's, which is a major plus.

My argument for MDI:
-Don't mind injecting, and you know the amount you inject is the amount you will get, as with the pump you have to consider age of the site, site integrity, is the pump flowing like it should etc.
-Less variables to consider. For example, if my before lunch is high, then I need more Apidra, if my fasting is high, is it food, dawn, rebound, or my bedtime Levemir dose.
-Carrying around my Apidra Pen is a pain, but not really, since I would not have my pancreas clipped to my belt.

Other things to consider:
Daily routine:  My routine is stable, Monday to Friday job, predictable exercise patterns, week-ends are a little unpredictable.  Pumping is good for fluctuating schedules and eating patterns, I am a predictable fellow.

As you can see I can justify both methods to control my blood glucose level.  Which will I choose?

Still thinking about it.