I hope after last week's blog that you are now in the position to make an educated decision about which form of basal/bolus therapy is or is not for you. Only you, your family, and diabetes team can make that decision. In all honesty, I believe that, in the end, it must be up to YOU to decide what will work best with your lifestyle, support network, and personality. Let's discuss the benefits and disadvantages of the pump and multiple injections.

PUMP POSITIVES:

1. No more shots (unless the pump malfunctions, which they do sometimes; or if you have ketones)

2. Less hypoglycemia

3. Gives insulin before and during meal as needed

4. More flexibility of different basal (background) insulin rates depending on the time of day (you may need more insulin between 3 and 7 am, for example)

5. Calculations of insulin can be programmed in your pump--you just tell it how many carbs you are eating and your current blood sugar

6. Ability to extend insulin over a period of time especially when you eat the fun stuff (pizza, ice cream, pasta, etc.)

7. Eventual possibility of combining the pump with a continuous glucose sensor in an effort to mimic an artificial pancreas

8. If there is a problem with high or low blood sugars, generally you can fix it very quickly (extra insulin, temporary basal rates, suspension of pump)

9. Your health care team can obtain insulin information from the pump (which is good for us, but may not be good for you)

10. Cool factor (The pump really does look cool with its different colors, alarms, etc.)

PUMP NEGATIVES:

1. Wearing it all the time (you can disconnect when you take a shower or when you are playing football etc., but need to reconnect to give some insulin no longer than an hour)

2. Change the catheter that is inserted under the skin into the subcutaneous fat (a tiny thin plastic straw-like device that connects to the tubing that connects to the pump) at least every three days, sometimes more

3. Pump malfunctions (the machine can break, tubing kinks, your friend pulls the catheter out by accident, you pull it out inadvertently, the screen cracks, computer glitch... you get the idea)

4. Having to pay more attention to blood sugars and checking them frequently because if the pump malfunctions you have no background insulin and you can get high REAL fast and therefore get ketones incredibly quickly, which can lead to diabetic ketoacidosis

5. Needing a back-up plan if pump breaks

6. Needing extra supplies such as catheters, tubing, insulin, etc.

7. Potential of infection around the catheter sites (especially if you don't change them at least every 3 days)

8. Running out of catheter sites due to frequent use

Finally, you really have to know what you are doing. This means you need lots of training with the pump company representatives and in a diabetes program like mine at Children's. At my institution patients consult with our designated pump nurse at time of pump start and frequently thereafter. We don't let you fly solo--we are your co-pilots at all times!