If this doesn't sound great to you, you should consider manual basal bolus therapy.

MULTIPLE INJECTION POSITIVES (basal insulin plus rapid acting insulin):

1. Body not attached to life-sustaining equipment

2. Use of neat insulin pens: dial up the dose, inject, done

3. Long acting insulin (Lantus-1 shot/day, Levemir-2 shots/day) is on board., which means that if you accidentally forget to give insulin for lunch, you STILL have background insulin available so you won't necessarily develop ketones quickly

4. Less equipment than all that pump gear

5. No equipment malfunctions (unless you forgot your meter, etc.)

6. Less daily routines (changing catheters, running out of insulin in the pump, alarms etc...)

7. Sports (don't have to take pump off)

MULTIPLE INJECTION NEGATIVES:

1. There are many shots (if you do it correctly and bolus for all carbs)

2. Need to plan ahead and determine how much you plan to eat so that you do not have to give more than one insulin injection per meal or snack

3. Less flexibility of background insulin--only one "basal" rate--if Lantus; 2 basal rates if Levemir

4. Need to give rapid acting insulin before meals to be most effective

5. Still need to check blood sugars at least 4 times/day

6. If there is an omission of long acting insulin (Lantus or Levemir) then you need to give insulin at least every 3-4 hours

7. Still need to manually count carbs and use insulin/carb ratios, correction factors, etc. (although the pump does it for you automatically if you program it correctly)

I also recommend close follow-up with your diabetes team for dosage adjustments.

Still not sure? That is ok. You can also do a combination of the two forms of basal bolus therapy. In fact, Svati discussed going on a pump holiday. A pump holiday is when you take a vacation from the automatic pump and use manual basal bolus therapy. You already know how to do that. You just give shots based on the same principles and concepts that are applicable to the pump. A pump holiday is great in the summer when you are swimming and don't want equipment attached to your swimsuit or don't want your $5,000 device in the sun. Therefore, you can ditch the pump for the summer and go back on it when school starts. Your diabetes team can easily help you with that transition. We do it all the time: even if someone needs a break for any reason: prom, whitewater rafting, ski trip, etc.

The key is to remember to choose the form of insulin therapy that works for you, which may mean making different choices at different times of your life. It is important to voice your concerns to your diabetes healthcare professionals, so that they know what is in your best interests. Feel free to send me any questions or comments. I am happy to help.

DrC