MD here: (disclaimer - I'm A doctor, but not YOUR doctor, so ask YOUR doctor). Seriously consider a pump. Seriously.

A pump does not remove the need for shots and as for the accuracy, well that is up for debate. You still have to learn the bias of the readings it generates versus the manual test. It is a lifestyle change from shots, you will be moving the point of insertion quite a bit and some sports may be better served with a shot regimen.

There is one nice feature of having a pump, with an always attached device you can get warnings when your asleep which can save your life. Many of these devices will either beep or vibrate or both when you enter a danger range. Even if it does not alert you it could alert whomever your sleeping with; even pets will take notice and possibly wake ya.

Last note, most insurance plans expect the pump to be replaced after a couple of years so find out up front how many years before you should expect to replace it.

I've always thought the pump is not for me. It seems to be pretty big and you always have to carry around it with you. My life is still pretty fast paced and sometimes that kind of machinery is just an annoyance to get along with. The shots are not the problem, the everyday need of full control of your life is.

It's smaller than the phone you already carry around. It's mathmatically and demonstrably superior to shots. They have integrated CGMs now. Ask around, the folks with the fastest paced lives (diabetic Olympians, marathoners, world travelers, etc) ALL have pumps.

Unless you have a 6% HA1C on shots, get a pump and live decades longer.

My wife is Type 1, and was on the pump but went off of it after about a year. Says she feels in more control without it, and that it gave her a false sense of "security." And she has had better results since, and more stable sugars.

I don't know, obviously, not being diabetic myself, but I will say she went on the pump really soon after being diagnosed and didn't really have a chance to establish a routine first, and that probably played a large part in her doing better on shots right now. I've been encouraging her to start thinking about using the pump again, as I do feel that, used correctly, as I believe it is a better method, but she has to do what she feels works best for her.

Being a developer myself, the idea that she has to use a custom cable and custom software to manage the data she has in her meter drives me a bit nuts. But the meter industry is, IMO, full of companies that don't really want to help users, they just want to get rich off of diabetics. I know thats a bit cynical, and I'm sure there are companies that sincerely care as well, but it's how I often feel about the meter industry.

Will back up Scott here -- while not an olympian, I rowed for 4 years on the pump and have biked x-country w/ it.

I seriously doubt if I would've been up to doing either while managing injections instead of button presses.

Thanks everybody, I'll talk with my doctor tomorrow when I have an appointment.

I used to think the exact same thing, somehow I think I was really just afraid that someone would see thing thing embedded in me if I ever had my shirt off. When I finally got a pump I realized that it simultaneously keeps itself out of the way while allowing me quick access to my (approximate) levels. I can give my self insulin mid sentence in a board room meeting. I can see my levels dipping and get a lifesaver before it sets in. The worst that ever happens is that someone asks what the hell I am doing with a pager.

In short, the pump CGM combo it is the best thing I have ever done.

I wrote them off as too experimental and bulky when I was first diagnosed just over 10 years ago. I guess technology has advanced since then. I'll make an appointment with my doctor to chat about it. Thanks for the reminder to re-evaluate.

Totally. I don't even care if someone sees it and I'm happy to explain if they do. It's a lifesaver.

You DO have to constantly calibrate the pump though. It's not a perfect solution.

I am astounded there is not a close loop system yet.

Are the papers here [1] relevant? I sat in on this conference session as a student, and don't have access to the full papers to check my recollection. As I recall, most of the papers revolved about the theme of closed loop control of blood sugar.

At the time this was presented, the results were billed as the biggest advance in Intensive Care in recent history. The authors claimed to have hard numbers, showing that closed loop control of blood sugar for ICU patients was delivering (something like 40% if memory serves me???) fewer deaths for ICU patients. I'm not in the ICU area, so I don't know if the techniques outlined in the paper made it into clinical practice or real products. If so, you'd think it would trickle down into diabetes management. As a non-diabetic, am I completely misunderstanding the problem?

The International Federation of Automatic Control (IFAC) is the peak body for control research, so there's a good chance you will read about any new closed loop system there.

[1] http://www.sysid2006.org/Wednesday.html#web4

---

Edit: A couple more links from my poking around. Might provide some reading if closed loop control of diabetes is of interest.

http://www.medschl.cam.ac.uk/paediatrics/pages/wilinska.html

Closed Loop Insulin Infusion for Critically Ill Patients (with pictures of an actual device):

http://www.clinicip.org/

---

Edit: Found the actual numbers here: http://cordis.europa.eu/search/index.cfm?fuseaction=proj.doc...

42% reduction in mortality, compared to the old insulin control method, which I presume is open-loop?

You mean calibrate the CGM? There's no pump calibration needed.

My relative is definitely calibrating some instrument related to the pump multiple times per day.

Ah, then they are calibrating their CGM (likely integrated into the pump, as they are likely using either an Animas Vibe (outside the US) or a Metronic Minimed Paradigm). They aren't calibrating the pump, they are calibrating the pump's CGM vis a vi their meter via finger stick.

Not an expert, but maybe he's talking about the relative changing the basal rate (correct words? The 'give me this amount continuously' rate a pump will inject) or (this is something my type I ex-gf did a lot) he mistakes some 'correction shots' after meals for calibration?

Definitely involves blood and a small oval thing with a LCD screen.