Updated: May 25, 2020
I want to begin with a disclaimer. I'm solely sharing my experiences, not giving any medical advice. What works for me may or may not work for you. Take this as a personal anecdote and opinion!
My usual night-time levels with Tresiba
My Insulin History:
From age 4-6 I used MDI's (Multiple Daily Injections). From age 6-18 I used a Medtronic insulin pump. Once I hit college I needed a change. I needed some kind of freedom from the confines of being attached to a pump. So I decided to ask my endo about Afrezza (a cool new INHALED insulin that I saw on a Facebook Ad). Much to my surprise, my doctor happily agreed to let me give it a try. For all 4 years of college, from age 18-21 I used Tresiba for long-acting insulin and Afrezza at mealtime and for corrections. It was great having the fastest-acting insulin around, not having to inject myself constantly and to not be tethered to a pump My control was the best it had ever been, with my lowest A1C around 5.8. Not too shabby for a college kid!
That being said, 2020 came along and I began to get a bit "greedy" so to speak. While my A1C and time in range was great, I craved even flatter, spike free lines on my Dexcom CGM. I thought I could do better (always strive for perfection right?) and really dial in my blood sugars if I switched back to a pump. So given my active lifestyle I decided to try out the tubing-free Omnipod pump in February of 2020.
My time getting back on the pump was a massive learning experience for me, and helped me to realize a lot of things I wasn't necessarily doing "correctly" with my older insulin regimens. I even tried "looping" (or using a closed-loop insulin system) with my Dexcom and omnipod for a bit. Now this was supposed to be the gold standard in diabetes care and make it easier than ever to control my BG's...
In all honestly, after experimenting with this for a few months, I'm not a huge fan of pumping or looping at all, and am back to trusty Tresiba/Afrezza/Fiasp combo.
1. Too Many Variables
When using long-acting insulin and Rapid-acting shots/Afrezza, the insulin always does its job, and if my blood sugars fall out of whack, its typically some sort of human error on my part.
"oops I must not have given enough for my dinner"
"oops I probably didn't pre-bolus long enough"
"oops my long-acting basal is a bit too high today, lets lower it tomorrow"
With the pump, you introduce a whole host of variables into the equation.
"Is my cannula bent?"
Is my cannula seated right?
Is my pod stuck to my body?
Is this site absorbing properly?
The biggest for me being insulin absorption. With the Omnipod, I had immense struggles trying to find spots on my body where insulin would absorb properly. two of the sites where it definitely didn't absorb barely at all were both of my upper arms aka the two sites I was most excited about using!
I'm a simple guy that doesn't like to overcomplicate things. I function best when working with things that always work as they should, and cause the least amount of headache possible. That for me, is certainly not an insulin pump
2. My life is not predictable enough to properly adjust my pump on the fly
Part of the excitement of getting a pump is the ability to change basal rates on the fly depending on your activity level, stress level, illness, etc. This was one of the big reasons why I wanted to make the switch.
When it came down to it though, even on the pump I found myself still having to eat snacks before exercising and giving larger boluses when I was more stressed out. The simple truth is my life isn't predictable enough to change my basal rates on the fly. For example, If I were to know that tomorrow afternoon I was going to go on a long bike ride, tomorrow at 11 am I might drop my basal rate so that in 2-3 hours my blood sugars ran a bit higher and didn't plummet during my ride.
This is a great tool.... for anyone with a very routine or predictable lifestyle. The issue is.... my life is never routine or planned out like that. I typically decide when I'm headed out for a bike ride 5 minutes before I leave. Rendering any basal changes useless, and a recipe for high blood sugars later on.
The other point to add to this was the fact that I felt like me changing my basal rates constantly, was just really me adjusting for insulin that was absorbing irregularly. I seemed to have no specific basal patterns, my rates seemed to be different with every single day. Whereas with Tresiba, my basal rate was solid. If I gave the right amount of insulin, I would stay between 100-120 mg/dl every time. This allowed my time in range to be MUCH better on shots, compared to a pump.
3. Constant Worry
This expands a bit on the "too many variables" point but while on a pump, I had this constant worry in my head that something would go wrong. Whether my insulin was absorbing or not, whether my cannula was seated right, whether or not my pod would fail, whether or not I would crush my site. These weren't just aimless worries either, these things happened... quite often.
With my long-acting basal insulin, It kept me steady, I always knew it was doing its job, no matter what. The fact that my pod could just stop working at any time was enough to make my blood pressure rise just thinking about it.
4. Constant Site Changes
Going from one injection every morning to one site change every 3 days seemed like a welcome switch in my eyes. Fewer needles poking me? Always a good thing. However, the supplies, effort, and time that goes into changing an insulin pump every 3 days was obnoxious to say the least, compared to my simple one and done long-acting insulin shot every morning that I knew so well.
Aside from the physical effort, there was also an insane amount of mental effort that goes into this biweekly ordeal. Having to guesstimate the proper pre-site change bolus on my old pod and the accompanying jumpstart bolus on my new pod, along with the next 5 hours of worrying whether or not the new site was a success and if I had been getting insulin was too much for me.
I'm so busy mentally and physically as it is, constant site changes were not something I wanted to have to deal with on a regular basis.
5. Active Insulin Buildup
For someone as consistently active as I am, it was no Bueno having active insulin on board all the time. I'm one to eat lots of small meals throughout the day rather than 2 or 3 big ones. I also tend to take little "movement breaks" rather than one big bout of exercise. Meaning I always had some kind of insulin on board, and I was always moving around. This is a recipe for LOW BG's!
With Tresiba, I always had my predictable amount of insulin working on me and Afrezza/Fiasp was out of my system fast. Which was a perfect recipe for avoiding lows!
6. I spent WAY more time on my Diabetes
With Tresiba and Afrezza, things work great, and its a bit of a "set and forget" sort of system. With the pump, I was CONSTANTLY making little tweaks all day, obsessing over my ratios, microbolusing, checking my blood sugar, and obsessing over all the numbers on my screen. I wanted to make everything perfect, so I became overly engulfed in my PDM and Dexcom.
Living with Diabetes takes up A LOT of your time regardless of what your insulin regimen is. The last thing I needed was more of my life being spent obsessing over my diabetes. With my diabetes care, I want the most effective, while also being the least hands-on. For me, the pump could not supply that,
7. Too much screen time
I'm someone that despises being attached to their phone. I like the ability of using my phone for a while, then being able to shut it off, put it away and spend time in nature, away from technology. I usually refuse to even connect my Dexcom with my phone! So with the pump, I was constantly glued to my devices. Not to mention the sheer number of devices I had to carry around with me and remember to charge. Either it was my phone, a Dexcom receiver, and a PDM OR a phone and a Rileylink (the mini-computer you must carry around in order to use a closed-loop system.) Overall, it was just too much for me, I DO NOT like being tethered to technology.
8. My intuition > technology
Don't get me wrong, technology is amazing. But given my time in the holistic health world, I've made it a point to become very in touch with myself and how I'm feeling at all times. This meant that it was hard for me to “let go” and let the pump do its thing. Often times I knew my body better than the pump did, and was constantly overriding its suggested changes!