In defence of multiple daily injections

By | 19 June, 2009

As we all know there are a few choices when it comes to managing Type One diabetes. We can rely on multiple daily injections (MDI), using a pump or other solutions – such as homoeopathy. The latter option usualy results in a slow, lingering death and other answers, such as inhaled insulin are just rubbish. So it’s basically down to MDI or pumps.

For the last wee while, pumps seem to be given as the must-have diabetic accessory. Without one you’re seen as a throwback to the early 20th century, having little progressed from the days of Banting and Best. Essentially you’re the diabetic equivalent of the caveman (or, of course, cavewoman) – a drooling, half-mad imbecile pitied by the pump-wearing community.

Well, the tide has turned my friends as I’m coming out in support of MDI!

“For God’s sake, why?” You may ask. Well, in my view MDI has a lot going for it. No, it really does.

The main benefit of MDI is its simplicity. There’s no complicated machinery for one thing. I haven’t been able to set the timer on any video player or DVD recorder I’ve owned for the last ten years. That I might be put in control of a complex device on which my life wholly depends is frankly terrifying. If I had a pump I would end up with the diabetic equivalent of my favourite program being recorded over by a repeat of Masterchef – as happens with monotonous regularity with my video (whatever the diabetic equivalent of that could possibly be…)

Second; MDI is extremely portable, robust and virtually indestructible. Should I choose to go out hoola-dancing in a grass skirt on a tropical island (now that’s going to be a hard image to shift…) then I can do that without the slightest difficulty. A quick squirt of humalog and I’m away. There are no problems wondering where I’m going hide my pump in my grassy skirts or whether the mile of tubing I have attached is going to pop out during the wild equatorial festivities.

It’s also worth remembering that contrary to popular belief you can actually maintain very good control with MDI. I don’t like to brag (well, actually I do) but my last five A1C’s have all been 6.5% or below – all achieved by just using simple old humalog and basic lantus. By carefully adjusting the long and short term injections you can get a really good balance that’s just right for you. If you can do this with basic equipment then why bother with the expense and complications of pumps?

So there we have it – MDI rules and pumps suck! Comments below please – bring it on!

22 thoughts on “In defence of multiple daily injections

  1. Alison

    What complete and utter rubbish, the only way forward is pumps, you are simply Neanderthal in your thinking. Is that what I’m meant to say? 😉
    Actually, I think you’ve got a fair point. For some people MDI works wonderfully, it is really simple and involves less faffing around than a pump. For me MDI was ok, but a pump is fantastic. What’s important is that MDI isn’t the only option, that no matter what your post code you have the chance to use the best treatment for you.
    As you don’t have a pump to hold you back, I’ll look forward to seeing the photos of you in a grass skirt on here soon!

  2. Tim

    And another thing…with your combined pump and CGMS, Alison, you’re now part-human part-machine.
    It may be a minor thing now – but that’s how the Borg started. And the Cybermen off of Dr Who.

  3. Alison

    I’m proud to be a bionic woman. My husband thinks its cool that he has a wireless-enabled wife!

  4. Heather

    Congratulations on getting a HBA1C of 6.5% on MDI. That is a great achievement. However my son was never below 8% on MDI and it is only since getting a pump that we have been able to improve his control. His last HBA1C on MDI was 9.1%, his first after pumping had dropped to 7.4%. For us the pump is fantastic and we wouldn’t change it for the world.

  5. Tim

    Thanks Heather – I have to confess it’s not been entirely easy to keep the A1C down so low on MDI. I actually have an appointment to see about getting a pump next month – but don’t tell anyone, it does rather fly in the face of my article 😉

  6. Sam

    And as I am feeling very proud of myself today I might as well wade in! Today I got my first Hba1c results since being on the pump – I have managed to bring it down from 9.5 on MDI to 6.7! Yay!

  7. Alison

    Sam, that’s a fantastic result, congratulations!

  8. Tim

    That’s bloomin’ marvellous Sam, well done! Permission to feel smug – granted! 🙂

  9. Lesley

    Neanderthals have clearly come a long way – running blogs and all… I just hope that you manage to plan ahead for your hula dance, or carb up prior to your shimmy, otherwise your nice portable insulin delivery device might end up in the sand beside your sweaty convulsing body 😉

    Congrats though on your commendable HbA1c. But what’s your standard deviation?

    Lesley from the INPUT blog

  10. Tim

    @Lesley Deviation is pretty good – I keep it fairly low over a reasonably long period of time; but I bet I could do better with a pump as I think it would reduce the daily range I get.

    I didn’t know you had a blog too – I’ve duly added it to the Resources section above. Yay!

  11. Sarah

    I think I agree with you on the MDI is simpler and you can get good results with it side (I had 6.0 A1cs both before and after pumping). On the other hand, pumping makes your life more flexible and makes diabetes take up less “brain space” once you get it working well. Glad to hear you’re moving into the future with us cyborgs in that respect 😉

  12. Tim

    @Sarah I just worry about the whole cyborg thing though – you’ve seen Terminator and you know how that ends up? Total world slavery by the machines – pumps are just the thin end of the wedge!

  13. Mark

    Greetings. Have you considered the OmniPod? It’s tubeless. I’ve used it now for 3 months and love it. I can wear my grass skirt anytime I darn well please. 🙂

  14. Tim

    @Mark Interesting Mark; but I’m not sure if it can be funded by the NHS here in the UK. I’d better check the NICE guidelines and report back.

  15. Tim

    Further to last comment, NICE say the following are available through the NHS:

    Animas 2020 (Animas, Johnson & Johnson, cost £2600)
    Paradigm real-Time MMT-522 (Medtronic, cost £2750)
    Paradigm real-Time MMT-722 (Medtronic, cost £2750)
    Accu-Chek Spirit (Roche Diagnostics, cost £2375)
    Accu-Chek D-Tron Plus (Roche Diagnostics, cost £996)
    Deltec Cozmo (Smiths Medical, cost £2750)

  16. Angie


    I was chatting to my DSN last week, and she said they’re actually trialing the omnipod in the UK at the moment, our hospital has five to try out. 🙂

  17. Tim

    @Angie See, that’s how powerful our campaigning is – we even change policy before the campaign even starts 😉

  18. Pingback: I’m getting a pump. Eventually. | Shoot Up or Put Up

  19. Johno

    Good shout about MDI being a good choice when simplicty is needed!

    The absolute key regardless of whether on MDI or PUMP is the education you recieve or get yourself with the way insulin works, how to CHO count correctly, how different element effect your sensitivity (e.g. exercise, weight, weather, periods etc). Also your dedication to keep and assess your blood glucose logs!

    I actually like to use a combination of the both! For mundane day to day life i use my pump. But when it come to playing cricket and out in the field diving about for three hours, also when out raving (vanity reasons) at the weekend i switch back to MDI.

    So i say all hail the education and whatever technology you apply it to is a bonus!

    Keep raving


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