Insulin Pump? CGM? One Choice……What Do You Choose? A Needed Dialogue.

pumpsSo, say you are speaking to a newly diagnosed parent.  They are slowly coming around to understanding this new thing called diabetes and the doctor starts to inform them that it’s time to start thinking of having their child consider an insulin pump.  The conversation and the plans begin.

But is that an error?

Well not really an error, but let’s just say we have a choice of one because you do not want to experience your child being on two different devices from the get-go; you have a choice of one.  Is the insulin pump the choice?  Or do you go with a continuous glucose monitor (CGM)? Conventional wisdom seems to be that ‘the pump’ is the way most practices tend to lean and I’m just not so sure anymore that the insulin pump is my first choice anymore; and I want to tell you why?

Very quickly; the insulin pump has insulin entering your body 24/7 and before each meal you dose more to cover the food about to be eaten.  The CGM is a device worn that checks blood sugar continuously and blood sugar readings are constant, and also if one is trending high and/or low the device informs of that as well.

To be clear—-they are both incredible marvels of research and development and given the choice, I think anyone would/should be wearing both.  Because I believe knowledge is good and the more knowledge in front of you, the better care in making decisions.  I also do not have diabetes and I have never worn either device for any length of time over 5 days; so the decision to wear both, one, or none; is up to each individual/family.  I want to be clear about this from the get-go.

But I also believe in dialogue for that is how we all learn.  So for the sake of this discussion, the choice is that your child will not hear of wearing two devices; the choice is one—–which one is the choice?  I get that if your child is old enough you will speak to them and discuss it, and a decision will be made.  But is there a choice of one device over another?  Yes, it is everyone’s individual choice; but what do you choose and why?  I would REALLY love input from adults living with T1D, as well as parents.

But before I tell you why to my reasons, I want you to know that I want you chime-in on this because it is a very important issue and decision.  I’m not saying I’m right, and I want to present all thoughts because newly diagnosed families will see this and I want them to see both sides of the discussion.   But you cannot just ‘chime in’ with just a choice, kindly give the why as well.

If I was back at the beginning (when Kaitlyn was diagnosed; CGM was barely a dream and pumps were really in their infancy on general use—-the take-away here is also that the development and research in the diabetes world is moving faster than you think, although never fast enough) and the choice was only one, I would choose a CGM.  I say that based on a few observations.  With one child choosing MDI (multiple daily injections) and one child on an insulin pump; I have the luxury (THAT is not the right word here) of observing both means of insulin delivery.

When done correctly, both seem to work with people very well.  They adjust and they make both means of delivering insulin work, and work well.  The ‘pain’ of shots with the ‘pens’ is so much less than it used to be.  The decision of both is based on the level of glucose.  No adjustments can/should be made without knowing one’s blood glucose level.  If you were able to know what your blood sugar was, not only at a given-moment-in-time, but also knowing which direction one was ‘trending’ in a certain direction; you can make choices to avoid swings.  If you can avoid swings, you can also avoid(lessen) those horrible feelings of being both very high or being very low.

Getting the ‘insulin in’ is crucial, but having a window of seeing blood glucose is worth its weight in gold.  It is ‘those numbers’ of which everything you do is based, so it just makes sense to me that the clearer that picture is, the better the choice of ‘what to do next’ can be answered?

So given that I must make a choice, I’m wearing a CGM.   But that’s me.  What do you say?  Kindly post your answers as a reply to this article so everyone can share in reading the discussion.
I am a diabetes dad.

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47 replies on “Insulin Pump? CGM? One Choice……What Do You Choose? A Needed Dialogue.”

Could you kindly add why you choose CGM over pump (I would rather not get into one brand over another, just because that is not the purpose of this discussion but…) as we would be interested in why CGM over pump?

Yes, I’m sorry I didn’t realize this published. The message I got was it did not. Sorry for posting twice.

This is a difficult choice because our son has more than just t1. He has 13 diagnoses. I have observed how each affect the other and complicate the diabetes, the biggest problem.

On the one hand the micro bolusing of an insulin pump is a must to combat the crazy highs from epilepsy and the crazy lows from gastroparesis. It also helps with the sensory issues MDI creates because he gets less needle sticks for insulin delivery.

On the other hand I would have no way of knowing his trending without a CGM. I would not know to intervene before he was crazy high from seizures or crazy low from slow digestion.

Theoretically I would have to do a gazillion more finger sticks to even come close to getting the much needed trending information. It is for this reason I would choose CGM over pump. As hard as the decision would be it would win by a landslide.

I would certainly pick a CGM for my child. For me, having the graph to see what trends and patterns are looking like is more important than the ‘way’ insulin is delivered – whether via pump or MDI.

We would choose the cgm because it gives us real time to the minute data. We then can make better decisions and fine tune our mdi dosing. However, insurance won’t cover and much like everything else in t1 the cost out of pocket is prohibitive.

Have you checked with your sales rep.? Many states now have coverage for these—-even if it takes an appeal process, and you may have done all this already, I clearly understand. Thanks for adding your thoughts.

As a parent of a child with T1D, we were MDI for 4 years, pumping for 2 years so far, and utilizing a CGM for the past year. I would hands down choose a CGM over an insulin pump. Not because the pump isn’t worth it’s weight in gold–it truly is for us–but because the CGM has given us peace of mind. We are no longer caught off guard by lows. We can make better decisions based on current trends in BG levels. We can SLEEP with a little less worry. And with today’s technology, my son can be on the other side of the world and I can still monitor and keep him “safe” in a sense. Bonus: his fingers get a much needed rest from the endless lancing.

Depends on the kid. For my kid the pump was most important. She was the kid who would refuse a treat or snack if it meant an extra shot. She’s also a kid who eats little at a time through the day and she’s tiny (and of course was more tiny at diagnosis). She needed to eat and she needed to eat on her own natural pattern. The pump allowed that.

My son has been Dx for 5 years. He has a Dexcom and does not have a pump. He has no desire to ever have a pump because he feels he has more control over his T1 with shots. The Dexcom is a real game changer and we love it!

and I don’t think they are both too much to handle right away; my 2 year old had a pump 1 month after diagnosis and a cgm a few months after that– as soon as I could get them.

I chose the Dexcom CGM (do not have a pump). We got it as my daughter has hypoglycemic unawareness when sleeping, and the Dex alerts us to a low (or that her BG is dropping, thereby giving us more peace of mind. When we upgrade to the G5 Dexcom, it will enable me to see her BG anywhere from my phone, giving me even more peace of mind (especially when she’s by herself). Also, it has caught lows while at school preventing missed class time at the nurse’s office while waiting to come up from a horrible low.

I am 37 years old, diagnosed 21 years ago this week, pumping for 16+ years, CGM on and off for 9+ years.

My gut first said “CGM”. To always know my child’s glucose level, no matter where they were, and where I am, or what either of us are doing would give me piece of mind.

And then I thought a little more. I regularly take breaks from the CGM. At first because the systems were quirky enough that it drove me nuts at times and I needed breaks. The accuracy has improved greatly in the past 9+ years, it is much more reliable. Yet still, I periodically feel the need to take a break. Seeing the constant numbers gets to me. It demands more of my attention. Or I’ll wear it and then ignore it, making it useless. Since my initial diagnosis, I’ve never been in DKA again. I’ve only had 1 low that required assistance (and ironically, I knew I was going down, told the oral surgeon, he didn’t believe me/respond until I went unconscious). Those are two very important facts.

On the other hand, in my 16+ years on the pump, I’ve never willingly took any break from pumping. 2 years ago, I was forced to do MDI for a little over 6 weeks due to a dispute with insurance over my pump I tried to order. I was miserable. I could care less the number of shots I had to do, I don’t mind, but I’m on a horrible unending rollercoaster for blood sugar levels. My dawn phenomena is particular strong. There is no way to manage it reasonably well on MDI. Every morning I wake up feeling awful, and spend the better part of my morning (if not the whole day) trying to feel better. Every. Single. Day. No exceptions.

I can feel generally well when I’m doing traditional finger sticks. I do not feel in general well when I’m on MDI.

If my kid was young and couldn’t discuss it with me, I would choose both. If I had to choose 1, I would look to see how many incidences of DKA and/or hypoglycemia that needed outside assistance. I would try to see if there was some specific things that basal rates could help with but could not be mimicked with MDI.

For me personally, I would choose pump if I had to choose only 1. If it was my child… I don’t know, it would depend on the child and their diabetes.

(Sorry for the very long winded answer, that really isn’t a clear answer)

Totally agree with you Maureen! Type1 for 38 years, pumping and cgm for 8. I too take breaks from my cgm but never from my pump. I find at times the high and low alarms on my pump become disturbing and so every two three months I take a week off from the cgm. Also, my partner is a light sleeper, which is great for me as he wakes me up as soon as he hears an alarm, but he also needs a break from the alarms too! I think the pump gives me great control and so I would choose it as number one. Cgm is great, but I can always test…I started by testing my urine with a fuzzy tablet 38 years ago to see whether there was any sugar in it, do cgm’s are great, but not as needed for my survival.

for my family personally, we would choose the CGM over the pump if we were down to one choice. My son was diagnosed at 12 months and at age 6, he still is unable to communicate to us his highs and lows. Our CGM has helped put extra eyes on him in between our checks. I think if an individual were able to feel his lows, perhaps a pump would be best. It really helps tighten any “control” you might have and address changing insulin needs. I feel extremely fortunate that we didn’t have to choose……

I would choose CGM, although I have never used a pump in my 30+ years as a type 1 diabetic. But since getting a CGM my A1C has not been over 6. So for me getting constant glucose feedback is more important than changing out injection for a pump

CGM. Although hard-pressed to ditch the pump, a CGM is such an amazing tool for small children like my daughter, who was 23 months old when she received hers. I truly believe that it saved her life multiple times, as she is hypo unaware and/or too young to recognize what the symptoms mean. A pump is fantastic for helping control what we see reflected by the CGM but ultimately CGM not only helps better the control but also reduces hypos in both length and quantity. Unfortunately my cousin passed at 17 from a severe hypo before CGM’S were around so I’ve fully realized the risk of not having a means to alert others to a low.

LOL….no one is asking you to ‘ditch’ anything but I get the point.
So sorry about your cousin….I have always felt that all those that went before us with this disease are heroes. Whether they lived or did not; they fought in a battle before so much was allowed to them and they all taught ‘something’; either by living and yes, even by dying. They’re all heroes in my book because they all left lessons to be learned.

LOL….no one is asking you to ‘ditch’ anything but I get the point.
So sorry about your cousin….I have always felt that all those that went before us with this disease are heroes. Whether they lived or did not; they fought in a battle before so much was allowed to them and they all taught ‘something’; either by living and yes, even by dying. They’re all heroes in my book because they all left lessons to be learned. Thank you.

Please note: This is just an opinion – neither = We check 12 to 15 times daily to catch all (every 1.5 to 2 hours), we also inject insulin 7 to 10 times daily with the smallest needles and lancets possible, been doing this for 7 years. My son is 10.5 years old who was diagnosed at 3.5 years old, He is Hypoglycemic Unaware, He does not like anything attached to his body not even band-aides. As parents bottom line we have to what is best for our children and not for us just to make things easier, but also we must not force such things onto our children, respect and honor our child’s body, their disease and wishes till they can choose what to do with the cards that we were all dealt in our lifetime and which were handed to us, we should not choose for our children’s disease because it is NOT our disease, Most doctors are always too quick to jump today. We have to keep our kids alive regardless. We may live with the disease such as Type 1 Diabetes and the management is needed on a daily basis, never the same but we do not live it daily as our kids do and or as they will for the rest of their lives. it is their disease, their choice on how to manage when they get older -NOT THE DOCTORS or the PARENTS in my opinion, Not our choice, no one should ever push a device onto a child without choice or till they are of age to get a tattoo, smoke or drink when or till they can choose themselves what or how to do . A disease they will have to live with for the rest of their lifetime till there is cure and a disease that we will help them with till they are old enough to make choices. just saying!!! REPEAT: It states what to choose for your child – dislike it = their choice, their disease. “Check Don’t Guess” to Help Save -A- Life – LIFE FIRST = It does not have to be with a CGM or PUMP. Insulin is not a cure, as insulin saves lives so does it take lives as well or just as easy as the body stops to make insulin before being diagnosed with type 1 diabetes Awareness and Education is the key! – there is no wrong way BUT remember this, to be pressured or forced to do something for another person or companies gain is not right and to make our kids a subject for devices for the ease on our self is not right either. We need a CURE!. Please consider FaustmanLab to stop the auto immune attack with the BCG Vaccine already proven to work and in human trials approved by the FDA. Please consider so that one might not have to ask such a question in the future. Thanks for your time.

The children are the true heroes and should always get the best hero award of the year of the day at any given time, their voices need to be heard – each and everyone of their voices – all of them, not ours!!! they all are, We or I am here for Life and I will try to speak for our children till they can, we have to speak up and advocate for them. I am just a parent wanting the best for my child as everyone else does out here as well. Tired of devices / choices what color, what brand, what make or model. There are many many good dads out here that do their share of work as well, for those that don’t SHAME ON THEM!. Many many single moms out here as well that have no help and then team work for the lucky ones so that the other spouse gets a break (must be nice). Atleast they can try to get some rest, To me a CGM or Pump does not guarentee life or rest, its no different then what we do without, many that drop low might be too low to do anything for themselves either way. Folks / people / children don’t wake up when they are low. A doctor told me that when my son was diagnosed that he would wake up if he went low. That is not true!… I only want the best for my child and for him to not to be or to feel any different than anyone else, i want the least amount of pain for him as possible and to honor his wishes as best as possible without attachments of any kind to his body and knowing that insulin was delivered to him by injection (knowing its inside his body) no attachments, no problems, no dis-connects of any kind, no batteries dying, nothing coming undone. call us old fasion but unless it is life or death I will not put a pump or cgm or recommend one over the other for him or for anyone. it will be his chioice and we will continue to stick and go and set our alarms and wind up our clocks to check often every 1.5 to 2 hours to catch all- for someone to say choose one or to make one choice – i say i choose neither, one size does not fit all and does not work here. We stick and go and have many tireless / sleepless nights and days as anyone else with or without a device taking insulin and with type 1 diabetes = we are parents or grandparents, it is what we do and what needs to be done regardless for the life of our child. We check often, don’t guess, we use accu-check drum style lancets and the device on the lowest most smallest setting possible to draw a tiny drop and we also use freestyle light test strips for the most smallest drop of blood drawn and we get 2 sides or 2 tries per test strip incase the first drop did not take or register (the best ever), He has to date over 41.000 finger pricks and over 21.000 insulin injections (thousands) no bruises, no pain an occasional ouch here or there, he still types on the keyboard, we use one or two fingers only. He is 10.5 years old today. We use the smallest everything, most thinnest syringe needles. I mean the smallest drop of blood will read on the freestyle lite meters, smallest syringe by BD, the smallest lancet by accu-check, smallest everything is way less pain then sticking wires and attachments to a body and having to worry about ketones still or insulin delivery, droping too low and then having to still check constantly everything in my opinion. Many to become attached to devices and to take for granted or assume they will catch all and work for all and everyone equally the same. It is absurd, It is causing many to rely and let the guard down and them getting to be too relaxed and thinking that electronics is more reliable and the number one choice in management for all, It is not. which it can also have many things go wrong with them from what was listed above to lets say folks needing to have to go to the hospital still or needing a glucagon to even hopefully not death because of DKA or hypoglycemia (insulin shock) happens either way old way or new way. When I inject my son, i know the insulin is delivered in his body and when we check we know if something is wrong or not working properly without guessing what went wrong to catch all of the highs and lows, night and day. I still don’t understand why doctors do a blood draw for A1c if all devices keep track of 7 days, 14 days, and 30 days readings and if folks take accurate notes and document everything- why put our kids through that pain either??? – because the ADA suggests to do it!!! and the doctors think its mandatory cry emoticon – A1c blood draw should be used to diagnosed and not for results of management already diagnosed, one should know what needs to be done by their averages, just in my opinion again, If devcies and meters keep averages. I am just not into making our children first choice in device management to being born and then to come home out of the hospitals with attachments to live for life instead of stopping the attack and trying to cure everyone first without thinking $$$$$$$$$ for testing and new devices. better colors and better options… – its just is not fair that most everyone pushes devices or teams up with organizations for funding of or for device management instead of stoping the disease to give towards a possible cure instead. Even with proper management one is not guarenteed life :'(

CGM as long as it’s a Dexcom ! The last thing you want to do is get a CGM just because it’s a CGM. All CGM’s are not created equally. Your child is safer when wearing a dexcom CGM and you can also use it as a tool to help you make adjustments to your management routine no matter if you are MDI or pumping. A pump is just another insulin delivery device, albeit a very very handy insulin delivery device than can give you more food freedom. Hands down get a Dexcom CGM if you could only get one device.

Thanks Doug, clearly others may disagree with the product choice; and this was not meant to choose a ‘brand’ over another—too proprietary in how it could turn out. The only discussion is about the device and you surely answered that as well.
Thanks again.

Can you please tell us why you are asking this question? Is it to be passed on to someone in the diabetes technology business? I have used both devices and don’t know of anyone who has to make a choice except for financial reasons. Thanks!

Nope—–no reason but to show those who might want to know that there are different sides to the thought process that they MAY not have heard before; or even thought of before. If you look over the answers…….you will see heartfelt answers that clearly show the ‘personalness’ of the decision process. I know I learned a lot today reading the answers and my hope is that others did also. And I know MANY people who have to make the choice—-everything from what you stated to the idea that some of our kids DO NOT want two devices. All of it——food for thought.

I would choose the cgm because I love seeing how she’s trending, but my T1D 13 yr old would choose the pump. She hates shots, even with pens. She will go hungry if it means an additional shot. Her disposition when she’s on shots is very melancholy.

Thanks – just seems like the question should be why do you choose to use a Pump or MDI, since the CGM provides something totally different from insulin delivery. I wear both a pump (10 years) and a CGM (5 years) for I am amazed that people seem to use the CGM in lieu of bg readings (often phrases as needing to do less finger pricks). Yesterday my CGM said I was low while a finger stick said 92 – if I had treated based on that low I would have seen very high numbers! I love the CGM for the additonal information it provides. A finger stick reading of 77 would typically be lovely for me, but if the CGM shows a downward trend I know to treat to prevent a low. And an upward arrow means I need to keep an eye on it to make sure it levels off before I go high. I do MORE finger sticks wearing the CGM, and it has helped me gain much more control. If I had to choose between them, I would keep my pump with the ability to change basal rates in the fly, suspend insulin delivery, and it’s ease of use.

My 19-yr-old son also wears a pump (9 years) but does not want a CGM. As a user myself, I totally understand – it is one more thing to change, charter and charge! Also, he has always been hypo-aware so he doesn’t see looming lows as a reason to wear one. Options are wonderful. My hope would be that every family has access to good information on what’s available and the insurance or means to get what they want.

i would chose the pump for my son. He is 11 months old and we have to use a diluted insulin to be able to have measurable doses of insulin to give him. He still runs over 400 right now for 3 hours or so after eating, especially breakfast. I’d love to be able to better control that and also give him a higher basal rate as 1 unit of lantus is too little but 1.5 is too much. Alas, insurance will not approve a pump for us

Pump. With one needle-phobic child and one who needed far smaller amounts of insulin than were achievable with injections, moving to the pump was a relief and (for the second child) a literal lifesaver. My second child does also have a CGM and the low suspend feature is invaluable, but wouldn’t work without the pump, so if we had to choose it would be pump only, and do LOTS of tests.

We chose pump first and I would do it again that way. (My 5 year old uses both now).

Having a pump gave her back some freedom to eat like a regular kid. Also it made it much easier for her to go to school and camp. It’s much less of a big deal to ask a camp counselor or babysitter to press a few buttons than to ask them to stick a needle in your child.

I love the CGM and feel crazy when I don’t have access to the numbers. But that amount of knowledge would have been insanely overwhelming to us when we were newly diagnosed.

I would choose CGM, BUT my 21 year old type 1 daughter has chosen pump, and she gets to choose. We let her choose at the age of 15 which was very difficult, but its her body. She does not want to give up the ease of the pump. She changes her basals frequently, snacks nonstop, and hates to do the math. No CGM because she won’t wear two sites. We have pushed, especially after a few lows that caused her to be unresponsive, and because she lives away at college, but she’s not giving in!

I would choose CGM. My son was diagnosed at age 3, and is now 11. He has always been hypo unaware, and having no warning of a drop in BG for a very active young child has always scared me. With advances in CGM technology, we now can monitor his BG remotely, giving him much more flexibility and independence to be a typical pre-teen – go to friends’ houses, have sleepovers, etc., while we watch his numbers and keep him safe. The remote monitoring piece is a game changer for me!

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