Q: Our teenager has told us that he no longer wants to be tethered to so many diabetes devices. He wants to keep using his CGM (continuous glucose monitor) but asked if he could switch back to multiple daily injections instead of using his insulin pump. Won’t this make blood sugar management harder rather than easier?
A: People with diabetes can achieve good blood sugar control whether they use an insulin pump or multiple daily injections (MDI). It all comes down to preference and motivation. I like to tell my patients to think about it like driving a car. Most people drive cars with automatic transmissions. They don’t need to think about the car shifting through different gears; the car just does it. On the other hand, there are drivers who will only drive a stick shift. They will tell you it’s because driving stick gives them so much more responsiveness in how the car handles. They like that feeling of control.
The same really is true for the choice between using a pump or MDI. Insulin pumps can be wonderful tools for children with type 1, because kids and parents can quickly become experts at using the device. Using MDI effectively requires more awareness and consciousness of what you’re doing, but it may make management feel easier rather than harder. Some kids and teens really do prefer MDI and are up to the task of learning how to make injections work.
Before making the switch to MDI, there are some things for parents to consider. Kids need a solid, supportive family environment to handle the added steps involved in using injections. Parents should have realistic expectations of the learning curve and refrain from pointing out faults. Some people who aren’t accustomed to MDI think it is just like loading a pen. There is much more to it than that.
As for any cons to MDI, if there is something going on in the family — a divorce or other big transition in the family — it could be impractical at the moment to switch to MDI, because the child may not have that bedrock of stability that is necessary while learning a new skill. Other parents don’t do well with their kids getting shots, because they have needle phobias themselves! Think carefully about your family situation and ability to help your child smoothly transition.
If your child is ready to try MDI, your diabetes care team can teach you and your child what to expect and how to practice. This is a big step and an important choice your child is making to take more ownership of his or her diabetes. Your job is to be the support your child needs for success.