Pens vs Pumps

What is your personal preference to manage T1D, pen or pump? And why do you prefer pen or pump? Do you think ones “safer” than the other? I was recently approached about the subject. Thank you.

I am also keen to hear what people say about this. Kate, my 14 year old daughter, is adamant she wants to use pens only. Of course, as it is her body, I completely respect her decision. She feels a pump might stop her “hearing” what her body is telling her, and she doesn’t want to rely on technology.

A little background first: I’ve had diabetes for more than sixty years and have had tens of thousands of needle sticks including the old stainless steel one and a quarter inch length the thickness of a 3d nail; a body can take only so much of that before it turns to leather and fails to absorb insulin. I began using pens in the 1970’s - not the prefilled pens which ar a “new fangled” thing. January 2005 I changed to a pump - I had been offered pumps since the 1980’s including the pump worn as a backpack. I’ve figured out how to manage my “brittle” diabetes quite well if we can use the A1c as a guideline by administering many mini-dose corrections.

By far, my preference is a pump. Why? Instead of two thousand or more needle sticks over the course of a year, the only poking myself now for insulin administration is insertion of a new canulla every three or four days. I’m conserving my body infusion sites so I can live well into my 90’s.


Wendy @francesjean,
Please suggest to your daughter that wearing an insulin pump does not relieve me of the need to read and feel my body. I will “speak” with your daughter and try to let her know my reasoning for her to at least try a pump - besides allowing your daughter to “save” her relatively few sites for insulin so she can live a long, full and active life I’ve found that a pump permits me to be more flexible with meal schedules and permits travel between time-zones, etc.

Your daughter is very intelligent when she says wants to “hear” her body - I’ve found that is the most important aspect for me to have survived 60 years - more than half of which was before glucose meters. Being able to hear one’s body speaking and to read it is one of the reasons that I’m opposed to slapping a CGM on anyone within the first few years of diagnosis. Picture what happens when suddenly CGM supplies become unavailable and a person has never, on her own, “heard” a sudden drop in body glucose level.


I have to agree with Dennis. I prefer to stick myself once every few days rather than multiple times a day. Also, I too find that I actually have MORE control over how much insulin a get with a pump than with needles.

For one, the needles can only give multiples of 1 Unit. The pump can administer down to tiny amounts. For example if I need 0.3 units of insulin per gram of carbs eaten, I get just that. I don’t have to round up or down.

The biggest bonus to a pump for me is the basal dose. A long acting dose via needle cannot mimic in any way how a pancreas might behave. It is just one shot that is absorbed evenly throughout the day and night. But many people require different amounts of basal during different times of the day. You program the pump to more closely mimic the pancreas by proving what you need when you need it. This means for me, no more lows, and no more “feeding the insulin” (meaning having to eat just because I have that basal injection in me). I have found the pump and CGM to be so freeing and allowing me to live a more normal life.

Lastly with the pump I can just pull out the device and tell it what I am going to eat (counted carbs) and I get dosed. No excusing myself to dose with a needle.

Just my 2 cents, I hope it helps.

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@thefarmerswife, @francesjean

Hi! MDI for 27 years, pumping since 2005. for me it’s the pump but you have to understand the pump is not for everybody.

the scarring and risk of infection is higher for pump users. The risk of DKA is higher for pump users, and you must be both willing and able to push the buttons, manage the alarms, and troubleshoot high BS with a pump that is significantly more difficult than when on syringes or pens.

there is also psychology with pumps, yup, you are wearing a AA powered machine that screams I AM DIFFERENT THAN YOU louder than if you had a yellow flashing light hat on. this is significant for many people, and specifically for me when I was in school. in high school - all I wanted to do is just be like everyone else. some folks can use a pen in front of an audience - I never could.

the most significant thing the pump does for me is basal, just like @momoftwins said. I treat T1 aggressively, and I need to turn up or down basal all the time. I can sit for days behind a computer, and I can be on a jobsite climbing rigging or through tunnels at a moment’s notice. I travel out of my time zone constantly, and I need to be able to hop off a plane and get to work, even if it’s 6 hours or 12 hours difference. I can’t be a slave to that basal shot.

MDI and pumps both work well with enough effort. Pick the one you like, the one that fits your life not the one that forces you to fit in to its requirements. cheers and good luck.

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Thanks - that is such good info for me to think about

My daughter was also adamant about using pens during her first year and then decided to add in a pump and is now considering a CGM. You don’t mention how long it’s been since your child’s diagnosis, but I hear from the clinic that this pattern is usual. Eventually teens (and probably adults) figure out what works for them after having tried out all the options.

When I first started using insulin to manage my diabetes I used an insulin pen. Eventually I moved to using a pump. I have used a pump for the past 20+ years and find a pump to be much more convenient than a pen. I appreciate not having to carry a pen with me, get it out, and inject myself with insulin in preparation for a meal. I prefer delivering insulin using a pump that is already attached to my body. With the improvements in the integration of a Continuous Glucose Monitor (CGM) with an insulin pump, I am looking forward to having the technology improve the regulation of my ongoing blood glucose levels.

I wear my pump on my belt. As a result people can easily see it, which I don’t mind. Very few people ask me about it. I expect many people don’t know what it is or assume it is a cell phone. I have friends who wear their insulin pump in a pocket or inside of their cloths. There are a variety of ways to slightly alter clothing to accommodate and hide an insulin pump. Insulin pump manufacturers and third party suppliers sell a variety of cases, pouches, and bags to help accommodate and hide an insulin pump.

Thanks - my daughter was diagnosed three years ago, aged 11. She has tried a cgm for a short while, and really disliked the experience.

@francesjean, What is it about a CGM that she disliked? My daughter’s concern is that it’s one more doodad stuck to her body,

Kate doesn’t like technology attached to her body - she says it makes her “feel less human - more robot”. She also doesn’t like visible technology, as she feels it makes her feel exposed /vulnerable to others. She sees it as a constant reminder that she “is different.” I am using quotation marks, because these are her actual words. She also found the site uncomfortable when sleeping.

What changed your daughter’s mind about using the pump and maybe a cgm?

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Abby used the same kind of words about pumps before having one. She didn’t want something attached to her. But Abby is a snacker and she missed being able to snack more easily. Also Lantus stings and she hated dosing it. Those were the reasons for contemplating a pump. The catalyst for the actual move was a teacher reacting negatively and publicly to her dosing at the lunch table (which resulted in an immediate meeting with administration and a review of the 504 plan). The incident bothered her so much that she wanted to be able to be more discreet with dosing.

She wants to try a CGM to catch blood sugar surges earlier without checking 10 times a day because she wants also to be discreet about checking her blood. I haven’t figured out if her desire for discretion is shame, hatred of being different, or just exhaustion with being gawked at. My guess is the latter two.


I was diagnosed when I was 7 (I’m now 15) and I’ve been on MDIs the whole time. I’m pretty active and I’ve never liked the idea of having tubing attached to me all the time. That said, I got a CGM recently and I absolutely love it, so I’m beginning to rethink my opinion on pumps too. I tend to be pretty resistant to change in general, and my current routine works for me, so I guess I’ve just never seen a reason to change it.

I was diagnosed at 9 (almost 10) and am now 28. I was put on a pump about a year after diagnosis. I LOVE my pump. I feel that it has been key to me being able to live a very normal life with diabetes. I’ve never felt that having something attached to me has slowed me down in any way… really we have our cell phones attached to us at all times and it’s really not much different than that! lol. I love the flexibility of the pump; I don’t have to worry about eating at a certain time or having to do things by the schedule of my insulin; my insulin lives by my schedule. The pump also allows better control due to being able to adjust basal rates as needed and have multiple insulin to carb ratios throughout the day without having to remember all of them.

To the concern about not wanting to lose the ability to “hear” your body. I agree that is SO important! I’ve been on the pump for the majority of my diagnosis and I hear my body freakishly well.

To the concern with people seeing the pump and knowing you are different… it’s valid. I keep my pump in my pocket and most people think it’s a cell phone or pager or think nothing of it. People are used to carrying around technology. I do have a T1 friend who is very private about her diabetes and wears her pump clipped to her bra. You’d never know she has a pump on.

I hope your kids consider the pump; it’s a life changer!

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Hi. The most important consideration in these decisions is that there’s no right or wrong answer, it a personal decision based on an individual’s needs and personality. And of course, it’s reversible :blush: And always remember, quality of life.
I have experience…20 plus years using a vial and syringe, 22 plus years on a pump, the last year using a Pen.
And the winner is…hands down, THE PEN! It’s convienent, accurate, painless and NOT attached to me 24/7. Do I give up a little technology? Certainly. But for me, there’s good economy in the trade off. The two things I miss about the pump are the Temporary Basil Rate and Bolus History, other than that, the Pen works for me very well.

With a pump or a pen, the key to success is monitoring. I use a CGM and a pump, but would keep the CGM over the pump if I had to make a choice. I use 8-10 different spots on my stomach for the CGM. I rotate my pump between my arms every 3 days and use 6-8 areas on each arm. If I feel my glucose dropping fast, I can suspend the basal dose for an hour or so until it levels out. This technique keeps me from consuming carbs to raise my levels. I can take my regular bolus before a meal, but I can quickly give myself more if I decide to treat myself to dessert or bread. I am active, so the wireless pump and CGM give me the freedom to swim or exercise without any restrictions. The CGM helped me understand the feelings in my body when my levels are rising too fast or dropping too fast. I can now feel the change before my CGM, but I use the CGM to confirm the activity. My last A1C was 6.6, so with the CGM and pump, my doctor expects my levels to stay between 6 and 6.5. Each person must find the right plan to keep their A1C below 7 in order avoid future issues.

This is a topic that has been common conversation in our house. My daughter is 3 and was diagnosed 8 months ago with T1. We were put on the Novalog pens at diagnosis, then moved to the Omnipod pump in November. From an administrative standpoint, my wife and I prefer the pump by far. However it is a traumatic fiasco, every time we have to change the Omnipod. My daughter is terrified of changing the unit, we presume because of the pain of the insertion. Part of this is also a three year old trying to get attention. But she has asked to stay on the pens. Even on the pens, we were able to get her A1C down to 6.3. So we are considering going back to the pens.

Philip @phlashmcdaniel,
My thought, for what it is worth, depending on how many shots with a needle does she need to endure every day? Multiply that number by three and ask her if she would rather have one poke every three days for the Pod, or the three day number of needle sticks.

Personally I change to a pump after giving myself tens of thousands of needle pokes after 48 years and was running out of usable real estate that would absorb insulin. In retrospect, I wish I had begun using a pump 30 years before that when pumps were worm as a backpack.

Thank you for sharing. I love to hear from people who have lived both sides and can share their story. Again thank you

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