How to Safely Transition to Multiple Daily Injections (MDI)

How to Safely Transition to Multiple Daily Injections (MDI)


As the reality of living during a pandemic slowly starts to sink in, people are changing their expectations for what 2020 (and beyond!) looks like. Some people have delayed their weddings, or put plans for a baby on hold, and many people have lost their jobs.

In the US, where health insurance is so intimately tied to employment, which also, unfortunately, means that many people are currently without health insurance and are quickly searching for a plan that will work for them. This is infinitely more complicated when you’re living with diabetes, as health insurance is even more essential for your health and well-being, but this can also cause problems.

Coverage for diabetes supplies varies by insurance carrier. For example, many Medicaid programs across the United States do not have an adult CGM benefit, and some health insurance plans on the federal and state health exchanges will not cover the type of insulin pump you need and are used to. These transitions have many people considering a switch to MDI, or multiple daily injections. Here’s how to transition safely, if this is you.

Reasons for Switching to MDI

People may switch from their insulin pump back to multiple daily injections for any number of reasons, but some may include:

  • Needing a mental health or “tech” break
  • Diabetes burnout 
  • Not wanting pump sites and tubing during the summertime (when lots of heat, humidity, pool, and beach time can cause many headaches with sites coming out more frequently)
  • Losing health insurance, and new insurance doesn’t cover your preferred pump
  • Saving money (a 2019 study found that annual costs are ~$4,000 higher for pump therapy than for MDI therapy: $12,928 vs. $9,005, respectively)
  • Experiencing frequent pump and/or cannula malfunctions
  • Experiencing sensitive skin and adhesive issues at your pump site
  • Absorption issues with insulin pump therapy

Some people switch pretty frequently between insulin pump therapy and daily shots, while others stay strictly in one camp or the other for years, and only switch when they absolutely have to. Remember that you don’t have to justify your reasons to anyone.

Talk to Your Doctor

Once you’ve decided to switch back to MDI, you should contact your primary care physician or endocrinologist (or any other provider who you regularly see for diabetes care). They can help you develop a plan to convert your basal (pump) settings to a long acting insulin injection (Lantus, Levemir, and Tresiba are common brands). Additionally, they can help you navigate the transition for bolus doses, as well as help you figure out your insulin sensitivity and correction factors.

Stock Up on Supplies

Once you’ve spoken to your doctor (and have gotten some prescriptions for long-acting insulin), it’s time to stock up on supplies. You’ll need both short and long-acting insulins (for bolus and basal insulin replacements), syringes or pen needles, and alcohol swabs. It’s helpful to have plenty of low snacks, like juice and glucose tablets, on hand as well. A silver lining of MDI is that there are way fewer supplies you’ll need, and they cost less money.

Buckle Up for the Roller Coaster

Switching back to MDI after using an insulin pump will not be without issues. You may experience both more frequent high and low blood sugars as you navigate the transition, and figure out both how much and how frequent you need to dose insulin. Don’t be surprised if you find that you need much more insulin on injections than you needed on a pump (or vice versa). Everyone is different, and having a little patience (and plenty of low snacks handy) can go a long way.

Listen to Your Heart

It’s important to remember that people living with diabetes can have excellent control whether or not they use an insulin pump. Multiple daily injections is a form of diabetes therapy that works wonderfully for millions of people. That being said, you may have family or friends who will try and change your mind about switching back to MDI. Be let’s be clear: if you need a pump break (for ANY reason), listen to your heart. Don’t let people talk you out of it. Diabetes is for the long-haul, and sometimes taking a break (or going back to insulin injections permanently) is just what can be needed to achieve better physical and emotional health.

You Can Always Change Your Mind

Made the switch to MDI, and can’t stand it after 2 weeks? Remember, your diabetes management is just that, yours! No one will judge you if you are ready to go back on insulin pump therapy sooner than you anticipated. You are allowed to change your mind as many times as necessary to find the best therapy that will fit your lifestyle and meet your needs most effectively.

Have you made the switch to multiple daily injections from insulin pump therapy recently? How was your experience? Any advice to share? Please share your story below; we love hearing from our readers!

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Read more about insulin, insulin pump break, insulin pumps, Intensive management, Lantus, Levemir, low blood sugar (hypoglycemia), multiple daily injections (MDI), Tresiba insulin.



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