Multiple Daily Injections, a Second Time Round

I definitely felt hesitant about going back to Multiple Daily Injections when I was contemplating a pump break.

I didn’t really have too many fond memories of managing diabetes prior to insulin pumping. Lantus was very uneven and inconsistent the last time I used it. I felt I could never get the dose quite right. I remember lots of carb guesstimates, and the wildly fluctuating levels that followed.

But at the same time I knew that I was armed with a lot more knowledge, and motivation compared to when I last did injections. I was actually curious as to whether I could apply these newfound skills into Multiple Daily Injections a second time round.

I gave 9 units of Lantus at around 9pm on the first night of my pump break, which was the sum of the 24 hour basal profile on my pump. I was pretty pleased to see that it did keep me fairly stable when I woke up the next morning.

I was definitely contemplating splitting my Lantus dose, but I wasn’t sure how best to go about it. The general consensus in forums seemed to be that Lantus lasted around 18 hours at best. After running high during the first two afternoons, I decided to experiment with a smaller second dose at 1pm to cover the final third of my day. 3 units seemed to be enough to cover, without sending me low overnight.

After months of diligent carb counting, I knew I definitely wouldn’t be able to survive without a bolus calculator. Although there were plenty of flashy diabetes apps to choose from in the App Store, many of them lacked a bolus calculator. I eventually found RapidCalc for $12.99. Although it didn’t have the flashiest interface, it fitted my needs nicely. I was able to set up my insulin to carb ratios, correction factors, insulin usage profile, and reminders for my Lantus doses.

This break definitely reinforced that to me that you tend to use less insulin on the pump. On the pump, I was using a carb ratio of 1:10g and a correction factor of 1:2.6mmol. On injections, I needed a ratio of 1:6g and a correction factor of 1:1.6mmol. Being off by even half a unit of insulin had a big impact on my blood sugar levels after meals.

What I loved most about injections was the simplicity of it all. There was instant relief from the lows, and far less thinking about where my blood sugar was heading. Small activities around the house had minimal effect on my blood sugar levels. I witnessed steady trend arrows on my Libre during afternoon walks, rather than downward ones. Using Lantus for my basal, rather than rapid acting insulin on the pump, made a BIG difference here. The only time I had to think about lows was when I had mealtime insulin on board.

Gotta say, it was also just awesome to sprawl out on the couch or in bed and not feel that chunk there in my pocket. And I loved having a little less weight in my pockets every time I left the house.

Overall, my blood sugar levels were just as good on injections as they were when I was pumping.

But shots were definitely a LOT of work. Although I carried my pen around with me in my pocket everywhere, I don’t shoot up in front of others. So I really had to make a point of finding a quiet corner to do so when I wanted to eat or correct a high blood sugar level. Speaking of, morning blood sugars were a LOT harder to manage. I didnt have the flexibility of increasing my basal insulin to cover the morning rise after I woke up. I often found myself giving at least 3 corrections after breakfast to bring me back into range. If I had stuck with injections for longer, I would definitely basal test with a few extra units of rapid acting insulin to cover the morning rise.

My pump break definitely reminded of something that Ginger at Diabetes Daily wrote recently. She says that neither pens or pumps were perfect, and that we were choosing between the flaws that bothered us the least. I couldn’t agree more.

For me personally, an insulin pump is a LOT more work than injections. Keeping on top of site changes, dying batteries and insulin cartridges, and having to be on my game in setting basal rates around my activity. It’s more careful thinking about what you’re doing. Not to mention the extra chunk in my pockets pulling my shorts down!

But a pump also offers me more convenience when I’m on the go, more precision in my basal rates and greater flexibility with insulin dosing to cover different kinds of meals.

For the time being, those benefits outweigh the flaws when managing my diabetes.


  1. Marguerite

    Hi Frank, Interesting to read your post. I went back on needles after being on the pump for about 3 years. I never went back on the pump as I was no better off and didn’t like wearing it in the end being a woman with slim fitting clothes.
    Injecting is no biggy to me esp after 33 years and testing all the time as I do, I keep a pretty good control. Sometimes it goes up and sometimes I have hypos but I just correct for them as I always have done. I find if I am happy and not stressed I am better. I just roughly calculate when eating and its not always right of course as so hard to judge with the different foods. I take 13 Lantus at 7.30 am religiously and then just Humalog every time I eat. I’m a small eater and slim so only need 2-3 units for a meal.
    I do wish it was more consistent but that’s the nature of the BEAST!
    Cheers Marguerite

    • Paul Stefanetti

      Hi marguerite and frank.I am 51yrs old and have had type 1 for 30 yrs.I have always used injections.A bit scared to use pump yet.I have good control and started using libre glucometer.I use 18 units of lantus at bedtime.12units of humalog at breakfast 13 for lunch and 24 for dinner.I weigh 69kg and exercise. I sometimes have too many hypos and recently becone hypo unaware but dealing with that now.I have considered pump but why change things especially reading your comments

      • Hi Paul, as I said in my post, neither is perfect and injections had just as many flaws as pumping did. Last month, the pumping flaws were bothering me a great deal more than they normally do, so I took it off!

        Why did I decide to change it up? The pump has helped me to achieve my best a1c in six years with significantly less deviation in my blood sugar levels. It helps me to tend to insulin delivery more conveniently and precisely. It makes diabetes more manageable for me, despite it’s flaws. Of course, it won’t suit everyone but it does for me and that’s why I’ve stuck with it. Thanks for reading.

        • Paul Stefanetti

          Hi frank thanks for your reply.i’m glad the pump significantly reduced your hbca1.
          I am still waiting for a significantly better pump that are on the market at the moment before i give up needles.
          I hope we are not far off a pump that communicates directly with a continuous glucometer and makes adjustments just like a pancreas or i am just hoping they use stem cell technology and clone me my own pancreas.ha ha ha

  2. Frank:

    In my opinion the thing to improve the pump woudl be faster acting insulin. The thing to improve injections would be better convenience. The best thing woudl be fast acting insulin that dropped out of the sky and injected us when we need it but only then. Yeah I am not holding my breath.

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