Emma Cartwright: The importance of choice between an insulin pump or multiple daily injections

Emma Cartwright describes how she made the decision to switch to using an insulin pump

When I was diagnosed with type 1 diabetes, over 25 years ago, treatment options were limited. I was started on daily injections which meant I had to follow a strict routine of food, injections, and blood testing. One of the main skills I had to learn was being able to calculate my insulin doses using my blood sugar readings and carb counting. All of my diabetes management was manual. Being on injections meant that I had to understand the basics of diabetes. It also meant that I had more room to make errors in my management as I always had my background insulin.

There were times when I knew that I was different to my friends. Being on injections allowed me to forget about my diabetes in-between injections, which felt very important to me growing up. I could go back to being a normal child, not worrying about my diabetes until my next meal (or hypo). Being on injections also allowed me the full control of who knew about my diabetes. It was easy to disappear into the bathroom to take my blood sugar or take an injection without having to explain to everyone around me what I was doing.

Insulin pumps were introduced to me around the age of 12, 8 years after my diagnosis. I had no interest and completely dismissed the idea anytime it was mentioned to me. The idea of a pump sparked a fear in me of having to have something attached to me all the time. To me it meant no escape from diabetes, no periods of being normal in-between meals, everyone knowing that I had diabetes. I knew that having a pump would mean that I had to be more on top of my diabetes. There was more room for error. It would mean that I would have to think about my diabetes more often, checking my blood more regularly, and reacting to high blood sugars much more quickly.

I also had a fear around stopping injectionsthe thing which had kept me alive for as long as I could remember. They had been my lifeline and I was comfortable in my knowledge of how my body reacted. I didn’t have to let diabetes take over my life on injections and worried this would change on a pump. I worried about placing my life into the hands of a machine. I also worried that I would lose my basic skills of diabetes management. I wanted to know that I could manage my diabetes myself, without technology, just in case I didn’t like the pump, or it failed. I hated the idea that my family or health professionals could download and see all the data from my pump. Struggling to manage my diabetes was much easier to hide when I didn’t have horrible graphs in front of me. I also couldn’t “forget” my pump at clinic the same way I could with my blood tester.

My decision to change onto a pump took me 10 years to make. During this time my health professionals never pushed the idea onto me. They explained the reasons why it might make my life easier. However, they also ensured that I knew that it was my decision to make. It was important for me to have control of the decision as it was my life that it affected. I also knew that having a pump would give me more flexibility and accuracy in my diabetes management.

With my pump, things can go wrong much faster than they can on injections. I therefore knew I had to understand my body and diabetes before the switch. I spent a couple of years ensuring that I could successfully manage my diabetes on injections before considering the change. It was important for me that the switch to the pump wasn’t a quick fix for improving my diabetes. Having the knowledge that I could try the pump with the support of my health professionals and go back on injections at any point helped my decision.

The use of a pump or injections require a different level of knowledge, and skills. There are also different fears, worries, and challenges. For me, having more than 20 years’ experience on injections helped me use all the knowledge of my body and diabetes to ensure I made the pump work for me. This time getting the basics right has helped me in managing challenging situations with my pump including bent cannulas and Diabetic Ketoacidosis (DKA) which I had never experienced whilst on injections. I knew my body well enough to know when things weren’t right. This gave me the confidence to hand over some of my diabetes control to a machine.

For me a pump has been life changing. However, that is only because I took it on when I was ready and felt like I had the tools, and support, to step my diabetes management up a level.

Emma Cartwright is currently completing her PhD in health psychology at Nanyang Technological University in Singapore. Emma was diagnosed with type 1 diabetes at the age of 4 and is a patient editor at The BMJ, editing the “What Your Patient is Thinking” series. 

Competing interests: Emma Cartwright is a freelance patient editor for The BMJ.