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What are the benefits of Multiple Dose Insulin (MDI) using a pen or a syringe?

Actor MDI CSII
Glycemic control Optimal glycemic control is feasible for the majority of persons with type 1 diabetes who have a relatively stable lifestyle

May lower rates of severe hypoglycemia more than conventional therapy

May improve hypoglycemia awareness because of fewer episodes of low BG
Optimal glycemic control may be obtained for those with frequent hypoglycemia on MDI, those with erratic swings in BG or an erratic lifestyle and those with a marked dawn phenomenon

May lower rates of severe hypoglycemia more than MDI (Lenhard & Reeves, 2001)

May improve hypoglycemia awareness because of fewer episodes of low BG
Equipment cost Less expensive than CSII Relatively costly: pumps cost $6,400 –$6,800 (Can) and infusion supplies cost $2,000 (Can) per year
Self-management education Extensive self-management education required for the adequate use of the full system of IT, including use of scales, carbohydrate:insulin ratios and other dose adjustments

Minimal time is needed for pen or syringe operation
Same self-management education is needed as with MDI, with some adaptations for pumps

Extra time needed for pump operation training (≈3 hours)

Additional technical support may be required
Psychological impact No visible indicator of diabetes Acceptance of pump being attached and being a visible indicator of diabetes is necessary

Less frequent injections required

Those with significant psychological problems tend to do worse on CSII
Flexibility Meal bolus may be needed to contribute to basal insulin levels and may limit flexibility with timing
 
Dose in one-half unit increments only

Limited flexibility in changing basal rates
Maximal flexibility with meal timing and choices

Dose in 0.05 unit increments

Maximal flexibility in changing basal rates (hour by hour) and adjusting to variations in lifestyle events
Disadvantages/
risks
Frequent injections

May be more hypoglycemia

Greater risk of DKA if insulin flow interrupted

Risk of site infection or contact dermatitis

Hypoglycemia from ‘runaway pump’ has not occurred in U.S. for more than 10 years (Lenhard & Reeves, 2001)