Chris is a 45-year-old male with a long history of type 1 diabetes since the age of 15. He’s currently on a multiple daily injection (MDI) regimen, consisting of 35 units of Tresiba (long-acting basal insulin) once a day in the morning, and approximately 5-10 units of Fiasp (fast-acting insulin) for meals and corrections, depending on what and how much he’s going to eat and the directional trend arrow on his continuous glucose monitor.
The CGM Download:
Chris’ 7-day Dexcom download is below:
As you can see, his mean glucose is 144 mg/dL, with a very tight standard deviation of 34 mg/dL (very little variability throughout the day and night) and a time in range of 89%!! In addition, he has had no hypoglycemia.
Pumps vs. MDI
What is amazing about this patient is that he’s not on a hybrid closed-loop system consisting of an insulin pump that communicates with a CGM with automatic insulin delivery. Instead, he’s injecting himself multiple times throughout the day with fast-acting insulin and adjusting his dose based on his CGM values. He has extremely good diabetes control.
Not all people with diabetes need to have an insulin pump to have excellent control, which is the point of this case. He likes the flexibility of his regimen because he does a lot of water sports and likes being untethered from any type of pump. He’s doing quite well.
He has used HCL in the past, namely Tandem CIQ and looping, and he did have good control on those systems too, but he went on MDI a few years ago when he went to Hawaii on holiday, and he felt he had just as good control with the added bonus of freedom from a pump.
This just goes to show that you can be successful on different types of regimens, and you can always change things up to suit your needs.