JB,
You make a lot of good points. However, I'm wondering if you're aware that because the pump can give you a bolus in many different ways (all at once, spread out over a period of time, half at once and half spread out over a period of time) it does make it possible to safely eat foods that we never could have eaten on MDI. For me, that is the biggest advantage of the pump. Now I can eat ice cream and pizza, and still keep my numbers under control.

Of course - I can't eat ice cream and pizza all the time...I'd gain a ton of weight which would necessitate more and more insulin...plus it would change my basal needs as well. But it truly is nice to be able to eat those previously "forbidden" foods, at least on occasion.

The other BIG advantage of a pump is that one can fine-tune the basal insulin to one's daily needs. For example, I'm a lot less insulin-sensitive at night when I'm asleep, so I have a slightly higher basal rate for those hours. Oh, and did I mention you can give your basal rate in 100ths of a unit per hour! Also, for people who have different schedules during the week than on weekends, they can set up basal patterns to take that into consideration.

Of course, having come on to the pump straight from NPH and a sliding scale (boo-hiss!), the control I get with the pump is like the difference between night and day. Of course one can certainly get better control with MDI and today's insulins - levemir or lantus and rapid-acting - but you still can 't bolus in 10ths or hundreths of a unit, and you can't set patterns. Some people even have different insulin-to-carb ratios for different times of day, and with the pump, you just set it all up and then you don't have to do any math except counting carbs...the pump does the rest for you.

Of course, the pump IS very expensive, and if you don't have insurance that covers it, it would definitely be prohibitive for most people. Do I think people who aren't on the pump are behind the times? No, not at all. Not everyone needs or even wants all the latest bells and whistles, and I see absolutely no need to change something that works for you just because there's a new something out there.

Having said that, I'm really dreading turning 65 next year and going on Medicare, because I don't know if they'll pay for pump supplies. So, as much a fan of the pump as I am, I'm reading everything you MDI people are talking about because I may have to join you in a year or so. Yikes!

Ruth