Pens, Pumps, and Syringes. Even though they give the same insulin, they all seems to use different insulin:carb ratios. Let me explain.
I have been a diabetic for 23 years now. I was on a pump for about 14 years, before that I was on syringes for about 9 years, and for very brief periods here and there, I have used pens. Therefore, I have experience with every major method to administer insulin for T1Ds.
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PENS: Every time I have tried pens, I have been dumbfounded at how much insulin I have to give myself for such minuscule amounts of carbs. I have found that it is nearly impossible to eat even a moderate carb diet, and because of such a reduction in carbs, I find myself upping the protein to compensate. With a higher amount of protein and such low carbs, I find my blood sugar slowly and randomly rises throughout the day, and the fat and protein makes my BS more stubborn to get it down (takes more insulin and persistence). Pens are convenient, but they are not sensitive, you can usually only administer by whole units. At the same time, because pens do not seem to be nearly as effective, 1/2 units would probably be close to useless.
PUMPS: I love pumps. With pumps you are able to get a level of sensitivity and control that syringes and pens cannot offer. You can completely tailor your background insulin to fit your lifestyle. For example, if you have higher numbers between breakfast and lunch, you can bump up your insulin for that time period. Pumps let you know how much insulin you have on board, and it has the ability to calculate exactly how much insulin you need for meals and for a correction while subtracting a portion of insulin depending on how much insulin is already on board to prevent stacking. Pumps are GREAT! But, after years and years of being on a pump, you may build up scar tissue so your pump sites do not work as well. If your site doesn't work well, you will not be receiving insulin. That is where I am at right now which is why I am on a pump break. Mostly benefits for pumps, but pumps and pump supplies are extremely expensive if you don't have great insurance and there is always a worry of a bad site that doesn't allow insulin to get in effectively.
OmniPod Pump (tubeless)
Tandem Pump (T-Slim)
SYRINGES: Syringes are a little bit more painful, but they are the most reliable in my book because the leakage is very minimal and you can be more confident that the amount of insulin injected, is the amount of insulin effectively inside of you (as long as put into a place without scare tissue). Syringes are not sensitive, meaning you can only give yourself 1 and sometime 1/2 unit increments. They are also not convenient because you have to carry around syringes and a vial which has to remain cold. When I was on the pump and had a high blood sugar and was worried that I didn't have a great site, I would give myself a shot because I could count on the reliability of the syringe. The two top reasons syringes are not super effective is if they are removed too quickly once the insulin has been injected (leakage) or the insulin is old (you shouldn't keep insulin past 28 days once the seal has been broken). NOTE: The BD short needles have been found to be more effective and are much much more painless. I prefer #3 of the syringes depicted below (BD Ultra-Fine II Short Needle Syringe / Half-UnitsScale).
To put this information into perspective, today my blood sugar was about 95 mg/dL before I worked out. I did not eat anything, and I expected my number to increase a little bit d/t the anaerobic activity. My BS spiked to 152 mg/dL with a diagonal up arrow (yikes).
Below are what I would have done depending on the method used for administering short-acting insulin:
PEN: 2 units
PUMP: 0.6 units
SYRINGE: 1/2 unit
Pens are convenient, but they are much less effective for administering insulin compared to pumps or syringes. Therefore, do not worry or even think about your insulin ratio while using pens.
Pumps are convenient, sensitive, can caluclate your carb ratios and corrections, but they are expensive, you need to change your site every 3 days, and you always run the risk of a site going bad. When you have a bad site, you can't get insulin = high numbers.
Syringes are reliable, but a bit more painful and not convenient or sensitive (only in 1/2 and whole unit increments).
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If you are having trouble with your diabetes and/or weight loss, send me an email so we can figure out a customized game plan (firstname.lastname@example.org). I'm 100% here for you and understand all your frustrations as a T1D.
When we talk, I will look in detail at your nutrition, your macros, your exercise routine, and your Dexcom reports to give you reasoning behind your "random" blood sugar spikes, and together we will create goals to decrease your HbA1c, and help with your weight loss/body toning.
After talking, we will stay in touch, and you will have direct access to me for any questions. I will also be periodically checking your Dexcom to see how you are doing with all of our changes created in our 1:1 session. I deeply care about each and everyone of my clients.
If you just have a general question, send me an email and I will get back to you ASAP.
Ariel Warren, RD, CD, T1D