Every Way I've Delivered Insulin in 43 Years: Pens, Pumps, and the Honest Tradeoffs

Forty-three years, six delivery methods, one disease

When I was diagnosed in 1983, my “insulin delivery system” was a glass syringe, a steel needle thick enough to catch a blood vessel, and a vial of beef-pork insulin that you had to draw up by hand and hope you got right. I am not kidding about the glass syringe. I’m old enough that the earliest insulin I ever took was literally extracted from animal pancreas at a manufacturing plant in Indianapolis.

Forty-three years later, I’m writing this with a hybrid closed-loop pump on my hip, a continuous glucose monitor on my arm, and an algorithm running in the background that makes tiny adjustments to my basal rate every five minutes without me even noticing. Every insulin delivery method ever commercialized for Type 1 Diabetes, I have lived with. Some for a decade at a time.

The diaTribe Foundation’s guide is a solid overview of the current categories. What I want to add — from inside the disease, and from four decades of actually wearing these things — is the honest version. The tradeoffs that the sales rep and the starter kit video always seem to skip.

The four categories that matter in 2026

Stripped of marketing, there are four real ways to get insulin into your body today:

1. Syringes and vials — the original, and still the most reliable fallback
2. Insulin pens (MDI) — pre-measured, portable, and the quiet workhorse of global T1D care
3. Tubed insulin pumps — continuous subcutaneous infusion, with or without automation
4. Patch pumps and AID — tubeless delivery and algorithm-driven automation

There’s a fifth if you count smart pens as their own category, which I’ll get to. Let me walk through each, with the lived-experience side that the guides almost never give you.

1. Syringes and vials — the method you should never forget how to use

I took my first injection in 1983 with a glass syringe my mom sterilized on the stove. We moved to disposable plastic syringes a year or two later, and that is the setup I used for the first seven years of my life with T1D.

What the guides are right about: it’s the cheapest option, it’s the most portable if you don’t mind carrying a supply kit, and it puts insulin in your body as directly as anything else. Nothing can fail. There is no battery, no tubing, no algorithm, no Bluetooth pairing. You draw up a dose and you push it in.

What the guides don’t tell you: you should never stop knowing how to do this. I don’t care how fancy your pump is. The day your pump fails in an airport, your OmniPod gets kicked in a parking lot, your infusion set occludes at 3 a.m., or a hurricane takes the power out for four days — the ability to measure insulin units out of a vial with a U-100 syringe is the backstop that keeps you out of the ER. I’ve taught every newly diagnosed friend I’ve ever had to keep a vial of long-acting insulin and a handful of syringes in a drawer, even if they never plan to inject again.

The technology people will tell you this is paranoid. The forty-three year people will tell you it’s primary care.

2. Insulin pens — the quietly dominant method

For about ten years in the 1990s I used insulin pens, and for the overwhelming majority of the global T1D population today, insulin pens are still the dominant delivery method. Not pumps. Not AID systems. Pens. The pump and AID conversation tends to dominate English-language diabetes media, but globally, pens are the workhorse — and for good reason.

You get:

• A pre-measured cartridge that won’t let you draw up the wrong concentration
• A click-per-unit dial that turns dose titration into muscle memory
• No infusion sets to change, no sites to rotate (well, fewer)
• A delivery method that is almost foolproof

Smart pens like Medtronic’s InPen and the Mallya smart cap are the 2020s upgrade: same pen form factor, but now the dose and the timestamp get logged over Bluetooth to an app. That’s a genuinely meaningful change for anyone who used to scribble doses on the back of a receipt in a restaurant and then forget whether they bolused for the bread. I wish I’d had one in 1995.

The honest tradeoff: pens do not replicate basal insulin the way a pump does. On multiple daily injections (MDI), your basal is whatever long-acting insulin you injected at bedtime or in the morning — a single curve that does not care what your day actually looks like. For some people that’s perfectly workable for a lifetime. For others, like me in my twenties when my schedule was chaos, the rigidity started to cost too much in the form of chronic highs and 2 a.m. corrections. That’s when I moved to a pump.

3. Tubed insulin pumps — when the basal profile starts to matter

My first pump was a Minimed 508 in the early 2000s. It had two buttons, a monochrome LCD, and a 1.8 mL reservoir. It was also the single biggest quality-of-life improvement I had experienced with T1D up to that point.

A tubed pump like the Tandem t:slim X2 or the Medtronic MiniMed series gives you something that MDI fundamentally cannot: a basal profile that can change by the hour, on its own, forever. Low at 2 a.m., higher at 5 a.m. to catch the dawn phenomenon, a quiet bump in the afternoon for stress, whatever your body actually does. The algorithm doesn’t have to think — the curve is just there, running in the background, while you live your life.

The honest tradeoffs I wish someone had told me:

• You become a person who has a medical device physically attached to their body, 24/7. This is a bigger mental adjustment than the sales materials admit.
• Infusion sets occlude. Not often, but occasionally — and when they do, you’ll usually find out because your CGM is climbing and you don’t know why.
• Tubed pumps are the opposite of discreet. They clip to waistbands and pull out of pockets and get caught on door handles. You will lose at least one to a doorway in the first year.
• You still need to know how to inject manually. The pump can fail, and when it does, you have about 4–6 hours before your basal runs out and ketones show up on the horizon.

None of that stopped me from choosing a pump again, and again, and again. The basal profile advantage is that big.

4. Patch pumps and tubeless delivery — the OmniPod era

The first time I put on an OmniPod (late 2010s) and realized I could swim without disconnecting anything, it felt like the future had finally shown up. Patch pumps remove the tubing entirely — the reservoir, the cannula, and the pump mechanism all live in a small pod glued to your skin. You control it with a separate handheld (or now, your phone).

What the OmniPod got right: the mental weight of tubing is real and constant until it’s gone. Once it’s gone, you notice. Active people, kids, anyone who swims, anyone who doesn’t want to think about a clip or a belt — the tubeless format is genuinely liberating.

The honest tradeoffs:

• Every pod is disposable. Every three days you throw out a plastic-and-electronics module. That’s an environmental cost that the industry is not honest about.
• You cannot detach the device. If you don’t want insulin delivery for an hour — a deep-tissue massage, a particular type of physical activity, a pod on a spot that’s suddenly bothering you — your only option is to pull the whole pod and waste it.
• Site failure with a patch pump is harder to troubleshoot than with a tubed pump, because you can’t isolate the cannula from the reservoir.

Even with all that, I’ve been a repeated OmniPod user. For my life in my forties — more active, more travel, more swimming — the tubeless format was worth the compromises.

5. Automated insulin delivery (AID) — the quiet revolution

For the last several years I have used Tandem Control-IQ and, more recently, the MiniMed 780G. Both are hybrid closed-loop systems — meaning a CGM streams glucose data to the pump, and an algorithm adjusts your basal (and in 780G’s case, delivers correction boluses) automatically. You still bolus for meals yourself. The machine handles the in-between.

I want to be very specific about what AID changed for me:

Before AID: I woke up at 3 a.m. several nights a week to correct a rising glucose. I had a handful of serious hypos per month, usually overnight. My time-in-range hovered in the low 60s% if I was disciplined, high 50s% if I wasn’t.

After AID: My time-in-range is routinely above 80%. I almost never correct overnight. My A1C dropped almost a full percentage point without any change in my diet or exercise. The number of 3 a.m. wake-ups is measured in months, not weeks.

This is not a sales pitch. It is a description of what a lifetime of T1D looks like before and after an algorithm is allowed to run in the background while you sleep.

The honest tradeoffs:

• You still have to announce meals to the pump. “Closed loop” does not mean “no carb counting.” That is still the part of T1D that breaks newcomers, and AID does not fix it.
• The algorithm can be conservative in ways that feel frustrating. If you want to hit a 4.5 mmol/L time-in-range target because you’re running marathons, most commercial AID will refuse to let you. This is a safety decision, not a bug.
• You are now running a very expensive, very complicated, very connected piece of medical infrastructure on your body every day. When it works, it is miraculous. When it doesn’t, you have to diagnose it while also running your life.

A quick comparison — updated for 2026

Method	Cost	Basal flexibility	Automation	Best for
Syringes + vials	Lowest	None	None	Backup kit, cost-constrained, travel fallback
Insulin pens (MDI)	Low	Fixed (long-acting)	None	Stable schedules, pen-preferring users, global majority
Smart pens	Low–mid	Fixed	Dose logging only	MDI users who want digital tracking
Tubed pump (non-AID)	High	Hour-by-hour	None	Variable basal needs, precision dosing
Tubed pump + AID	High	Algorithm-driven	Yes	Time-in-range focus, overnight stability
Tubeless pump / Patch AID	High	Hour-by-hour / algorithm	Varies	Active lifestyles, swimmers, kids, travel

I want to emphasize one thing: the best delivery method is the one you will actually stick with. I have watched newly diagnosed friends choose the most expensive, most automated option available — and then quietly revert to pens six months later because the device fatigue got to them. I have also watched pen users move to AID and never look back. Both paths are legitimate. Neither path is “giving up.”

What I’d tell a newly diagnosed T1D today

Since you’re here, and since I have four decades of being wrong about this in a thousand small ways, here’s what I would actually say if you were across the table from me:

1. Start with pens and a CGM. The learning curve is already brutal. Don’t add pump training to your first six months.
2. Keep a syringe-and-vial kit in your house forever. Even after you move to a pump. Even if you never use it.
3. Don’t let anyone — doctor, rep, Instagram — shame you into a device you’re not ready for. T1D is yours. You will use it longer than your care team will treat you.
4. When you do move to a pump, give it a full year before you judge it. The first two months are always the worst month.
5. AID is not cheating. It is the first piece of technology in all my years with T1D that genuinely gives me back cognitive load, and I don’t owe anyone a gritty-determined version of my disease.

The tools will keep getting better. The decisions — what to wear, when to eat, whether to run, whether to sleep — will still be yours. Choose the delivery method that lets you spend the least possible conscious time on the mechanics, and the most on the life.

That’s the whole point.

— John Chitta

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This article is written from four decades of lived experience since my 1983 diagnosis and builds on the diaTribe Foundation’s A Guide to Insulin Pumps, Pens, and Syringes. Device feature descriptions are updated to 2026 and reflect the author’s personal experience, not manufacturer marketing. Always consult your endocrinologist before changing insulin delivery methods.

References

1. A Guide to Insulin Pumps, Pens, and Syringes · diaTribe Foundation
2. Standards of Care in Diabetes — 2025: Diabetes Technology · American Diabetes Association
3. Insulin Delivery Devices — overview · NIDDK / National Institutes of Health
4. Automated Insulin Delivery Systems — JDRF · JDRF
5. FDA Approved Insulin Pumps and AID Systems · U.S. Food and Drug Administration