One Person's Journey From Multiple Daily Injections To Automated Insulin
Key takeaways:
- While studies on automated insulin delivery have shown that it can improve diabetes management, the transition can be physically and emotionally challenging.
- Device glitches, lifestyle trade-offs, and steep learning curves are a few challenges people experience when starting AID.
- It may take time to see progress, but starting AID when you’re truly ready and having the right support can lessen the burden of diabetes management over time.
In recent years, automated insulin delivery (AID) systems have revolutionized diabetes care. Backed by a growing body of research, these systems, which combine continuous glucose monitoring (CGM), an insulin pump, and an algorithm running on the pump or another device such as a smartphone, have been shown to increase time in range, lower A1C, and reduce hypoglycemia.
As a result, the American Diabetes Association (ADA)'s 2025 Standards of Care now recommends AID as the preferred method of insulin delivery for people with type 1 diabetes.
However, the numbers don’t tell the whole story.
After two decades of managing type 1 diabetes with multiple daily injections (MDI), diaTribe staff member Derek Helm had it down to a science. But when it came time to try AID, all those years of experience suddenly felt like starting over.
While AID is recognized as a major advancement in diabetes care, the reality of adjusting to a completely new way of managing diabetes is complex. Like many others experiencing challenges with AID, Helm’s story is punctuated with frustrations and setbacks, cautious optimism, and a steep but rewarding learning curve.
Here’s how Helm navigated the transition from MDI to AID – and why the switch was worth it.
Before AID
After being diagnosed with type 1 diabetes at age 13, Helm’s earliest memories as a child involved strict carb limits, pricking his finger 10 times a day, and drawing insulin from vials. He learned early on that managing his blood sugar required constant vigilance, which was both physically demanding and socially isolating.
“It felt very alienating at first. I was the only person with diabetes at my school, and I got picked on – kids didn’t really understand why I’d get to have snacks when they didn’t,” Helm said.
Over time, he moved from vials to insulin pens and then eventually from pricking his finger to wearing a Dexcom CGM. At this point, his doctors began strongly encouraging Helm to try an insulin pump as the next step.
But his experience of wearing a tethered pump at a basketball game was a nightmare, which was one of the major reasons he held off using an AID system. The idea of wearing yet another device that could get ripped out during jiu jitsu or surfing (two of his passions), combined with years of confidence using MDI, made him hesitant to make the switch.
Over time, Helm’s perspective began to shift. Working at diaTribe exposed him to promising research on AID systems, and seeing his coworkers with diabetes have success with AID made him more open to trying technologies that could improve his long-term health. His recent diagnosis of diabetic retinopathy was also a wake-up call, he said.
This shift reflects the importance of starting AID when you’re truly ready for it. For Helm, that readiness came not just from the data and being urged by his healthcare providers, but from a change in his mindset driven by new health priorities, less stigma from his peers, and a willingness to trade comfort in his routines for long-term benefits.
Initial impressions after one month on AID
While AID is known for reducing the mental load of diabetes management long-term, the initial transition stage can actually feel more burdensome. The first two weeks were particularly challenging, Helm explained, as he had to think more about his diabetes than usual while getting used to wearing a pump 24/7.
One common assumption he had heard was that the pump wouldn’t affect his routine activities – but its physical presence was hard to ignore, especially during exercise. Occasional pump failures also add to the stress, and the conservative default settings (which protect against the immediate dangers from going low) can lead to frustration.
While some activities, such as jiu jitsu or other contact sports, do require extra preparation or specific precautions when wearing a pump, staying active with AID is both achievable and empowering, Helm said. To prevent the pump from getting ripped off during jiu jitsu, for example, Helm used a Simpatch, an adhesive patch that helps keep CGMs and insulin pumps in place. If the pump was on an arm or leg, he’d also add a compression sleeve over it to keep it secure. For surfing, he would switch the pump to manual mode since going low in the ocean can be dangerous.
Dr. Anne Peters, one of the world's leading diabetes experts and Helm’s endocrinologist, said it’s important for clinicians to manage expectations and allow their patients to make their own choices about transitioning to AID.
“Most of my patients really like AID because their glucose management is better with less burden, but not zero burden. I think that’s key – you can’t oversell it, and you have to stay realistic. AID works, but it has its limits,” Peters said.
While Helm mentioned that the emotional toll of unexpected failures can feel demoralizing at times, Peters emphasized the importance of not taking these difficulties personally.
“Learning to use an AID system can be incredibly challenging, and how well it works isn’t a reflection of skill or intelligence in the person using it,” Peters said. “It can be difficult for patients to see improvements right away. That’s where an outside observer, like a diabetes educator or healthcare practitioner, can help to provide objective feedback.”
Helm said that the key to overcoming these challenges is simply sticking with it. After the first two weeks, Derek met with a nurse practitioner to fine-tune the ratios and insulin sensitivity. This is when he started to feel the mental load begin to lift. His time in range, which was around 67% in the first two weeks, stayed consistent but with less input.
“When the pump works, it’s amazing,” Helm said. “It’s freeing to not be constantly thinking about diabetes, to wake up in range without effort, and to feel great after stable nights.”
He explained that although he had weeks where his time in range was 80% with MDI, getting there felt like a full-time job. Even with all of AID’s initial imperfections – like needing to adjust certain settings to dial in on the individual’s insulin needs – and the ongoing challenge of learning how to exercise with the device, he said the process is becoming more manageable and the mental burden is easing.
“It’s not perfect, but it’s meaningful progress – and that’s worth something,” he said.
The bottom line
As AID becomes easier to use and more common, it’s essential to recognize that the clinical benefits are only part of the story. Real life is messy, and diabetes management – even with advanced technologies – still requires patience, support, and compassion.
Learn more about AID and advanced diabetes technologies here: