Ready for the serious answer? They are BAD ASS!!
I've been a type one since I was 16. I avoided a pump for 20 years because my first doc told me, "One day maybe you can get a pump put in you." There was no way I was gonna let anyone surgically put anything inside me. I was afraid I would break it.
Anyway, I've always had very good control, but a few years back, it got really hard...It was making me crazy. Lows were sneaking up on me and taking me forever to recover from. I ended up getting a high A1C result at a Dr. visit because I was having a lot of problems with control.
She recommended a pump and sent me to a Diabetes Education place that specializes in them. I have been using a Medtronic pump since then and couldn't be happier (Well, If I wasn't a diabetic, I'd be happier, but whatever...). Control is way better and much easier. In my job, highs and lows can be very bad things. I have ridden my bike all over the country with it. Ride the dirt bike too. Ride horses, shoot, work, run, you name it.
There is a small infusion catheter that I put into my stomach and move every 4-5 days. NOTHING is permanently implanted. The infusion sets can be ordered with different length tubes, and currently, I use the longer tube, just to clear my vest and have enough to not pull on it. At work, I keep my pump inside my vest. Another guy I work with has his on his belt. Some of us are running the tube down their leg and attaching it to their boot. I use that boot option when I go to the range.
I sleep with the pump connected, and really only take it off for showers and swimming. Medtronic says it is water resistant, but everything is sealed with O-rings, and it seems waterproof, but I donno that I wanna test that out too much.
The pump is good for control and really good for me due to the way it delivers insulin. When I was doing injections, I was using Lantis for the 24 hour baseline control (Basal rate) and Humolog for fast acting needs, like when I eat (Bolus control). The bitch was, if I took Lantis expecting to eat a certian amount over the next 24 hours and something prevented me from eating, I would slowly sink into these lows that were awful.
With the pump, it injects a certain amount of insulin per hour...Like 1.5 units per hour from 0800-1200. It is Humolog or Novolog only. I have different rates for different times of the day...Afer some trial and error, you will get yours straight for you. The pump works on this standard, and the only thing I have to do is adjust for carb intake. So, I stick my finger and my tester tells my pump my BG level. Then I tell the pump how many carbs I'm eating and the pump does all the math and adjusts enough insulin to maintain my BGL from 80-120. If I don't eat, it doesn't matter because the basal rate does not take my eating into consideration...The Bolus rate only comes into effect when I tell it to.
Here's the cool thing, as the pump is not always perfect: If I test and am a little low, but gettin ready to eat, the pump will give less insulin. If I am high, the pump will give more insulin. If I test and am not eating, but am high, the pump will, at my direction, give what it is programed to give to bring my BGL down. If I'm doing something that I know will bring my BGL down, I can decrease the basal rate by percentages to reduce lows.
The pump has not decreased my need to stick my finger...I do it 5 times a day, most days. However, that leads to good control, and ensures that my pump is in line with my metabolism and activity level. I can get a sensor that goes on the opposite side of my body that will talk to the pump about glucose levels, but for now, those sensors work off of intercostal fluid and are; therefore, about 20 minutes behind...They also don't negate the need for the finger pricks, so I'm not gonna waste my time and money until the sensors are better...It is an option that may work for you though.
So...To answer your question, there are almost no disadvantages...A little planning about where I may put an infusion catheter, or getting creative about attaching the pump to my pants or belt so I don't lose it during a ride. A very small price to pay for the increased control and ease of use. It is like wearing a pager...Almost no one knows I even have it. 90% of the people on this Forum I ride with don't know I have it...Until now.
The other disadvantage can be cost, depending on your insurance...When I got mine, my insurance covered 100% of "durable medical equipment" which is what the pump is considered. These bad boys are about $4k. I get 90 days of infusion sets and test strips at a time. With my previous insurance, the 90 day supplies were much more expensive.
We changed carriers, so my strips, insulin and infusion sets are much cheaper now...However, now only 50% of the cost of a new pump will be covered when this pump is done. FWIW, pumps are warrantied for 4 years. My pump's warranty is almost done...I have gone through 4 of them so far. When this one dies, I will have to spring around $2k for a new pump, but it will be a new model with new technology and worth every frigging dime.
Quite honestly, I'm a fool for waiting so long to go to a pump. If I had known earlier how cool it is, I would have done it years ago.