Insulin Pump Therapy
With increasing frequency, individuals with type 1 diabetes (and, to a lesser extent, type 2 diabetes) are being placed on insulin pump therapy (also called Continuous Subcutaneous Insulin Infusion or CSII for short). Unlike the usual form of intensified management which generally requires injections of insulin between 4 to 6 times per day and uses a combination of rapid or short-acting insulin as well as intermediate-acting insulin or long acting insulin, pump therapy uses only rapid-acting insulin and gives the insulin in tiny doses (called "basal insulin") around the clock. An insulin pump also allows you to give "boluses" (a few extra units of insulin) when you are about to eat.
There are hardly any scientific studies comparing intensified therapy (i.e.; multiple injections of insulin given with a needle) with pump therapy despite the fact that there are hundreds of thousands of pump users in the world. The few studies that are available have shown, at best, only modest improvement in blood glucose control with pump therapy. Regardless, the great majority of people with diabetes who go on pump therapy LOVE it and would NEVER go back to conventional injections. The most common comment I hear is: "It's so much more convenient." Note that I do not hear that it is less work (cuz it ain't less work; if anything it's more work).
One potential turn off about being on a pump is that you have to wear it, basically, around the clock (it is disconnected when showering, swimming and so forth but otherwise it is "always attached"). Sure, that sounds pretty unpleasant, BUT I must say that these words are seldom spoken by actual pump users; it's pretty well only people that haven't yet tried a pump who voice this concern.
So, if you are considering pump therapy I'd suggest you mull over the following (I'll mention only major points):
- Pumps have to be worn around the clock (with brief exceptions).
- Pumps are very expensive (count on $6,800.00 CDN) and about $300.00 per month for supplies - and that does not include the cost of insulin or blood glucose test strips).
- Pumps are not less work than conventional intensified therapy; they are more work.
And The Good:
- Despite the extra work involved, people almost always find pump therapy makes managing diabetes more convenient (easier to bolus for meals and - especially - snacks; much greater flexibility regarding meal timing & exercise, etc)
- Pumps help avoid inconsistencies in glucose control caused by erratic absorption of typical insulin injections (especially with NPH insulin).
- Some people experience less hypoglycemia; especially overnight hypoglycemia
I find that many people who advise me they would like to switch to pump therapy are checking their blood sugars two or three times per day and are not on an optimized, intensive insulin schedule and believe that changing to a pump will, in and of itself improve and stabilize their blood sugar readings. This is FALSE. Switching to a pump does NOT, just by virtue of being on a pump, make things better any more than driving a Porsche rather than a Hyundai makes you a better driver. Indeed, many (but most definitely not all) people with poor control can achieve excellent control WITHOUT a pump if they monitor their blood sugars four or more times per day and are given expert and ongoing instruction about intensified insulin management. Pumps are highly sophisticated computers. Pumps are also STUPID! They only do what they are programmed to do. They do not monitor your blood glucose levels and they do not figure out on their own how much insulin to give you. You have to tell them how much to give you.
The bottom line: If you are on intensified therapy and doing well with it and are happy (so to speak) with it, then there's no compelling reason to make a change. If, however, you are not doing well with intensified therapy or if the lifestyle of pump therapy appeals to you, then insulin pump therapy may well be a better option so long as you:
- Can obtain the funding to pay for the pump and supplies.
- Are highly motivated and up to the challenge of very frequent glucose monitoring, carbohydrate counting, and, crucially, frequent contact with the health care team.
At the risk of sounding corny, I must say that with every smiling face I see on a new pump user; with every "Oh doctor, I should have done this sooner" I hear, I become more and more convinced that pump therapy is the way of the future. Indeed, I am convinced of this.
Pumps can also be used with a glucose sensor. Glucose sensors measure the glucose level just under the skin surface (typically, of your abdomen) using a tiny probe that you insert and leave in place for a few days. The glucose level is then displayed on a pager-size device you wear (or, if you are using a certain type of pump, the result is displayed right on the pump) and, basically, gives you a continuous readout of where your glucose levels are at.
If you are a pump wearer and are looking for accessories (like pants with a hidden pocket to hold your pump), these can be very hard to find. Pump Wear Inc. has some interesting items to help. (I have no financial - or other - relationship with this company and mention this only as a 'for your information;' not as an endorsement).