If you are a Type 1 Diabetic chances are you have heard doctors, nurses, friends and family rave about how fantastic Insulin Pump Therapy would be for you. The brochures you picked up have happy smiling people in them. You’ve seen the DVDs extolling the benefits of wearing a pump. You have read all the statistics. Heard it is like a mechanical pancreas. Why wouldn’t you decide to do it? It is a no-brainer, right?
The truth is the decision to start using an insulin pump is not an easy one. And probably should not be an easy decision. There are many factors you must think about before making such an important decision. Deciding on insulin pump therapy is not like buying a watch. Where you buy the one you think looks the best and then just wear it and forget about it for the next several years. Many folks – friends, family and even Diabetics themselves – wrongly think of an insulin pump as a cure. Wear it and forget it. That is not the case. It is like car commercials. Big sales pitch to buy the biggest, coolest truck on the block. It will climb mountains, drive on sandy beaches, haul trailers and get through any snowstorm. What the ad does not tell you is that the big truck only gets 4 miles per gallon, is so big it will not fit in any parking space, and costs more than the mortgage on your house.
So what should Diabetics consider when thinking about Insulin Pump therapy? Here is some Diabetic Information to consider:
Advantages (with caveats)
1. Your A1C will be close to perfect all the time. It is true that many Diabetics who switch over to the pump do get good A1C’s even in the 5.0-range. However, there is a chance that your A1C results could worsen after going on the pump. A Diabetic that has wild high/low swings in their blood sugars on multiple daily injections could have an okay A1C in the high 6′s or low 7′s. But after going on the pump then see A1C’s jump as much as 0.5%. The reason is that A1C is an average measurement of how well you are doing over a 3-month period. If you have a lot of extreme lows, your average could fall in a good range. But pump therapy will even out your lows and highs, which is what you want, but could result in your average now being higher without all of the wild fluctuations to throw off the results.
2. Eat anything, when you want. This is true. There is great flexibility in what you eat and when you eat. You do not have to abide by a very strict regimen, for example, of eating dinner at 5pm every day. With no worry of long acting insulin peaking, you can easily adjust when you eat with a bolus of insulin. Just don not think you can eat everything in sight and just give boluses all day. The rules of a balanced Diabetes diet still apply.
3. You will never have to use insulin syringes again. While this is true for the most part, the fact is you will still need to occasionally inject insulin with a syringe. The general guideline is that if your blood sugar is extremely high (over 300) then you should take an injection of fast acting insulin to bring down your high glucose reading. The reason – your blood sugar may be high because of a blockage in the pump or even a bad battery. Despite this scenario, the need for multiple injections every day is eliminated with a pump.
4. Exercise whenever you want. No need to eat before exercising. Maybe. This benefit will be totally dependent on what your blood glucose is just prior to working out. If it’s in the low 100′s and you do strenuous exercise, you could find yourself with a severe low when you are done. A power bar prior to working out might avoid that. Taking the pump off during your workout may be best.
5. Set your basal rate, wear it and forget about it. Yes, you can program the pump to adjust to your busy life. But it is not exactly completely hands-free. There are a lot of adjustments that need to be made. Sometimes it requires weekly changes and sometimes even daily modifications. Health, illness, tension, anxiety, fears – are all factors that can change your insulin needs. This is no different from injections.
True Disadvantages to Consider
1. The tubing can become hooked on just about anything. Hooked on a doorknob you walked past. It gets stuck in your belt. It falls off your belt and tugs at your stomach as it swings in the wind. If you have very young kids they can tug on the tubing. It may get in the way of putting on a car seatbelt.
2. You will actually need to test your blood sugar more often. Since someone on an insulin pump is receiving a continuous stream of insulin, then you need to make sure you are not running low all the time. The only way to ensure the pump is properly calibrated is to analyze it against multiple glucose readings.
3. One of the biggest drawbacks is that there is a chance of infection. The pump delivers insulin via tubing attached to an infusion set that places the tip of the tubing underneath the skin for several days. Most manufacturers recommend only using the infusion site for two to three days. Leaving the insertion in longer than that could lead to infection at the insertion site. Some people are more sensitive than others and may find that leaving it in for only two to three days can cause an infection.
4. Using an insulin pump is expensive. Yes, you will no longer have to pay for lots of syringes. However, all of the tubing and reservoirs (the cylinder that holds the insulin) have to be changed out every three days. And these items are not cheap. A month’s supply, without insurance, can run several hundred dollars. And generally going on the pump will require purchasing more insulin than with syringes. A lot of insulin gets “wasted” priming the tubing and left at the bottom of the insulin bottle. So if a Diabetic injecting with syringes uses one bottle of insulin per month they may need to purchase two bottles per month to cover what gets wasted when they start pumping.
5. Finally if you are self-conscious about wearing a pump and being seen with it, then going to the beach or a public pool or even swimming at a friend’s house may be problematic and embarrassing. Of course you will hear that you should not get embarrassed. But if you do feel embarrassed there is no hiding it easily with a skimpy bathing suit. You can remove the pump for a period of time. But unless you completely remove the insertion device, it will still be very visible as this circular disc on your stomach.
The goal here is not to scare anyone off from using an insulin pump. As a tool for managing Diabetes it can be very beneficial. But it’s important to know exactly what you are getting in to before taking on the responsibility.
Shawn Dempsey is a IT professional and has lived with Type I Diabetes for over 40 years. For the past 6 years he has been using an insulin pump and just recently started using a Continuous Glucose Monitor. Being the IT geek that he is, Shawn has calculated in a spreadsheet that he has given himself over 28,000 injections over his lifetime prior to going on the pump.