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Question:

From Salisbury, North Carolina, USA:

My 46 year old husband has had type 1 diabetes for 22 years, is on intensive management, and is considering a pump. This is primarily due to severe, recurrent [mostly] nighttime hypoglycemic episodes. For the last two years, we've gotten up and checked blood sugars one to three times nightly, with fair results at best. His main fear is that since he is thin (165 pounds at 6 feet) and all muscle, the infusion tubes will hurt. He is very squeamish about it also. My concern is the use of Humalog with his severe gastroparesis.

Answer:

First, regarding the infusion devices which go into the subcutaneous tissue. These have evolved from the use of a metal needle into the use of plastic catheters which are much more comfortable to use. There are a variety of models available. There is no reason why you couldn't request your diabetes care provider to let your husband actually try the infusion systems before he gets the insulin pump to see which ones he feels comfortable with. (By the way, the infusion sets be changed out at least every three days.)

The use of pumps to combat recurrent severe hypoglycemia is definitely an indication to try pump therapy. The gastroparesis does raise a concern. In other words, you would have to have a strategy to prevent hypoglycemia around meals. This could include delaying the bolus till later in the meal or after the meal. The other possibility would be to use a square wave bolus function which alters the bolus delivery to be more gradual over a preset period of time (e.g. 6 units over 45 minutes) or some derivation of that.

JTL

DTQ-20010128130819
Original posting 2 Feb 2001
Posted to Insulin Pumps

  
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Last Updated: Tuesday April 06, 2010 15:09:18
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