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Question:

From Palmdale, California, USA:

I have had diabetes for about eight years which has been in control for the last five years, but my doctor seems to be procrastinating about putting me on a pump. What should I do?

Answer:

You don't say how old you are. I presume you have type 1 diabetes. How well controlled are you?

You may get different opinions about this, but here are my general feelings about insulin pump therapy.

  1. If it's not broke, don't fix it. Meaning if your glycemic control is fine, your hemoglobin A1c is within the target set by you and your healthcare team, and you are satisfied with your lifestyle relative to meal planning and activities, then there is no medical reason to go on an insulin pump.
  2. The pump is just another way (albeit a very good way) of giving insulin. It is not an artificial pancreas. It will not automatically give you more insulin for a high glucose or automatically give you less insulin when your glucose is low. A pump is moreM work -- not less work for your diabetes management. You can get into DKA [diabetic ketoacidosis] quite quickly if your pump misbehaves or the insulin can't get through a kink in the tube, etc.
  3. You may be able to effect the changes in meal planning and lifestyle and flexibility that the pump provides by using an insulin regimen often referred to as "Multiple Daily Injections" (MDI). This means using dose(s) of very long lasting insulin such as Lantus (insulin glargine) or Ultralente for the "baseline" insulin, and then take additional shots of very short acting insulin (like Humalog or Novolog) or Regular, based on when and what you eat. With MDI, as with insulin pump therapy, you should be very good at carbohydrate counting,and be able to figure the math as to what your specified dosage(s) of insulin might be per gram of carbohydrate consumed. MDI is much less costly than a pump (the cost of a bottle of insulin, syringes,etc, vs. $5000 for a pump and ongoing costs for tubes, supplies, catheters, etc plus insulin).
A pump is an excellent way of giving insulin to maximize your diabetes into your life (rather than your life into diabetes), so if with the above caveats, you are ready and willing to work with a pump, and if your doctor does not have a medically or socially compelling reason to dismiss a pump, you may ask for a second opinion.

DS

[Editor's comment: See Is pumping for you?. SS]

DTQ-20011113152630
Original posting 24 Nov 2001
Posted to Insulin Pumps

  
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Last Updated: Tuesday April 06, 2010 15:09:28
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