[mtendler]

January 15, 2010 (Newswise) - A new evidence review suggests that using a pump to deliver insulin continuously — instead of taking three or more daily injections — might result in better control of blood sugar for people with type 1 diabetes.
“The findings of this review tell us that both continuous subcutaneous insulin infusion and multiple injections correct blood glucose levels. However, [continuous infusion] may be better for reducing harmful fluctuations in blood glucose,” said lead author Marie Misso, Ph.D.
Type 1 diabetes — which used to be known as juvenile diabetes — results when the pancreas is not able to secrete enough insulin, causing the levels of glucose (or sugar) in the blood to rise.
Chronically high blood glucose can lead to heart attacks, circulation problems and blindness. Low levels can lead to unconsciousness and even death. Type 1 diabetes is one of the most common chronic diseases of childhood.
Most people with the condition control their glucose by injecting themselves with insulin three or more times per day. Others choose to use a pump, which gives continual, smaller doses of insulin without the discomfort of injections.
“There are numerous studies that evaluate these treatments, but most are of poor quality,” said Misso, a research fellow at the Monash Institute of Health Services Research in Clayton, Australia. “So there has been uncertainty about which treatment is best for maintaining consistent levels of blood glucose and reducing harmful fluctuations.”
In the new review, Misso and colleagues analyzed the results of 23 studies that assigned 976 adults and children to one of the two interventions randomly. Researchers looked at measures such as levels of hemoglobin A1c (or HbA1c), a widely used marker for assessing long-term glucose control. They also looked at the incidence of both high and low blood glucose.
The review appears in the latest issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
While participants using the insulin pump had significantly lower HbA1c levels than those using multiple daily injections, no differences existed between the two for non-severe low blood glucose levels. However, there appeared to be a reduction in severe incidents of low blood glucose among those using the pump.
“Good evidence is now available to support the use of continuous subcutaneous insulin infusion in the appropriate patient. It is essential to consider adverse events, late complications of diabetes, mortality and cost when deciding whether [a pump] is appropriate for the patient,” Misso said.
For people who likely have to deal with their condition for the rest of their lives, convenience is another consideration that comes into play.
The advantages of using the insulin pump include being able to avoid possibly painful injections several times a day. In addition, pumps administer the medication without the user having to find a private place to give the injection.
The downside to pump use includes having to wear it like a pager or cell phone throughout the day, concerns about protecting the tubing that goes into the body –– although wireless pumps have recently come on the market –– and worries about breaking the pump during rough play or exposure to water.
Ramin Alemzadeh, M.D., director of the Diabetes Program at the Children’s Hospital of Wisconsin in Milwaukee, cautioned that although the researchers reported pumps might improve glucose control overall, pediatric patients should not expect major changes in the longer-term control of blood glucose.
“In our experience, we don’t see a significant overall blood glucose improvement beyond six months or one year of treatment in most children and adolescents. Initially, the patient’s HbA1c levels improve, but after a while levels begin to rise and are not significantly different from where they started,” Alemzadeh said. “A patient’s diabetes management starts with them and their family. How well they do is independent of which method of insulin administration they use.”
The review discloses that one of the co-authors has received compensation for lectures and advisory board participation from companies who make insulin or insulin pumps. His department has also received funding for research and educational activities from these companies.

[stu2010]

I've been on a pump for just over a year and seen my hba1c reduce from 13 to just above 5. Yes you have to wear it all the time however the benefits out wiegh the cons so to speak.

[minto2k]

Stu,

I have managed to get my HbA1c down to 6.9, and have been just changed my long term insulin to help reduce this further. The hospital suggested that I consider the pump.

I would definately be interested, but have concerns that it may not be for my lifestyle. I play football 3 times a week and run a couple of days a week also. Have you any links that would give me a better visual insight into life with the pump? Otherwise I would love to hear how you got the pump (I assume on the NHS). I am in the UK also and was wondering what I needed to do to get a pump?

Was there a number of pump choices or just the one? Do you do much sport with yours???

Sorry for the million questions...

[nvlady]

Im a type 1 diabetic, and have been for about 16 to 17 years. When i was diagnosed, i was on injections. I was on a 70/30 insulin, which did not work well on me. In june of 2003, I got the insulin pump. Yes I had a lot of choies, but one pump could be pay for by the insurance company. I absolulely love my pump. I hope that this has made a inpression on this topic. Make sure u are happy with your choice, and that you understand how to use it.

[notafraid1021]

Well, in my opinion I dont like my pump. I got mine in 2007 and my A1c has stayed the same for years......some people might say its awesome but im not a fan
_________
~Pj

[timmyr]

Hi all,

I started pumping just over a year ago, my HBA1C's have always been good however I found that I tended to hypo quite a lot with daily injections due to my tight control.

I'm a very active guy, weight training, swimming every week, some Running and a skier during the winter...my biggest fear was how I could adapt the pump to my active lifestyle.

To anybody with similar concerns all that I can say is make the change!

Seriously, the pump is just so much more convenient and effective for controlling your diabetes. The fact that you can make instant adjustments to basal/ bolus rates, set different dosage patterns depending on your daily activity and even adjust insulin delivery for those food types that play havoc with sugars (pizza anyone?)!

I quickly adjusted to wearing it, have two little boys who regularly jump all over me and have no issues, it a robust little thing and just tucks into my trouser pocket. No injections anyone, just a simple change out every 3 days, when showering it just clips off and during full on exercise such as swimming, running or football I don't wear it as blood sugars are naturally brought down over these periods.

I hope this goes some way to helping anybody who might be doubting the benefits of a pump or their ability to wear one with an active lifestyle.

Tim

[luckiepony04]

I was on the pump for years and while it worked for the first two it was horrible the last three. It got to the point that it would not deliver insulin to me at all. It was more stressful than anything. Be sure your ready for this complete lifestyle change. Be aware that the injection site can "come out at anytime" and at the most inconvenient, like at work or on a plane. While it has several advantages, I feel it has to many disadvantages and much rather shots. Good luck to you and your choice.

[dleiser]

I have had it for two years and am pretty sedentary type of guy. Some aspects i have not seen mentioned:
One great advantage compared to injections is that as I do not have to inject 5-6 times a day I find myself checking bg more often. How many times a day can one puncture one's skin?
Another neat aspect. If you do have a hypo you can stop the pump. Try that with an injection!

[tillzdabomb]

My 14 year old son has been wearing a pump for 6 months. He plays ice hockey and lacrosse and the pump was the best move for him. Takes a little getting used to where sports are concerned but well worth it. Don't let sports hold you back from regaining a little bit of freedom that the pump allows. As long as your physician is willing to work with you on the sports schedule you will benefit.

[juliettepol]

I have used the insulin pump for about 7 years and my blood glucose levels have been completely stable. Therefor your theory is denied. Lol im12