In October 1998, 16% of CWD readers reported using an insulin pump. Sixteen years later, in September 2016, that number was 74%. Study after study report on the benefits of pump therapy, including a reduced risk of hypoglycemia compared with a regimen of Regular and NPH and better control as evidenced by HbA1c levels. Control is comparable when comparing pump use to a regimen of multiple daily injections of Lantus and NovoLog or Humalog18, but still people choose pump therapy. Why is that?
First and foremost, pump therapy provides an enormous amount of freedom. You have essentially normal schedule freedom. You can eat when you want, not when some long-acting dose of insulin is peaking. (Lantus users experience the same freedom from the long-acting peaks of NPH.) You also have the freedom to eat more often, and in smaller amounts, than you would if you have to take an injection for each and every morsel that you ate. While MDI users could do the same, it could means an enormous number of injections per day. Pump users simply program their pump to deliver an insulin bolus whenever they eat. This has profound implications for quality of life*.
You also have the freedom from injections. Pump users replace their infusion set on average every three days (poll from February 2016), compared with someone who would need to take more than a dozen injections during that same period if on MDI with Lantus or Levemir.
The precision with which pumps can deliver small amounts of insulin cannot be matched by syringes or pens. This gives pump users the ability to cover smaller amounts of food more precisely, and to take tiny extra amounts of insulin to bring down blood sugars that are higher than desired. This flexibility cannot be matched by syringes or pens due to the limits of their dosing accuracy.
Pump users also always have their insulin with them. There’s no “I forgot my insulin” moments when you’re out or at school.
Pump use isn’t for everyone. Some people don’t like the idea of wearing a medical device all the time. Some people would prefer not to spend the extra money on the pump when the same level of glucose control can be achieved with MDI using Lantus (though the schedule and eating freedom is not the same). But for many people, an insulin pump represents the best that medicine and science has to offer today.
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- Continuous subcutaneous insulin infusion leads to immediate, stable and long-term changes in metabolic control.
- In Type 1 diabetic patients with good glycaemic control, blood glucose variability is lower during continuous subcutaneous insulin infusion than during multiple daily injections with insulin glargine.
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- Continuous subcutaneous insulin infusion therapy: effects on quality of life. Free full text available in PDF format.
- Continuous subcutaneous insulin infusion attenuated glycemic instability in preschool children with type 1 diabetes mellitus. The influence of long-term therapy with the insulin pump (CSII) in patients with type 1 diabetes mellitus on metabolic compensation and on the incidence of hypoglycaemia. Comparison with intensified conventional insulin therapy (MDI).
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- A Randomized, Controlled Study of Insulin Pump Therapy in Diabetic Toddlers
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- Less severe hypoglycaemia, better metabolic control, and improved quality of life in Type 1 diabetes mellitus with continuous subcutaneous insulin infusion (CSII) therapy; an observational study of 100 consecutive patients followed for a mean of 2 years [Diabet Med. 2002 Sep;19(9):746-51].
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