Insulin Pump for Type 1 and Type 2 Diabetes

When are insulin pumps appropriate for treating diabetes?

An insulin pump, also known as continuous insulin infusion therapy, can be exactly what insulin-dependent, type 1 diabetics need to keep blood sugar levels under good control. And even some non-insulin dependent, type 2 diabetics also benefit from insulin pump therapy.

When insulin pumps are appropriate for treating diabetes

Insulin pumps overcome the biggest limitation of treating diabetes by insulin injections. An insulin injection provides a relatively large amount of insulin at a single time. An insulin pump provides a steady stream of insulin to keep blood sugar levels under constant control.

An insulin pump comes closer to the function of the pancreas in providing a steady stream of insulin needed to keep blood sugars under 24-hour control. Diabetics who overindulge in carbohydrates, of course, still suffer spikes in their blood sugar levels that are only slowly brought down by the insulin pump, and if they go off their diets often enough, even type 1 diabetics can develop a phenomenon known as insulin resistance.

Insulin resistance, a problem for all diabetics

Insulin resistance is more commonly discussed as a cause of type 2 diabetes. When something makes blood sugar levels go too high, usually an infection or toxic exposure, at least at first, fat cells, muscle cells, and the liver turn off insulin receptors to protect themselves from a flood of incoming glucose. Were these cells to absorb a large amount of glucose at a single time, the resulting production of free radicals would damage their DNA.

A functioning pancreas, however, still tries to lower blood sugars, by producing even greater quantities of insulin. Cells become even more insulin resistant, and the pancreas produces even more insulin. Eventually the pancreas cannot produce enough insulin to lower blood sugars and type 2 diabetes results.

Before the onset of type 2 diabetes, however, insulin resistance has another unwanted effect: weight gain. Insulin transports not just glucose but also fatty acids out of the bloodstream. Cells that are non-responsive to insulin as a sugar transporter are very responsive to insulin as a fat transporter. Insulin resistance, however, causes weight gain, not the other way around. Or as some commentators are finally beginning to admit, fat is not the type 2 diabetic's fault.

Type 1 and type 2 diabetes at the same time

Type 1 and type 2 diabetes at the same time

Type 1 diabetics can also become insulin-resistant. In type 1, insulin-dependent diabetes, the pancreas does not produce enough insulin, but cells still protect themselves from a flood of blood sugar when blood sugar levels go above about 170 mg/dl (approximately 9.0 mM, if you use the European system). This means the type 1 diabetic has to inject more and more insulin to get the same effect--and this is why type 1 diabetics need to be very careful to monitor blood sugar levels when they use insulin pumps.

The user of an insulin pump can "dial up" the insulin dosage when blood sugar levels are running too high, but the diabetic won't know to do that without taking blood sugar readings. Using an insulin pump "on automatic" is a sure way to lose control over blood sugar levels, and the major reason some diabetics have to have their pumps removed.

Are you a good candidate for an insulin pump?

The big advantage of insulin over absolutely every other diabetes medication is that it always lowers blood sugar levels. The timing and dosage of insulin have to be worked out, but absolutely every diabetic responds to insulin with lower blood sugar levels--assuming of course, they eat the same foods, their digestive tracts process the food at the same right, they have the same level of physical activity, they are not experiencing infection or inflammation, and are taking the same dosages of other medications that are being metabolized at the same rate in the liver because they are not being exposed to liver-toxic substances from food or the environment.

And that's the basic problem with insulin pumps. Insulin pumps deliver the same dosage of insulin all the time. The body does not necessarily need the same dosage of insulin all the time. And if you are a type 2 diabetic cutting calories to lose weight, you'll need to turn down your insulin pump to keep from experiencing the low blood sugar levels that can cause you to (1) pass out or (2) experience uncontrollable appetite. Unless it is used smartly, an insulin pump can make improving your basic health quite difficult.

Key considerations to benefit from continuous insulin infusion therapy

So how can you know for sure you would benefit from continuous insulin infusion therapy? Here are the key considerations:

• You test your blood sugars regularly and know how to lower high sugars and raise low sugars.
• You have had a problem with low blood sugars shortly after eating (taking too much insulin before a meal) and you want to avoid hypoglycemia.
• You aren't especially prone to bacterial infections, and you don't have a problem taking appropriate precautions when you shower, bathe, or go to the beach. (The pump can be disconnected for sports and sex, but only for short periods of time.)
• You are very familiar with the way your body responds to extra insulin, allowing you to use the pump to release a bolus (relatively large amount) of insulin when you eat more than usual.

Insulin pump users don't have to worry about running out of insulin on a trip (assuming they change insulin cartridges ahead of time), and they don't have to worry about giving themselves injections in public places, such as dirty restrooms. On the other hand, some diabetics should avoid using a pump:

• Infections at the insertion site can be very nasty if they are not treated promptly. If you can't see your skin, and you don't have a partner who can tell you when you have an infection, you may be better off not using the pump.
• Since the pump uses only fast-acting insulin (which wears off in four to six hours), you can run into serious problems if the pump fails during the middle of the night. If tend to sleep through diabetic disturbances, you may be better off not using the pump.
• If you tend to drop or break things, you should not rely on a pump for your insulin. Sometimes the electronics of the pump continues to work even after the canula that delivers insulin is broken.

And if you are used to managing your diabetes with Lantus alone, you probably don't want to switch to a pump, either. Lantus insulin is slow acting, giving you plenty of time to correct mistakes. The fast-acting insulin used in pumps requires frequent monitoring of blood sugar levels, certainly before going to bed, upon rising in the morning, and before and after exercise.

Fitting a diabetic with an insulin pump usually costs several thousand American dollars, and you will probably only save about US $20 a month on diabetes supplies. If you just don't want to give yourself injections, however, the insulin pump can be a viable way to keep your blood sugar levels under good control.