Diabetes Technology: Electronic pumps offer numerous advantages.

My daughter Allison has had type 1 diabetes since she was diagnosed at age 11.

That’s five years of finger pricks for blood-sugar testing and insulin injections, or some 9,125 pricks and 10,950 injections. But advances in insulin pump technology has helped reduce wear or tear on a diabetic’s body from all of the pricks and injections.

Type 1 diabetes is usually diagnosed in children and young adults when their bodies no longer produce insulin. Insulin enables glucose from food to be used by the body’s cells as fuel. Without insulin, the body would starve.

Once diagnosed, Type 1 diabetics must measure their blood-sugar levels several times a day and inject the correct amount of insulin, based on their food intake and physical activities. They must do this for the rest of their lives.

Blood sugar is measured by a small amount of blood taken from a pricked finger and absorbed through a test strip into a meter about the size of an iPod. The meter then computes the amount of insulin needed. The insulin is drawn up into a syringe and injected into the fatty part of the skin. Insulin is given at mealtimes and whenever the level is high, but both highs and lows are dangerous.

Diabetes is a life-altering condition that affects the whole family. It requires constant vigilance, especially given a child’s growth spurts and puberty. It can be especially tough on little kids, who may not understand why they’re being poked every few hours.

Since being diagnosed, Allison has had to prick her finger at least five times, and sometimes give herself up to six insulin injections every day. Scar tissue and calluses can form at the sites of the injections. This might prevent insulin from being fully absorbed. Tough skin from repeated finger pricks can lead to decreased sensation in the fingers.

When Arnold Kadish developed the first insulin pump in 1963 it was about the size of a marine’s backpack. Today, pumps are no bigger than a cell phone and can be adjusted with technology that is constantly updated.

An insulin pump mimics the body’s natural insulin secretions by delivering a tiny amount of insulin continuously (the basal rate), and also allows larger doses to be calculated and given at mealtimes (boluses). For unexpected food intake it’s now only a few keystrokes to receive insulin instead of getting another shot. This is because a pump is connected through a small needle or catheter inserted into the tissue under the skin. Thin tubing connects the site to the pump and reservoir, which holds the insulin.

Lightweight and discreet, the pump can be clipped onto a belt loop or kept in a pocket, and the tubing can be disconnected from the pump and removed for showering or swimming.

Currently, there are eight pumps on the U.S. market, all battery operated. Some run on rechargeable batteries that can be plugged in. All the pumps are computerized so insulin delivery is more accurate than what can be drawn up in a syringe. This means better blood glucose control and less potential for complications later in life.

Alarms and hard-stop features increase safety. They offer high and low limits to reduce human mathematical error. Ratios can be personalized to accommodate challenging circumstances or activity changes like soccer game days.

Pump systems can be suited to specific needs. Different models offer different features. Tandem’s t:slim G4’s pump has touch screens and is watertight, while

Medtronic’s OmniPod is wireless so there is no tubing, allowing freedom to get wet without disconnecting. The Animas MiniMed 530G has an integrated glucose sensor that gives continuous glucose readings every five minutes, almost eliminating the need for pricking fingers.

With one insertion these devices can deliver insulin for up to three days before needing to be replaced. For a child who averages five shots a day, a pump can make life simpler and easier on the body. Through the course of a year that means about 122 pump insertions as opposed to 1,825 injections.

Of course there are some downsides. The diabetic must have a record of good testing habits and results in order for the physician to calculate a pump’s rate. She must commit to following the rules, because interruptions to receiving insulin can be life threatening.

Pumps and pump supplies are expensive; pumps average $6,500, and supplies are about $1,500 a year and may not be covered by all insurances.

Susan Rioux, a diabetic educator at St. Joseph’s Hospital Health Center, says the No. 1 pump complication is infection at the site due to not changing the equipment when directed.

Insurance companies usually require the child to keep the unit chosen for at least three years, even if better models become available. There is always the potential for mechanical malfunctions; problems such as tubing kinks, blockages and dead batteries can result in dangerously high blood glucose levels.

Compared to injections, using an insulin pump is still work, but the rewards are better. Along with less pain, there is more flexibility and spontaneity. Usually, control is better, too. Allison can now enjoy a spontaneous ice cream cone like everyone else.

Type 1 Diabetes Symptoms

• Frequent urination

• Increased thirst or inability to
quench thirst

• Feeling very hungry despite eating

  Extreme fatigue, having no energy

  Weight loss even while eating more

• Blurry vision

• Cuts and bruises healing more slowly than they should

Contact your child’s doctor right away
if you have any concerns.

Source: American Diabetes Association

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