Weight control. Better weight control is another potential benefit of using an insulin pump. Because the pump constantly delivers an adjustable stream of tiny amounts of insulin, the chances of developing hypoglycemia (and the resulting need to eat to raise low blood glucose) are reduced. There is also no need to eat to “feed” insulin peaks (such as those that occur when taking an intermediate-acting insulin such as NPH) even when one’s not hungry. The calories consumed to treat (and sometimes overtreat) or prevent low blood glucose add up, so the reduced risks of lows can help keep weight off.
Generally speaking, less insulin is used with a pump than with injections. In fact, trainers typically drop the total daily dose of insulin used by an individual by about 25% when he starts using a pump because the small amounts of insulin from a pump are absorbed more consistently than insulin from one or two large injections. Needing to use less insulin overall is also associated with better weight control. However, attention to diet remains important.
Flexibility. In a study published in the September 2003 issue of the professional journal Diabetes Care, people with Type 2 diabetes used either a pump or multiple daily injections for blood glucose control. Those using a pump reported greater satisfaction than those on multiple daily injections in all areas measured, citing less life interference, more general satisfaction, greater flexibility, and more convenience.
The flexibility offered by a pump goes beyond the obvious advantage of not having to carry around an insulin vial and syringes. Because basal insulin is being constantly delivered by the pump, users are not chained to eating or exercising at certain times to match any peaks in intermediate-acting insulin. Basal rates can be increased during times of stress or illness or decreased for some spur-of-the-moment exercise.
You don’t even have to eat at all on a pump. The first day I used a pump was a very busy — and tiring — day. When I got home, I was too tired to fix dinner, and I was not hungry. So I skipped dinner. I checked my blood glucose about every half an hour, in increasing wonder and fascination that I wasn’t going low — the inevitable result of skipping a meal when I was on multiple daily injections. My trainer was mildly horrified, and I will say that it is not recommended that you skip a meal on your first day pumping.
Getting a pump
Insulin pumps cannot be bought off the shelf; you need a physician’s letter to get one. However, many doctors are not familiar with insulin pumps, and even some who readily prescribe pumps to people with Type 1 diabetes may be reluctant to prescribe one for a person who has Type 2 diabetes. According to Rem Laan, former director of marketing for insulin pump maker Disetronic (since acquired by Roche), “Of the 25,000 doctors in the United States who prescribe insulin, only about 2,000 prescribe pumps.” Those who prescribe pumps are more likely to be endocrinologists, so you may need to see an endocrinologist to get one, and you may need to learn to be persuasive if the doctor you see does not already prescribe pumps for people with Type 2 diabetes.
The cost of a pump and pump supplies can also be an obstacle. A pump costs about $5,500, and supplies cost about $100 per month. A portion of the cost of both pump and supplies is generally covered by a person’s health insurance. My first pump was covered at 80% and the company let me make payments on the remainder. Only $2,500 of my second pump was covered, but the company gave me a discount and let me pay off the balance. Some insurance covers all of the cost of supplies, some only a percentage, and others may pay nothing. Medicare initially only offered coverage of pumps for people with Type 1 diabetes in 2000, but because of a change made in 2002, people with Type 2 diabetes with low or low-normal C-peptide levels also qualify. (Low C-peptide levels indicate reduced insulin production by the pancreas.)