Diabetes Self-Management Articles

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Insulin Pumps
Not Just for Type 1

by Jan Chait

Too many calculations, you say? Many of today’s insulin pumps will figure out bolus doses automatically based on the user’s blood glucose reading and the amount of carbohydrate he plans on consuming. To do this, the pump must be programmed with a user’s insulin sensitivity factor and insulin-to-carbohydrate ratios, and the user must still count the grams of carbohydrate in his meal himself or at least enter the foods and portion sizes into a device programmed to count the carbohydrates. Some pump companies have “married” their pump with a blood glucose meter, eliminating the need to manually enter blood glucose readings. The meter transmits readings directly to the pump via infrared or radio waves.

The pump’s insulin comes from a cartridge that is refillable with insulin from the same vials that syringe users buy. The pump is connected by flexible tubing to an infusion set (the OmniPod is attached directly to the skin) — an external plastic “hub” that is taped to the skin and a catheter that is inserted into subcutaneous tissue in any body region that is suitable for an injection of insulin (that is, the abdomen, upper arm, thighs, or buttocks). Infusion sets come in a variety of styles, with one main difference being the angle at which the catheter is inserted: Some are inserted at a 90° angle, and others at a shallower angle. It’s generally recommended that users change their infusion set every two or three days to reduce the risk of an infection. For most sets, the tubing disconnects from the hub, allowing people to go pumpless when bathing, swimming, or during intimate moments.

Pump benefits for Type 2 diabetes
Increased flexibility in scheduling daily activities such as meals, exercise, and social activities may be the main reason for you to consider using an insulin pump if you have Type 2 diabetes. There is also the potential for tighter blood glucose control and a reduced risk of diabetes complications.

Diabetes complication risk. According to the United Kingdom Prospective Diabetes Study (UKPDS), tight control of blood glucose in people with Type 2 diabetes helps to delay or prevent the development of microvascular complications such as retinopathy (eye disease), nephropathy (kidney disease), and neuropathy (nerve damage). Simply using an insulin pump is no guarantee of tight blood glucose control, of course, but studies have shown that pumps can help people to achieve control that is at least comparable to (and possibly better than) that of people on insulin injection regimens.

In addition to the benefits of tight blood glucose control, the UKPDS showed that tight blood pressure control can reduce risks of cardiovascular diseases for people with diabetes. Although high blood pressure is more of a proven contributor to heart disease and stroke than high blood glucose levels, getting better control of your blood glucose may help to reduce at least one risk factor for cardiovascular disease.

According to Philadelphia cardiologist Robert Bulgarelli, DO, people with Type 2 diabetes are assumed to have cardiovascular disease unless proven otherwise. “When your blood sugar remains high over a period of time, your lipid particle sizes and characteristics change,” he says. High blood glucose results in small, dense, LDL (“bad”) cholesterol particles that more readily contribute to the plaques at the root of heart disease. What you want, he says, is large, fluffy LDL. The National Cholesterol Education Program recommends that people with diabetes achieve LDL levels below 100 mg/dl and that people at very high risk for cardiovascular disease (such as people with diabetes who also have very high triglycerides, another blood fat) strive for LDL levels below 70 mg/dl. HDL (“good”) cholesterol loses its protective quality when blood glucose remains high. The American Diabetes Association recommends that women with diabetes achieve HDL levels higher than 50 mg/dl and men achieve HDL levels higher than 40 mg/dl. Triglyceride levels should be less than 150 mg/dl. Because tight control can be easier for some to achieve on an insulin pump, Dr. Bulgarelli is a great advocate of pumping.

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