Insulin pumps, those wearable devices that take over the work of the pancreas for many people with type 1 diabetes (and some with type 2 diabetes), have been around since the late 1970s. Small computerized pieces of technology, the pumps deliver insulin through a thin tube that goes under the skin.
A lot has changed since insulin pumps were first introduced. Today they’re equipped with an impressive array of technology. That makes it easier than ever to manage blood sugar levels for people with type 1. The new technology can be intimidating, especially for older adults. However, upgrading to a new insulin pump, even one paired wirelessly to a continuous glucose monitoring device, may be easier than it sounds.
“Insulin pumps can be beneficial for everyone,” Samantha Lange, CDE, told an audience at the American Diabetes Association (ADA). “Whether it’s the right treatment is another question.”
Technology such as insulin pumps, continuous glucose monitors and other devices can help insulin-users manage their medicine and their glucose levels. Studies show these devices improve glucose control, reduce hypoglycemia (low blood sugars) and even raise people’s quality of life, but many older patients may not benefit for several reasons.
Some older patients aren’t comfortable with technology in general.
“There’s a bias that older adults are less able to use technology,” Dr. Richard Pratley, Medical Director of the Florida Hospital Diabetes Institute told ADA. “There’s some truth to that assumption, but it’s changing as more people have been using tech in their working lives.”
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Northwestern University Hospital’s Grazia Aleppo, MD, pointed out other problems that older people have with diabetes devices. “Older adults with cognitive impairments, visual and hearing impairments, and dexterity problems face significant challenges in using diabetes technology. These devices will be new to them, and learning new skills or behaviors can be more difficult with age.”
These technologies have tremendous potential advantages, however. Karen Weissman, a certified diabetes educator (CDE) at California Pacific Medical Center in San Francisco, cites continuous glucose monitors with alarms, which are “great for people at risk of lows (and their partners or caregivers).”
Some devices have small buttons placed close together and may be difficult to use if you have arthritis. All insulin pumps require attaching infusion sets and refilling insulin. Continuous glucose monitors require insertion of new sensors. Tubes need to be taped down; sets need to be clipped to clothes. Can you do all that?
If you haven’t used a smart phone, you will probably find pumps are too difficult. If you can successfully download and use most apps on your phone, then diabetes tech may feel like just another app you can handle.
But it’s a complicated app. According to Gary Scheiner, CDE, of Integrated Diabetes Services, all pumps need to be told to give boluses at meal times, and basal rates sometimes need adjusting. Most pumps and continuous glucose monitors have other features that may be valuable but take time to master.
Some pumps and meters have small numbers and text. The glucose level reading is usually pretty big, but other information may not be.
Many systems tell you if your glucose is going up and down. All pumps have alarms for glucose that is too low or too high, low battery and insulin running low. Lange says, “Systems can create information overload, particularly since these device types can create numerous alerts that must be addressed. There are so many alarms and alerts and buzzers all over our world today. Patients may not want more.”
Pumps and continuous glucose monitors can be expensive; infusion sets and sensors need to be replaced frequently. Rebecca Longo, NP, CDE, at Lahey Hospital in Massachusetts, told ADA,“Cost is still the number one problem for CGMs. They’re expensive. Each individual company has different subscription programs, out-of-pocket policies.”
Some patients may not qualify for coverage at all. “For Medicare patients, criteria for covered CGM is strict; patients must perform self-monitored blood glucose monitoring at least four times daily, need at least three insulin injections daily or be on pump therapy, and must be seen by a health-care provider every six months to assess the patient’s CGM regimen and diabetes.”
Sensors, transmitters and infusion sets need to be taped securely. Some people get significant skin irritation, though most can ultimately find tape that works.
The University of California at San Francisco (UCSF) requires an eight-hour training for new pump users. Before starting the class, patients are required to “demonstrate competency in carbohydrate counting, calculating insulin-to-carbohydrate ratio, calculating insulin for high blood glucose correction and interpreting blood glucose patterns.”
They also need to “understand the advantages and disadvantages of insulin pump therapy, the increased risk of ketones on an insulin pump, infusion set selection and placement.” And that’s before the class starts. So, there’s alot to learn.
There are several different types of pumps, continuous glucose monitors and combined systems on the market. You will need to compare them and actually try them out before buying. Gary Integrated Diabetes Services compares insulin pumps here. And here. Pictures are included.
You don’t need to become a techie to use diabetes tech well. Weissman says, “Products may have more features than you need, and you don’t need to learn them all.”
Clearly, there’s a learning curve with pumps and continuous glucose monitors, as with all tech. Will your doctor, nurse or diabetes educator help you choose, learn, troubleshoot and problem-solve? Will they teach you about sensor placement and other skills you need to know? Do you have a family member or friend willing and able to help you with difficulties?
Be aware that all manufacturers provide 24-hour help lines, safety features, simplified programming options and other ways to make things easier. You may well be more tech-capable than you realize. But there’s no substitute for hands-on practice with a health professional.
Everything needs to be taped down or clipped on when it comes to type 1 diabetes insulin pumps. Pumps need to be carried with you everywhere. Though they can be disconnected for showers or sex, they make some people feel unpleasantly tethered to a machine. Also, pumps aren’t fashion accessories. The American Diabetes Association advises, “There are many clever ways to wear pumps, and hide them from view, but they do take a bit of getting used to at first.”
So, managing diabetes with technology is more complicated than older methods in several ways. However, it normally gets easier with time, and you will feel better and probably healthier. Better and easier tech may be coming soon. Those include integrated systems that monitor glucose and adjust insulin without patients having to do anything.
No need to wait though. Dealing with the challenges of existing systems will help you grow. Learning new things keeps you young. Weissman says, “In my experience, most older patients do just fine with tech. For older learners, the key is to go one step at a time and practice. If people believe they will benefit, they’ll get there.”
Want to learn more about recent type 1 diabetes research? Read “Reversing Type 1 Diabetes: New Research From Boston Children’s Hospital,” “Can a Very Low-Carb-Diet Help People With Type 1 Diabetes?” and “Vaccine Leads to Lasting Improvement in Type 1 Diabetes,” then see our weekly roundup of breaking diabetes news.
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