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Insulin Pumps and Type 2 Diabetes

You have been taking four insulin shots a day for a few years and it’s getting burdensome. You have a friend with type 1 diabetes and she wears a pump. All she has to do is push a button every time she wants to give herself insulin. You think to yourself, why couldn’t I do this?

Actually, insulin pumps are becoming much more common for people with type 2 diabetes who take multiple daily insulin injections, for some of the same reasons people with type 1 diabetes use them: They can more precisely meet your basal (background) insulin requirements, they can calculate your bolus (mealtime and correction) insulin doses for you, and you have more flexibility in terms of your food choices and mealtimes. From a control standpoint, they have some advantages also. People on pumps don’t tend to have the same level of blood glucose variability that those taking injections do. An insulin pump can even out some of the extreme highs and lows some people using injections experience. Clinical trials comparing continuous subcutaneous insulin infusion (insulin pumps) to multiple daily injections (MDI) have found them, at a minimum, to be comparable; and in several studies the pump has outperformed MDI in reducing both A1C and hypoglycemic episodes.

Some of you may not be familiar with insulin pumps. A pump is a computerized insulin delivery device that you wear on your person. It usually has two overt parts: the infusion set (or pod for tubeless pumps) that attaches to your skin (on the buttocks, stomach or thighs), which contains a needle or catheter to deliver the insulin, and the small, wallet-sized computer part, which looks like a pager or PDA device. The two connect through tubing, for most pumps, or wirelessly for patch (tubeless) pumps. The infusion sets, or pods, for the patch pumps are changed every two to three days.

Up to now we have been talking about all the great things about wearing a pump, but there are some downsides. A pump is attached to you all the time and some people find that annoying. You still have to carry insulin and a syringe or pen with you everywhere you go as backup in case the pump fails. Monitoring the pump is a daily chore; since it holds only fast-acting insulin, a failing pump is much more of an emergency than missing a mealtime dose on injections. (With a pump you have only four hours of insulin coverage available if it breaks down). Pumps can help control blood glucose, but they aren’t magic wands; you still need to focus on eating and exercise behaviors. Finally, going on the pump isn’t like selecting a shirt to wear for the day; getting accustomed to the pump and fine-tuning your insulin doses can take two to three months.

There are six major companies in the United States supplying pumps: Animas, Medtronic, Insulet, Accu-Chek, Tandem and Sooil. Five of these have pumps with tubing. Insulet, maker of the Omnipod®, is currently the only patch pump available in the United States, but that is likely to change as more companies enter the market. All of the pumps will calculate your insulin doses and deliver basal and bolus insulin. Like cars, they differ in the bells and whistles they provide.

A plus for people with type 2 diabetes who are interested in a pump is that the insulin pump companies are interested in expanding into the type 2 market. After all, between 90 and 95 percent of people with diabetes have type 2 diabetes and approximately 4.5 million take insulin to control their diabetes. Now, not all people on insulin need mealtime insulin, but even if only 30 percent of them do, you can easily see why this would be a lucrative market for the pump companies, and why they might start to develop features that would appeal to people with type 2 diabetes. For example, pumps with larger insulin reservoirs to enable less frequent infusion set changes and those with preset bolus features for fixed-carb meals.

If you would like to consider a pump, start by checking out the web sites for each of the companies, talk to your health care provider about attending a class, or talk to a diabetes educator about pumping. Find out if your insurance will cover the cost of a pump. Most insurers (except Medicaid) will cover some type of pump for people with type 2 diabetes. Ask your educator to put you in touch with someone with type 2 diabetes who wears a pump.

Finally, you can try out a “pump-lite” device called the V-Go® that is made especially for people with type 2 diabetes in mind. Stay tuned for my next blog on this pump hybrid.

If you are already on a pump, write in and tell us about your experience.

Live well and enjoy!

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