Living with diabetes: insulin pumps


        LIVING WITH DIABETES: INSULIN PUMPS

Insulin pumps provide a system for injecting insulin continuously beneath the skin, and they have the ability to give extra insulin at meal times. This has the advantage that insulin can be given in a way that is very similar to the way the pancreas works naturally. There are many types of pump, and they vary in size from that of a small transistor radio to not much larger than a credit card.
They have the same principle: an electrically driven pump operates a syringe at a preset slow continuous rate. The rate can be increased at meal times. The increased rate can be triggered off by the wearer when he is ready to eat, and the extra amount of insulin can be pre-determined according to calculated need. It can also be varied by the person who is wearing the pump according to how much food he expects to have.
A fine tube leads from the syringe to a needle beneath the skin. The amount of insulin given this way has to be judged very precisely, and frequent monitoring of the blood glucose levels is essential. Some people working with this system advise up to seven blood tests a day at first, and four a day after gaining experience with the pump.
The major objective of the system is to achieve better diabetic control. It is certainly possible to achieve good control by this method, but it still needs constant care and self-discipline. Some studies have shown that equally good diabetic control can be achieved by two or three injections of insulin a day given in the conventional way. It is all a matter of strong motivation, care and attention to detail.
There are potential disadvantages especially for young people. Failure of the proper pump function may occur and this can be dangerous, especially at night. The pump may have to be disconnected during sport or swimming and bathing. Some young people might have difficulty in coping with the rough and tumble of school life if they had to protect their pump at all times.
The ideal pump system would be one that automatically adjusted insulin flow during the day according to the body's needs. To do this, the system would need to respond to rising blood glucose levels and this would depend on a device to measure the levels of glucose in the body moment by moment. This information would then have to signal a message to the pump to vary its rate of injection. If the blood glucose level was rising, then more insulin would be injected to prevent it going too high. If the blood glucose level fell, less insulin would be injected so that hypoglycemia didn't occur.
This ideal system is sometimes referred to as an artificial pancreas or 'closed loop pump system'. It is technically possible to provide such a system now, but two things so far make this impractical. Firstly it is very large because it needs a computer to translate the information from the blood testing device to instructions for the pump. Also the glucose sensor device tends to malfunction rather quickly as the body builds up a wall of tissue around the device after a few days.
No doubt these problems will be overcome. Then there will be a problem of expense. In the meantime, just about as good a degree of diabetic control can be achieved by means already at our disposal - twice daily injections of insulin, blood glucose monitoring and using human intelligence as the computer.
In general, pumps are not recommended by most specialists who care for children. They do however have a place in the care of young adults and the role of pumps is likely to increase in the future.

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