Pumps, Control and You
Why is Good Glycemic Control Important?
Better blood glucose control has been the focus of a lot of attention since the release of the results of the
Landmark Diabetes Control and Complications Trials (DCCT) in 1993. The DCCT was the largest longterm
research study on the effects of glucose control ever conducted. There were two groups of subjects in
the study. One group managed their diabetes using "conventional" methods (1-2 injections/bg tests a day),
while the other half used "intensive" methods, with frequent blood glucose monitoring and daily adjustements
of insulin to keep blood glucose as near normal as possible. Nearly half on the intensively treated
group used insulin pumps to help them achieve that level of control. The chart shows the differences
in control that the different styles of treatment produced.
| |
Average Blood Glucose |
Average HbA1c |
| DCCT Intensive Treatment Group |
8.6 mmol/L |
7.1% |
| DCCT Standard Treatment Group |
12.8 mmol/L |
8.9% |
The DCCT showed clearly that those who achieved better blood sugar control - an average
2% lower glycohemoglobin value - had a tremendous decrease in their risk for the long-term
complications of diabetes. Risk of diabetic eye disease was decreased by 76% and
reductions in risk for kidney and nerve damage were nearly as great. Obviously, diabetes
control matters... a LOT. In fact, these results were so significant that the DCCT investigations
felt compelled to end the study one year early so the conventionally treated patients could have the
opportunity to realize the benefits of intensive diabetes management.
An insulin pump is a great way to achieve the degree of control we now know is your best defense against long-term
health problems.
But Why A Pump ?
There are several reasons why a pump is the best tool available to help you simulate the action of the pancreas, replacing the missing
or impaired activity of your own insulin supply.
You can achieve "tight control" of your diabetes while minimizing your risk of hypoglycemia.
One of the issues associated with intensive management of diabetes is the somewhat increased risk
of hypoglycemia. With a pump, you can carefully target your insulin delivery to match insulin
need. This ability to easily adjust insulin delivery is particularly helpful in preventing hypoglycemia during
sleep.
The pump is very predictable because it uses only regular insulin, just like your body. This
is important because regular insulin has a more predictable pattern of absorption than modified
insulins like NPH and Ultralente. Unpredictable absorption of modified insulins accounts for a large part of the
"unpredictability" of blood sugar control on conventional insulin regimens.
The pump is extremely flexible. Everyone's need for insulin is unique: both how much is needed and
the best times to give it. The pump allows almost an infinite number of combinations of insulin regimen WITHOUT
ADDING any more injections. With only one "injection" every two to three days - when you change
the infusion set - you can have precisely the right amount of insulin available twenty four hours a day.
The pump is very accurate. It can deliver extremely small insulin doses - down to
1/10th (0.1) unit of insulin. Try THAT with a syringe! The lower your total daily dose, the more
sensitive to small differences in insulin doses you're likely to be, and the more important to
your stable control the pump's precision becomes.
Is That Much Flexibility Really Needed ?
For many people with diabetes, it is. The alternative to flexible insulin availability is to attempt
to control schedules, activity and food intake, to match the available insulin. This is extremely difficult
for most people. But even monumental efforts at maintaining a stable lifestyle don't always produce the
desired results. Insulin needs vary for many reasons and in many ways, some of which are simply not within the control
of the person with diabetes. Using the results of blood glucose monitoring to make and evaluate
daily decisions a pump user can respond to most such needs quite easily. Responding to the same situations
may be difficult or even get as close as is now possible to providing insulin as your body would if you didn't have diabetes.
Flexible Response to Meal-Related Insulin Needs (Bolus Insulin)
If you didn't have diabetes, your body would release the insulin needed to handle everything you
eat in EXACTLY the right amount and at EXACTLY the right time. The pump makes it possible
to do the same thing. Of course, the process isn't automatic. YOU need to figure out how much carbohydrate
you're eating and then decide what dose of insulin is needed, but you can give it with the pump,
accurately, precisely and at the right time ...before the meal, while you're actually deciding what and how much
to eat. Just like the normal pancreas, you can give less when you eat less, and more when you eat more.
You're not tied down to eating a certain amount of food because you took a certain dose of intermediate-
acting insulin several hours ago. With the pump, you can respond to the immediate situation.
Flexible Response to the Unpredictability of Life
Very few people live totally predictable lives. Things change from day to day: you have to go in
to work early one day, and stay late the next, a meeting runs too long delaying lunch, you get
caught in a traffic jam and get home an hour and a half later than usual; you sit at a desk all
week but like to hike on the weekends, and so on. The possibilities are as varied as the people
who have diabetes. When these things happen to people on conventional diabetes treatment plans, the
result is often worry, hassle, and ultimately temporary loss of diabetes control. The pump can greatly reduce
the worry and hassle of dealing with the life, and can also help you protect your hard won control in a great many
situations that are hard to manage on injections. Meal delayed ? No problem once your basal rate is correctly set.
Got an unexpected invitation to play tennis after work ? OK. Just temporarily reduce your basal rate to avoid both hypoglycemia
and the need to eat a lot of extra food to prevent it.