Following Dr. Bernstein's solution while using an insulin pump


My son was recently diagnosed with type 1, Aug.2. His opthamologist has strongly urged him to consider using an insulin pump. Currently, he is using roughly 12 units of humalog per day and a 10 unit dosage of Lantus at bedtime.He has steadily been bringing his average bgs down to the 100 range from the 200s.He is learning to use the insulin well with Bernstein's suggestions. Can the pump be an effective way to go? I know Bernstein doesn't think much of the pump. I'd be interested to know of other's experiences.


As a pump user and retired teacher, let me offer a few comments. Being that your son is recently diagnosed (you did not mention age), it is important for him first to understand his individual's body reaction to insulin. Sounds like he is early on in that process. It is essential to determine basal insulin needs as well as bolus need per grams of carbs. It sounds, also, that he is in process of doing that as you indicate he is gradually bringing his BG levels down. (Let your ophthalmologist know he is in the midst of that process. (I am certain that he is well meaning but not as informed as he should be.) As long as he is able to achieve his goal BG levels with injections decided jointly with his endocrinologist or primary care doctor that is a great and necessary accomplishment. Dr.B understands that often well meaning physicians automatically assume an young Type I will go on the pump for convenience.
My teaching experience of many years with the occasional Type I student suggests that often a pump is a personal embarrassment for a young person particularly if in adolescence the student is active in room scenarios. Every school that I have ever taught in make arrangement for discrete injections as needed. I have known many students abandon pump usage mainly for such personal reasons. As a teacher, the pump was a great convenience. However, understand that is the value of a pump. Insulin dependence can be handled effectively with appropriate injections and that is why Dr.B "doesn't think much of the pump".

Thanks very much for your reply. My son is 30, lives at home and is somewhat dependent on me to help him through major life issues. My son is definitely in the experimental stage with his insulin to find out what dosages work for him. It seems like the insulin pump could just make the process more complicated at this point. At first I thought the pump was fully automatic so to speak and would be a boon to maintaining stable bgs, but I understand now that you have to accurately program the basal rate and give boluses before meals, hardly an automatic process.
His ophthalmologist got her training at Joslin Diabetes Center so she feels she is an expert on diabetes management. She's been an excellent doctor and she did diagnose his diabetes (He had anterior uveitis). i do feel as well that she should not be pushing the use of a pump. As you rightly point out too, there are body image issues. You are connected to this reminder of your chronic condition 24/7. My son has no problem giving himself multiple daily injections very quickly and discreetly in public situations. I guess we will stick to our guns and insist
on continuing with the same delivery methods.

I don't use a pump, but I've thought about it. In my case, as long as I can maintain tight control with MDI, I'm staying with MDI.

A pump offers some signficant advantages that may make a difference despite Dr. B's not liking pumps. A pump fine tune insulin dosages and it can accurately deliver smaller doses than a syringe (which is limited to 1/2U). It can generate basal profiles that are impossible to generate with MDI. I don't have a pump now, but in my case I suffer from morning highs (Darn Phenomenon) and there is nothing more that I can do to deal with it except to wake myself in the middle of the night, testing and inject Humalog.

And there are some downsides to pumping. One immediate downside is cost. The "street" cost of pumping is at least several times the cost of MDI. And the reason Dr. B doesn't like pumping? He beleives that over time it causes scarring at a high rate than injections. That after a decade, many pump users have developed permanent scarring that impedes insulin absorption (and makes it variable). I think if you asked many long time pump users, they would probably confirm this. In truth, some of this can probably be prevented by aggressive rotation of sites, but still. And a pump is only as effective as the users. My experience learning to use insulin is that it took months to learn everything. And things like carb counting are not simple things, it takes a lot of learning to understand all the sources of carbs and how to properly estimate the carb content of meals.

Your son is only thirty, he has only been diagnosed a month. He has many years ahead of him and much to learn.

From my understanding Dr.B's reasoning for not liking pumps is the damage to the tissue that takes place at the infusion site. The idea is with shots, you have more available places to use for injections.

My second thought, is that your Ophthalmologist is a retina specialist and while I'm sure he/she sees a good number of PWD, I would seek advice from your son's endo about appropriate action regarding BG control. Also he is most likely honeymooning still which should be taken into consideration.

That said, I use a pump with Dr. Bs diet. I debate constantly with myself about it's usage, but it allows for many small boluses and boluses over time which are nice. Otherwise, there isn't much issue other than the "real estate" factor.

Good catch on the Dr. B diet. I've been a T1D for 27 years and that is the only way I've found to have any sort of good control.