This is the view of my doctor here in Paris, and not mine! He does not believe a pump in itself will offer any better control than my shot regime with Humalog (as long as I am prepared to inject as often as necessary : 4-6 times/day). He states that the main benefits are in the discretion with which one can inject in public i.e. it is a lifestyle choice. He states that studies have not shown pumps themselves to make a significant difference and that a sensible diabetic will achieve the same results from short-acting shots as from using a pump. His team are part of mainstream diabetic research here in France and they are involved in a number of international trials (CGM for example) so I can’t dismiss him as a European quack (France also does pretty well on the international health rankings). What trials have you seen that clearly indicate that the use of a pump can further improve the control of a well balanced diabetic on shots?
having great control is a matter of adjusting to many things on a daily / hourly basis. The more control you have over how specifically you can respond with your insulin delivery will results in better over all control.
Well it seems to be a matter of fact not opinion that with the pump one can deliver a bolus in various increments as small as .05 U. this is a much more fine tuned method than the eyeballing it in a syringe that you doctor seems to advocate. There are many statistics in a book titled “Pumping Insulin” that should help support the pump argument it is an excellent resource and a must read for anyone on the pump.
Be Well!
Justin, Sham is right on the money with this one. Also if you are using a long to mid acting insulin such as lantus or N you do not have to be on as rigged of a schedule. The pump allowes you to skip meals if you like.
The studies show that there are benefits to using a pump, but they are not as big as one might expect. On average, there is a 1% reduction in HBA1c. Here is a summary of a meta analysis done on these studies. Read the whole report (link at te bottom)
“Results: A total of 52 studies, consisting of 1,547 patients, were included in the meta-analysis. Results indicate that CSII therapy is associated with significant improvements in glycemic control (decreased glycohemoglobin and mean blood glucose). A descriptive review of potential complications of CSII use (e.g., hypoglycemia, diabetic ketoacidosis [DKA], pump malfunction, and site infections) suggests a decreased frequency of hypoglycemic episodes but an increased frequency of DKA in studies published before 1993.
Conclusions: CSII therapy is associated with improved glycemic control compared with traditional insulin therapies (conventional therapy and multiple daily injections) and does not appear to be associated with significant adverse outcomes. Additional studies are needed to further examine the relative risks of CSII therapy, including the potential psychosocial impact of this technologically advanced therapy.”
http://www.medscape.com/viewarticle/451682_1
I live in Europe as well (Hungary) and I have heard here (from other diabetics, not doctors) that pumps are just an excuse for diabetics to eat more and get fat. That’s why they are so common in the USA.
Sorry I don’t have anything intelligent to offer, but I know that my pump does a lot of wonderful things for me.
I really didn’t see any A1C improvement w/ the pump - actually it went up a tenth of a percentage pt. because I no longer had lows from the peaks in the basal insulin - however, my mindframe towards dealing with diabetes totally changed. Granted, I was diagnosed as an adult and hated having to deal w/ needles and insulin and injecting 7-8 times a day so the pump fit more into my routine. But psychologically, I think the pump has done wonders for me. If I was still injecting that many times a day and having to make sure I ate carbs in lots of 15grams, I would probably be one royal ■■■■■ by now.
I can see their point and I would actually agree with them one can gain and fully control their diabetes with shots. Being a pump user myself I think they are entitled to their opinion even though they are totally WRONG!! I have enough things to deal with being diabetic, take this pill here, carb count this, bolus that. The last thing I need to be thinking about is stacking my insulin, busting out an insulin pen screwing on a needle and pulling my shirt up in the restaurant or at work or anywhere else. Diabetes is in my face every minute of my life and the more that I can do to make my life simpler the better off I am. Not to mention stress does play a part in BG levels. Is the pump convenient? Hell Yes. Most doctors who are not in to pumps are also the ones who don’t care for technology. Pumps and CGM are the only way a closed loop system will ever be developed short of an actual cure.
As MarkA mentioned there are studies that show pump users have better A1c results. The other thing to consider which is also very important is your BG deviation. I would bet there are studies that show pump users have a lower average deviation in their number than people who just use shots. This of course is just my opinion. I don’t fault anyone who would rather use shots I just hate hearing about doctors who are against certain types of treatment. Their job is to advise the patient and work with them and help them achieve the best possible health.
It’s unfair to suggest a doctor is not helping a patient “achieve the best possible result” solely because he won’t recommend the pump. I’m a pumper, but I can see that the pump is not for everyone. As long as the doctors opinion is not simply a knee-jerk reaction to technology there’s no basis to ridicule his advice. Some are more cautious than others.
His primary obligation, after all is to “do no harm.” I don’t see that a doctor is harming a patient by keeping them on MDIs. His job is to treat the patient and provide the best treatment he knows of, not to simply cater to the patient’s convenience. It’s more convenient, but harmful, to do nothing and let the patient eat what she wants whenever she wants. The pump has made my life easier, but its also expensive. A doctor can certainly decide that the incremental improvements brought by pumping do not justify the expense.
To me a doctor who deals with diabetics needs to be open to all forms of treatment. Personally they are doing harm when they are not up on current medical advancements and treatment methods.
Saying that pumping is for the birds because they see no benefit when there clearly are benefits is pure ignorance. If the best treatment the Dr. knows of is MDIs then that speaks for itself–time to get a new doctor. The last thing anyone needs is a doctor who thinks that it is their job to decide whether incremental improvements are justified by the expense. That is what we have insurance companies for!!! If I want to pay more and have a pump then so be it. If I had a doctor that didn’t believe in pump therapy I would give them the curb and get a new one. Again this is just my opinion.
I went from an A1C of 7.0 to 5.4 in just a month of pumping. That is all the proof I need there that the pump does help achieve tighter control.
My support system has just been my pump trainer. I am my Dr’s first patient on the pump and I learned what I needed to know from here and also from the book Pumping Insulin. I think in the last 4 months that I have been on the pump my sugar has been over 150 maybe 4 or 5 times. Before I went on the pump I was having a lot of highs so it has made a huge difference in my control. I do check my blood sugar more often now that I have the pump and I am also able to prevent the lows from happening as fast as they used to hit when I was on MDI’s. I can do a temporary basal setting on my pump and not have to feed the lows so then I don’t have the extra calories. Before I was pumping I was doing 8 shots a day and had an A1C of 7 with that so I was able to get control with MDI’s but with the pump it is a lot easier. My next battle will be do get the CGMS because I believe with that I can achieve even tighter control knowing exactly how my body is reacting to the insulin, but Medicare/Medicaid is always the last to cover what other insurance companies will cover. I fought with them for over a year before they okayed me to have a pump.
Exactly!!
The biggest deal is the basal insulin. You can’t get the same control with a long acting insulin that you can get from hourly control with the pump. I take 1.0 units per hour in the morning and am down to .75 at some points during the day. My A1c dropped from a 7.1 to a 6.3 with the insulin pump.
I’m not agreeing with your doctor but the education that I received before using a pump is what has helped me to stay within range. I appreciate the pump because when I was on shots, regular and NPH my management wasn’t good. With the pump once we figured out my basal rate I think it’s more accurate then a long acting insulin. So in some ways your doctor is correct. My belief and others is…education is the key to managing well with Diabetes.
I’d ask him if he had to take a medication frequently through the day ‘wouldn’t it make more sense to have a 24/7 trickle?’ If he had to make a trip to say, western Spain, wouldn’t he drive there in longer legs of the journey, or would he stop every hour and sit waiting?
What a boor! I know a number of Retinologists who are part of major known groups about ROP and other diseases of the eye, but they as individuals are VERY bass-ackward. This is indeed a 'lifestyle choice as I don’t feel I should have to get questioned by police or others about a syringe in public when a pump is more discreet and easier to maintain one’s dosages.
Jenny
I also think that this is a good discussion! I often wonder about the real benefits of my pump-- if they are from pumping or all that I have learned since pumping. I think that my basic understanding is that a pump enables better control IF YOU USE IT EFFECTIVELY.
There are many benefits of the pump that I don’t use, but I should try out…
Just to copy an article from Diabetes Health that Scott posted in another discussion.
The speed of absorbing insulin is increased if the insulin is given in smaller doses. This means that if you use a dual wave or extended bolus with the pump, it will likely bring your blood sugars down faster (even though you delay giving some of the insulin). In my limited experience with using the dual wave bolus, I find this to be true!
Also, when I used Lantus, I found high variability with my fasting blood sugars. Some mornings I would wake up over 200, some mornings under 70. This seemed like an unpredictable variability that I had to accept (different absorption?). With the pump, day after day, I tend to wake up in the same range. If it’s high, then I increase my overnight basals and it goes down. If it’s low, visa versa.
I feel like the pump does give me much more consistent results. And this is easier to react to.
Some day now, I think that I will go back to MDI for 6 months or so. Just to see if I can obtain the same level of control without the pump, but that won’t be for a few years…
Hi Justin,
I live in France and have just gone on a pump.My doctors were very keen to get together a group of people wanting to go on a pump so that they could start doing ‘pump starts’ locally rather than have to go 140km to Toulouse to start. I think its common practice here to start a pump on a 3 day course as an in patient.
If you really want to go on a pump surely there is no reason why you can’t change your specialist. There is more than one diabetologue in Paris. You would just need your medecin traitant to refer you to someone else.
The reason I went on a pump was not to lower BS further, I already had a very low HBA1c, I was in the opinion of my doctor ‘trop bien equilibre’ . What it has done has given me better control. I used to be fine, so long as I was inactive but as soon as I moved, whether I was walking, running or doing the gardening my BS plumeted. I’m now able to adjust my basal rate for the activity (just a trickle for running or hill walking) and so hopefully avoid many of the hypos I had. I say hopefully since I’ve only had it since April and I’m still experimenting. I haven’t yet had an HBA1c on it but one thing is very noticeable is that I’m using about 25-30%less insulin.
The AFD is trying to get more even access to pumps in France(its very patchy at the moment) and has set up a website eclairersurlapompe.fr.
I too am enjoying this discussion. Ultimately, choosing to use a pump or MDI’s is a personal choice that you should make with the help from your dr.
I have been a part of the DCCT Study and the follow-up portion EDIC since 1987. My A1C’s have been in the low 6’s for years now and were even in the mid 5’s while using MDI. I have found that I have gained weight as a result of being in these studies, mainly from the “tight control” mindset. It is easier to bolus for unexpected food opportunities.
My youngest sister is also a T1, but she is still using MDI’s. I often feel sorry for her at meal times when she needs to find a private location to inject.
I feel that my control is better with a pump. The more we can duplicate a pancreas without having to think though each minute of the day about what to eat, inject, or exersize, the better we will be. Bring on technology
I can think of several reasons why pumps make sense. Here are a few.
- You’re only dealing with one type of insulin. This makes it a lot easier to figure out what’s working when.
- You can control delivery much more accurately. Trying getting 0.8 units accurately with a syringe.
- It makes the calculations much easier. If you’re eating a meal with 45g of carbs, you took a correction bolus 45 minutes ago and your BG is high how much insulin do you need?
There are downsides. For example having to carry another device and deal with supplies and set changes, or dealing with the super highs that result if it’s not delivering properly.
After nearly 9 years on a pump, NOTHING would make me give it up.
I agree with Kimberly who addressed the issue of the emotional side of diabetes. I don’t have diabetes, but my husband AND my 11-year-old daughter have it. My daughter was diagnosed at age 5, and the pump has been a God-send for us. Try chasing a 5-year-old around the house with a needle…it was a horrible time in our lives. There are problems with the pump also, but life is much easier with it vs. making her take a shot every time she eats. The majority of the medical field only looks at the technical side of this disease. They don’t see how we have to live, and they have no sympathy at all for having to live with this every day. If the A1C is as good or better with the pump, why not make life easier?