Insulin Pumps Might Have Slight Advantage In Type 1 Diabetes

[cugila]

A new evidence review suggests that using a pump to deliver insulin continuously instead of taking three or more daily injections might result in better control of blood sugar for people with type 1 diabetes.

http://www.medicalnewstoday.com/articles/176245.php

 

[jopar]

I would suggest that they have more than a slight advantage, if you look at past research and long term costing you will find that long term use has the protential of saving over £20,000 compared to injections.. With savings being made, as the diabetic suffer less complications so requires less treatment of complications... Eyes alone pumps can reduce complications by over 70% if I remeber rightly.. Then you've got the short term saving of less admittence to hospital (DKA/Hypo) one night in hospital costs at the last time I looked £320 just for the bed space, no medication cost involved...

I had a snigger reading the article, when it said that pumps reduced painful injections, even though pre pump I injected 5-9 times aday, I wouldn't say that they were painful... Pain in the butt getting your injection kit out and faffing around with injecting but no phsyical pain..

 

[janabelle]

Hi Ken,
tried looking up this on the Cochrane website with no luck, can you help?
It wouldn't surprise me that patients on pumps would have better BG control than patients on basal bolus, if the patients involved in this study were on long-acting analogue insulins. I'd be interested to find out if this is the case.
Jus

 

[jopar]

Janabelle

I doubt if any of the pumpers on the trial was using a long acting insulin, the pump works with quick acting only. most pumpers would be using either Humalog or Novorapid, as these are really the only two that manufactureres have licenced with pumps, There are only a handfull of pumpers that use the newer human insulin (name escapes me) and even fewer that is a animal insulin this ones tends to give a lot of consultants/pump manufactuers the hebe gebes..

In very rare cases will a pumper inject a long acting insulin along side pump thearpy, most cases I've heard of, have been based on having a very high insulin residence with requires major doses of insulin to be delivered

Hopes this helps

 

[rgarcha]

Hi.
I agree 100%, just over a month ago, i was taking 6 injection a day, and my hbac1 was 11.5%. I could'nt even bring my bm levels below 12mols, i thought that, insulin doesnt work any more. But ive been on the pump, for a month now, and im in heven, my hbac1 is 6.3%, and thats in a month , (ok i did have loads of hypo's to add to that figure), but overall my levels hardly go over 12. The pump is surely doing something right, also, i suffer from nerve damage, and thats seem to disappered altogether.
YES PUMPING IS THE WAY FORWARD, BY FAR!!!!
I VOTE FOR THE PUMP

 

[cugila]

Hi Ken,
tried looking up this on the Cochrane website with no luck, can you help?
It wouldn't surprise me that patients on pumps would have better BG control than patients on basal bolus, if the patients involved in this study were on long-acting analogue insulins. I'd be interested to find out if this is the case.
Jus

Hi Jus.

I too have had a hell of a job trying to find this. I don't think it has been fully published and the article is just a 'taster.' I managed to find the Protocol, not sure if that is any help ???

Have a read here: Click on background on the left of page.
http://mrw.interscience.wiley.com/cochr ... frame.html

 

[janabelle]

Thanks for that Ken-will have a look.
Jopar, you misunderstood me, i did not mean that the "pumpers" would be on long-acting analogues. I meant the pumpers were compared to a group of patients on long-acting analogues, or the pumpers were switched from long-acting analogues.

Rgarcha, i remember from your previous postings' that you changed to a pump because you were having similar problems that Loneranger and I experienced on Lantus. You'd been type-1 for a long-time before having these probs with your insulin not working. I was wondering if you had ever tried or considered trying animal insulin before changing to the pump?

I just think it's a shame that so many people, especially kids are being put on pumps, when changing to real insulin might give them stable BG control without being tied to a machine.
Jus

 

[CarbsRok]

Re: Insulin Pumps Might Have Slight Advantage In Type 1 Diab

y

 

[jopar]

Janabelle

There have been a lot of research surrounding the benefits of pumping against injections (which includes patients using long acting insulins) hence some of my figures given in the first post I did a lot of research about pumps before and during my quest to get one..

I appreciate that you had problems using human insulin, and for you returning to Animal insulin has resolved the problems that you were having, but not every bodies control issues is down to using human insulin nor can it be fixed by returning to Animal insulin’s, this really needs to be looked at on an individual bases.

I find it a crying shame that children don’t get a automatic choice of using a insulin pump, and find it disgusting that you would prefer that children were prevented access to a very useful and successful piece of kit, based on your personal view.

I have used both Animal and Human insulin, and not had a problem with either, the control issues that lead to using a insulin pump, would not have been resolved by returning back to Animal insulin. My husband who’s has been a diabetic longer than myself, also used both insulin’s, while on animal insulin he had to change 3 times due to the animal insulin becoming ineffective over a period of time causing control problems, since using human insulin he’s had one change this is when he swapped to basal/bolus regime a couple of years ago...
But it does seem that not only are you very Anti about Human insulin, you are very Anti about the use of insulin pumps

 

[janabelle]

Hi, meant to say Rgarcha thta it's great you've got your control sorted and the pump is obviously the best thing for you, as for you Carbsrock.
I had **** control for yours on synthetic human insulin, the only time it was ever stable was during pregnancy. Over those long years I was NEVER offered animal insulin but told I would always have brittle control. Similarly when I was changed to Lantus by my hospital clinic, my control was crazy erratic and running to 15 most days; again I was given no help.
Just as you have found the pump to be the answer to your BG control problems, I have found animal insulin with a basal/bolus regime to be the answer to mine. Had it not, I may have considered a pump- but that would definetely be a last resort for me.
Our experiences show that different regimes work for different people, and clearly many people do manage their condition well on basal/bolus analogue insulins, or on mxtures, etc;
I am concerned that, in the same way people were forced on to synthetic human insulins in the 80s, and the same with analogues in recent years; patients will be offered pump therapy before considering all the alternatives- that is if we still have any :cry: Research on analogue insulins proved they had only minor benefit over synthetic human insulins. That didn't prevent the push to put everyone on analogues; nor did it stop companies discontinuing human and animal insulins. Novo disconintued it's actrapid pen-cartridges, which was clearly a ploy to discourage it's use.
Jus

 

[janabelle]

Dont try and turn this into a silly argument Jopar, this is a discussion and my personal views are as valid as yours or anyone elses.
I have NEVER said I am anti-human insulin, what a ridiculous statement. However I do acknowledge that many people have problems with them-contact the IDDT, the charity was set up for such people.
I find it more disgusting that patients have been used as human ginuea pigs for some of these new insulins, without any evidence that they are superior in managing diabetes-especially kids. Neither have I said i am anti-pumps!
I am not against 'modern' treatments- my son has had enough chemo to kill him, and were it not for modern treatments he would not be here today.
Jus

 

[jopar]

Janabelle

I'm only doing the same as you expressing my opinion, it seems that you think that anybody having a differing opinion to yours then must be creating an argument! As to my view point I gave about being Anti Human insulin check your posts in verious threads! And your reply to rgarch 'didn't you consdier Animal insulin instead of a pump! Then followed with children should be tried on animal insulin shuldn't be tied to a machine! Not what I call an pro-active point of view..

Insulin pumps as carbrocks as said there are like a mini-pancreas and I really don't know I have mine attached... But I do know what benefits having it means, not only that it enables my insulin to match my basal profile (which can't be done with injections) but how it can cope with changing needs on a daily bases if necessary to maintan good control..


It's my opinion that children derive great benefit from pumping, there activity levels change from hour to hour, let alone day to day... They have to contend with growing spourts, hormonal changes which with MDI is difficult to do at the best of times..

For Adults it enables then to match basal patterns much better, plus give more flexiblity in day to day control that more ables to match working patterns even shift work patterns..

Given the choice between using the pump or Animal insulin, pump any day... One of the main problems I've found with using Animal insulin in injections form is the inconvience of injecting 1/2 before you eat and losing some of the flexability this causes, as when I did use the Animal and older insulins, I would work out my cabrs, then inject and by the time I was able to eat I didn't want my food and had to force myself to eat it.. Can you imagine what this would be like for a child to cope with?

 

[janabelle]

I did not suggest you were trying to cause an argument because you have a different viewpoint to me, but because you were misquoting me.
I NEVER suggested that children should be prevented from having access to pumps.
RE-your suggestion that I am anti-human insulin; previous postings state that my problems were asscociated with a particular "analogue" insulin NOT "human" insulin.
I don't think my suggestion that a person should try animal insulin before trying a pump, is an odd one, and what, in the name of all that's holy, was wrong with me asking whether Rgarcha had tried animal insulin before going on a pump??
I think it's great that people get control whatever way they can, be it a pump or any type of insulin. I only post my experiences with regard to that particular insulin I had a prob with, in the hope of helping others. I don't know why that would bother you so much.
Can I apologise to anyone who didn't like me using the term "tied to a pump". My intention was not to be derogatory about the use of pumps, but just how I imagined it would feel to be on one.
Jus

 

[rgarcha]

hi,
listen guys, i had experience with both human and animal insulin, before i considered the pump, i tried the basal/bolus, and i've even tried lantus and levevmir, and surprise surprise, nothing working. When i first joined this site, i was endlessly searching the net for some answers to my long and stressful, diabetes problems. my partner had no choice but to take it private health care, and we are not rich people, trust me on that. He had not choice but to remortage the house, and fund anyway possible, to save my life from long term complication. As some of you may be questioning if the pump is ideal for young and old, BELIEVE ME!!! when i say this, its the only way forward for complete diabetes control.
If some perfer to stay on the injection, thats there choice, but i think it also should be a free choice on the NHS, that the pump should be available, which at the moment, its not that easy, as there is the postcode lottery saga as a major issue. :?

 

[janabelle]

HI Rgarcha,
your post and Carbrocks have certainly made me think differently about pumps. It doesn't seem fair that you couldn't get one on the NHS; especially as you'd clearly tried all options to get your diabetes under control. You must be so pleased to have your BGs sorted now, especially after such a long hard slog.
If my control went haywire, for whatever reason, I wouldn't rule out a pump, doesn't sound so scary now.
It's all about choice, but a shame Rgarcha that you weren't given that on the NHS.
I still believe that analogue long-acting insulins are not all they're cracked up to be, so many people have problems on them. Let's hope in the future that choice of treatments is available for all, this thread certainly shows how different we all are.
Jus

 

[phoenix]

I'm lucky, I doubt very much that I would have got my pump in the UK, unless I had a doctor willling to be creative with the criteria. I could have raised my overall levels and led a more 'regular' lifestyle
and still have glucose levels well within official targets.
What it has allowed me to do is to live a normal/non regulated lifestyle whilst keeping low numbers but reducing the hypos. To give an example, I can lower my basal to a tiny amount for exercise so I don't have to keep warding off the hypos. Backpacking weekends or very long runs (I run very slowly so they take a long time :wink: ) are much easier My OH is happier that he no longer has to persuade me to take sugar when I've sat down in a ditch in the middle of nowhere!
In contrast I've just spent the last 2 days travelling home from the Uk. I get nervous in the car on long journeys and this coupled with a lack of exercise would on MDI have lead to higher levels, as would the sometimes less than healthy meals. ( if you're a low carber don't attempt breakfast at cheap French motels!). I was able to raise the basal a bit for travelling and give dual wave boluses for over fatty meals: result good levels for the whole journey.
I'm sure pumps aren't for everyone, my hospital doesn't offer them to those who aren't motivated or would find carb counting etc difficult. Many have had to be persuaded to give it a try, often because of a dislike of the idea of being tied to a machine. Only one has given it back during the 6 month initial trial. Sadly this was because her husband didn't like/approve of it.

 

[jopar]

My husband who is also a fellow T1, was unsure about pump therapy that is until I got mine, and he’s seen what it can do its flexibility alongside the difference in me not only my diabetic control and the health benefits it’s given me, but its returned me to the person he met the fun loving persons a bit of a nutter in truth... But he would love the opportunity to have one, as he knows many situations that he would benefit from it, one main area would be within his job as a care supervisor which some shifts can be dynamic to say the least, and even with basal/bolus regime that his calculations are thrown into disarray when he’s calculated injected, and everything changes or goes belly up on shift... But he wouldn’t get a funded pump as his control in the main is pretty good so doesn’t really fit any part of the criteria set by the NICE guidelines...

If I’m discussing with a diabetic who’s considering using a pump and they are a little hesitant concerning being attached to it, if female I point then back to their teenage years, when they first started to wear a bra, and how self conscious they felt, but after the first couple of times it sort of disappeared and you don’t know you are wearing one! Explaining to a male is a bit more difficult apart from saying do you constantly feel the watch you’ll wearing?

My husband will never forget the expression of shear panic on my face when I thought I had lost my pump! We used to work together and while in work I was nattering to him and another colleague, then it dawned on me that I couldn’t feel my pump (I had only been on it for around a week or so) so I start to feel my waist at the front, no pump under my clothing started to panic, until I realised I had clipped it out the way at the back of my waist band doh!
I would hate to have to count how many times, I’ve had a bath and after I’ve finished my husband has then gone to the loo, and come back down with my pump that I’ve forgotten to reattach it, he’s even got used to asking if I’ve reattached it when I’ve gone cloths shopping just in case!

Pumps may not be for every-one, but shouldn’t be knocked until they have been tried, as once tried there are a very few people who hand them back... As to the French lady who handed hers back because hubby didn’t like/approve of it, I think in her position I would hand back hubby to his mum with I don’t approve/like his attitude and keep the pump..

 

[iHs]

Reading this thread, I'll add my take on this

For the 2 months that I used a pump last year, I really loved it.

During the spring and summer I tend to go around massive car bootsales held in large fields. Using basal/bolus I normally tend to go low when half way round them and need to feast on a hamburger, etc in order to feel ok, but using a pump, I was able to reduce the basal setting down, walk around the bootsale, not feel hypo and eat a burger because I wanted to (not because I felt hypo). All I had to do was quickly do a bg test and then press the bolus button on the pump and walk round the rest of the carboot :mrgreen:

The companies selling the pumps in the UK do charge an awful lot of money (£3000 is not really justified) but of course they have something that we all want so that is why we are all held over a barrel :evil: Hopefully within the next 18 months there will be 6 pumps offered by 6 companies so the competition will hot up and lets hope the prices will drop.

Will I get a pump this year - I should do but not sure if I will meet the NICE criteria as since altering my target bg level to 6, I have had better bg levels regarding hypos but still higher than I would really like. But even if PCT funding is turned down, I will get my D consultant to write me a letter to say that I am suitable to use a pump and then go and approach a pump company and buy my own.

I think it would be nice if PCTs funded the consumables for pumps (the sets and reservoirs) but allowed the diabetic to buy their own pump.

 

[roo.be]

I've only followed this thread loosely so forgive me if I repeat what someone else has already said or misquote anyone! Also what I'm writing below is as I recall it, i.e. I didn't go back and check the facts.

Up until approximately 12 month ago for a pump to be supplied by a PCT was at the discretion of the clinic. The patient had to meet very specific criteria and of course the cost would always be a factor. I understand that my pump cost £3k and the annual running cost is about £1800. pa.

At about 12 months ago the NICE reported that the ongoing studies had proven the pump to be beneficial to a level that it be taken out of it's then current standing and be made available to all and not just the criteria box ticking few.

Obviously cost will always remain a factor but for those who talk about not being able to get one and that this was more than 12 months ago it is maybe worth trying again with your clinic. I understand there are 38 people in my area with a pump. This is a very small number but obviously they are people whom the clinic felt would most benefit from this type of treatment.

There is also the option of changing clinics. I remember many years ago when the pens first came available and I so desperately wanted this but neither my GP clinic nor my PCT clinic would provide it so I transferred to a much larger teaching hospital much further away to attain this. I got my GP to refer me. I am also aware of a patient who complained persistently to the highest level of their PCT to attain pump treatment, and won. It just took time.