To Pump or Not to Pump

Of the 17 million people with diabetes, only 10 to 12 percent treat the disease with pump therapy. After using the pump, however, more than 90 percent are hooked and continue to use it. So, why are there not more people considering the insulin pump? After all, every clinical trial completed to date has proven that "insulin pump therapy, when practiced by motivated and educated pump users, leads to better control than multiple injection therapy" (Kaplan-Mayer 5). Pumping insulin is the best option for diabetics who want to live more normally. The insulin pump provides many advantages over the use of multiple daily injections and improves the overall quality of a diabetic's life.

In people with diabetes, their pancreas either has trouble producing the hormone insulin or their body is not able to use insulin properly, which is known as insulin resistance. Insulin is of great importance because it "unlocks" cells enabling glucose to enter (Laliberte 35). This causes blood sugar levels to fall and consequently insulin levels also decrease so that a condition called hypoglycemia does not occur. Hypoglycemia is when a person's blood sugar gets too low (35).

To treat this problem, modern medicine has invented a new way of delivering insulin. An insulin pump is a beeper-like device that provides insulin 24 hours a day much like a real working pancreas. This offers an alternative method to the usually utilized multiple daily injections. It delivers continuous basal insulin, which are low doses of insulin to ensure stable blood sugar levels between meals and overnight. Before or after eating meals, "preprogrammed" bursts of insulin, called boluses, can be given with the press of a button (Laliberte 160). Boluses are given when blood sugar rises too high or when eating to match the dose of insulin to the amount of food consumed, usually based on carbohydrate content (Marschilok).

Using an insulin pump rather than multiple daily injections is ideal for not only adults but also kids. Pump therapy could be the solution to a child who suffers from extreme high and low blood sugar. Research from Dr. Michael Freemark supports this in pre-school aged kids and even infants. Nine kids, between 20 months and five years, developed diabetes between the age of 10 and 40 months. They were placed on multiple injection therapy for six months before going on the pump. There was a five-fold decrease in the number of hypoglycemia cases, and the number of days that parents contacted doctors declined from one contact every 5.9 days to one every 46.3 days (Kaplan-Mayer 156). Dr. Freemark reports, "In conversations, parents stressed their increasing level of comfort with diabetes management, their sense of improvement in quality of life for all family members, and their high levels of satisfaction with pump therapy" (qtd. in Kaplan-Mayer 159).

Some doctors fear that children will not be responsible in testing their blood many times a day and will not be careful in programming their insulin doses to the equivalent of their meals. Not only does it take a willingness to learn from the young child but parents also must be dedicated and motivated to help with the duties that go along with the pump. Once at ease with the pump, however, there can be an improvement in the child's diabetes management. "I would say within the first two weeks I was confident in my choice to use a pump versus injections," claims Mary Potter, mother of a six year old diabetic. The 2002 study at Strong Children's Hospital in Rochester, New York found that 53 children under the age of 13 attained better blood sugar control. They had fewer cases of hypoglycemia using an insulin pump than they had in comparison to using injections, which is similar to Dr. Freemark's findings (Laliberte 160).

Teenagers are also ideal applicants for the pump because of their unpredictable schedules and longing to fit in with their friends. Ashley Beard, a diabetic, remarks "My control has gotten much better, and if I want to go to the mall, I don't need to carry insulin and syringes. It gives you a sense of freedom that I didn't realize was possible" (qtd. in Kaplan-Mayer 162). Self-image is another stressor that teenagers who want to fit in worry about. Because the pump is close to a pager's size, it is possible for peers to mistaken it for a real one. There are many other ways that it could be worn besides being out in the open to others. The pump can be discreet and hidden away in one's pocket, attached to one's thigh, or even stuck in a bra. To be more fashionable, colored covers and stickers are sold by pump companies to match outfits ("Wearing Your Pump").

Another reason that a person might consider switching to a pump is because the use of a pump allows a person to keep closer control of their blood sugar than when they were using only injections. Gary Scheiner, a diabetic and doctor who specializes in intensive diabetes management, confirms this. He comments, "For me, the pump has brought a level of control that I could not achieve with injections.... I'm talking about quality blood sugar control: fewer highs and lows, and more readings within my target range" (Kaplan-Mayer XII). Optimal control is achieved because insulin pumps work on short-acting insulin making the affect on one's body more predictable. Compared with long-acting insulin, which is used in multiple daily injections, the short-acting insulin is absorbed more quickly, so the diabetic will know when to expect the insulin to take effect. With the pump, it is possible to minimize a person's delivery rate if their blood glucose goes low or if they believe it will go too low. If using shots, absorption is often unpredictable, and the insulin may not take effect when it should causing dangerous variations in blood sugar levels everyday (Marschilok).

This control that the pump provides is an important advantage over injections because it can be "lifesaving" for someone who has a history of high and low glucose levels (Marschilok). In 1993, the Diabetes Control and Complications Trial found that if diabetics kept close control of their blood sugar, their risk of complications such as eye, nerve, and kidney disease was reduced by half of more. For example, maintaining tight control of blood sugar cut the risk of eye disease by 76 percent and nerve damage by 60 percent (Laliberte 153).

The availability of insulin pumps allows a diabetic to maintain tight control of their blood sugar without the use of multiple daily injections. Insulin pumps are very convenient because they hold a supply of insulin for numerous days, which lessens the need for routine injections (Marschilok). For those who use injection therapy, the need for