Disconnecting the pancreas: The type 1 diabetes predicament

(BPT) - For people living with diabetes, managing blood glucose levels is a full time job. It is a constant struggle to manage diet, exercise and stress, which all affect blood glucose levels. As anyone with diabetes will tell you, no two days are alike.

People with type 1 diabetes have a variety of tools at their disposal to manage insulin delivery. For people living with type 1 diabetes, picking the right tool for taking insulin is a complex process of weighing lifestyle considerations, versus the benefits and limitations of each insulin delivery system.

There are three main forms of insulin delivery methods patients can choose to manage their diabetes including: Multiple Daily Injections, known as MDI (using pens or needles and syringes), traditional tubed pumps or a tubeless pump (also known as pod therapy). While every method has its own benefits and challenges, the important thing is the individual patient chooses the right method for them and their daily lifestyle. Here is what you need to know about insulin options today:

1. MDI – Multiple Daily Injections

Though they are the most dated method of insulin delivery, many people living with type 1 diabetes prefer insulin syringes and their close cousins, insulin pens, over traditional tubed pumps. MDI is fairly inexpensive, simple to use and requires no maintenance. However, patients using MDI require multiple self-administered injections (anywhere from four to six shots per day or more) throughout the day that can, over time, cause scar tissue to build up that can impede insulin absorption. MDI is still the delivery method of choice for most people living with type 1 diabetes, according to the U.S. Department of Health and Human Services National Institute of Diabetes and Digestive and Kidney Diseases.

2. Traditional (tubed) pumps

Traditional tubed insulin pumps have been growing steadily in popularity for the last decade, especially in the pediatric type 1 diabetes population. They simulate non-diabetes physiologic levels of insulin throughout the day and overnight. Insulin pumps require only one needle insertion every few days. Users can program them to administer consistent basal rates of insulin throughout the day and larger bolus doses to accommodate the accompanying intake of carbohydrates at meals and snacks. In this way, pumps more closely mimic the body’s natural pattern of insulin release. They are usually removed during strenuous physical activities where tubes could become snagged, infusion sites could become dislodged, or pumps could get damaged. Despite their advantages, many diabetes patients who could benefit from insulin pumps avoid them. Their size often presents too much of an annoyance to some prospective users. The tubes also present problems, in terms of the potential to snag, dislodge, or to develop kinks and blockages that can impede insulin flow. Site locations for the cannula that sits beneath the skin (subcutaneously) are also limited in comparison to locations for MDI.

3. Tubeless pump therapy or pod therapy

Tubeless pump therapy, or pod therapy, is gaining popularity due to the same clinical benefits of a conventional pump, but without the drawbacks of tubing and restricted site locations. Pod therapy packs the same functionality into a smaller form; a wearable insulin pod weighing less than an ounce and a wireless personal diabetes manager (PDM) to control it. Insulet Corporation, the maker of the OmniPod, the only tubeless pump on the market in the US, has developed a user friendly system for patients of all ages. The pod, about the size of a large strawberry, sticks to the skin through an adhesive pad and continuously supplies insulin throughout a 72 hour period before needing to be changed. The PDM works in combination with the pod to monitor blood glucose levels and monitor the patient’s insulin release, but is not attached to the pod. Many users keep their PDMs in bags, purses or school backpacks. The pod requires no tubing, is fully waterproof (up to 25ft for 60 mins) and can be worn continuously for up to three days.

Overall, pumps have substantial long-term clinical benefits. They reduce the risk of low blood glucose (hypoglycemia), reduce wide fluctuations in blood glucose levels (blood glucose variability), and help manage early morning high blood glucose levels known as the “dawn phenomenon,” according to the Joslin Diabetes Center in Boston. A 2014 study of more than 18,000 patients with type 1 diabetes in Sweden documented a 29 percent reduction in all-cause mortality and 43 percent reduction in the risk of fatal cardiovascular disease (CVD, i.e. coronary heart disease or stroke) in patients that used pumps instead of daily injections (MDI).

Insulin pumps can support a broad range of lifestyles, from the busy professional who is always on the go to the most physically active athlete and everyone in between.

The growing options in diabetes management technology allow users to minimize the impact of daily management while also improving the quality of life and control of those with type 1 diabetes. If you have not done so already, doesn’t today sound like a good time to explore what’s out there for yourself or your loved one?



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