Insulin Pump Therapy

Insulin pump therapy (also called the Continuous Subcutaneous Insulin Infusion or CSII) is more expensive way to counteract Type 1 Diabetes, rather than the conventional syringe or pen therapy. In countries where insulin pumps are not subsidized, they may be difficult to afford. If this applies to patients, they may ask their diabetes team whether they might be eligible for any grants or other financial help from local organizations or national charities (Hanas 2003, p. 160).

This is more convenient for children or working individuals with Type 1 Diabetes because it delivers intensive insulin therapy that is considerably more stable to absorb, it lowers the risk of nocturnal and activity-related hypoglycemia, and it enhances the lifestyle of patients to become more flexible. Insulin pump therapy has evolved from its invention in the 1970s as an experimental treatment designed to test the relationship between glycemic control and diabetic tissue complications to its present status as a routine therapy for selected Type 1 diabetic patients.

However, the use of insulin pump therapy varies markedly throughout the world; there are some notable high-use countries, like in the U. S. and Israel, where it is estimated that 20% of Type 1 diabetic patients use CSII (manufacturers’ estimates), whereas in other countries, such as the U. K. and Denmark, 1% use pump therapy (Pickup, June 2006). Since young people with Type 1 Diabetes is increasing, an individually tailored insulin treatment program that is as close as possible to ideal for them should be applied. If treatment by regular insulin injection does not give acceptable glucose control, it is often suggested to try an insulin pump.

The pump delivers insulin to our body in a way that much more closely mimics that of a normal pancreas. Many of the children and teenagers, especially those with brittle diabetes, feel much better after changing to pump therapy. More than 40% of those in the intensive treatment group in the DCCT studies chose an insulin pump. In 2002 alone, there were approximately 200,000 people with diabetes on insulin pumps in the US (Hanas 2003, p. 160). Type 1 Diabetes often begins in late childhood, around the age of 8 to 12 years, but can occur at any age. The disease runs in certain families, indicating a clear genetic link.

Children usually are admitted to the hospital with abnormally high blood glucose after eating, as well as evidence of ketosis. The onset of Type 1 Diabetes is generally associated with decreased release of insulin from the pancreas. As insulin in the blood declines, blood glucose increases, especially after eating. Figure 1 shows a typical glucose tolerance curve observed in a patient with this form of diabetes after consuming a load of glucose (about 50 grams). When blood glucose exceeds the kidney’s threshold, excess glucose spills over into the urine.

Most cases of type 1 diabetes begin with an immune system disorder, which causes destruction of the insulin-producing cells in the pancreas. Most likely, a virus or protein foreign to the body sets off the destruction. In response to their damage, the affected pancreatic cells release other proteins, which stimulate a more furious attack. Eventually, the pancreas loses its ability to synthesize insulin, and the clinical stage of the disease begins. Consequently, early treatment to stop the immune-linked destruction in children may be important. However, research into this area is still ongoing.

Glucose Tolerance Test. A Comparison of Blood Glucose Concentrations in Untreated Diabetic and Healthy (Normal) Persons After Consuming a Load of Glucose (Wardlow and Smith, 2006). Type 1 Diabetes is treated primarily by insulin therapy, either with injections two to six times per day or with an insulin pump. The pump dispenses insulin at a steady rate into the body, with greater amounts delivered after each meal. Dietary therapy includes three regular meals and one or more snacks (including one at bedtime), having a regulated ratio of carbohydrate: protein: fat to maximize insulin action and minimize swings in blood glucose.

If one does not eat often enough, the injected insulin can cause severe hypoglycemia, since it acts on whatever glucose is available. The diet should include ample fiber and polyunsaturated fat, supply an amount of calories in balance with needs, and be low in both animal and trans fats, include fish twice a week, as well as moderate in simple carbohydrates. Meeting magnesium needs is also helpful, as is some cinnamon (1/2 teaspoon per day) and coffee consumption (if desired). These likely contribute to blood glucose regulation (Wardlow and Smith, 2005).

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