For Type 1 diabetics, Wardlow and Smith (2006) also suggested that if a high carbohydrate intake raises triglycerides and cholesterol in the blood beyond desired ranges, carbohydrate intake can be reduced and replaced with unsaturated fat. This change tends to reduce blood triglycerides and cholesterol. Some consumption of sugars with meals is fine, as long as blood glucose regulation is preserved and the sugars replace other carbohydrates in the meal, so that undesirable weight gain does not take place. The latest evidence suggests that diabetes essentially guarantees development of cardiovascular disease.
Because people with diabetes (Type 1, as well as Type 2) are at a high risk for cardiovascular disease and related heart attacks, they should take an aspirin each day (generally 80 to 160 milligrams per day) if their physicians find no reason not to do so. Blood cholesterol lowering medications also may be prescribed. Despite the perceived efficacy of the insulin pump therapy for Type 1 diabetics, some staff in diabetes centers is reluctant to initiate pump therapy in patients. The reasons for this are a lack of knowledge about pump therapy and a lack of the skills and confidence to initiate the treatment.
However, the benefits for existing pump patients is rewarding because it can help health professionals up to date with this modern technology and gain the confidence and skills to further their knowledge in this field. In fact, the Diabetes Control and Complications Trial (DCCT) Research Group (1993) have proven that insulin therapy patients showed lower hemoglobin A1c (HbAlc) levels, achieved with intensive treatments to improve glycaemic control. Lower HbAlc levels have been shown to reduce the risk of long-term complications, such as retinopathy, nephropathy, and neuropathy (DCCT Research Group, 1996).
Patients who have great difficulty in achieving good diabetes control are at a higher risk of these long-term complications and would benefit most from use of pump therapy. Insulin pump therapy offers the patient a way of slowing the progression of the complications of diabetes and attaining a better quality of life. The central feature of CSII is a small mechanical insulin pump about the size of a beeper that the patient carries on a belt, in a pocket, or elsewhere. A set of thin tubing and a disposable reservoir–the infusion set–connects the patient to the pump, which holds up to a 3-day supply of insulin.
The pump system is essentially a motorized syringe controlled by a computer chip and powered by a battery. The mode of transferring insulin to patients will be more controlled as opposed to twice-daily insulin injection therapy because insulin pump therapy supplies insulin steadily. The mechanical device pushes the syringe’s plunger at a controlled rate, effectively delivering an amount of insulin every hour equivalent to the amount that would be delivered by hourly insulin injections, but without those multiple needlesticks (Van Buren, July 2003).
However, the downside of using insulin pump therapy is that it requires more effort from the patient; including monitoring blood glucose levels four to six times daily, injecting boluses of insulin either at mealtimes or when blood glucose levels are elevated, and keeping meticulous records of carbohydrate grams consumed and injecting a correction bolus when necessary through control buttons on the pump. The patient must change the infusion set and reservoir every 2 or 3 days. (Fredrickson 1995, p.111)
Also, CSII costs twice as much as multiple daily injection (MDI) and conventional therapies Although insulin pump therapy has been successful in adults, adolescents and school children, its use has been limited in young children. This is why Berhe et al. (2006) evaluated recently the glycemic control, safety and efficacy of continuous subcutaneous insulin infusion via pump in young children (2-7 years old) with Type 1 Diabetes. They found that there was a significant improvement in the average hemoglobin A1c after continuous subcutaneous insulin infusion therapy.
The average fasting blood sugar was lower in the continuous subcutaneous insulin infusion group. Severe episodes of hypoglycemia and episodes of lipohypertrophy were significantly higher before insulin pump therapy initiation. Also, there were significantly fewer sick day calls after continuous subcutaneous insulin infusion. Blood sugar variability improved significantly after insulin pump therapy. There was no significant difference in body mass index (BMI) or amount of carbohydrate consumed.
None of the patients experienced diabetic ketoacidosis requiring emergency treatment before or after insulin pump therapy. As the most recent studies have proven, insulin pump therapy is more beneficial and cost-effective rather than the old method of injecting insulin. Although initially the cost will be definitely greater, in the long run, the cost will be overshadowed by way of slowing the progression of the complications of diabetes and attaining a better quality of life. Especially for children, it will be easier to monitor their diabetes using insulin pump.
This is why health professionals should gain knowledge about insulin pump therapy and they should experience more patients using pump therapy so that they could help more diabetic people lead quality and productive lives.
References Berhe, T. , Postellon, D. , Wilson, B. and Stone, R. (2006, June). Feasibility and Safety of Insulin Pump Therapy in Children Aged 2 to 7 Years with Type 1 Diabetes: A Retrospective Study. Pediatrics 117(6): 2132-2138. Fredrickson L. (ed. ). (1995). The Insulin Pump Therapy Book: Insights From The Experts. Sylmar, Calif: MiniMed.