Contributed by Annye Notman, Director, Healthcare Technology Planning with additional Clinical contributions from Wendy Phillips, MS, RD, CNSC, CLE, NWCC, FAND, Division Director of Clinical Nutrition for Morrison Healthcare, a division of Compass One Healthcare.
When Isabella Pileggi was 9 years old, she began using an insulin pump. The small device attaches to her clothes, enabling her to adjust the insulin levels provided through the catheter to treat her Type 1 diabetes by simply pushing a few buttons.
Three years later, the pump now interacts with a continuous glucose monitor (CGM) to monitor Isabella’s glucose levels at all times and sends her alerts when it’s too high or low. It also helps her calculate the exact amount of insulin needed so she can manage it without help from her parents. “Life is a lot easier now without all of those needles,” she says, “not only for me but my family, too.” Here’s more on Isabella’s story.
Insulin pumps have the potential to have an extraordinary impact on the lives of those living with diabetes. Before insulin was discovered in 1921, people with diabetes didn’t live for long. The most effective treatment was to put patients with diabetes on very strict diets with minimal carbohydrate intake. This could buy patients a few extra years but couldn’t save them.
In the 1950s, the first oral medications to stimulate insulin production by the pancreas were discovered and were used in conjunction with injectable insulin. Insulin pumps have gained popularity since the 1990s, especially in children, once technology advanced and insulin pump size was significantly reduced. As in Isabella’s case, they are now handheld devices that can easily be clipped on to clothing or carried in a pocket.
Benefits of Insulin Pumps
Many people with diabetes need to maintain a stable meal schedule to keep insulin requirements consistent. Injectable insulin (as opposed to an insulin pump), often doesn’t change this - people using injectable insulin may also have to follow strict schedules for their meal times. The need for administration of injections prior to meals is cumbersome and consequently, indirectly limits a person’s social activity.
Patients have said they believed onlookers in public places were concerned they were drug addicts while they were administering their premeal dose of insulin. The anxiety and fear of their glucose swinging high or low after meals, combined with the potential awkwardness around administering a drug during social activity, is understandably too much for many people with diabetes. Sadly, many people choose to sit out of social activities altogether.
Insulin pumps are great news for this situation: because an insulin pump can continuously inject small amounts of insulin and provide additional insulin when needed as a single dose, glucose levels can be managed at mealtime and snacks, in private or social settings. It is used most often among children with Type I Diabetes (T1D) as a measure to regulate glucose levels. Most wearable insulin pumps still require a separate method for glucose monitoring and dosage calculation, which is called an open loop.
The insulin pump has significantly improved the quality of life of patients in terms of better self-esteem, decreased stress, and better mood. Insulin pumps have improved physical health, mealtime flexibility, and ease of travel for many. And social activities? The pump enables patients to be active participants in social and recreational settings, ultimately improving their personal and family life.
Even More Improvements on the Way
A new kind of pump, called a closed loop, became available to consumers in 2017. This pump combines the continuous glucose monitoring (CGM) and insulin pump into one device, so it can continuously monitor a person’s blood glucose and remove the patient’s involvement in calculating the insulin dosage they need the pump to provide.
In 2018, the Cleveland Clinic named the hybrid closed-loop system the top medical innovation of the year. Described as an artificial pancreas, the hybrid closed-loop insulin delivery system helps make Type 1 diabetes more manageable. This is because it enables direct communication between the continuous glucose monitoring device and insulin pump to stabilize blood glucose at an unprecedented level.
According to the Cleveland Clinic, the market for insulin pumps may see significant change as more patients demand the technology and more insurers reimburse for the system. Experts are also optimistic that positive outcomes demonstrated in Type 1 diabetes will generate more demand for similar products for the millions of people living with Type 2 diabetes in the near future.
Last year, the Federal Drug Administration approved the closed loop pump for use in children as young as 7 years old and research has shown a positive outlook for the use of pumps for people with Type 2 Diabetes who have become dependent on insulin.
While this breakthrough will clearly make life better for people with diabetes, there are also some potential drawbacks. Cyber hacking, for example has become a potential threat, not just to insulin pumps but any “connected” healthcare technology device. Users need to be aware of these risks and monitor their device for potential issues. Weight gain and infections are other concerns for many patients. Because the insulin pump uses a catheter to transfer the drug, it’s also possible for an infection to develop and go undetected (Diabetic ketoacidosis). Practically speaking, insulin pumps require extensive training and are very expensive. Depending on a patient’s insurance provider, there is no guarantee the insurance company will pick up the tab.
Despite these concerns, advances in insulin pumps are giving new hope and freedom to people with diabetes. The device has the potential to provide a new level of flexibility and quality of life for people worldwide.
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