Recently the CBC and partnering news agencies released an article on the dangers of certain medical devices. In the article, it was suggested that insulin pumps are lethal and should be more closely scrutinized by Health Canada. I would have to correct the CBC in that it is not just insulin pumps that are deadly, but insulin itself.
Too little or too much insulin can lead to death and the amount that constitutes too much or too little varies from person to person, from hour to hour. There is a term used in the diabetes community, “your diabetes may vary”. It is because there is no one size fits all dosing when it comes to insulin. A doctor cannot prescribe 6 units of long-acting insulin and 2 units of rapid per meal for all 6 year old children. She cannot tell all young males of 25 that they should set a basal rate of 1.2units per hour in his pump and bolus 10 units for his meals.
Diabetes varies between two seemingly similar people. One six-year-old could be taller than the other. One could be in hockey all day while the other was in a piano recital. The twenty fives year old males could both be on the same soccer team but one is a vegan and the other will be enjoying a post-game meal at Boston Pizza. While both individuals need insulin to live the amount of insulin that they need will vary in every one of those situations.
It is just as impossible to prescribe one insulin treatment for one person. As one person with diabetes discovered, there are over 42 things that can influence blood glucose readings. There is the fat content of a meal. How many grams of carbohydrates are in the meal? What activity level occurred before the meal? How active will the person be after the meal? What was their blood glucose level before they ate? Are they coming down with a virus? Are they menstruating? Do they feel stressed at work? The list goes on making the “take 2 units a day and call me in the morning” adage impossible to follow.
Instead of injecting a long-acting insulin, the pump administers small amounts of insulin on a regular basis throughout the day. The amount of insulin it delivers is decided on based on a number of factors. These factors are examined by both the person’s diabetes team and the person with diabetes themselves. They examine blood glucose and/or a continuous glucose monitor readings. This is the same way that a person on injections will decide if they need to inject more long-acting insulin.
An insulin pump also allows delivery of insulin for meals and the correction of high blood glucose levels. Instead of injecting a syringe of insulin into their body, a person with diabetes is able to do the calculation with the help of their pump. They then tell the pump how much insulin he/she needs based on previous glucose readings, trending arrows on a continuous monitor, amount of carbohydrates in a meal, planned activity levels, and much more.
Insulin Pumps do not think
As Dr. Peter Senior stated, the insulin pump does not think for you. It will help you to make decisions but it is just a machine. Machines malfunction. As pumpers, we understand this but as Dr. Senior also states “Type 1 diabetes carries life-long risks regardless of how people with the condition choose to receive their insulin.”
We understand that machines can fail. We can only imagine the heart-break of the families who were interviewed for these articles. The diabetes community is very familiar with how deadly diabetes is no matter what method of delivery you use.
If you spend any time in the Diabetes online community, you will quickly know whenever a member passes. A sea of blue candles will appear on your feed. Our hearts break. We know all to that it could be us. It may very well have been a friend.
We understand that diabetes is not about the jokes or the memes about Starbuck’s drinks. It is a careful balance of diet and insulin and never knowing when something will tip the scales.
To manage that balance, we need tools. Tools like insulin pumps that carefully mimic the insulin delivery of the pancreas. We need tools like continuous glucose monitors that now tell us and our insulin pumps what blood glucose levels are in real time and are able to track if they are rising or falling. This ability to predict glucose readings can help to avoid further impairment.
Impairment like the 1445 incidence of hyperglycemia mentioned in the articles. Hyperglycemia is a very real threat when you use an insulin pump. There is no background insulin. If you infusion set kinks inside your body (this is the piece that delivers insulin under the skin), you will not be getting the proper amount of insulin and blood glucose values will begin to climb.
A sensor in the body tracking glucose levels on a continuous basis tells the wearer that more insulin is required. They are able to stop, examine their infusion set, the insulin pump, their activity level and diet to decide the best course of action. It might be changing their infusion set. It could mean injecting insulin through a syringe. There could be a problem with the insulin pump. This complete system allows a person with diabetes to more quickly access the issue before they begin to suffer the cognitive impairment that can accompany high blood glucose levels.
Checks and balances
Checks and balances for medical technology are very important. Devices such as insulin pumps must be thoroughly tested and reviewed before being approved for use. Companies must be held accountable for their customer service and providing proper education to their clients.
The recent media stories, however, creates fear in the wrong place. The CBC and its partners need to understand that diabetes is unlike most other diseases. Most people with diabetes walk around and look like everyone else. They fix your plumbing, teach your children, climb mountains and run countries. You might see their pump or their glucose monitor sensor. What you don’t see however is the hundreds of life and death decisions that they make each and every day. You don’t see the challenges that they face. They often don’t see them either because it becomes part of who they are.
Please understand that diabetes is terrifying. Insulin pumps are simply helpful tools that allow our loved ones to live full and healthy lives. We need more access and understanding not more fear of something that is already well regulated.