Doctors Arent Completely Pumped by Insulin Pumps
â??You can be stupid and be OK on a pump, but it"s better if you"re smart." By [Joseph Alexiou] This past July, the New England Journalˆ of Medicine released a study showingˆ that people with Type 1 diabetes's theˆ metabolic disease with high levels ofˆ blood sugar caused by the body"s inabilityˆ to produce insulin's were able to moreˆ effectively reduce their levels of bloodˆ sugar using insulin pumps than theˆ traditional self-injection method. According to the report, authoredˆ by Richard M. Bergdenstal, Williamˆ V. Tamborlane, Andrew Ahmannˆ and others, the level of glycatedˆ hemoglobin's the scientific name of theˆ blood sugar test often called the A1C byˆ most diabetics and endocrinologists's in 485 patients aged 7 to 70 was reducedˆ on average from 8.3 percent to 7.5, aˆ much more acceptable level. Twenty-sevenˆ percent of pump-therapy patientsˆ were able to reduce their A1C to underˆ 7 percent, which is essentially the Holyˆ Grail of acceptable sugar levels for Type 1ˆ patients. Only 10 percent of self-injectingˆ patients could achieve this. So why is it, with 700,000 New Yorkersˆ affected by diabetes, we don"t hear moreˆ about the use of insulin pumps versusˆ traditional injection methods? Are theˆ pumps not as effective as studies claim, orˆ are we only now starting to benefit fromˆ the efficacy of these marvels of modernˆ medical technology?ˆ â??The technology, in general forˆ patients with diabetes, has improvedˆ dramatically in the last 10 years, said Dr.ˆ Joel Zonszein, a director of the Clinicalˆ Diabetes Center at the Albert Einsteinˆ College of Medicine's a division of Montefiore Medical Center in the Bronx.ˆ â??But I always say that the pump will beˆ only as good as the person who"s usingˆ it. Patients think, â??OK I get a pump, anˆ automatic pilot." But really, they are veryˆ labor intensive. Insulin pumps are small electronicˆ devices made up of a syringe and a motor-drivenˆ screwdriver. The patient attachesˆ the pump to a catheter, which he or sheˆ has inserted into his or her skin using aˆ needle, allowing a continuous deliveryˆ of fast-acting insulin. This plastic tubingˆ must be changed everyˆ three days, but the constantˆ stream of insulin allowsˆ for patients to easily adjustˆ their level of intake for mealˆ portions, exercise and otherˆ factors that longer-termˆ self-injection insulin makeˆ more complicated. And the amount ofˆ needle sticks, which is usually three to fiveˆ injections daily by patients who use theˆ traditional method, are much reduced. While diabetes experts like Dr.ˆ Zonszein and Dr. Daniel Lorber, anˆ associate professor at the Weill-Cornellˆ Medical and an instructor at the Newˆ York Hospital in Flushing, Queens, agreeˆ that there are advantages to using theˆ insulin pumps, â??There"s no such thing as treatment without negatives, saidˆ Dr. Lorber in a recent phone interview.ˆ â??Pumps take work, they require logic andˆ brain power's you can be stupid and beˆ OK on a pump, but it"s better if you"reˆ smart. According to Dr. Lorber, using theˆ pump also requires patient training,ˆ which has more of a learning curve andˆ can take at least a full day of trainingˆ from a practice educator in the mostˆ sophisticated of diabetes medicalˆ practices. Beyond the training, thereˆ are two serious negatives for pump use:ˆ the risk of infection from improperlyˆ sanitized catheters; and mechanical pumpˆ failure's a patient who stops receiving theˆ constant stream of fast-acting insulin canˆ quickly develop complications of diabeticˆ ketoacidosis, an affliction of diabetics withˆ symptoms including falling into a coma. Other cons of pumps include theˆ cost's an extra $10,000 a year, which isˆ often covered by insurance, but also the emotional and psychological weight ofˆ being attached to a machine. The size ofˆ pumps has certainly been reduced sinceˆ they were introduced in the early 1990s,ˆ but â??there"s an emotional response andˆ resistance on being machine dependent, ˆ said Dr. Lorber, who, in the face of all theˆ negatives, sees them as minimal risks. â??If Iˆ had Type 1 diabetes I"d be on a pump in aˆ hot minute. Dr. Zonszein is more cautious in hisˆ view of the pump, and believes that theˆ effectiveness of the treatment is mostlyˆ a result of the patient"s efforts, and lessˆ the technology. He sees the extra cost, noˆ small number, to be a lot to pay for whatˆ he believes is â??not such a big increaseˆ in efficiency. Unlike the findings inˆ the study cited above, Dr. Zonszein"sˆ patients's 80 percent of whom use aˆ pump's are rarely able to reduce theirˆ A1C below 7 percent, regardless of theˆ method they use for insulin delivery. Ultimately, according to Dr. Zonszein,ˆ the best way to treat diabetes is to mimicˆ the deficient human system as best asˆ possible: a mechanical pancreas implantedˆ in the pelvic region, secreting insulinˆ directly into the central venal system.ˆ This kind of technology has been underˆ development as long as insulin pumps,ˆ but an effective version is years away fromˆ completion.