Diabetes Forecast

Tim Jones Uses an Insulin Pump to Reduce Lows

By Gina Roberts-Grey , , , ,

Terry Doran/Mittera

Name: Tim Tones
Age: 52
Hometown: Los Angeles, California
Occupation: Engineer
Diabetes: Type 1 since 1998

For nearly 20 years, Tim Jones treated his type 1 diabetes with NPH insulin that he injected using vials and syringes. But that plan was far from foolproof, and he experienced frequent bouts of low blood glucose (hypoglycemia). “I had to eat exactly four hours after using my NPH or my sugar levels would crash,” he says. “That regimen was very difficult to maintain because it’s tough to be so scheduled about meals and keep track of their timing.”

As a result, Jones says he “encountered a lot of timing and adherence problems.” But he stuck with that plan for a few years, until his endocrinologist switched him to a regimen of twice daily injections of long-acting insulin, plus rapid-acting mealtime insulin. That routine was part of Jones’ life until his long-acting insulin was discontinued.
The unavailability of his insulin brand prompted Jones to take a close look at his diabetes treatment routine and the way vials and syringes—and multiple daily injections—fit into his life. He took the opportunity to ask his doctor for more convenient alternatives. “My [endocrinologist] suggested I try an insulin pump,” he says.

Taking the Plunge

Insulin pumps are small, wearable, computerized devices that continuously release insulin into the body. Most devices use a flexible tube to deliver insulin from the pump to an infusion set needle or cannula, which inserts under the skin, often on the abdomen. Pumps draw from a reservoir of insulin (usually aspart or lispro), continuously delivering insulin into the skin at the pump’s infusion site. This supplies “basal” insulin and takes the place of long-acting insulins such as detemir and glargine. Pump wearers deliver a dose of insulin at mealtimes as well, which is referred to as a “bolus” dose. It’s based on a premeal blood glucose reading and the carb content of the meal. Wearing a pump helped Jones gain greater control over his health. As soon as he started using an insulin pump, he noticed a difference in his diabetes management. “Almost immediately, I got my A1C down into the 5 percent range,” he says. “Now it’s 6.1 or 6.2.”

The ability to easily adjust his insulin delivery helped with frequent hypoglycemia, too. “I had so much more minute-to-minute control, and the pump drastically reduced my incidences of low blood sugar levels to almost none,” he says. “I experienced hypoglycemia often when I was giving myself injections. Since going on a pump, I have [low blood glucose] maybe once a year.”

There are other reasons some people with diabetes prefer an insulin pump to injections: Mealtime insulin can be delivered with the press of a button and with the help of a dose calculator. And users can change a pump’s basal rate to adjust the amount of background insulin they receive throughout the day based on factors such as sickness and changes in activity levels. Jones finds that particularly useful.

Because exercise can cause blood glucose levels to go low, when he’s at the gym or taking a brisk walk, Jones now has the flexibility of setting a temporary basal rate, which tells his pump to deliver less basal insulin for a short period of time. “I like to walk 2½ miles when I come home from work, so I’ll set a basal rate at 75 percent of my normal rate,” he says. “When I’m going to do heavier activity like running, I adjust the basal rate to 50 percent. I no longer have to worry about my glucose levels dropping too low.”

Using an insulin pump has also trimmed his dry cleaning bill. “When I was giving myself injections with syringes and vials, I’d occasionally bleed through my shirt and had blood spots on my clothes,” he says. “I felt like I stuck out, which was annoying and embarrassing.”

After several years, he updated to a new insulin pump, this time opting for a pump that uses an integrated continuous glucose monitor (CGM) to also measure his glucose level in real time. He has two insertion sites—one for his pump’s infusion set and another for his CGM sensor—but all glucose data is sent to his pump. Jones finds such device communication essential to having a keen grasp on his health and making sure his diabetes is properly treated.

Location, Location, Location

About 10 years after he started pumping, Jones started to have unexpected high glucose levels. Despite rotating where he inserted his infusion sets on the front of his abdomen, scar tissue had formed, and it affected absorption. “I’d put a set in and think I was pumping just fine, but my sugars went high and weren’t going down.” Complicating the situation was the development of an allergic reaction to the adhesive tape used to hold the set in place on his stomach.

Jones talked to his doctor about both of these issues in order to sidestep future problems. He has followed his doctor’s advice about site rotation. He also uses a clear, flexible barrier beneath his infusion set to prevent the adhesive from coming in contact with his skin, which will, in turn, prevent him from developing another allergic reaction.

Jones has experienced a few other snags over the years. He switched to shorter tubing on his pump to keep it from catching on doorknobs. (With his insurance coverage, a tubeless pump isn’t in his future.) He has also had to juggle the contents of his pockets. “I can’t keep keys or my phone in the same pocket with my pump, as they’ll scratch it,” Jones says.

He admits he was uneasy about making such a drastic change to his insulin delivery treatment plan after 20 years of vials and syringes. But he’s glad he made the switch. “Once you get used to using a pump,” he says, “it’s something you don’t want to live without.”

  Download a full chart of insulin pumps and their features.



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