Thursday, 5 April 2012

Disadvantages to insulin pumps

I am very strong advocate of using an insulin pump, for type I diabetics, although, I am not blind to the disadvantages that are inherent in them.  I will briefly discuss each of the disadvantages I can think of.  After all, when you are deciding if the pump is right for you, you want to be able to see both sides of the story.

1. Expense: Right off the bat, this can be a prohibitive factor for some people.  An insulin pump can run you $5,000 and more, and that is just for the pump.  Insulin pump supplies (for things like cannulas, tubing, and reservoirs) can cost in the area of $3,000, annually.  These costs are in addition to those that you will still have to pay for your other diabetic care regimes, such as blood glucose testing strips.  Many countries realize the cost that diabetes is going to have on the public funds in the near future in terms of health care for diabetes not managed as well as it should be.  For this reason, many places are funding the purchase of insulin pumps, allowing people (who meet certain requirements) to either pay nothing or a minimal portion of these costs.  Some insurance companies are also starting to come around and pay for the pumps, as well, in countries where the costs are not picked up by the government. 

2. Diabetic ketoacidosis: A shortage of insulin being supplied to the body forcing your body to switch to burning fatty acids and producing ketones (in high doses, ketones are poisonous).   Obviously this is also an issue under regular syringe therapy, as well, if you leave your diabetes unchecked and unmanaged.  The same thing can happen with an insulin pump if you leave your diabetes unchecked and unmanaged.  The risks of this occurring with your insulin pump relates to the fact that your insulin pump simply supplies you with fast acting insulin, so if you have no insulin delivery for a number of continuous hours, and let your blood sugar raise to dangerously high levels, you are at risk of ketoacidosis.  Reasons that your insulin pump may stop delivering insulin for hours on end include:
- your battery dying
- a kink or puncture in your tubing
- run out of insulin in your reservoir
- some sort of technical malfunction (these are mini computers, and something could happen)
Your insulin pump will have alarms for most of these items, and it is incumbent upon you to adhere to these alarms and pay attention to them.

3. Scar tissue build-up: I discussed this previously in that you must make sure you rotate the insertion points for your cannula.  This is a bit of plastic inserted under your skin, and your body will develop scarring around the site as it is inserted to your skin for up to three days at a time.  You must make sure you rotate your insertion point to avoid a build up of this scar tissue, which will hinder insulin absorption. This is true, however, for regular syringe therapy, as well.

4. Allergic to adhesive: some people will be allergic to the adhesive used by some suppliers.  This is generally not a huge issue as you can choose from other suppliers in most cases, and most pumps will offer a trial period of their pump at first and if you notice that you are allergic to the adhesive and cannot find another type of adhesive, you can return the pump and use another.

5. To be careful when involved in rough sports: Depending on the sport, or other activity you are involved in, you may have issues with the tubing or wearing of your pump, in that the cannula could get pulled out or get tangled up in your activity.  There are ways to ensure your pump and tubing are out of the way of "dangerous areas" or a host of other solutions you can either discuss with your diabetes educator or pump supplier.

6. Weight gain: this is the issue that I suffered from the most when I started on my pump.  In the months preceding my insulin pump adoption, I lost a large amount of weight, despite eating really anything I wanted to.  If you are reading this blog, you know a few things about diabetes and know that isn't right.  My blood glucose control was not good and my HA1C test proved that.  When I got on the pump, my blood glucose levels came under tremendously better control, allowing my body to properly process the food I was eating.  When I kept my same eating habits, my body held onto what I was eating, because of my better control.  I therefore gained a lot of weight.  However, I am now less likely to have future diabetic related health problems in the future.  Now I just have to worry about losing the weight again in a healthy fashion!

While it is true there are a few disadvantages to pump usage, overall, I still am very pleased with how relatively seamlessly the pump became an integrated part of my life.  I am lucky to live in a province in Canada where the pump purchase was paid for by the province and the supplies are subsidized.  Expense is really the biggest inhibitor of insulin pump adoption, in my mind.  Having that obstacle removed has added years to my life and improved my quality of life dramatically, of that I am certain.

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