Insulin Therapy - Part 1

In 1921, Dr. Fred Banting discovered insulin and developed the very first medicine to treat diabetes. After that discovery, insulin was injected once, twice or several times a day to control blood sugar. For those people with diabetes who need insulin to survive there are choices: insulin injections or the insulin pump. Diabetes, for people who make little or no insulin, is best controlled with a basal insulin that works nearly peakless throughout the day like Lantus or Levamir in addition to bolus injections that work for a short period of time after each meal like Novolog, Humulog or Apidra . If you are injecting yourself three to four times each day, you may want to consider the insulin pump.

The pump is a remarkable device that provides ultimate control for those people with Type 1 diabetes (who make little or no insulin) or those with Type 2 diabetes who now are taking many injections. With the insulin pump, you have a device that mimics your own pancreas' natural abilities with a steady flow of small amounts of insulin called the "basal". To improve blood sugar readings after a meal and to add flexibility to your food choices the pump allows you to deliver insulin as needed with a "bolus".

Just imagine, you wear a tiny, pager-sized device for 3-4 days that delivers insulin throughout the day like the pancreas would and it replaces 9- 16 injections in that time period. And when you eat meals or snacks, you program the device to deliver more insulin so your blood sugar won't spike. You can even use a "correction bolus" to lower blood sugar at any time of the day you find it to be higher than your target range. There are countless features to these pumps to help you avoid the many diabetes complications.

With the help of your diabetes healthcare team you will quickly learn more specifics. For example, there is an insulin to carbohydrate ratio that your healthcare team will set for you that allows you to bolus the amount of insulin you need for a particular meal or snack. Many people begin with a 1:15 ratio - this means that for every 15 grams of carbohydrates that you consume you need 1 unit of bolus insulin. If you eat 1 slice of bread worth 15 grams of carbohydrates then you would bolus 1 unit of insulin. But, if you decide you feel like 3 pieces of bread, you would bolus 3 units of insulin (1 unit for every 15 grams of carbohydrates eaten). It's easy and keeps you in the best blood sugar control imaginable. Fine tuning of this ratio can be done by your healthcare team by evaluating your blood sugar readings and food records.

Many options of pumps are available: Animas (IR-2020 and the IR-1000), (Accu-Check Spirit), Insulet (Omnipod - the only remote controlled pump without tubing), Medtronic (MiniMed Paradigm 522 and 722), Sooil Development (Diabecare II or the IIS) and Smiths Medical (Cozmo).

If you are taking multiple injections and are interested in achieving the best diabetes control with the most flexibility then you want to consider the insulin pump.