Endocrinology, Diabetes Questions Insulin Injections

Insulin injections vs. insulin pump?

My daughter doesn't like to inject her insulin. She does it, but it's only because she has to. The overall process just makes her feel uncomfortable, which is why I'm considering having her use an insulin pump instead. Do you think a pump would be more beneficial?

3 Answers

Pump requires a lot of training, she still needs to get injections, and also she needs to count carbs. The benefits will only be noted if she is engaged with her therapy
Yes it would. I don't know her age but she is probably old enough to wear it. Of course she will still have to stick her finger to get blood glucose values so she can control the pump unless you also get a continuous glucose sensor or a Libre sensor. I have diabetes & have worn a pump for 25 years. I wouldn't part with my pump for anything. I also use a Libre sensor so I don't even have to do finger sticks for blood sugar. If she is old enough to understand the pump & how to use it, I would not hesitate to get it with a sensor of some type.
One of the greatest discoveries in the history of medicine was the discovery of insulin in 1922 by an orthopedic surgeon named Frederick Banting and a medical student named Charles Best in the Physiology laboratory of a Scottish professor named J Macleod at the University of Toronto Canada. It was purified by a biochemist named James Collip. It was so wonderful that the fastest Nobel prize was awarded to Banting and Macleod in Nobel prize history. It was also sad that Charles best and J Collip did not share the Nobel prize for the discovery of insulin, though they share the money among four of them. One of the greatest ironies of modern medicine is that, Banting who was not successful as an Orthopedic surgeon and with out publishing a single scientific paper was able to claim one of the greatest glories of modern medical discoveries.
J Collip purified insulin was tried on a 14 years od dying patient named Leonard Thompson in 1922 at the Toronto Hospital Canada who was in diabetic coma. After the discovery of insulin Thompson lived another 13 years and died of complications of Pneumonia.
After the discovery of insulin many dying diabetic patients flocked to Toronto to get the wonderful medication called insulin from Banting before it become available world wide in industrial scale shortly . Before the discovery of insulin diabetes was a sentence of a slow death especially for type 1 diabetes. The primary treatment then was starvation (low carbohydrates). Starvation therapy was so cruel that it made patients live few week ?months but, changed the patients to a ghost as they slowly die.
After the discovery of insulin, Ely Lilly of Indianapolis and Novo Nordisc of Denmark made insulin available globally in a very short period of time. Diabetes treatment was then transformed from starvation therapy to insulin therapy world wide. A disease which was a death sentence was transformed to a disease with chronic complication. Different insulin types were developed. They were from pork or beef with lots of impurities. Short acting insulin and long acting, intermediate a acting insulin were advanced. Most diabetic patients were not well controlled. Acute and chronic complications of diabetes were rampant. Our understanding of diabetes started to broaden and the concept of insulin pump therapy was introduced in the 1960s. A prototype of insulin pump was developed similar to a backpack however a wearable insulin pump prototype was not developed until 1973. In 1976 manufacturing of was started. The 1980s human insulin was manufactured using Coli bacteria and animal insulin were abandoned slowly. Most of the complications of these insulins were also avoided. The 1980 also saw the advancement in genetic engineering, proliferation of diabetes gadgets and diabetes management. Home self monitoring blood sugar devices, ketone strips and insulin pump therapy became available. Acute and chronic complications start to decline as the management of diabetes continue to advance and advanced diabetes gadgets started to become widely available. The 1990 saw discoveries better designer insulins called long acting and fast acting insulins. Insulin pump therapy started to become better and reliable. Diabetes education, nutritional education, flexible insulin therapy and insulin pump therapy almost replaced the old insulins. From the mid nineties use of insulin infusion pump started to explode not only in adults but also in children and adolescents. At this time about (400,000 25% of type 1 diabetic patients (there are 1.3 million of them in the USA) and about (35,000 pumps) 0.1% type 2 diabetics patients are on insulin pump therapy. Most of the pumps are Medtronic insulin pumps. Animas, T slim and Omnipad are other examples in the USA. In the last 15 years continuous blood glucose monitoring systems (glucose sensors) have become widely available. AS the technology and our understanding of diabetes advances, these gadgets may be reliable replacement for capillary blood glucose (finger stick) testing in the future until we have a cure for diabetes.
Diabetes management has advanced so much from the days of starvation therapy and intramuscular injections of less purified animal insulin
to todays advanced different types of pure human insulin , insulin pumps, inhaled insulin (Afraza) and continuous blood glucose (monitoring systems) sensors. This is a tremendous progress in modern medicine short of finding a cure.
With todays advanced understanding of diabetes, better insulins and sophisticated gadgets, we can postpone or eliminated complications of diabetes that were rampant before the 1980s.
Today we can administer insulin in many different ways using many different insulin regimens and would get similar glycemic out come. The most important issue is to have fairly good understanding of diabetes, nutrition and how different insulins behave for the different foods we eat. Whether we use subcutaneous insulin injections using different insulin injection regimens, insulin inhalation or insulin pump therapy the glycemic out come would be comparable as long as we have a good understanding of the diabetes and its therapy. Todays insulins work similarly regardless of how the insulin is delivered. In the hand of knowledgeable patient or caretaker.
Though current insulin regimens may work similarly, they may not give us flexibility or may not be convenient for ever body or for our different circumstances. Therefore, since we have different advanced insulin regimens, sophisticated gadgets and delivery systems and means of insulin delivery, we can choose the one that fits our individual needs and circumstances. It is also important to note that every insulin regimen has advantage and disadvantage regardless of how good we use them.
some of the examples of insulin regimen would be fixed insulin therapy, flexible insulin therapy, insulin pump therapy and insulin inhalation therapy.
(1) fixed insulin therapy would be taking fixed amount of insulin for meals with or with out sliding scale for high blood sugar correction above target range. This can be accomplished using intermediate acting insulin NPH or long acting insulin (lantus, levemir etc.) with short acting (regular insulin) or fast acting insulin (Humalog, Novolog Apidra etc.), with or with out sliding scale for high blood sugar correction. These insulin regimens can be mixed or given separate (big) snacks are usually given. There is little flexibility in life style but good for some people and people with some circumstances. hypoglycemia and hyperglycemia are common if food portions are changed during meal time.
(2) Flexible insulin regimen; This is based on a basal bolus principle were insulin is given as a long acting insulin once or twice a day with peak less long acting insulins such as lantus, Levemire, Tresiba etc., and fast acting insulin based the amount of carbohydrate consumed and using correction for blood sugars above target. This regimen gives great flexibility with life style and controls diabetes much easier. Here multiple injections may be needed depending on the meals and snacks consumed. It is also very important to note that one may only use fast acting insulin with out long acting insulin as long as insulin is given more often (every three ours for food and for correction of blood sugars our of target >100mg/dl).
(3) insulin pump therapy; This is based on the basal bolus insulin therapy principle, the same as flexible insulin therapy. Here the basal insulin is a continues infusion of fast acting insulin and boluses of fast acting insulin delivered at each meal or snack time with correction for high blood sugars out of target at each meal, snacks and as needed. There is no long acting insulin is given here. The pump gives minute amount of insulin if necessary that are not possible by injection. The pump will give the greatest flexibility in those who have hectic life style and though who want to control their diabetes better. It may also be excellent for little children who graze through out the day and whose eating habits are variable. It would give small amount of insulin for the small food they eat to also correct blood glucose out of target. Pump site is changed every 2-3 days. unlike 4-5 injections a day in flexible insulin therapy. This will also be ideal for younger children and people with needle fear and phobia. Note also that 10% of the population have fear of needles and 1% have severe needle phobia.
(4) inhaled insulin therapy Afraza) will be beyond our discussion at this time especially in children.
Going back to your question: Is insulin pump more beneficial?. If you use it properly with good understanding, the pump is more advantageous than any insulin regimen available for children with type 1 diabetes at this time. If it is not used properly, it would not do better that any treatment regimen available.
There may be more going on with your daughter. Such as anger, denial, sadness, fear of needle/needle phobia and more, which are common with people with chronic illness or right after diagnosis with diabetes. She may need support and counseling at this time. As long as you control the diabetes, she needs to be told that she is perfectly healthy, and she can realize the American dream through hard work, and, that she could be one of the best and brightest in our society. Nothing will stop her. Not diabetes if you manage it well which is not hard to do. At this time you need to help her and walk her though this difficult time. Support and counseling would be important. The pump will be a good asset to have. Todays pumps are more advanced and more reliable. You can also include blood glucose sensors. Some of them are integrated to the pump it self. Therefore with the use of the pump you minimize injections. better quality of life, give insulin many times a day, give precise amount of insulin, document amount of insulin given etc.,
There are also some disadvantages such as pump failure, discomfort with wearing pump, scar tissue etc. These not a big barrier, but, inconvenience. If you add blood glucose sensors, it will help manage diabetes much better, though you don't have to. Remember that any insulin regimen will have advantages and disadvantages. Just think what will make your life and your child's life better.
Finally with good diabetes education and understanding insulin using any regimen will work with reasonably similar outcome. But flexible therapy is better than fixed insulin regimen and insulin pump therapy is superior than flexible insulin therapy for many type diabetic patients at least in my opinion.
Please discuss this with your doctor and diabetes educators and work as a team.
Good luck.