Insulin Pumps May Work Better Than Shots In Type 1 Diabetes

young man looking into the camera(BlackDoctor.org) — A new evidence review suggests that using a pump to deliver insulin continuously — instead of taking three or more daily injections — might result in better control of blood sugar for people with type 1 diabetes.

“The findings of this review tell us that both continuous subcutaneous insulin infusion and multiple injections correct blood glucose levels. However, [continuous infusion] may be better for reducing harmful fluctuations in blood glucose,” said lead author Marie Misso, Ph.D.

Type 1 diabetes — which used to be known as juvenile diabetes — results when the pancreas is not able to secrete enough insulin, causing the levels of glucose (or sugar) in the blood to rise.

Chronically high blood glucose can lead to heart attacks, circulation problems and blindness. Low levels can lead to unconsciousness and even death. Type 1 diabetes is one of the most common chronic diseases of childhood.

Most people with the condition control their glucose by injecting themselves with insulin three or more times per day. Others choose to use a pump, which gives continual, smaller doses of insulin without the discomfort of injections.

“There are numerous studies that evaluate these treatments, but most are of poor quality,” said Misso, a research fellow at the Monash Institute of Health Services Research in Clayton, Australia. “So there has been uncertainty about which treatment is best for maintaining consistent levels of blood glucose and reducing harmful fluctuations.”

In the new review, Misso and colleagues analyzed the results of 23 studies that assigned 976 adults and children to one of the two interventions randomly. Researchers looked at measures such as levels of hemoglobin A1c (or HbA1c), a widely used marker for assessing long-term glucose control. They also looked at the incidence of both high and low blood glucose.

The review appears in the latest issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

While participants using the insulin pump had significantly lower HbA1c levels than those using multiple daily injections, no differences existed between the two for non-severe low blood glucose levels. However, there appeared to be a reduction in severe incidents of low blood glucose among those using the pump.

“Good evidence is now available to support the use of continuous subcutaneous insulin infusion in the appropriate patient. It is essential to consider adverse events, late complications of diabetes, mortality and cost when deciding whether [a pump] is appropriate for the patient,” Misso said.

For people who likely have to deal with their condition for the rest of their lives, convenience is another consideration that comes into play.

The advantages of using the insulin pump include being able to avoid possibly painful injections several times a day. In addition, pumps administer the medication without the user having to find a private place to give the injection.

The downside to pump use includes having to wear it like a pager or cell phone throughout the day, concerns about protecting the tubing that goes into the body –– although wireless pumps have recently come on the market –– and worries about breaking the pump during rough play or exposure to water.

Ramin Alemzadeh, M.D., director of the Diabetes Program at the Children’s Hospital of Wisconsin in Milwaukee, cautioned that although the researchers reported pumps might improve glucose control overall, pediatric patients should not expect major changes in the longer-term control of blood glucose.

“In our experience, we don’t see a significant overall blood glucose improvement beyond six months or one year of treatment in most children and adolescents. Initially, the patient’s HbA1c levels improve, but after a while levels begin to rise and are not significantly different from where they started,” Alemzadeh said. “A patient’s diabetes management starts with them and their family. How well they do is independent of which method of insulin administration they use.”

The review discloses that one of the co-authors has received compensation for lectures and advisory board participation from companies who make insulin or insulin pumps. His department has also received funding for research and educational activities from these companies.

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What Is Gastroparesis?

female student working on a laptop(BlackDoctor.org) — Gastroparesis is a diabetes-related condition where the stomach cannot empty itself of food in a normal fashion. Most often, gastroparesis occurs in people with type 1 diabetes; however, it can also occur in those with type 2 diabetes. Most sufferers have had diabetes for at least 10 years and have other complications of diabetes.

What causes gastroparesis in diabetes?

Gastroparesis is caused by damage to the vagus nerve, which regulates the digestive system and makes muscles function. Diabetes is a leading cause of gastroparesis, accounting for about one-third of cases. Damage to the vagus nerve keeps the muscles of the stomach and intestine from functioning properly. In gastroparesis, food remains in your stomach because it is not processed and pumped through the intestines.

Other causes of gastroparesis include:

• Viral infections
• Abdominal surgery with injury to the vagus nerve
• Medications such as narcotics and some antidepressants
• Amyloidosis (deposits of protein fibers in tissues and organs) and scleroderma (a connective tissue disorder that affects the skin, blood vessels, skeletal muscles, and internal organs)

What are the symptoms of gastroparesis in diabetes?

The symptoms of gastroparesis linked to diabetes include:

• Heartburn or reflux (backup of stomach contents into the esophagus)
• Nausea
• Vomiting undigested food
• Poor control of blood sugar in diabetes
• Feeling full quickly when eating
• Abdominal bloating
• Poor appetite and weight loss

What are the complications of gastroparesis in diabetes?

If you have diabetes and gastroparesis, you should be aware of the following complications:

• Food that stays in the stomach for a long time can spoil, which can lead to the growth of bacteria.

• Food in the stomach can harden into a lump called a bezoar. Bezoars can cause blockages in the stomach that keep food from moving into the small intestine.

• Gastroparesis can cause additional health problems for people who have diabetes. When food finally does leave the stomach and enter the small intestine, there is a rise in blood sugar levels. Gastroparesis can make it difficult for the person with diabetes to control his or her blood sugar levels consistently.

• In severe cases, daily vomiting may occur.

How is gastroparesis diagnosed in diabetes?

If you have diabetes and your doctor suspects gastroparesis, he or she will review your symptoms and medical history with you. Your doctor will also perform a physical examination and may order certain blood tests, including blood sugar levels. Your doctor will want to make sure an obstruction is not the cause of your symptoms. Tests used to diagnose gastroparesis may include:

What is the treatment for gastroparesis in diabetes?

Just like diabetes, gastroparesis is a chronic (long-lasting) condition. This means that while the treatment usually doesn’t cure the gastroparesis (or diabetes), you can still manage gastroparesis and its symptoms.

People who have diabetes should try to control their blood sugar levels to minimize the problems of gastroparesis. For instance, if you have diabetes, you may want to change when and how often you use insulin, and check your blood sugar levels more often. Adjusting your diet may also help to alleviate your symptoms of gastroparesis.

Talk to your doctor about discontinuing/changing medications that might worsen gastroparesis, such as some antidepressants, high blood pressure drugs, or certain medications used to treat diabetes.

Should I change my diet with gastroparesis and diabetes?

• If you have diabetes, one of the best ways to help control the symptoms of gastroparesis is to vary when and how you eat. For instance, instead of three meals a day, you can eat six small meals. In this way, there is less food in your stomach; you won’t feel as full, and it will be easier for the food to leave your stomach. Another important factor is the texture of food; liquids and low-residue foods are encouraged (for example, applesauce should replace whole apples with intact skins).

• With gastroparesis, you should also avoid foods that are high in fat (which can slow down digestion) and fiber (which is difficult to digest).

What is dumping syndrome?

Diabetes makes you susceptible to dumping syndrome. Dumping syndrome produces symptoms like gastroparesis. With dumping syndrome, you might feel uncomfortable after eating high-sugar/high-fat foods with symptoms of lightheadedness, rapid heart rate, cramping, nausea, sweating, and fatigue. People with severe cases of dumping syndrome may experience weight loss and even malnutrition.

Contact your doctor if you develop signs and symptoms of gastroparesis or dumping syndrome.

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