Type 1 diabetes mellitus (DM) is a condition in which the pancreas cannot produce insulin. As a result, the body cannot use sugar correctly; unused sugar accumulates in the blood, leading to serious complications. In the mid-1980s, the first insulin pumps started becoming available. Today’s pumps consist of a reservoir of insulin and a small, programmable pump that continuously delivers insulin under the skin. Insulin pumps eliminate the need for daily injections, allow insulin therapy tailored to a patient’s lifestyle, and may improve patients’ control of their blood sugar. However, several disadvantages should be noted.
Hypoglycemia
If the patient using an insulin pump incorrectly programs the pump to deliver too much insulin, the level of sugar in the blood will drop. If this occurs, the patient has hypoglycemia–abnormally low levels of sugar in the blood. Symptoms of hypoglycemia include dizziness, lightheadedness and loss of consciousness. In patients who are “pumpers” (users of insulin pumps), this mistake may occur in several ways. First, patients may input the incorrect amount of insulin necessary with a meal. Secondly, patients may give themselves multiple “boluses” of insulin over a short period of time; if this occurs, the combined amount of insulin may be too much and lead to hypoglycemia. Finally, if patients give themselves insulin and then go exercise, this combination may lead to hypoglycemia.
Ketoacidosis
Ketoacidosis is a life-threatening emergency that occurs when levels of sugar in the blood become abnormally high. This is a known complication of insulin pumps and can occur if, for a variety of reasons, delivery of insulin is interrupted. For instance, if the tubing that is inserted under the skin becomes kinked or twisted, insulin cannot be delivered. Another potential reason for interrupted insulin delivery is that the insertion site is scarred, so the insulin does not absorb well. Finally, if a person takes off the pump and forgets to reconnect it, insulin will not be delivered, and ketoacidosis could develop.
Site Insertion-Related Disadvantages
One of the disadvantages of using an insulin pump is that the insulin must be delivered under the skin using clear tubing. A needle is quickly inserted with the tubing, then removed so only the tubing remains under the skin. The tubing must be replaced every 2 to 3 days. Several side effects of insulin pumps relate to the insertion site. First, there is the risk of bleeding and bruising at the site–if the tubing is inserted at the wrong angle, bleeding under the skin can lead to bruises. Secondly, if an area is repeatedly used as an insertion site–for instance, it is often recommended that the abdomen be used to provide the best absorption of insulin–a small area of scar tissue could form at the site. Perhaps the most important disadvantage that is related to the insertion site is that of infection: every time a needle is inserted into the skin, there is the risk of bacteria entering the site and causing infection. In severe cases, this could lead to formation of an abscess, which is a collection of pus surrounded by a region of inflammation.
Psychosocial and Lifestyle-Related Disadvantages
Some of the most significant disadvantages of the insulin pumps are not medical but have impact on daily life nonetheless. An obvious disadvantage of the insulin pump is a sense of self-consciousness. A person who uses insulin injections can discretely give herself an injection, but the pump user is a bit more “in the spotlight.” A pump-user is always wearing what looks like a pager and occasionally needs to press buttons on it. The tubing may be visible under the clothing. None of these scenarios are horrible–they are simply potentially uncomfortable. In addition, certain changes in lifestyle may accompany wearing the pump. A woman wearing a pump may find it harder to wear dresses. Men and women may be unsure how to deal with intimacy and pump-wearing. Finally, the performance of certain sports, such as swimming, might have to be changed–most pumps are not water-proof.
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