Thursday, May 31, 2012

Insulin Pump Therapy vs. Shot Therapy

What is Type 1 Diabetes?

From the Animas (our pump company) website:


In type 1 diabetes, the body no longer produces its own insulin. Insulin is created in the pancreas by 
cells called beta cells. When a person develops type 1 diabetes, these beta cells are being destroyed 
through an autoimmune response.

Insulin is necessary for the body to be able to correctly use blood glucose. Without insulin, blood glucose can't be used, so the body doesn't get the energy it needs.

Without insulin, blood glucose simply stays in the blood stream. A normal blood glucose level — that is, in a healthy person without diabetes — is about 100 mg/dL. It is not uncommon, however, for a person with type 1 diabetes to have blood glucose levels four to six times that amount at the time of diagnosis! These high blood glucose levels leave the person dehydrated, thirsty, hungry, rapidly losing weight, drowsy and often nauseated. In extreme cases, a person might become unconscious. A resulting condition called diabetic ketoacidosis, if not treated immediately, can even lead to death.

When you have type 1 diabetes, you must inject insulin. The discovery of insulin in 1922 was a landmark in medical history. Before injectable insulin was available, type 1 diabetes was fatal. But medical insulin makes it possible for people with type 1 diabetes to live long, healthy lives.


When TJ was diagnosed (at 15 months), his blood sugars were in the 700's. His current target blood sugar range is from 100-200. 


He had a lot of those symptoms. He was insatiably thirsty, peed through every single diaper, went from 1 nap to 3 naps a day, lost 3 pounds, and was lethargic any time he was awake. The Spirit definitely prompted me to order a blood test. This was out of the ordinary wrong. Yes, he had just gotten over the common cold and had his immunizations and an ear infection, but this was different.



Diabetes was always a disease that I avoided learning about in school because I thought it was too complicated with high and low blood sugars and pancreas and insulin and glucose and I just didn't want to wrap my head around it. While in the ICU at Children's Medical Center here in Dallas, I asked the doctors to explain diabetes to me like I was a 5 year old. I really just wanted to understand at least what was going on with my son. Here's how they described it (if the other description was still too much):

Your pancreas makes insulin which is a hormone that acts as a key to your cells. Cells have doors that need to open to bring in sugar. That sugar can then be used as energy once inside the cell. If you stop making insulin, your cell doors are never opened and never get the sugar to make energy (that's the reason why he was so lethargic). The sugar stays in the blood and makes you sick.

Type 1 diabetics are insulin dependent in that they don't even make any insulin. Type 2 diabetics are insulin resistant in that their cell doors don't open because their insulin isn't working. They need insulin shots at times as well and many take pills to get their body to use the insulin properly.

Explain multiple daily injections (MDI, or shot therapy).

Initially we managed TJ's diabetes using shots. We would draw up insulin into syringes from a vial and then administer the shots he needed. It was at LEAST 4, but sometimes 5 or 6 shots a day, not including checking his blood sugar/glucose (BG) that many times or more with finger sticks and getting a blood drop.

The needle on the syringe is really small and just hurts right when it goes into the skin. It doesn't produce any blood because it only goes into the fatty tissue under the skin where there are no blood vessels.

For the first few months, TJ's schedule became very strict. Things had to happen at certain times of the day. He had to eat a certain amount of carbs for every meal, no more, no less. If he wasn't that hungry, we'd be feeding him cookies to get his carb amount up to the right point. If he was starving after that many carbs, we'd be trying to substitute cheese and ham (or other 'free' foods, aka 0 carbs), hoping that they would be enough.

If he had a snack or meal, he could not have ANY more carbs for 2 full hours. That schedule is hard on anyone, but especially hard for a toddler or young child.



What does a pump do to help?

Now with the pump, his number of sticks goes from 12-16 shots in 3 days to ONE! The one poke is to insert the cannula, or a catheter, a little plastic, flexible tube that stays under the skin. Then the pump administers tiny bits of insulin like an IV would at the hospital. The fluid insulin travels from the pump cartridge that houses all the insulin through a tube and into his fatty tissue just under the skin.

It monitors everything except his actual BG, although some pumps have a separate feature which can check your blood sugar every 5 minutes, 24 hours a day. 

Pumps simplify the process of delivering insulin and calculating the right dose for the right amount of carbohydrates (which, when digested, always turn to sugar). With shots we would have to count the number of carbs he ate, divide that by his insulin to carb ratio (how many carbs does 1 unit of insulin cover) at the moment, round to the nearest 0.5 of a unit, fill a syringe with that much insulin and then give him a shot. 

Now with the pump, we enter in how many carbs he ate into the pump electronically and it tells us how much insulin he will get down to the nearest 0.025 of a unit. We accept that and it delivers the insulin into his body. Done.

After we reset all his ratios and doses and fine tune exactly what he should be getting for his lifestyle, he will be able to eat whenever he wants, even if it's right after a normal meal.

Please comment and ask any questions that you may need clarified or want covered in the next blog post.

Thanks for prayers or donations for a cure









No comments:

Post a Comment