Is flexibility really needed? For many people with diabetes, it is. The alternative to flexible insulin availability is to attempt to control schedules, activity and food intake to match the available insulin. This is extremely difficult for most people. But even monumental efforts at maintaining a stable lifestyle doesn't always produce the desired results. Insulin needs vary for many reasons and in many ways, some of which are simply not within the control of the person with diabetes. Using the results of blood glucose monitoring to make and evaluate daily decisions, a pump user can respond to most such needs quite easily. Responding to the same situations may be difficult or even impossible with conventional insulin injections. With the pump, you get as close as is now possible to providing insulin as your body would if you didn't have diabetes.
Meal-Related Insulin Needs (Bolus Insulin)
If you didn't have diabetes, your body would release the insulin needed to handle everything you eat in EXACTLY the right amount and at EXACTLY the right time. The pump makes it possible to do the same thing. Of course, the process isn't automatic. YOU need to figure out how much carbohydrate you're eating and then decide what dose of insulin is needed, but you can give it with the pump: accurately, precisely and at the right time...before the meal, while you're actually deciding what and how much to eat. Just like the pancreas, you can give less insulin when you eat less and more when you eat more. You're not restricted to eating a certain amount of food because you took a certain dose of intermediate-acting insulin several hours ago. With the pump, you can respond to the immediate situation.
Non-Meal Related Insulin Needs (Basal Insulin)
People who don't have diabetes always have insulin in the bloodstream. The amount present between meals is very small, but that small amount is important for keeping the blood glucose level from rising between meals. On the other hand, if too much is present, the result would be a low blood glucose level. The risk for low blood glucose in people with diabetes is created by having too much insulin in the bloodstream at times when the amount actually needed is small... like between meals and overnight. The pump can do a much better job of meeting this need exactly, because it allows you to program in one or more rates of insulin delivery that will maintain your blood glucose level when you're not eating just like a person who doesn't have diabetes. This makes it possible to stop worrying about eating according to the clock. It also means that the blood glucose can be kept level while you sleep. The pump can prevent your blood glucose from falling too low because of insulin peaks in the middle of the night and from skyrocketing in the morning because the insulin injected the evening before is running out of steam just as your needs are rising around dawn (due to the dawn phenomenon).
Depending on your particular insulin requirements, the Paradigm® insulin pump can be programmed to deliver between one and twelve different basal rates per 24 hours. About 35% of people on pumps require just one basal rate for the whole day. Most people whose insulin requirements change during the course of a day need three basal rates: a daytime rate, a lower basal during sleep, and a higher rate of insulin in the dawn hours. The Temporary Basal Rate is a valuable feature which allows pump wearers to make short term adjustments to their basal insulin delivery. The MiniMed Paradigm® insulin pump can be programmed to adjust the basal rate in 0.05 unit increments and has the added flexibility of allowing you to select how long you want your basal rate adjusted. For example, most people lower their basal rate temporarily during exercise. So, if one Saturday afternoon you decide to go on a four-hour mountain bike ride, you can program the MiniMed Paradigm® insulin pump to deliver a reduced amount of insulin during that time. Then, four hours later, the pump will remember to automatically resume delivery of your permanent basal rates. The Temporary Basal Rate can also be increased to adjust for times of stress or illness. Some women who wear pumps program the MiniMed Paradigm® insulin pump to deliver a higher temporary basal rate on the first day of menses. The ability to make short term adjustments in the basal delivery of insulin is one of the most important advantages of insulin pump therapy. It allows people with diabetes to lead unpredictable lives and have different activity schedules each day, while still having predictable insulin delivery which you adjust on the spot -- as your schedule changes.
Flexible Response to the Unpredictability of Life
Very few people live totally predictable lives. Things change from day to day: you have to go in to work early one day and stay late the next; a meeting runs too long, delaying lunch; you get caught in a traffic jam and get home an hour and a half later than usual; you sit at a desk all week but like to hike on the weekends, and so on. The possibilities are as varied as the people who have diabetes. When these things happen to people on conventional diabetes treatment plans, the result is often worry, hassle and, ultimately, temporary loss of diabetes control. The pump can greatly reduce the worry and hassle of dealing with the variety of life, and can also help you protect your hard-won control in a great many situations which are hard to manage on injections. Meal delayed? No problem once your basal rate has been correctly set. Got an unexpected invitation to play tennis after work? OK. Just temporarily reduce your basal rate to avoid both hypoglycemia and the need to eat a lot of extra food to prevent it. Education and experience teach the pump user how to respond to these and other types of changes.
Flexible Response to Diabetes-Related Problems
Diabetes will throw you a curve on occasion. Sometimes, in spite of your best efforts, blood glucoses get out of range. This happens to everyone because many factors that affect blood glucose are beyond your control. With the pump, you can respond immediately to blood glucose outside your target range by adjusting the size of your next bolus to compensate for the high or low reading. Because you're using only fast-acting insulin, the response is quick. You don't have to worry about the interaction of extra bolus insulin with the peaking of intermediate-acting insulin injected earlier in the day. Or maybe you've lost some of the warning signs of low blood glucose and are having problems with frequent or severe low blood glucose reactions. The pump can help to stabilize your blood glucose patterns in a safe target range. What about sick days, those diabetes horror stories where the plain old flu can send your blood glucose to very high levels and make you prone to diabetic ketoacidosis? The pump allows you to program a higher basal rate during illness if it's needed to keep blood glucoses in check. And poor appetite or nausea are less of a problem during illness because you only need to give bolus insulin when you actually are able to eat or drink carbohydrate containing foods. Otherwise, you can rely on the basal rate to keep your blood glucoses in a reasonable range when you're feeling too queasy to eat. Taking advantage of these potential benefits of the pump will require added responsibility on your part, but our pump wearers tell us it's more than worth it. Having a pump means paying close attention to your diabetes, but you've done that before. The difference with the pump is that you can now get the very most out of all the effort you put into diabetes care.
