I am 29, Type 1, duration 16 years. The endocrinologist I saw last month recommended the insulin pump without even looking at my blood sugar readings. This to me sounds like a very drastic last resort measure. I do not want the pump unless it is the only thing left to try. I take Humalog and Ultralente. She says she has no patients on Ultralente. She says it is unpredictable. She made no comment on the new longer acting insulin glargine. When will glargine become available for public use? I want to try all that I can before resorting to pump therapy. I have had trouble with fasting sugars for seven years. Although the Ultralente has improved my overall control, it is still not as good as it should be. Should I hold out for glargine? Should i get a second opinion from another endocrinologist? I would sure hope that i do not have to resort to insulin pump therapy, but, if it is absolutely the only thing left then I will.

There is good evidence that taking insulin through a pump makes life more flexible and in addition improves control and diminishes the incidence of hypoglycemia. You would not however be the only person to still hesitate over committing to one. It could well though be the step that finally keeps your A1c below the 7% level.

In the meantime, with the help of your endocrinologist, it’s important to be sure that you’ve tried everything in the Humalog/Ultralente regimen. Have you for instance given the Humalog immediately after the meal so that you can adjust the dose for the pre-meal blood glucose as well as for appetite?

Glargine will probably not be available for another six months, a once a day injection is equivalent to NPH twice a day. In the meantime though it might help you to try to specify for yourself exactly what it is about a pump that you dislike so much so as to find out how to get around it and you might also see if your endocrinologist can arrange with a pump representative for the use of a loaner for a week or two which you could try out filled with saline. In the first few weeks after going onto a pump it’s important to have ready access to your doctor or an experienced nurse educator and if that is going to mean a change of diabetes care team you need to explore this now.

DOB
Additional comments from Dr. Tessa Lebinger:

If your control is suboptimal and you don’t want to try the pump, I would suggest two things to discuss with your endocrinologist:

Adding a small amount of lente either before supper or bedtime to try and improve the fasting blood sugar.
Taking a mixture of Humalog and Regular before each meal.

TGL