I have had type 1 diabetes for 30 years, I take two to three shots per day, and I am on a sliding scale. I do take the same dose within a range of 5 units, depending on my glucose levels. Currently, the only complications I have is beginning neuropathy in my legs, and there are two to three days out of the month where I feel very ill due to high/low fluctuations. I am very athletic and exercise.

I have seen a physician within the past year, but not an endocrinologist, and I am considering an insulin pump. Would switching to an insulin pump make my diabetes more manageable? Would it add years to my life?

We have discussed the pros and cons of insulin pumps in detail on this site. Some people find it improves their control, others don’t. The only way to find out is to try it. Anything that improves your control may theoretically add years to your life, though there is no guarantee.

Whatever you do, it seems you want to find a way to minimize the extreme fluctuations in blood sugar that actually make you feel sick. Even if you can’t get perfect control (and most people can’t no matter how hard they try), you shouldn’t feel sick. Sometimes trying too hard can actually give you more fluctuations (i.e., chasing down high blood sugars too aggressively leading to severe lows which then can lead to temporary increase in blood sugar sometimes with ketones (“rebound hyperglycemia” or the Somogyi Effect).

Often, (but not always), taking smaller amounts of insulin more frequently and trying to match insulin with food intake (for instance taking a fast-acting insulin before every meal) may decrease the swings from high to low. The major advantage the pump has over multiple daily injections is the ability to adjust the basal insulin dosage more frequently during the day, for instance during exercise when basal insulin requirements may decrease significantly.

So, I would certainly discuss the pros and cons of multiple daily injections versus the pump with an endocrinologist. At the very least, you might want to try taking the new long-acting basal insulin Lantus once a day and Humalog or NovoLog before each meal. If you eat three meals per day, this would require four shots per day as Lantus can’t be mixed in the same syringe as any other insulin.

If this solves the problem, and you don’t want the hassle of wearing a pump (some people think it’s less hassle and others think it is more hassle than multiple injections), you don’t have to try the pump. If you want to try the pump, it is very easy to go from Lantus once per a day with premeal fast-acting insulin to the pump.

TGL