September 24, 2004
Insulin Pumps, Other
Question from Washington, DC, USA:
I have been on the pump for about five months now. Although I had good control overall using injections (A1cs in the high 6s, low 7s), my blood sugar always bounced around a little too much for my comfort. I am 26 years old, have been a diabetic for 20 years without any complications. I am very active (a runner) and, if anything, have been getting thinner/more toned in the past few months. This is why I am puzzled to find that my basal rates continue to increase every few weeks. The increases aren’t substantial, but I am starting to wonder if I’m becoming insulin resistant. My basal doses started at 0.75 and are now at 1.2. I am pretty sure that my boluses are not the problem as my highs do not follow meals. Instead, I get high at strange times, like at 3:00 in the morning. Is it possible that I am becoming insulin resistant due to the pump?
Answer:
In order to accurately compare the pump to intermittent injections, you need to compare total insulin doses. A change of 0.4 u/hr over 24 hours is not a lot of insulin. Most patients have a 50:50 ratio of long-acting to short-acting insulin. Remember, you are trying to prevent those highs with the flexibility of the pump. I would not worry about the changes, especially if your weight is stable. They may not be exactly comparable.
JTL
