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May 6, 2005

Insulin Pumps, Type 2

Question from Australia:

Can you tell me if it's possible for type 2 diabetics, insulin dependent, to find success using an insulin pump? Or, is this unheard of?

Answer:

Indeed, there are patients who are being treated with insulin and are using continuous subcutaneous insulin pumps as a means of delivering that insulin. However, there are some things that make therapy with an insulin pump problematic in patients with type 2 diabetes. First, because of the marked insulin resistance, insulin requirements are greater (on average) for patients with type 2 diabetes. That means they infuse more insulin per unit time and would have to change their infusion site more often because they are filling the reservoir on the pump more often. Second, insurance companies don’t fund this as easily. Third, it is important not to overtreat with insulin to prevent weight gain for patients with type 2 diabetes. This last is a relative contraindication. I have seen pumps used successfully in patients with type 2 diabetes.

JTL
Additional comments from Dr. Alan Schorr:
I have about 50 individuals with Type 2 diabetes using insulin pump therapy quite successfully. The choice is up to the patient and her/his willingness to improve glucose control. I do not find difficulty in obtaining insurance approval, except for Medical Assistance programs. There, I have to infrequently talk to the Medical Director or CEO to set things straight so to speak.

Certain of the smaller pumps may not be ideal for an individual with type 2 diabetes: you would want a cartridge with 300+ unit capability to allow you to change less frequently. You also may start to see pumps used in conjunction with the newer drugs such as Symlin and Byetta (exanitide). These medications will lower the insulin requirements and may make pump therapy in type 2 patients more effective.

I would not be discouraged by either a physician or insurance company who tells you that someone with type 2 diabetes is not a candidate for pump therapy—they are most certainly successful if you have the desire and work ethic.

ABS