I am a type 1 diabetic with celiac disease and hypothyroidism. I was originally diagnosed as a type 2, but when treatment with Glucophage put me in the hospital with an 800+ mg/d [44.4+ mmol/L] blood sugar, the diagnosis of type 1 was made. Nine years later, I am still on injections of Humalog and Lantus. Whether I am strict with my diet and exercise or not, I struggle with my A1c. Having a very hectic schedule makes me a “problem” patient. I had inquired about the pump several years ago, only to be told by my endocrinologist that I needed to gain tighter control first. The more I study about the pump, the more I think it is the answer for me. My question is not if you agree (I know you won’t prescribe), but instead what do I go in armed with to my next appointment with a doctor who is knowingly anti-pump?

It is a bit of a contradiction that pump therapy is recommended only for those with good control as this may not be possible or control could be improved by the new insulin delivery system in the form of the pump. What we tell our patients is that they need to be more knowledgeable about diabetes self-care skills. In your case, the celiac disease may make it more difficult for you to have good control and this might be made better with pump therapy. As a checklist, we make sure our patients monitor frequently, learn to do carbohydrate counting, are responsible for reporting back to the care providers, show some ability to problem solve, and have initiative to learn new techniques. If you can do these things, especially with a hectic schedule, you could be a good candidate for a pump. You may be seeing a physician that is not as enthusiastic about this form of treatment.

JTL