By: Alan Schorr
In addition to being a big hit for people with type 1 diabetes, it is my opinion that insulin-pump therapy can be beneficial to type 2s as well.
People with type 2 diabetes can be difficult to treat. Some individuals can be treated with diet alone, while others are treated with medications. There are, however, type 2 patients who require the use of insulin with or without the addition of oral agents. These people, like type 1s who are insulin-dependent, are ideal candidates for the pump.
Why a Pump is Right for Certain Type 2s
The use of an insulin pump should be considered in type 2 individuals who require large dosages of insulin. Pumps use only fast-acting insulins, which are more predictable than longer-acting insulins, such as NPH or Lente, which can vary up to 52 percent of each injected dose. This allows the pump to more closely match insulin need to insulin action.
Some type 2s also require large amounts of insulin. If you inject large amounts of insulin, it can create a pool or “depot” under the skin. This depot can be mobilized with activities and lead to unexpected hypoglycemia. Pumps deliver in slow, controlled pulses and virtually eliminate this pool-again leading to better insulin absorption.
I have started approximately 25 people with type 2 diabetes on the insulin pump. All have had success.
The success of pump therapy in people with type 2 diabetes depends on patient selection, as well as the enthusiasm of the patient. In addition, communication between the physician, patient and pump educator is very important, as well as the implementation of a comprehensive training program.
Finding the Right Physician
If you have type 2 diabetes, it is important that your physician be experienced in pump therapy and able to discuss its pros and cons with you. He or she should be willing to give you a choice of pumps and provide you with all specifications of the five pumps available by the three different pump companies.
By doing so, you will be able to make an informed decision regarding your treatment and your chances of success will be increased.
What Does a Prospective Type 2 Pumper Need to Bring to the Table?
To succeed on the pump, type 2s must depend upon similar criteria as type 1s. These include:
- the ability to perform glucose monitoring three to six times per day
- the ability to determine the amount of insulin prior to their meals via carbohydrate counting
- the ability to not be concerned that there is a device on them that reminds them that they have diabetes, and
- the desire for good BG control.
Any patient who wishes to start pump therapy receives 10 or more hours of intensive education prior to the initiation of pump therapy by a certified insulin pump trainer, diabetes educator and dietitian. Most of these patients have had insulin requirements of 100 units or more per day-many with requirements exceeding 300 units per day-and have used both insulin and oral agents.
With the use of pump therapy, insulin requirements have decreased an average of 15 to 20 percent in most type 2s. Several of the patients have been able to decrease the use of oral agents as well.
What About the Corresponding Weight Gain?
One of the main “pluses” of an insulin pump is the ability to have flexibility with meal planning and scheduling. However, since insulin is a hormone, some diabetic patients who take insulin increase their weight an average of five to 10 pounds.
Adherence to a diet is a must in treating type 2 diabetes who are using insulin – either by a pump or by injections.
What if a Type 2 Starts Pump Therapy and Wants to Stop?
In my own practice, I have not had anyone discontinue the use of insulin-pump therapy. If for some reason, either personal or medical, the pump needs to be discontinued, the patient should be placed on a multiple-dose insulin regimen and control needs to be reestablished. Frequent monitoring of BGs is essential with any change in therapy.
Does Insurance Cover Pumps for Type 2s?
Insurance companies in my area have paid for the insulin pump as long as documentation is given regarding the patient’s adherence to diet, insulin regimen and BG control.
Some pump companies will help you with the insurance process by verifying your insurance and helping to gather the necessary documentation. However, your physician may need to call the medical director to personally facilitate the approval of the pump. The case managers may not fully understand the seriousness of the situation and a physician-to-physician conversation usually solves the matter with minimal aggravation.