4 ms·

I have type 2 diabetes and I've always been a bit envious of insulin pumps, not because I love having a machine plugged into my body (I don't), but because they

by ThJ 8y ago

I have type 2 diabetes and I've always been a bit envious of insulin pumps, not because I love having a machine plugged into my body (I don't), but because they offer better control of blood glucose peaks, since they use fast-acting insulin exclusively. The pancreas secretes insulin in pulses and pumps can mimic that. What has turned me off from pumps (apart from doctors generally not recommending them for type 2 diabetes) is the lack of a sensing mechanism. This DIY system sounds absolutely perfect. It could keep my blood glucose perfect at all times. At the moment, I'm injecting in the mornings and the evenings and have little control over my peaks apart from adhering to a strict diet (and we all know how hard that can be), and every peak does a little bit of damage to my eyes, nerves, etc. I've always wanted to have a more sophisticated treatment option, and this may be it.

ThJ 8y ago
Why don't doctors recommend them for type 2 diabetes? Well, my general impression is that doctors live under this illusion that patients will somehow succeed in making lifestyle changes that will cause the disease to go into regression or disappear altogether. Also, they prefer to try medications like glucophage before they resort to insulin. There just seems to be less eagerness to finely manage type 2 diabetics, maybe because it is felt that the patient is partly to blame for the disease, whereas type 1 diabetics are innocent victims of their own immune systems. I honestly don't know what they're thinking. An artifical pancreas would vastly improve the situation for type 2 diabetics too.
- bcatanzaro 8y ago
  I’ve heard that Type 1 diabetes is due to lack of insulin (malfunctioning pancreas) while Type 2 diabetes is caused by too much insulin (leading to insulin resistance.) If this is true, insulin pumps for Type 2 diabetes don’t help, because they can only add more insulin, when the fundamental problem isn’t lack of insulin, but lack of response to insulin.
  - pragone 8y ago
    That's more or less it on the dot! Edit: I'd add that type 2 is associated with increasing insulin resistance, causing the pancreas to work harder. Over time, this can cause the pancreas to essentially burn out, at which point exogenous insulin would be needed. Type 2 diabetics who are able to manage the associated risks - namely diet and exercise, almost universally focused on losing weight - can often improve or even reverse the disease altogether. I'll also add that this is not the entire discussion of diabetes. There's an increasing recognition of forms of diabetes outside of the known definition of type 1 and type 2. A so-called "type 1.5" is being further delineated and may explain why some type 2s don't behave the way we think they should.
  - gumby 8y ago
    That is the general characterization, though insulin is prescribed for some "type 2" patients, so the situation is more subtle than that.
  - randcraw 8y ago
    No matter who you are (T1, T2, neither), you die without insulin. It's the only way to remove glucose from the blood. Most T2's are resistant to the normal level of insulin in the blood, and must compensate by introducing ever more insulin until it reaches a high enough level to overcome the resistance and it acts to absorb glucose. Normally this is done through medications that either 1) increase the amount of insulin your pancreas secretes, or 2) decrease your insulin resistance (via the liver, IIRC). As such, most T2s maintain a higher continuing level of insulin than non-T2s. Thus an insulin pump like that in the article will work for both T1s and T2s alike, but the insulin dose for T2s simply will be higher than for T1s.
    - hycaria 8y ago
      No, you can also pee glucose away if over renal reabsorption capacity.
      - anon47389567 8y ago
        Renal treshold is around 180 mg/dL, at which point glucose level is alerady toxic and if not treated will lead to long-term complications.
- medymed 8y ago
  From a 2013 [1] paper, one obstacle may be getting the government or private insurance to pay for it outside of type I DM. Exceptions noted were France and Israel. In the U.S. only an exceedingly limited percentage of patients would be able to pay for the device and long-term supplies out of pocket. Until that changes, there may be little motivation for widespread adoption (until for example a large study is published in NEJM or JAMA showing extreme benefit). Many patients are able to achieve stable control of their glucose and HbA1c on metformin (Glucophage) alone. However especially for type II DM patient needing insulin, finely controlling glucose levels might reduce long term risks as mentioned above and in the paper [1], and a pump might indeed be far superior to the typical injected insulin regimen. Interestingly, there are trials on clinicaltrials.gov about pumps in type 2 DM sponsored by MedTronic (which makes sense) [2]. As a disclaimer, I am not an endocrinologist or internal medicine guy at all. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920779/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920779/ [2] https://clinicaltrials.gov/ct2/show/NCT01182493 https://clinicaltrials.gov/ct2/show/NCT01182493
- gumby 8y ago
  > my general impression is that doctors live under this illusion that patients will somehow succeed in making lifestyle changes > Also, they prefer to try medications like glucophage before they resort to insulin. A couple of points: 1- the targets set by associations like the ADA actually assume the patients won't be able to make significant lifestyle changes; for example the ADA A1C targets are higher than for healthy patients. The diet changes they preach are not that radical, e.g. cake is bad for you but you can have a really tiny slice and offset it by not eating bread. This belief isn't that unreasonable; FDA requires that medical labeling be targeted at a 5th grade reading level. 2 - And glucophage is much easier for patients to manage than insulin both in dosing regime and simply caring for the drug. 3 - Finally the insurance companies' actuaries have figured out that maintenance therapy of this nature has the best cost/outcome ratio. To that last point: I had "adult onset type 1" due to an autoimmune condition. The endocrinologist I was sent to was only interested in maintenance therapy and not at all in looking for root cause, even though I presented with a body fat of about 14%. She finally admitted that even if she did look into it the insurance companies would hassle her for going off the reservation without a good excuse. But my no-insurance primary doctor and I and a rheumatologist were able to dig into root cause and now I am "cured" (of diabetes at least) thanks to treating the underlying condition (note: this is glossing over a lengthy period of unpleasant work). Which is actually cheaper for the insurance companies, but honestly how many patients have the training to be able to be involved in their care to this degree?
  - ffgdgggg 8y ago
    If you don’t mind me asking, what was the underlying condition? I’m fascinated by endocrinology and rheumatology. We know so little!
  - peanutz454 8y ago
    I think quite a few people will be interested in knowing how did you cure yourself.
  - inetsee 8y ago
    I have latent autoimmune diabetes in adults (LADA), sometimes called type 1.5 diabetes. Onset was in my early 40s, and I am now insulin dependent. I have reasonably good control (estimated A1C about 6.5) without a continuous glucose monitor and insulin pump. I have been looking into the Freestyle Libre glucose monitor to get better monitoring of my glucose levels, but the cost is still quite high. I would really like to know more about how you and your doctors cured your condition.
- morganherlocker 8y ago
  Along with what others have noted, there is also risk associated with insulin therapy from hypoglycemia (low blood sugars). Low blood sugars can be deadly for type I diabetics, killing as many as 1 in 10[1]. This is at least one of the factors leading to insulin being a tool of last resort, and in fact, insulin is prescribed to type II diabetics with especially strong insulin resistance. http://care.diabetesjournals.org/content/35/9/1814 http://care.diabetesjournals.org/content/35/9/1814
- mtgx 8y ago
  Why don't more people realize this one simple logical conclusion: pumping more insulin into your body is going to end-up killing you. Sure, it will kill you more slowly than you'd die if you didn't get that insulin in the short-term, but it's definitely not a "solution". Diabetes is caused by insulin resistance. What do you think more insulin is going to do to your body in the long-term? The ultimate/only good solution is to make you insulin sensitive once again.
  - lolc 8y ago
    That's a commendable goal with type 2 diabetes. Still, therapy will start with insulin to normalize glucose levels. Sad fact: patients that don't manage to change their liefestyle or are too far into the disease will stay on insulin until they die.
- sfifs 8y ago
  > Well, my general impression is that doctors live under this illusion that patients will somehow succeed in making lifestyle changes that will cause the disease to go into regression or disappear altogether. Well in the last 3 months, I DID learn new eating habits, lost 15 kilos and had my meds cut from 6.5 tablets per day to 0.5 tablets a day working with a doctor and having good control on blood sugar. The big AHA is that progressive changes have to be made in how you eat rather than necessarily so much in what you eat. In general, unless you have significant beta cell death already, it IS possible to mitigate or reverse effects of type 2 diabetes and this is vastly preferable to pushing organs beyond limits through drugs or insulin.
  - kamaal 8y ago
    My mom has diabetes. I am interested in knowing what diet changes did you make. Only asking as it would be helpful for others.
    - taksintikk 8y ago
      keep it simple..Start with cutting out processed sugars and carbs/bread/rice. Maybe sub with alcohol sugars if needed.
    - sfifs 8y ago
      Basic principle is to try to build new habits of how we eat gradually changing only 1 or 2 things every week and re-enforcing what works/cutting what doesn't. Typical diets (in my community) are 70 percent carbs, 30 percent veggies. We started by basically reversing this ratio. We also completely eliminated sugar & processed carbs (ie. flour - basically no breads & only whole grains) - but apart from this, I didn't fundamentally change what I ate. Then we progressively started reducing eating window over 10-12 weeks to < 6 hours in a day and started adding 2/3 day fasts. However, there are many routes & it works best if customized to individual.
    - pdfernhout 8y ago
      Here is a recent book on the topic by Dr. Joel Fuhrman: "The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes". A more general book with good advice on nutrition that is perhaps easier to follow -- but not specific to diabetes -- is "The Whole Foods Diet: The Lifesaving Plan for Health and Longevity" by John Mackey , Alona Pulde, and Matthew Lederman. Good luck to you and your mom! It helps a lot in making lifestyle changes when family, friends, and neighbors are supportive. See also the book "The Blue Zones of Happiness: Lessons From the World's Happiest People" for a bigger picture view on that. Good sleep is another part of the puzzle -- see Matthew Walker's book "Why We Sleep: Unlocking the Power of Sleep and Dreams" on that. Essentially, good sleep gives you better self-control during the day -- as well as helping your health in many ways including regarding diabetes.
- consp 8y ago
  This is mainly because of the total cost. Pills and (minor) insulin intake is usually sufficient, especially if combined with some minor lifestyle changes. Big changes can probably delay the requirement of most medication if detected early. But most people go to doctors way too late if it's not free and thus causes more damages in the end. This is simply a cost question. In countries where the healthcare gives out the required pumps/injectors and medication for 'free', it is usually a cost/benefit tradeoff. On the other hand: Not providing proper insulin dispensers costs a lot more in the end. The world has moved from simple throw away injectors (i mean the ones with no proper dosage dispensers and bottles as a storage medium) for years and the benefits far outweigh the cost of relatively simple modern injectors or pumps. > maybe because it is felt that the patient is partly to blame for the disease Since there is a very big spread in onset age even for overweight people it would be very bad for a doctor to have these kind of thoughts
- sametmax 8y ago
  > will somehow succeed in making lifestyle changes that will cause the disease to go into regression or disappear altogether Well, isn't that a sane first approach ? I mean, yes, if it fails, find a workaround. But I don't see how __healing__ is a bad objective for a doctor.
- nradov 8y ago
  It's not entirely an illusion. Some patients do succeed in making lifestyle changes that cause type 2 diabetes to go into remission. But the best results have been achieved with healthcare providers actively helping patients make dietary changes on a frequent basis. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33102-1/fulltext?elsca1=tlpr https://www.thelancet.com/journals/lancet/article/PIIS0140-6... https://link.springer.com/article/10.1007%2Fs13300-018-0373-9 https://link.springer.com/article/10.1007%2Fs13300-018-0373-...

by ThJ 8y ago

ThJ 8y ago

Why don't doctors recommend them for type 2 diabetes? Well, my general impression is that doctors live under this illusion that patients will somehow succeed in making lifestyle changes that will cause the disease to go into regression or disappear altogether. Also, they prefer to try medications like glucophage before they resort to insulin. There just seems to be less eagerness to finely manage type 2 diabetics, maybe because it is felt that the patient is partly to blame for the disease, whereas type 1 diabetics are innocent victims of their own immune systems. I honestly don't know what they're thinking. An artifical pancreas would vastly improve the situation for type 2 diabetics too.

bcatanzaro 8y ago
I’ve heard that Type 1 diabetes is due to lack of insulin (malfunctioning pancreas) while Type 2 diabetes is caused by too much insulin (leading to insulin resistance.) If this is true, insulin pumps for Type 2 diabetes don’t help, because they can only add more insulin, when the fundamental problem isn’t lack of insulin, but lack of response to insulin.
- pragone 8y ago
  That's more or less it on the dot! Edit: I'd add that type 2 is associated with increasing insulin resistance, causing the pancreas to work harder. Over time, this can cause the pancreas to essentially burn out, at which point exogenous insulin would be needed. Type 2 diabetics who are able to manage the associated risks - namely diet and exercise, almost universally focused on losing weight - can often improve or even reverse the disease altogether. I'll also add that this is not the entire discussion of diabetes. There's an increasing recognition of forms of diabetes outside of the known definition of type 1 and type 2. A so-called "type 1.5" is being further delineated and may explain why some type 2s don't behave the way we think they should.
- gumby 8y ago
  That is the general characterization, though insulin is prescribed for some "type 2" patients, so the situation is more subtle than that.
- randcraw 8y ago
  No matter who you are (T1, T2, neither), you die without insulin. It's the only way to remove glucose from the blood. Most T2's are resistant to the normal level of insulin in the blood, and must compensate by introducing ever more insulin until it reaches a high enough level to overcome the resistance and it acts to absorb glucose. Normally this is done through medications that either 1) increase the amount of insulin your pancreas secretes, or 2) decrease your insulin resistance (via the liver, IIRC). As such, most T2s maintain a higher continuing level of insulin than non-T2s. Thus an insulin pump like that in the article will work for both T1s and T2s alike, but the insulin dose for T2s simply will be higher than for T1s.
  - hycaria 8y ago
    No, you can also pee glucose away if over renal reabsorption capacity.
    - anon47389567 8y ago
      Renal treshold is around 180 mg/dL, at which point glucose level is alerady toxic and if not treated will lead to long-term complications.
medymed 8y ago
From a 2013 [1] paper, one obstacle may be getting the government or private insurance to pay for it outside of type I DM. Exceptions noted were France and Israel. In the U.S. only an exceedingly limited percentage of patients would be able to pay for the device and long-term supplies out of pocket. Until that changes, there may be little motivation for widespread adoption (until for example a large study is published in NEJM or JAMA showing extreme benefit). Many patients are able to achieve stable control of their glucose and HbA1c on metformin (Glucophage) alone. However especially for type II DM patient needing insulin, finely controlling glucose levels might reduce long term risks as mentioned above and in the paper [1], and a pump might indeed be far superior to the typical injected insulin regimen. Interestingly, there are trials on clinicaltrials.gov about pumps in type 2 DM sponsored by MedTronic (which makes sense) [2]. As a disclaimer, I am not an endocrinologist or internal medicine guy at all. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920779/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920779/ [2] https://clinicaltrials.gov/ct2/show/NCT01182493 https://clinicaltrials.gov/ct2/show/NCT01182493
gumby 8y ago
> my general impression is that doctors live under this illusion that patients will somehow succeed in making lifestyle changes > Also, they prefer to try medications like glucophage before they resort to insulin. A couple of points: 1- the targets set by associations like the ADA actually assume the patients won't be able to make significant lifestyle changes; for example the ADA A1C targets are higher than for healthy patients. The diet changes they preach are not that radical, e.g. cake is bad for you but you can have a really tiny slice and offset it by not eating bread. This belief isn't that unreasonable; FDA requires that medical labeling be targeted at a 5th grade reading level. 2 - And glucophage is much easier for patients to manage than insulin both in dosing regime and simply caring for the drug. 3 - Finally the insurance companies' actuaries have figured out that maintenance therapy of this nature has the best cost/outcome ratio. To that last point: I had "adult onset type 1" due to an autoimmune condition. The endocrinologist I was sent to was only interested in maintenance therapy and not at all in looking for root cause, even though I presented with a body fat of about 14%. She finally admitted that even if she did look into it the insurance companies would hassle her for going off the reservation without a good excuse. But my no-insurance primary doctor and I and a rheumatologist were able to dig into root cause and now I am "cured" (of diabetes at least) thanks to treating the underlying condition (note: this is glossing over a lengthy period of unpleasant work). Which is actually cheaper for the insurance companies, but honestly how many patients have the training to be able to be involved in their care to this degree?
- ffgdgggg 8y ago
  If you don’t mind me asking, what was the underlying condition? I’m fascinated by endocrinology and rheumatology. We know so little!
- peanutz454 8y ago
  I think quite a few people will be interested in knowing how did you cure yourself.
- inetsee 8y ago
  I have latent autoimmune diabetes in adults (LADA), sometimes called type 1.5 diabetes. Onset was in my early 40s, and I am now insulin dependent. I have reasonably good control (estimated A1C about 6.5) without a continuous glucose monitor and insulin pump. I have been looking into the Freestyle Libre glucose monitor to get better monitoring of my glucose levels, but the cost is still quite high. I would really like to know more about how you and your doctors cured your condition.
morganherlocker 8y ago
Along with what others have noted, there is also risk associated with insulin therapy from hypoglycemia (low blood sugars). Low blood sugars can be deadly for type I diabetics, killing as many as 1 in 10[1]. This is at least one of the factors leading to insulin being a tool of last resort, and in fact, insulin is prescribed to type II diabetics with especially strong insulin resistance. http://care.diabetesjournals.org/content/35/9/1814 http://care.diabetesjournals.org/content/35/9/1814
mtgx 8y ago
Why don't more people realize this one simple logical conclusion: pumping more insulin into your body is going to end-up killing you. Sure, it will kill you more slowly than you'd die if you didn't get that insulin in the short-term, but it's definitely not a "solution". Diabetes is caused by insulin resistance. What do you think more insulin is going to do to your body in the long-term? The ultimate/only good solution is to make you insulin sensitive once again.
- lolc 8y ago
  That's a commendable goal with type 2 diabetes. Still, therapy will start with insulin to normalize glucose levels. Sad fact: patients that don't manage to change their liefestyle or are too far into the disease will stay on insulin until they die.
sfifs 8y ago
> Well, my general impression is that doctors live under this illusion that patients will somehow succeed in making lifestyle changes that will cause the disease to go into regression or disappear altogether. Well in the last 3 months, I DID learn new eating habits, lost 15 kilos and had my meds cut from 6.5 tablets per day to 0.5 tablets a day working with a doctor and having good control on blood sugar. The big AHA is that progressive changes have to be made in how you eat rather than necessarily so much in what you eat. In general, unless you have significant beta cell death already, it IS possible to mitigate or reverse effects of type 2 diabetes and this is vastly preferable to pushing organs beyond limits through drugs or insulin.
- kamaal 8y ago
  My mom has diabetes. I am interested in knowing what diet changes did you make. Only asking as it would be helpful for others.
  - taksintikk 8y ago
    keep it simple..Start with cutting out processed sugars and carbs/bread/rice. Maybe sub with alcohol sugars if needed.
  - sfifs 8y ago
    Basic principle is to try to build new habits of how we eat gradually changing only 1 or 2 things every week and re-enforcing what works/cutting what doesn't. Typical diets (in my community) are 70 percent carbs, 30 percent veggies. We started by basically reversing this ratio. We also completely eliminated sugar & processed carbs (ie. flour - basically no breads & only whole grains) - but apart from this, I didn't fundamentally change what I ate. Then we progressively started reducing eating window over 10-12 weeks to < 6 hours in a day and started adding 2/3 day fasts. However, there are many routes & it works best if customized to individual.
  - pdfernhout 8y ago
    Here is a recent book on the topic by Dr. Joel Fuhrman: "The End of Diabetes: The Eat to Live Plan to Prevent and Reverse Diabetes". A more general book with good advice on nutrition that is perhaps easier to follow -- but not specific to diabetes -- is "The Whole Foods Diet: The Lifesaving Plan for Health and Longevity" by John Mackey , Alona Pulde, and Matthew Lederman. Good luck to you and your mom! It helps a lot in making lifestyle changes when family, friends, and neighbors are supportive. See also the book "The Blue Zones of Happiness: Lessons From the World's Happiest People" for a bigger picture view on that. Good sleep is another part of the puzzle -- see Matthew Walker's book "Why We Sleep: Unlocking the Power of Sleep and Dreams" on that. Essentially, good sleep gives you better self-control during the day -- as well as helping your health in many ways including regarding diabetes.
consp 8y ago
This is mainly because of the total cost. Pills and (minor) insulin intake is usually sufficient, especially if combined with some minor lifestyle changes. Big changes can probably delay the requirement of most medication if detected early. But most people go to doctors way too late if it's not free and thus causes more damages in the end. This is simply a cost question. In countries where the healthcare gives out the required pumps/injectors and medication for 'free', it is usually a cost/benefit tradeoff. On the other hand: Not providing proper insulin dispensers costs a lot more in the end. The world has moved from simple throw away injectors (i mean the ones with no proper dosage dispensers and bottles as a storage medium) for years and the benefits far outweigh the cost of relatively simple modern injectors or pumps. > maybe because it is felt that the patient is partly to blame for the disease Since there is a very big spread in onset age even for overweight people it would be very bad for a doctor to have these kind of thoughts
sametmax 8y ago
> will somehow succeed in making lifestyle changes that will cause the disease to go into regression or disappear altogether Well, isn't that a sane first approach ? I mean, yes, if it fails, find a workaround. But I don't see how __healing__ is a bad objective for a doctor.
nradov 8y ago
It's not entirely an illusion. Some patients do succeed in making lifestyle changes that cause type 2 diabetes to go into remission. But the best results have been achieved with healthcare providers actively helping patients make dietary changes on a frequent basis. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33102-1/fulltext?elsca1=tlpr https://www.thelancet.com/journals/lancet/article/PIIS0140-6... https://link.springer.com/article/10.1007%2Fs13300-018-0373-9 https://link.springer.com/article/10.1007%2Fs13300-018-0373-...