The Insulin Pump – Advanced Insulin Delivery

In high school during class, I saw one of my classmates fiddling with a small electronic device that resembled a pager. I asked her what it was and she told me it was an insulin pump. I then proceeded to ask her what it was for and she explained that it helped her manage her diabetes. I had no idea what any of that meant until I did my own research. I found that the greatest benefit of using an insulin pump is that it delivers insulin to the body throughout the day; this allows for more accurate and precise dosages of insulin, as well as better control of blood glucose levels. The downside of using an insulin pump is that the pump has to be carried at all times and serves as a constant reminder of the condition.

What is an insulin pump?

The insulin pump is not a new invention – it has actually been around since the 1970’s – and it continues to be used to effectively manage diabetes. It’s a small electronic device – about the size of a deck of cards – that helps to deliver insulin to a diabetic through the subcutaneous tissue. The pump consists of the main pump unit that holds an insulin reservoir. This is attached to a piece of thin tubing with a needle (cannula) at the end – the infusion set – which is connected into the subcutaneous tissue and held in place with an adhesive patch; it remains connected to the body and controls the amount of insulin delivered by the press of a button.

Insulin Pump Diagram
Insulin Pump Diagram from
http://www.diabetes.co.uk

The advantages of using an insulin pump

An insulin pump helps to deliver fast acting insulin throughout the day in order to keep blood glucose levels in a desired range. The rate at which an insulin pump infuses insulin is known as the basal rate and it can be set or changed at any time with the press of a button. Insulin delivery can be programmed to provide different amounts of insulin at different times during the day and night.

When more insulin is needed to address excess carbohydrates from a meal, it’s easily achieved through the push of a button. Insulin pumps can deliver a bolus of insulin in order to cope with high blood glucose levels.

One of the other popular benefits of using an insulin pump is that it decreases the number of injections compared to traditional delivery methods such as through a needle and syringe or an insulin pen. The infusion site is typically changed every two to three days compared to traditional insulin delivery methods that require multiple injections throughout the day.

The use of an insulin pump also helps to reduce the likelihood of hypoglycemia or low blood glucose levels. There is a greater risk of hypoglycemia when taking insulin through injections because larger dosages of insulin need to be taken at a single time. The steady flow of insulin helps to reduce the risk of hypoglycemic episodes which is especially helpful at night during sleep.

Disadvantages of using an insulin pump

Although insulin pumps have become very popular among people with diabetes there are still some drawbacks to to their use. Because the pump is attached to the body, it serves as a constant reminder to wearers and to others of the disease of diabetes.

Using an insulin pump also increases the risk of skin infection at the catheter site which is why the infusion site needs to be changed every two to three days.

Another concern when using a pump is that the cannula can come out from the infusion site which results in no delivery of insulin. This is one of the biggest issues of wearing an insulin pump because if it goes unnoticed for several hours, it can result in diabetic ketoacidosis.

Also not all insurance providers cover the cost of an insulin pump. Insulin pump therapy is more expensive compared to the traditional needle and syringe.

If using a pump is a possible solution for insulin therapy, then a few questions need to be asked:

  • Am I okay with having a device attached to me reminding me and everyone else that I have diabetes?
  • Am I comfortable with the device and operation of the pump?
  • Am I committed to checking my blood glucose levels at least four times throughout the day?
  • Am I ready to have a full understanding of insulin, carbohydrate consumption, and activity levels to solve problems related to my blood glucose?
  • Do I have a healthcare team that is experience with insulin pumps?
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Insulin Delivery 101 – Injections

Insulin Injection
Standard Insulin Syringe

Being a diabetic creates a life that a follows different sets of rules than non-diabetics. Management of blood glucose is an everyday event that can lead to catastrophic and even deadly outcomes if not properly addressed. Insulin is the hormone that helps the body use or store the blood glucose it gets from food. There are different types of systems for insulin delivery with each one having its own advantages and disadvantages. It’s important to determine the option that is most suitable for specific lifestyles.

Needle and Syringe

The most common form of insulin delivery for diabetics is by injection using either a needle and syringe or an insulin pen. Insulin injection also requires less education and training than the use of an insulin pump.

The most common and affordable insulin delivery is in the form of direct subcutaneous injections using a needle and syringe. The greatest benefit of this delivery system is the cost savings and the fact that insurances will provide coverage compared to other delivery systems like an insulin pen or pump.

The biggest difficulty however is that insulin delivery via needle and syringe is a very involved process taking multiple steps. It is also performed manually which can lead to possible errors; it’s up to the patient to make sure the proper dose is given.

Insulin Pens

Insulin Pens

Insulin pens have become more popular around the world with 95% of insulin-treated patients in Europe, Asia, Australia, and Scandinavia using pens. There are two different types of pen systems: durable and prefilled.

A durable pen has an insulin cartridge that can be replaced. Once the insulin cartridge is empty, the cartridge is disposed of and replaced with a new one. Prefilled insulin pens are also known as disposable insulin pens because they can be thrown away after use. The pen is prefilled with insulin and once the cartridge becomes empty, the entire system including pen and cartridge is discarded.

Insulin pens are very easy to use and one of the big advantages for using them is its ability to adjust the amount of units needed. Insulin pens feature an adjustable knob or dial – at the end of the pen opposite the needle – that can be calibrated to deliver variable units of insulin. Other advantages of insulin pens are the convenience of transportation, compared to a traditional vial and syringe. Insulin pens also provide more accurate dosages and are easier to use for patients that have motor skills or visual impairments.

Although they are easy to use and convenient to transport, insulin pens are usually more expensive than the traditional vial and syringe method and insurance coverage for insulin pens vary widely in the United States. It is also not possible to mix two different types of insulin (short acting and long acting) with a pen.

Injection of insulin via needle and syringe or by pen is the most common insulin delivery system and both take little education compared to more complicated delivery systems like an insulin pump. In the next segment, the discussion will be in regards to delivery of insulin using a pump.

See Clearly with Diabetes!

Diabetic Vision Loss
Seeing is believing and yesterday, I took for granted how lucky I am to have my sense of sight. I tried to put in my contacts yesterday and as soon as my they got close to touching my eyes, a burning sensation occurred – like soap in your eyes – that caused immense pain. I thought I had gotten soap on my contacts or some sort of residue on the lens; I tried at least five different pairs (I wear daily disposables from Acuvue) but it was the same result each time.

I ended up going to the local optometrist at Costco for a checkup and I explained my situation. After examination, she informed me that my eyes were indeed dry and I also had allergens on my pupil which was causing the burning sensation when putting on my contacts. She told me to use lubricating eye drops and just deal with the pain because it would go away once the contacts are in place.

From this experience in itself, I realized how lucky I am to be able to see and I wanted to point out the related dangers between having diabetes and the loss of vision. When diabetes is not being properly managed and blood glucose levels are out of control, complications to the eye can occur resulting in loss of vision and even blindness. In fact Dr. Gary Rankin who is an ophthalmologist at the Retina and Diabetic Eye Center explains that 80% of diabetics (type 1 and 2) will develop retinopathy – acute damage to the retina of the eye caused by damage of its blood vessels – within ten to fifteen years of being diagnosed with diabetes.

The three most common forms of eye diseases caused by diabetes are listed below:

Diabetic macular edema (DME) which is the build-up of fluid in the macula – the part of the retina controlling the most detailed vision abilities -due to leaking blood vessels.

Vitreous hemorrhage occurs when blood vessels in the retina leak into the vitreous space of the eye, which is filled with clear gel in the space between the lens and the retina.

Retinal detachment is the result of abnormal blood vessels stimulating the growth of scar tissue. Complete detachment of the retina to the back of the eye can occur resulting in vision loss.

Anatomy of the Eye
If you have diabetes, it’s highly recommended that you see an eye care professional such as an optometrist or ophthalmologist at least once a year and opt in for the dilated eye exam, which allows the eye care professional to look in the pupil to see inside of the eye more easily and determine if there is any damage to the retina.

Losing your vision may seem scary but diabetic retinopathy can be easily managed. The best way to prevent loss of vision by diabetes is to keep blood glucose levels in control. Keeping A1C levels under control at 7.0 or less is extremely important as it helps to reduce the risk of developing diabetic retinopathy. In fact the American Diabetes Association says that even if retinopathy develops, patients with tight control of their blood sugar tend to have mild, non-sight threatening retinopathy.

I can only imagine how difficult the experience of losing your sight must be. Being a diabetic creates a lot of “what if” thoughts but luckily, those what if’s can be controlled by smart and healthy choices. Remember to always keep blood glucose levels in check, eat healthy, exercise, and be grateful for the blessings bestowed upon us.

Holiday Eating with Diabetes

"Thanksgiving Dinner" by atl10trader is licensed under CC by 2.0
“Thanksgiving Dinner” by atl10trader is licensed under CC by 2.0

Personally, the fall and winter months are my favorite times of the year. The days get shorter, the weather gets cooler and the leaves begin to change color in anticipation to the new season and festive events. The main reasons that I am a fan of the fall and winter months are because they are jam packed with holidays, family get-togethers and plenty of delicious food! But as a diabetic, holidays can be a challenging time because of all the temptation presented not only by the variety of different eats but also by imbibing in drink as well. We all know diabetes doesn’t prevent us from enjoying in the holiday festivities and eating delicious food but as a diabetic, we just need to properly plan for such events and have a greater amount of self-control.

To enjoy holiday meals with friends and family, follow some of these tips to prevent over eating while indulging in the flavors of the season!

  • Eat breakfast and/or snacks earlier in the day; the idea of saving carbs for a big meal may cause blood sugar to be more difficult to manage
  • Take a walk or another exercise session the day to lower your blood glucose
  • Limit the servings of starchy foods (potatoes, yams, rolls, stuffing); rather select one of the items or smaller portions of multiple items
  • Select vegetables served raw, grilled or steamed rather than in creams
  • Choose zero-calorie drinks such as water, tea or mineral water instead of sodas and other sugary beverages
  • Limit the amount of alcohol and take it with food; one alcoholic drink is:
    • 12 fl oz of beer
    • 5 fl oz of wine
    • 5 fl oz of 80 proof spirit
  • Enjoy holiday sweets but enjoy them in small portions, eat them slowly and savor the flavor and texture
  • After a big meal, take a walk to enjoy the cool weather with family and friends while also burning calories and removing yourself from the temptation of holiday treat

Even though diabetes is a condition that must be dealt with everyday including the most tempting of times during the holidays, it does not prevent the simple enjoyment of holiday meals and get-togethers. By following these simple steps and focusing on proper food choices and self-control, holiday meals and parties can be a time of great joy with friends, families and delicious foods! Cheers to the upcoming holidays and enjoy them in moderation!

Additional Holiday Eating Tips

Holiday Eating Infographic

Diabetes in India – An Upcoming Epidemic

There has been a dramatic rise in the amount of people type 2 diabetes throughout the world due to longer life expectancy, obesity, and sedentary lifestyles. The prevalence of type 2 diabetes can be seen especially in developing countries such as India. In fact India hosts an estimated 35 million people with diabetes – the largest in the world – accounting for 8% of the total adult population.

From a scientific perspective, the question that needs to be asked is why diabetes is so prevalent in India. The answer is multifaceted with genetic factors, environmental influence like obesity typically associated with an increase in living standard and changes in socio-economic status causing the migration from rural India to more urban areas.

In fact there are patterns displaying the geographical distribution of diabetes in India; rough estimates show that the distribution of diabetes in rural areas is a quarter of urban populations for India and related subcontinent countries like Nepal, Bhutan, Sri Lanka and Bangladesh. Studies performed by the Indian Council of Medical Research revealed that areas of Northern India had a lower distribution of diabetes in the population.

Although diabetes is less prevalent in the rural population, diabetes treatment including screening, medication and education is also less available. The disproportionate allocation of medical resources, lack of education and illiteracy between urban and rural areas may be a cause of improper diabetes screening and preventive care services. This then results in patients not following diabetes management/protocol.

There are a number of other challenges that plague diabetes care in India such as lack of HbA1c test which determines the amount of glucose concentration in the blood. The unavailability of this test prevents proper insulin treatment for diabetes. Additionally, there is no consistency regarding Indian guidelines for diabetes treatment resulting in a wide variation of treatments across the country.

In India, diabetes continues to grow to epidemic proportions affecting family and society. Many factors are a cause of the increase in diabetes such as the migration from rural to urban areas, the economic boom and the related lifestyle changes but despite the prevalence of diabetes, there remains an insufficient amount of studies to investigate the details of the disease within the country, with geographical, socioeconomic and ethnic background playing a large role. The disease has become highly visible across all areas of society within India creating an urgent demand for research and intervention at regional and national levels In order to reduce the long term affects the disease will have in the future.

3 Best Winter Boots for Diabetics (Part 2)

And we’re back with part 2 in our discussion of the best winter boots for diabetics! You can find Part 1 of our discussion here, which focuses on winter boots for men. To recap, there are a couple of major differences that make diabetic winter boots different from normal boots which are the extra depth construction and removable insoles – standard features in diabetic footwear – allowing the use of prescription orthotics for a personalized fit.

Today, we’ll be focusing on diabetic winter boots for women. Standard features that winter boots need to have include a waterproof construction to keep feet dry and a heat retaining interior to keep feet warm; additional features that are of benefit are durable outsoles with aggressive tread patterns.

Best Women’s Winter Boots for Diabetics – P.W. Minor Women’s Tribeca – $154
PW Minor Tribeca

P.W. Minor Women’s Tribeca wins the competition! If you don’t mind spending a little more for a high quality boot, this is the go to choice because of its lightweight construction. These chukka boots have a waterproof, full grain leather upper to keep feet dry; it also has a Thinsulate lining for extra warmth and a Dri-Lex treatment to control odor and keep feet feeling fresh. The boot is available five different widths from Narrow (2A) all the way up to XX-Wide (4E) which is perfect for a variety of foot types. The full length insole helps to cushion each step and it can also be removed to use personal orthotics.

  • Waterproof, full grain leather upper
  • Thinsulate lining with Dri-Lex treatment</li
  • Full length, removable insole with Dri-Lex cover</li
  • Biomechanical rubber outsole that is slip resistant for everyday settings

Runner Up – Propet Women’s Madison Strap – $90
Propet Madison Winter Boots for Women
The Propet Madison Strap is a great winter boot for diabetics not only because of the price point at $90 but also because of the many features to keep feet feeling great during the winter season. The Sealtex waterproof construction keeps water from entering while the Vaporex lined insole helps to maintain a warm interior temperature. What’s also great is the extra volume construction that provides a deeper fit thanks to the removable insole and extra insole spacer. For people that have difficulty putting on boots, the adjustable hook-and-loop strap is perfect because it creates an extra large opening for easy on and off. The boot is also available as a lace-up.

  • Nylon upper with Scotchgard treatment for salt resistance
  • Hook and loop closure and faux shearling lining
  • Sealtex Waterproof construction
  • Extra Volume construction
  • Removable, heat retaining Vaporex insole

Honorable Mention – Drew Women’s Glacier – $195

glacier

It was a close competition but the reason I think that the
The Drew Glacier receives honorable mention as it’s created as a hiking/trail boot rather than strictly as a winter boot. It has a waterproof nubuck and textile upper and a waterproof lining, however now insulation to keep feet warm during the winter. The aggressive tread on the outsole provides excellent traction even on hard packed snow; added and double depth construction provides a very deep shoe to fit prescribed orthotics. The Drew Shoes Glacier is available in the Narrow (2A) width up to the X-Wide (3E) width.

  • Waterproof nubuck and textile upper with waterproof lining
  • Rubber outsole with aggressive tread pattern
  • Firm heel counter
  • Tempered steel shank
  • Added and double depth with removable footbed and spacer
  • Fits prescribed orthotics

This brings a conclusion to our review of the best diabetic winter boots for both men and women. I hope this two part series was informative and helps with future purchases.

Alcohol and Diabetes – You Wont Believe What Drinking Red Wine Does for Diabetes!

Alcohol is a double edged sword in the nutrition world. A little enjoyment each day has shown positive benefits in mental well-being such as reduced stress while also improving physical health by lowering the risk of cardiovascular disease. There can however be “too much of a good thing” and drinking too much alcohol can hinder cardiovascular health by damaging heart muscles. Excessive alcohol consumption can also limit the effectiveness of white blood cells in the body which are responsible for keeping bacterial invaders at bay.

A recent study however has shown a positive relationship between the moderate consumption of red wine and management of type 2 diabetes.The study consisted of 224 participatents between ages 40 to 75 over a two year period consisting of alcohol abstaining type 2 diabetics that had their diabetes under control. They were randomly assigned to 150 ml of mineral water (control), white wine, or red wine with dinner for two years with wines and mineral water being provided by the study. All groups in this study followed a Mediterranean diet without restrictions on caloric intake. 87% of participants completed the trial with 80% drinking their daily dose of wine.

The results revealed that high-density lipoprotein (HDL) cholesterol – the good kind of cholesterol – was increased significantly through the consumption of red wine while also having a more beneficial cholesterol ratio compared to the group that only drank mineral water. Participants that were in the wine group also had improved quality of sleep. This study suggests that moderate consumption of red wine among well controlled diabetics can be part of a healthy diet and is not only safe but also helps to modestly decrease cardio-metabolic risk.

Red wine contains a number of unique antioxidants that are hard to obtain through other sources. The alcohol in red wine also helps to manage post-meal spikes in blood sugar by absorbing the sugar and calories in the meal.