New Insulin Pump Improves Hypoglycemia Control
Use of a new insulin pump that can stop delivering insulin before hypoglycemia occurs could be a life-saving device for people who have type 1 diabetes. The pump, which is currently available in Europe, is on the road toward approval by the Food and Drug Administration (FDA) for use in the United States.
Hypoglycemia (abnormally low blood sugar levels) is a major concern and can be a serious situation, especially at night during sleep when patients often are not aware of their insulin status. Symptoms of hypoglycemia can include feeling jittery, sweating, clammy skin, confusion, blurry vision, difficulty walking, seizures, coma, and even death.
Some people with type 1 diabetes choose to wear an insulin pump rather than take daily (multiple) injections of insulin. These computerized mechanisms typically deliver insulin in a steady dose, although extra or bolus doses can be delivered as well.
Until a reliable artificial pancreas is developed, insulin pumps can help patients better control and manage their insulin levels. However, individuals still need to take blood glucose readings to monitor the hormone status.
The new insulin pump, which is made by Medtronic Inc., has a sensor that causes the pump to stop sending insulin to the patient when blood sugar levels reach a certain level that has been programmed into the device. Therefore, patients who worry they may experience a hypoglycemic event during the night (or day) may be able to rest easier knowing their pump will adjust to their needs.
The results of a study of the new pump were published recently in the New England Journal of Medicine. In The News International, the study’s lead author, Dr. Richard Bergenstal, executive director of the International Diabetes Center at Park Nicollet in Minneapolis, explained that this new technology “is the first step that shows that the artificial pancreas can actually work.”
In the study, 247 individuals with type 1 diabetes were randomly assigned to receive the insulin pump therapy: 121 wore a sensor along with an insulin pump while 126 patients did not. The study lasted three months.
The investigators discovered the following at the end of the three months:
- Individuals who used the new pump had 31.8 percent fewer episodes of abnormally low blood sugar during the night than did patients who did not
- Those who used the new pump also experienced 31.4 percent fewer hypoglycemic events during the day
- Over the study period, the pumps stopped 1,438 times for 2 hours, and the mean sensor sugar level was 92.6 mg/dL
- A total of 111 of the 121 patients in the sensor group experienced at least one nighttime interruption of insulin delivery during the study period
- Use of the new pump did not have an impact on blood sugar levels, as those levels were similar in both groups of patients
- Hemoglobin A1c levels did not increase in either group throughout the study
- Four patients in the no-sensor group experienced a severe hypoglycemic episode
If you or a loved one has type 1 diabetes, be sure to keep up with the research and talk to your doctor about the possibility of using the new insulin pump and sensor when it becomes available. Be sure you understand both the advantages and disadvantages of having an insulin pump.
Advantages of using an insulin pump include elimination of individual insulin injections, delivery of more accurate doses of insulin, possible improvement of HbA1c values, elimination of unpredictable impact of intermediate or long-acting insulin, more steady blood sugar levels, and reduction of severe hypoglycemic events.
Among the disadvantages of an insulin pump are the possibility of weight gain, expense, the risk of experiencing diabetic ketoacidosis if the catheter is dislodged and insulin is not readily available, and being attached to a pump all the time. The decision to use any type of insulin pump should be made after considering all the pros and cons, the patient’s age, and lifestyle factors.
Bergenstal RM et al. Threshold-based insulin-pump interruption for reduction of hypoglycemia. New England Journal of Medicine 2013 Jul 18; 369(3): 224-32
The News International