Get Pumped

| Apr 1, 2003

Linda McNeely, a retired registered nurse, remembers her first insulin pump.

It was about the size of a paperback novel and had only one basal rate. You flipped a switch to put it into bolus mode when you wanted to give yourself insulin to cover your food. Each night, you changed batteries, plugging the one you'd used that day into an outlet to charge. And even with all that work, it was a crapshoot as to whether you were giving yourself an adequate amount of insulin.

It was 1979, and there were no home blood-glucose meters then to let you know how high or how low your blood-glucose reading was.

"It was catch as catch can," said McNeely, as she recalled 14 years with the Autosyringe ASC6, which she wore until she could no longer get supplies for it.

A self-described "Type A" personality, McNeely was diagnosed in August 1978 at the age of 40. At the time, she worked for the National Institutes of Health (NIH). When Autosyringe approached the NIH about setting up a pump program, she stepped forward to be one of the first insulin pump "guinea pigs."

The relative flexibility of even that early-generation pump fit into her frenetic lifestyle—one that included racing sailboats and showing dogs in her spare time—better than injections.

"My control wasn't good," she says, "but it was better."

Typical Pumper

In one way, McNeely is a typical insulin pumper: Once she found "freedom at the end of a leash," as one pumper described it, she never went back to injections.

Who is the "typical" pumper?

To find the answer, we went to, the not-for-profit Web-based Insulin Pumpers Organization (IP) of Milpitas, California. In the "About Insulin Pumpers" section of this Web site, executive director Michael Robinton has collected and compiled data from the more than 4,000 members who choose to fill out a survey.

About 20 percent of the members return a survey. Robinton estimates that the information lags from six months to one year.

"People don't update it all that often," he notes.

Still, the surveys offer a wealth of information, from age at diagnosis to what color pumps people prefer.

On average, an insulin pumper wears a gray or blue pump with a 43-inch infusion set, changes the set every three days and uses 42 units of insulin per day (57 units for pumpers with type 2 diabetes).

According to the charts on IP, Medtronic MiniMed is the most popular pump, followed by Disetronic, with Animas coming in third. Pumpers continue to use older models as well as the more current ones.

In late January 2003, neither Dana nor Deltec were represented on the IP list survey. Either none of the Dana users had filled out a survey or there were insufficient responses to register. While interest in the Deltec is running high, its Cozmo pump had just recently come out of the starting gate.

Although Rod Kellogg, general manager for the Deltec Cozmo, could not supply figures, he did observe at the end of January that Cozmo sales were "ahead of where we expected to be at this point."

"Based on what I see on the list," Robinton added, interest in the Cozmo is "very high."

Placement statistics could be a bit off, too: Animas claims to have taken second place in overall U.S. pump sales in 2002, a fact that might not be reflected in graphs that include all pumps in use.

The Most Popular Set?

The Tender/Comfort/Silhouette/Essential.

For those unfamiliar with infusion sets, these are all the same set, with each pump company calling its product a different name. The cannula can be inserted into the body at nearly any angle, making this set a good, all-around choice for any body type.

It was the popularity of this set that led Deltec to offer its version—the Essential—as the only one sold by the company so far.

"It's the most widely used set out there," says Kellogg. "Knowing that we were coming into the market without a set that was differentiated for us, it was a good fit."

According to the IP surveys, 44 percent of the respondents use the Tender/Comfort/Silhouette/Essential. The MiniMed SofSet comes in second, used by 39 percent, followed by the MiniMed QuickSet, used by 12 percent.

Pumpers are usually instructed to change the set every three days to avoid infection and to promote effective insulin absorption from the site.

But do pumpers really do that?

Most (48 percent) actually do change about every three days, with 11 percent who change every two days and 26 percent who change twice a week.

Who Pumps?

The IP list membership includes people of all ages, from the mother of a toddler who was placed on a pump at the age of 10 days to those who didn't begin to pump until they were in their 60s.

People with type 1 diabetes make up 95 percent of those who filled out the survey, with type 2s making up the other 5 percent. Of every five people on the list, three are female.

Only 10 percent of pumpers use a single basal rate; 14 percent use two. Most—22 percent each—use three or four basal rates. As many as 16 percent use five, although only 1 percent of the respondents use as many as ten basal rates (the highest number reported).

Meter Companies Should Like Pumpers

On average, pumpers test nearly seven times a day. And is pumping good for control? You bet!

The average A1C before pumping was 8%, going down to an average 6.8% after beginning pump therapy.

Visit the Web site to see how you compare to your fellow pumpers.

"It's 'feel-good' stuff," Robinton says. "It's information that's useful for people to know. It validates what people are experiencing."

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Categories: A1c Test, Diabetes, Diabetes, Food, Insulin, Insulin Pumps, Syringes, Type 1 Issues, Type 1 Issues, Type 2 Issues

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