What are your thoughts on insulin pumps?

9th Q&A With Dr. Richard Bernstein

Dr. Richard K. Bernstein

| May 15, 2013

I spent a month in a major insulin pump center and saw several things. Many of the female patients seemed to have wings on their sides where the pump tubing was inserted and they got lipohypertrophy from localized injections, but that was the least of it. None of them actually had remotely normal blood sugars

Of the new patients who visit me using pumps, there was only one whom I was able to get near normal blood sugars. It was because he was still in his honeymoon period of diabetes. After a year on the pump, his blood sugar started getting unpredictable. Why? I believe it is because of the scar tissue that forms where you have a foreign body inserted for days at a time.  

We find that if we take people off of pumps and have them inject insulin, they cannot inject into old pump sites because they won't get predictable absorption of the insulin. They have to find new places to inject the insulin. 

I assume that the reason I have never seen other pump users controlled, is because of the scar tissue that forms as a result of the pump's tubing. For some people it may take several years for the scaring to occur, but I would say that after seven years everyone who uses a pump gets scar tissue at the infusion sites.  

By the way, I looked at pump sales personnel, who are frequently diabetic, and when I've checked their A1cs, they are surprisingly sky high.  I was able to check these A1cs because I have an A1c meter in my office. It can use blood from a finger stick.

Richard K. Bernstein, MD is one of the most knowledgeable, committed and successful pioneers in the field of diabetes today.  He invented blood sugar self-monitoring  and basal/bolus insulin dosing, when he was an engineer.

Dr. B is Director Emeritus of the Peripheral vascular Disease Clinic of the Albert Einstein College of Medicine. His private medical Practice in Mamaroneck N. Y. specializes in treating diabetes and obesity.

He is a physician, research scientist, thriving Type 1 for  67 years, and best-selling author of nine  diabetes books including Diabetes  Solution , The Diabetes Diet and several E-books. This link diabetes-book.com will give you more information about his publications. To  sign up for his free monthly teleseminars, visit askdrbernstein.net.

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Categories: A1C, Blood Sugar, Diabetes, Diabetes Health, Diabetes Health Magazine, Diabetic, Dr. Richard Bernstein, Insulin

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Posted by Elzy1 on 16 May 2013

I have been using a pump for almost 9 years. I agree with Dr Bernstein as far as the scar tissue issue. However, I switched to an OmniPod last November and my blood sugars and A1C's are the best they have ever been.The OmniPod can be utilized in a multitude of locations on the body so you really never have the scar tissue issue.
I have had TYPE 1 Diabetes for 42 years and the control and convenience of the OmniPod is outstanding in my humble opinion.

Posted by Anonymous on 16 May 2013

While I agree that there needs to be more analysis of the effectiveness and problems of insulin pumps, I have had one for 10 years and would have a very difficult time without it due to highly variable basal rates (hour to hour) which are constantly changing because I have Lyme disease. I'm also hypersensitive to insulin so the smaller amounts that can be measured and inserted works better for me. I have be vigilant about rotating pump sites which may be helping with scar tissue formation, although it could certainly happen with time. My A1c is generally in the low 6s, despite highly erratic blood sugars due to Lyme and that's because I check my blood 10 to 20x/day. I do feel that scar tissue build up needs to be discussed more and considered.

Posted by olefart2 on 16 May 2013

I'm really sorry that you feel that way about pumps. I was taking 4-6 shots a day before I got my pump that switched to one injection site every 2-3 days! I keep a good record of all the carbs that I eat and program the pump! I now can lead a "normal" life. Have had the pump for 3 yrs and a1c has always been below 7 and thats taking blood work every 3 months. Every one is differant but like I say "don't think of it as a disease it's a challenge that you will face the rest of your life!

Posted by goozer on 16 May 2013

I had had an insulin pump for 11 years and love it. My HgA1c's are good. I change my site every three days and don't reuse a site for at least 2 months or longer. I don't have scar tissue because of this. I am able to adjust the basal rate when we hike in the mountains so lows are controlled. I have had type 1 diabetes for 65 years and still have my toes and excellent kidney function!

Posted by Anonymous on 16 May 2013

I am in the process of taking a pump break after three years of a1c's higher than 7% on a pump. 38 years of insulin injections have created lots of scar tissue in my abdomen and I have no other sites that work with the insulin pump due to my thin body. So far, I'm having more lows but overall, I'm feeling pretty good about having that piece of equipment off my body for awhile. I agree that a pump and scar tissue don't mix. I also know that on pod change days, my blood sugar was high for about 8 hours until the cannula got settled into my body. That results in high blood sugar 1/3 of the time since a pod only lasts three days. Oh well...diabetes control takes lots of patience and willingness to try new things. At least we are way beyond intermediate acting insulin with dramatic peaks. That was really awful! Good control is worth our best efforts so I say, do what works best for you and be willing to try new approaches.

Posted by Anonymous on 16 May 2013

I have been on a pump for 8 years and iI am consistently below 7.0. Great piece of technology and a great tool for BG control!

Posted by snjnt2 on 16 May 2013

I find the comments on the insulin pump wrong. I have been using for some time, and my a1c's are in the below 6.5 area. One problem most people have is they want to keep using the same area for their infusion. I found the same thing with people and their old fashioned shots. they stick to the same area. which hardens the tissue. I learned to go up and down and from the front to the back. and I have no problems. I have been pumping for 13 years. It is the best way to go. All one needs to do is learn the techniques.

Posted by Anonymous on 16 May 2013

I would like to know what the doctor considers a sky high Ac1. Also if the problem is scar tissue how can it be worse if you use one site every three days rather than multiple injection sites a day. I make sure I do not use the same area again for awhile but that is more difficult when you are doing five injections a day.

Posted by Anonymous on 16 May 2013

I love Dr. Bernstein...his advice is always spot-on.....I have been a diabetic for 47 years and after my 40 th year w/ diabetes, I decided to try a pump (I had been giving approx. 4 injections per day before that). My blood glucose was up & down (& everywhere), which was nOT the case when I gave my own injection...and i was told by the pump educator that this was "normal process" as the body gets used to the regimen of insulin through a pump. I wore it for 3 months and had the worst glucose levels I have ever had in the amoutnt of time I had the pump. So, I got rid of it and went back to injecting my own insulin. I have friends with insulin pumps and some love them, but some just cannot seem to get their blood glucose regulated and I am now wondering (after reading the article) if Dr. Bernstein hit the nail on the head?
Made me even happier that I decided to give up the pump and do it on my own!

Posted by Anonymous on 17 May 2013

I'm sorry but this article is ridiculous. I've been a pump user for 10 years and, while I have some scarring, I am aware of it and am sure to rotate sites every time I change my infusion set. My A1C has consistently been 7.0% and below since starting pump therapy (closer to 6% in the past few years). I was absolutely miserable on multiple-injection therapy and my blood sugars were completely erratic all the time. I'm sorry, Dr. Bernstein, that you have not been able to find a good balance using this device for your patients, but I assure you that it's not the norm.

Posted by Anonymous on 17 May 2013

I agree with Dr Bernstein on this issue. I had erratic blood sugars and high A1C's using the pump. As a T1D for 50 years injections seem to give me more control. Drs still push me to use the pump at every visit. It is an aid but not the best method for every patient.

Posted by Anonymous on 17 May 2013

This is absolute nonsense. Before I got a pump (9 years ago) my A1c was never below 8, no matter how hard I tried. With the pump, it it has never been above 8, most often below 7, and since I added a CGM, generally below 6. In my case, the basal requirement varies a lot with time of day. The pump can handle this. Lantus can NOT. Scar tissue? Never use the same site more often than once a month, or for more than three days. I use a regular rotation pattern that generally gives me a two month return period. Pumps can certainly be abused, but used properly they can really help control.

Posted by Anonymous on 17 May 2013

My son always refused to have his body invaded by something else beside the already annoying needles and constant checks. We insisted it would help him easy the continues prickling but he did not give in, and I am glad he did not go for the pump. His excuse was he will break them while doing sports and he did not want to feel even more "abnormal." He is very aware of his body and knows his levels in an almost scary accurate ways (low, high, normal, going up, going down), and prefers the old-fashion needles.

Posted by Anonymous on 18 May 2013

I think dismissing the insulin pump as a way to manage diabetes is unjustified. The insulin pump forums have an overwhelming number of success stories compared to failures. I've been a diabetic for 36 years. The first 30 I used the MDI method and the last 6 years an insulin pump. I've always counted carbs and tried to make informed choices. My A1c's after starting on the pump range low to high, 5.2 - 6.3, pre-pump 7.0 - 8. As a Type 1 I could not manage diabetes as well without the pump.

Just my opinion.

Posted by Anonymous on 18 May 2013

I found this article disturbing. It is really Dr B's opinion & not based on rigorous scientific study methods. I'm sure that for as many people as he found who do worse on the pump there are those who do better, I'm one of them & I've had diabetes for 52 years. Scar tissue build up at infusion sites is no worse than it was at injection sites. Maybe people did better off pump than on because of other changes like diet & exercise. So I say this is just Dr B's opinion not facts.

Posted by Anonymous on 19 May 2013

I have been a pump user for 16 years and only do it since its the lesser of two evils. I hate injections and I don't like the way it wrecks your skin and over time my insulin absorption has suffered. There's only so many places to inject in ones lifetime. I really wish more education could be done when 'advertising' how great pumps are. There is a lot of buzz in trying to sell the AP and it won't be for everyone, but its promoted like the greatest invention since the wheel.

A1c' were really good but after going on this pump I gained 30 lbs and my A1c went from 5.8 to now 7.8 and its been a real struggle. My lifestyle had not changed so I believe there are absorption issues with my sites.

Posted by Anonymous on 20 May 2013

Well I've had a pump for 3 years, no wings on me, blood sugar happily for me are spot on, & I went from an A-1C north of 12 prior to pump, to 6.2 A-1C taken at Endocrinologist's office last week. 65 yo female Type 2

Posted by Anonymous on 20 May 2013

My sister and I have both had insulin pumps for over 19years and feel we are healthier because of it. As a women it takes awhile for our bodies are always changing but after awhile it is your it is part of u .there is always a drew back on things but I just got done with triple bypass and everything went good and my healing has a lot to do with the pump for it is always in your body. I would not go back to shots for anything.

Posted by Anonymous on 23 May 2013

People should be realistic with their goals. A pump is a band aid. For some it works better than shots but for others it doesn't. It should not be pushed as the only 'best' option for control. People are different and need to be managed as such.

Posted by Anonymous on 27 May 2013

I got a pump on the 3rd of April 2013 and I'm coping really well it's made having diabetes a lot Easyer than before because you only have to inject a set every 3 days.

Posted by Anonymous on 2 July 2013

I am happy with using the syringe and I my A1C's are in perfect normal range for the past 23 years. I am waiting for the cure. I most heartily agree from anonymous that was posted May 23 2013. For me the pump is not the best option. Pumps can cause lows and Ketones , including weight gain, injections for me is the best option NOT THE PUMP. Having a needle in my skin 24/7 sounds gross. 

Posted by Anonymous on 28 October 2014


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