How is the followup done of individuals with DM who carry an insulin pump

These individuals should communicate with their doctor on an almost daily basis during the first weeks, until the blood sugar levels are controlled and there is certainty that the use of the pump and the measurement of the food carbohydrates are being performed correctly. Afterwards, these patients are followed in the same way as the other people with Type 1 DM, measuring their blood sugar levels at least four times daily and keeping records of the results and the units of insulin they receive.

If control is good, the insulin users should repeat their education on the measurement of the food carbohydrates after about one year.

Many patients who use an insulin pump feel that after a few months they can control their blood sugar levels without the help of their doctors and so they can omit visits. It should be stressed that this is wrong, because the follow-up of individuals with DM is not only limited to the regulation of the blood glucose levels, but also concerns the chronic diabetic complications that may potentially present.

What are the results of studies that compared treatment with a continuous subcutaneous insulin infusion pump to intensive treatment with multiple insulin injections?

As regards glycaemic control, the results are controversial. Some studies support the idea that treatment with pumps has an advantage and other studies show that the two treatments are equivalent. There is, however, a general consensus that the blood glucose fluctuations are smaller with the use of a pump, and the hypoglycaemic episodes are fewer. Moreover, a claimed increase in the percentage of ketoacidotic episodes with pump users, compared to those treated with multiple insulin injections, has not been proven. A lot of small studies agree that quality of life is better when a pump is used, and that microvascular complications occur less often. There is also evidence that diabetic neuropathy is improved with the use of an insulin pump.

There is no significant evidence that the incidence of macroangiopathy is reduced with the use of a pump compared with multiple insulin injections. Furthermore, the insulin needs are generally less (roughly by 15 percent) when a pump is used compared to multiple injections and some consider this element as a potential advantage for the prevention of atherosclerosis.

If the use of a continuous subcutaneous insulin infusion pump is considered as advantageous compared to the intensive regimen of multiple insulin injections, why isn't it imposed as a treatment for individuals with Type 1 DM?

Apart from the above mentioned conditions, the cost of the pump plays a significant role. In some countries, an unwillingness is observed concerning the use of pumps that stems from the conviction that their widespread application will adversely effect the insurance system. Studies in certain countries, however, have shown that treatment with insulin pumps is financially more beneficial, provided it is performed correctly, when the long-term economic benefits of the prevention of late diabetic complications are taken into account.

It should also be noted that psychological reasons deter some individuals with Type 1 DM from carrying the pump continuously. Provided that these individuals are sufficiently controlled with an intensive regimen of multiple insulin injections (which is not rare), and are satisfied with this treatment, obviously there is no reason to recommend treatment with an insulin pump.

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