Costly, but insulin pump can be ‘liberating’
While costly and difficult to master, an insulin pump can benefit people living with Type 1 diabetes. It may also benefit those with Type 2 diabetes who require insulin injections due to an inability to make sufficient insulin even after taking oral medications, said Dr Warren Lee, a private paediatric endocrinologist at Camden Medical Centre.
An insulin pump is a palm-sized device that works like an artificial pancreas to deliver the insulin round the clock, via a tube inserted under the skin.
Newer models of the pump now come with a sensor that allows continuous, real-time monitoring of glucose levels, said Associate Professor Loke Kah Yin, head of the Division of Paediatric Endocrinology at the National University Hospital (NUH).
It allows patients to flexibly adjust their insulin doses in relation to their lifestyles and diet, which benefits those who wish to travel or endurance sports enthusiasts. For example, they could temporarily reduce the rate of insulin infusion for a few hours before and after strenuous exercise to minimise the risk of hypoglycaemia, said Dr D S Deepak, senior consultant at NUH’s Division of Endocrinology.
In contrast, insulin administered via injections can only deliver a fixed dose with every shot. A diabetic may thus may be subjected to too much or too little insulin at the wrong time, said Dr Lee.
According to Dr Deepak, patients with Type 1 diabetes who are unable to achieve good control of their condition through multiple daily insulin injections, because of frequent and unpredictable hypoglycaemia that affects their quality of life and results in distress, may be considered for insulin pump treatment.
Poorly managed glucose levels can lead to health complications ranging from fits to organ damage. Assoc Prof Loke said studies have shown that insulin-pump therapy lowers the risk of developing very low glucose levels, or hypoglycaemia, compared to multiple insulin injections.
While some hospitals and private clinics here have been offering the insulin pump programme for years, the local take-up rate remains low. About 10 per cent of children and adolescents seen at NUH for diabetes are currently on an insulin pump, said Assoc Prof Loke. The hospital started offering the device to diabetic paediatric patients in 2004.
According to Dr Lee, the cost of an insulin pump may range from around S$3,500 to S$11,000, depending on the brand and model. This excludes recurring costs of the disposable components such as catheters, as well as the insulin supply the patient needs.
Using the pump also entails a steep learning curve, which requires greater commitment from the patient as well as communication and coordination with his diabetes team, said Dr Deepak. Not only would the patient need to learn how to use the device properly, he would also need to be competent in managing his condition. Those who eventually master it find it “liberating”, said Dr Lee.
Patients should also be ready to revert to insulin injections in the event of a pump failure, cautioned the NUH doctors. Eveline Gan
