Are Insulin Pumps Better Than Shots?
What the science says about two insulin-injecting methods.
By Wil Dubois
Insulin Pump / in·su·lin pump [noun]
a portable battery-powered instrument that delivers a measured amount of insulin through the abdominal wall. It can be programmed to deliver varied doses of insulin according to the body's needs at the time
When it comes to insulin pumps vs. shots, a lot of message board space on the web is being taken up discussing choice. Is it better to pump or not to pump? But that's not the real question. Well, not if you're an insurance company or the federal government, anyway. The real question is: Are pumps better than shots? Do they make people healthier?
As it turns out, I'm not sure that anyone knows.
Now before we get started, I have a disclosure: I currently wear an insulin pump. (We pumpers generally say that we "wear" the pump, rather than we "use" the pump.) Of course, like most type 1s, I started off my diabetic career taking shots. Lots of them. In the beginning, I used heroin-addict-style-syringes; later, insulin pens. This therapy is called multiple daily injection, or MDI.
MDI requires 4 shots a day at a minimum, and you might need as many as eight shots. Oh. And lots and lots of fingersticks, too.
Later I moved to wearing an insulin pump. Then, when my insurance changed, I found myself unable to afford to use my pump and was forced to go back to shots. You see, not only is the pump expensive, but the daily supplies are, too. They're covered in a hidden part of your health insurance policy called Durable Medical Goods—ironic, as these things are thrown away every three days. Some policies cover these supplies very poorly, so even though you are "covered" you may not earn enough money to stay healthy and keep the lights on.
Later still, when my insurance at work changed again, I was able to go back to pumping. So I think I have pretty good personal experience comparing pumps vs. shots, and I can tell you with absolute 100% certainty that it's possible to have near-perfect blood sugar control wearing an insulin pump.
Oh. And it's possible to have absolutely crappy blood sugar control wearing an insulin pump. And I've been in both places myself.
On the other hand, it's possible to have near-perfect control taking lots of shots. Oh. And it's also possible to have absolutely crappy control taking lots of shots. And I've been in both those places myself.
Pumpers vs. Shot-Takers
My clinical experience with pump wearers and shot-takers mirrors my personal experience. I've got folks on pumps who get awesome results, and folks on pumps who get less than awesome results. I've got folks on shots who get awesome results, and folks on shots who get less than awesome results.
But neither my personal experience nor my clinical experience matters to a shark in a suit whose job it is to maximize his shareholder's profits; or to a public servant who's trying not to waste the public's money.
(Let me know when you all stop laughing and we'll continue).
What those two people want to know is one simple thing: given that pumps cost a shit-load of money—about four times the annual cost of MDI—can they be proven to make dFolk healthier? Because, if pumps can be proven to improve diabetes control, you can make an argument that it's cheaper in the long run to pay for pumps.
So this is where I have to introduce you to the hot topic of Evidence Based Medicine, the final evolution of the Western Medicine Tradition. The theory behind Evidence Based Medicine is that we shouldn't give anyone any medicine, treatment, or a device that isn't proven to work. On the surface that sounds grand and sensible, but there are problems, as we'll see in a bit. But for now consider that Evidence Based Medicine is not only used by docs, but it's used by insurance companies, as well. Why should they pay for something that isn't proven to work?
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On endo appointment days, we first go into a small room where Charlie has his height and weight measured and recorded. The nurse also pricks his finger and absorbs a small drop of blood to which she feeds into an A1c machine. “Do you want?” Charlie asked, offering up his blood like a potato chip. “No,” I said. “We’re fine.” In the past, we wouldn’t let the blood go to waste without also checking blood sugar. ...