Different meters for different bleeders. Different pumps for different chumps. Call it what you want… diabetes management preferences are unique to each individual. Why else would there be SIX different companies making insulin pumps, EIGHT making various types of blood glucose meters, THREE insulin manufacturers, and at last count, ELEVEN classes of diabetes medications.
Why the need for so many options? We have to look beyond superficial features such as sizes, shapes and colors. The fact is, certain devices, medications and therapies simply work better for some people than for others. And that’s perfectly fine. It’s what makes diabetes management as much of an art as it is a science. And it’s why any healthcare provider or diabetes center that takes a “one-size-fits-all” approach to diabetes care and treatment is doing its clients a terrible disservice.
Anyone who has worked with our practice knows about the humongous self-assessment packet that we have everyone complete before their first appointment. We review those packets with a magnifying glass and usually still have many questions to ask when we finally get together (either in-person or remotely). Why spend so much time on the assessment? Because it lets us do our job correctly. We don’t want to waste our clients’ time teaching them things they already know, or working towards goals they never really had. We recognize that each of our clients has unique needs and expectations, and is likely to respond well to certain forms of treatment based on their personal history and preferences.
Case in point: Most of you know that I try virtually everything that comes down the ol’ diabetes pipeline. Amylin? Used it. GLP-1s? Did it and still doing it. Hyaluronidase? Tried it. Heck… I’ve used 26 different insulin pumps over the past 19 years!
The latest craze in diabetes treatment involves SGLT-2 inhibition. The medications that perform this feat turn the kidneys in glucose-excreting machines. The kidneys usually “spill” sugar into the urine when blood sugars are over 180 mg/dl (10 mmol/l). When taking SGLT-2 inhibitors, the kidneys spill sugar in the urine constantly – sort of like lowering a dam so that a river flows freely. It is a passive process, so it doesn’t hurt the kidneys or cause them to work any harder than usual.
By spilling sugar into the urine on an ongoing basis, blood sugar levels come down virtually around-the-clock, and calories are essentially “dumped out” every time you urinate. The result: insulin requirements go down and weight comes off. What could be better? Well, there are side effects. You pee a lot more than usual. Risk of urinary tract infections goes up. And blood sugars that used to be (hopefully) stable no longer are. Many of our Type-1 and Type-2 clients have started using SGLT-2 inhibitors with great success. Their blood sugars are much tighter and they’ve lose considerable weight. Personally, I found the frequent urination too disruptive, and even with a reduction in my insulin doses, my blood sugars were dropping low too often. So, while I recognize that SGLT-2 inhibitors are beneficial for many people, they just aren’t for me personally.
Insulin pumps are another source of debate. Although I’m personally enamored with the devices, I know they’re not for everyone. For some people, the drawbacks simply outweigh the benefits. And some folks just aren’t willing to do what it takes to use the devices safely and effectively. Then there’s the argument over which pump is “best”. I’m in a unique position of being able to try every pump personally and to experience each one as both a user and a trainer. After 20 years and 27 different pumps, I can honestly tell you that each one has its share of advantages and drawbacks (if you’d like the details, visit the pump comparisons at our website: integrateddiabetes.com/insulin-pump-comparisons/
Another case in point: for 19 years, I used traditional pumps with tubing. I never felt that the tubing was a burden, so why try anything else? Recently, I gave the OmniPod (a tubeless “patch” pump) a try. And you know what? I kind of like it! Granted, I find it a bit of a hassle having to carry around the PDM (remote control for the pump), but not having tubing and not having to disconnect for anything is really nice. My traditional pumps would often unclip from my belt (especially when I’m chasing one of my kids) and drag behind me like an electronic tail. None of that with a patch pump! But talk about old habits… sometimes I still find myself reaching to my side, feeling around for a pump that isn’t there. I’ll probably return to my usual pumps eventually, but for now, I’m enjoying the bit of extra freedom.
So bottom line… check out your options. Whether it’s a form of therapy, medication, meter or other device, learn what you can so that you can make an informed choice. And if your healthcare provider doesn’t offer you a choice, don’t forget, you have options there as well!
Hey, actually I never saw the results of your personal Hylenex trial. I would love to hear the verdict!
For insulin pumps, it would be nice to see a comparison in terms of reliability, i.e. frequency of pump-related problems. For instance I’ve heard people say that failures are much more common with the omnipods. Seems to be one aspect that’s never addressed in a systematic manner.