UNTIL WE HAVE THE CURE
THERE IS A MUCH BETTER WAY TO TREAT DIABETES
IT IS IN DANGER OF DISAPPEARING
The Implantable Insulin Pump
New documents available
|Research Paper Summaries
The science behind the implantable insulin pump
|The Developmental History of the Implantable Insulin Pump
How the implantable insulin pump was developer
|Why the Implantable Insulin Pump Works So Well
The physiology of intraperitoneal insulin
This web site has been created to tell the amazing story of the Implantable Insulin Pump and to explain why we believe that it is the very best way to treat diabetes. This technology is remarkable and if you or someone you care for has diabetes you owe it to yourself to learn about the benefits of this method of delivering insulin. Knowledge is the most powerful tool available to us to manage our diabetes. In the coming months we will do our best to present the clear and concise information that you deserve.
The story that will unfold is fascinating and it is a story of promise and immense hope for all Type I diabetics and insulin-using Type II diabetics. Our goal is to make sure that this story has a happy ending.
Who are we and why do we care: Our names are Anne and Greg and we have been friends for nearly 20 years. We met at Sequoia Hospital in San Mateo, California on the morning of January 26, 1992. We were about to become experimental subjects - volunteers for a study that included having a very specialized insulin pump surgically implanted in our abdomens. The pumps would deliver insulin directly into our peritoneal cavities (the space below the diaphragm where the liver, pancreas, spleen and intestines reside) and we would control just how much insulin we would get and when it would be delivered with a hand-held, radio frequency, remote control. The theory, based upon decades of research, was that this was a more normal (more physiologic) and far superior way to deliver insulin – that the insulin would work more effectively and we would be able to control our diabetes better than is possible with insulin delivered subcutaneously (by injections or external pumps).
Did it work? What are the differences between this and the ordinary way of delivering insulin?
These answers and a lot more will appear in this web site in the coming weeks and months – but for those of you who read the end of a mystery novel first and can’t wait, the answer to the first question is YES!
Each week we are going to add content to this web site. Our goal is to tell the most complete story of the implantable insulin pump that we possibly can. We are not professionals but we will do our best to present reliable information.
April 29, 2011: Our first update!
First, remember this: The information on this web site reflects our opinions and our personal beliefs. We are not medically qualified to offer medical advice and have no intention of doing so. Only you and your professional health advisors are qualified to decide what the best treatment program for your diabetes is and what practices you should follow.
Many of you may be aware that on April 17, 2011 an article titled “A Miracle Technology For Type 1s: Can It Be Saved?” appeared online in Diabetes Health Magazine. The link to this article is:
The article told the story of 4 of us who travel several times each year to France to have our implantable insulin pumps refilled or serviced. We do this at considerable inconvenience and a significant financial burden and the article talks about why we go to such trouble. The resulting comments in response to the article taught us that there is remarkably little awareness within the diabetes community about the implantable insulin pump and a significant yearning for better treatment than is generally available. We subsequently wrote our own comment, responding to the many readers who wrote in with questions, but we were not allowed to include the link to our web site (the site you are viewing right now) nor were we allowed to include our email link. With luck, people will eventually find their way here and be able to learn a lot more about the implantable insulin pump for themselves.
About a week later we noticed the appearance of another article – this one in Diabetes Mine. Here is the link:
In this publication the primary author, Amy, was a bit skeptical – in our opinion this is usually an intelligent position to take while collecting more information on a new topic. In the article and in some of the follow-up comments it was again apparent that there is a lack of solid information for people to consider. For the record, refills (for us 4 times per year) do not require surgically opening the implant site but rather are performed quite simply with a needle that is introduced through the skin and into a port on top of the pump. Interestingly, in the comments that mistakenly characterized the 4 times per year procedures as more invasive than they really are, a number of the writers say that they would still opt for the implantable pump – again an indication that there is dissatisfaction with currently available treatments and a yearning for something better. This level of interest is very encouraging to us and helps bolster our motivation to work to get the facts out.
Our View: By now it is probably pretty obvious that we believe deeply in the tremendous value of the implantable insulin pump. It is far from a perfect solution and on the way to attaining its current functioning status there were many problems that had to be overcome. Over the past 30 years, hundreds of patients like the 4 of us have willingly endured years of problems – the early pumps were not designed nor built perfectly, the optimal surgical procedures and post-surgical routines were not known, the insulin that worked wonderfully at first was changed to comply with environmental sensitivities – with disastrous results, the catheters were not optimally designed, the batteries did not last long enough and on and on. Today, however, patients in Europe enjoy a very low incidence of pump complications and benefit from years of service from their pumps. Few therapies start out perfect – it is the end point that counts. Unfortunately, the pumps that Anne and Greg (and all other implantable pump patients) have are of a quite old design with many components decades old. This is the primary problem – unless a significant engineering redesign is undertaken immediately (an effort that we feel should have been more aggressively launched many years ago) there soon will be no pumps available. The world-wide supply is limited by a small store of somewhat archaic parts that, once depleted, cannot be replenished. As of today, there are very few pumps available – too few, we believe, to even manage the existing population of implantable pump patients who now or will shortly need replacements (as batteries die, etc.). A new, updated version of the pump must be designed immediately in order to make it possible to produce the devices in quantity. Our hope is that Medtronic and at least one other company can be convinced to invest the needed capital to design and produce a modern version, begin full-scale testing and work diligently to make this therapy available to all who will choose to use it – and we know that this will include a very large percentage of our peers.
Some of you may be wondering why we think so highly of the implantable insulin pump. The answer is straightforward and is composed of 3 distinct elements; Personal Experience, Theoretical Advantages, and Research Data. The following is a brief overview of each of these elements. In future updates we will provide greater detail and references to the pertinent scientific literature.
Personal Experience: Anne and Greg have first-hand experience with implantable insulin pump therapy that spans 20 years. During most of those years we had working implantable pumps but for several interludes we went back on subcutaneous insulin therapy due to pump malfunctions, surgical complications, misbehaving insulin, etc. We have had multiple opportunities to compare IP versus subcutaneous (Sub-Q) insulin and we can say without reservation that the difference between Sub-Q insulin (multiple injections or external pump) and intraperitoneal (IP) insulin as delivered from the implantable pump is, in a word, staggering. To begin with, while maintaining good blood glucose control with IP insulin the incidence of serious lows is virtually gone – this is not the case with Sub-Q insulin. Regarding response time to an insulin bolus – IP is far faster, more reliable and more predictable than Sub-Q. Handling moderately low blood sugars on IP insulin means taking some fast carbohydrate and keep going. On Sub-Q, you stop what you are doing, take the carbs, wait it out, take more carbs, and keep waiting. Have you ever awakened from a deep sleep and realized that you were seriously hypoglycemic – headed to the kitchen and started eating everything in sight – feeling that your very survival depended upon getting as much sugar as possible into your body? We have – that is while on Sub-Q but never on IP. That frightening, momentum driven, downward heading roller coaster ride, deeper and deeper into hypo that happens with Sub-Q just does not happen with IP. Finally, (and this one is really hard to explain) while on IP insulin we just feel better – a lot better – we feel “normal”. Before IP insulin we were unaware that we were not feeling “normal” – you get used to it and the less than optimal feeling becomes your new normal. Anne likens the change from Sub-Q to IP to coming out of a light fog into full clarity and when going off IP and onto Sub-Q the fog returns and the clarity is lost. We both find that we can work much harder and way longer with less fatigue and faster recovery when on IP than when on Sub-Q.
All of this is very “anecdotal” and is not considered as scientifically sound proof – after all, people can become attached to some pretty unusual and often false ideas. Just the same – we and hundreds of Europeans consistently report the same types of experiences with IP.
Theoretical Advantages: At the most basic physiological levels IP insulin should be better than Sub-Q. Consider your friend who does not have diabetes, his/her pancreas delivers insulin through the blood stream directly to the liver – the liver gets the insulin first and it keeps the lions’ share for itself. The peripheral tissues get what the liver allows to pass through. Studies show that in non-diabetic humans over half of the insulin secreted by the pancreas is captured and kept by the liver. This is not the case with Sub-Q insulin. With Sub-Q, the insulin goes first to the peripheral tissues and a great deal of it is captured by the peripheral tissues – the liver never gets the share of insulin it was meant to get – it is relatively starved for insulin. This is pretty important when you consider that the liver is the primary organ for maintaining a steady blood glucose level. To add insult to injury, there is considerable evidence that Sub-Q insulin leads to peripheral hyperinsulinemia – a relative excess of insulin in the blood and that this hyperinsulinemia results in a decrease in insulin sensitivity – those very tissues that need the insulin are made less sensitive to it by having too much of it around.
IP insulin does not lead to peripheral hyperinslinemia – the liver prevents this by taking its lions’ share before passing the correct amount on to the rest of the body. In the normal, non-diabetic state, the body maintains what is called a Positive Portal/Peripheral gradient of insulin – in other words, the concentration of insulin in the blood entering the liver (portal circulation) is higher than the concentration of insulin in the blood bathing the peripheral tissues. Sub-Q insulin creates an abnormal Negative Portal/Peripheral gradient of insulin wherein the blood entering the liver has a lower concentration of insulin than the blood bathing the peripheral tissues.
The liver also plays an important role in recovering from hypoglycemia. When your non-diabetic friend’s blood sugar begins to drop his/her pancreas significantly slows down or stops releasing insulin thereby signaling the liver to not only stop storing glycogen but also to release some of the glycogen stores as glucose. Our situation is a little more complicated – if we have been injecting insulin Sub-Q (for example with an external pump) it takes a long time for insulin levels to fall when we turn our external pumps way down or off. However, with IP insulin, turning the pump way down or off results in a significantly more rapid decline in insulin being sent to the liver – not as fast as our non-diabetic friends, but much faster than in the case of Sub-Q insulin. This is one of the many advantages of IP insulin – the response times are faster and more reliable. When you need insulin you get the effect faster with IP, and when you need to diminish insulin, IP is also faster. This faster and more consistent response allows us to adjust to the unexpected things that happen to us each day far more effectively. We think this is one of the reasons that patients on IP insulin experience far fewer severe hypoglycemic episodes and recover from hypoglycemia much more quickly and easily. Since this is as important aspect of the physiology of insulin, we will be expanding on this more in the future.
Research Data: There are numerous published studies that powerfully suggest that IP insulin is superior to subcutaneous insulin. In future updates we will cite the research papers that address these issues and when possible (copyright issues) we will include links to these papers. If we are not able to give you a link we will do our best to summarize the findings for you. For now, here are some of the topics that we will explore:
· As we have experienced, when on IP insulin, severe low blood sugar events while trying to maintain good blood sugar control occur much less frequently than they do on Sub-Q insulin.
· Glucose excursion (the variation of high and low) are smaller with IP insulin than with Sub-Q insulin
· Some blood lipids that are usually out of normal range in Type 1s treated with Sub-Q insulin return to normal under IP insulin treatment.
· Quality of life studies show improved quality of life for patients switching to IP insulin.
· Hyperinslinemia (excess levels of insulin) – a common state with Sub-Q insulin treatment is reversed to normal by IP insulin treatment.
· The normal glucagon response to hypoglycemia – often lost under Sub-Q treatment – has been seen to be restored under IP insulin treatment.
· Hepatic (liver) glucose regulation capability improves when converting from Sub-Q to IP insulin treatment. The liver is more capable of doing its job when it is adequately supplied with insulin.
· And….. a lot more.
These are some of the reasons why we feel so strongly that the implantable insulin pump is a superior way to treat diabetes. But Remember: The information on this web site reflects our opinions and our personal beliefs. We are not medically qualified to offer medical advice and have no intention of doing so. Only you and your professional health advisors are qualified to decide what the best treatment program for your diabetes is and what practices you should follow.
Next, you may be wondering if this implantable insulin pump delivering IP insulin is so great why it is disappearing. Why after over 30 years of development is it not widely available?
Check back soon and we will tell you why we think this is so.
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