Dr Bernstein – Anti Insulin Pump
Dr Bernstein of low-carb for diabetes fame is anti insulin pumps. Actually, what he says is that he ‘doesn’t recommend’ pumps. He states his reasons in many interviews. Just one example from here:
Many of the female patients seemed to have wings on their sides where the pump tubing was inserted and they got lipohypertrophy. But that was the least of it. None of them had normal blood sugars. Of the new patients who came in using pumps, there was only one whom I was able to get near normal blood sugars. It was because he was still in his honeymoon period. After a year on the pump, his blood sugar started getting unpredictable. And why is that? I believe it is because of the scar tissue that forms where you have a foreign body inserted for days at a time.
First, from Wikipedia:
Lipohypertrophy is a medical term that refers to a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin. It may be unsightly, mildly painful, and may change the timing or completeness of insulin action. It is a common, minor, chronic complication of diabetes mellitus.
Here’s my response, directly to Dr Bernstein:
Much as I’m a low and lower-carb fan and I respect the logic behind your low-carb theories, I’m very pro-pump.
That stated, I read many blogs and forums and I don’t know anyone whose A1C hasn’t improved, or their diabetes has become more unstable on a pump – provided they’ve had the right education and continue to tweak their insulin until it’s right for them. Lack of proper pump education can be the cause, as can many other factors (eg insulin allergy) that can be investigated and dealt with. True, I don’t know everyone in the diabetes world, but the majority of what I read and hear doesn’t bear out your statement.
Scar tissue? Sure if you keep putting the inset in the same place and leaving it there longer than is recommended.
On the other hand, I can show you the huge, deep, very-slowly-fading bruise I still have 18 MONTHS after stopping Levemir! I was told to inject NovoRapid on one side and Levemir on the other. For now I’ve lost that area on my belly for my pump cannula because it’s as unreliable as I could ever imagine! All my pump occlusions have occurred in that area. I dare say there’s also some lipohypertrophy in that area.
One can get lipohypertrophy on injections too!
The body has plenty of areas to insert a pump cannula before there’s no place left because of hard, fatty deposits, if indeed you get them at all. If you really run out, you’ve been pumping for an awfully long time. In addition, the possibility of lipohypertrophy is reduced if you change your site within the recommended time. Some seem more prone to these fatty deposits than others.
And really, do you think, Dr Bernstein, that in 10 or 15 years time, we will still be using the same insulin pump technology? Surely not with current advances! But maybe we will. Who knows?
I don’t see a whole lot of people scrambling to get off insulin pumps because their blood sugars haven’t improved and stay improved. Sure, people do go back to MDI or take a break, but mostly for other reasons, as far as I can tell.
My own experience of moving from MDI to an insulin pump saw a 3 % point decrease in A1C by the first test after! It was the very best thing I’ve ever done for my health. My A1c is still improving as I tweak what I do with my pump ! How does that in anyway reflect unstable blood sugars or ones that don’t approach normal?
Actually, your idea of normal seems a tad narrow. Research shows when the damage from diabetes happens, and it’s certainly still within the higher range of blood sugar recommendations for people with diabetes, but above what you recommend. So, neither recommendation is necessarily right.
In this age of people being interested and involved with food, cooking, lifestyle programs, good restaurants, farmers markets, recipes, entertaining and so on, some of us simply can’t always do the 30 grams of carbs a day you recommend. Some of us also don’t want to. Some of us do mostly low-carb and everything in between. But we’re still achieving good A1Cs and we’re avoiding those damaging blood glucose spikes.
I’m not saying low-carb and injections don’t work, but for me, some days I do want to have an occasional piece of cake or pizza, or a slice of that new sourdough bread that everyone’s raving about, and my pump allows me to do that with extended boluses and calculations that I was so sick of doing in my head when on MDI and often getting nowhere even on low-carb.
Pumps are also great for people with gastroparesis, particularly with the ability to do extended boluses. Yes, I know you can achieve similar with longer acting insulin injections. Why bother?
I don’t want to continually draw attention to myself in restaurants with friends by having a 15 minute conversation with a server about what he or she can and can’t bring me to eat. I don’t want to live my life like that and I don’t want my friends to be subjected to that conversation ad nauseum. I just want to order the lowest carb thing I can find on the menu and if that ends up being way over a particular carb allowance, so be it. I yank out my pump, enter an extended bolus and I’m done. No bringing out shots or insulin pens and being looked at like I’m a drug addict. Not that I ever much cared about that, but it’s an issue for many from what I hear.
Sometimes my friends want to dine where almost everything on the menu is carb-laiden, or I’m invited someplace where there’s little that is low-carb. Do I have to stay home? How would I manage that with injections? Pull out a syringe every half an hour? Or maybe I just shouldn’t eat? Yes, people do manage on injections, but I say I have better and far easier control with a pump AND I have the quality of life I want. I can and do participate in social meals as a nearly normal person. That’s priceless!
I have another autoimmune disease that sometimes plays havoc with my blood sugars. Do I really have to manage that with injection boluses or an increase of a 12-24 hour basal when I can’t predict when it will stop? With a pump, I have minute-by-minute control of basals. I increase for a couple of hours at a time, test every hour or two, to see what’s happening and I’m done.
In conclusion, I would much rather have 10 years of far better A1Cs than I had on shots, and be more easily able to sometimes live outside the low-carb regime than not. And I would much rather and more easily achieve that with an insulin pump than with injections. If someday I have to go back to injections, because of lipohypertrophy or because my BGs have become unstable because of a pump, then I’ve still had 10 or 15 years of doing much less collateral damage from diabetes in a far more convenient way.
Again, I’m not saying your “normal” blood sugars can’t be achieved with diet and insulin injections, but why bother when most insulin pump users will probably tell you it’s so much easier with a pump?
If you think that all pump users have unstable blood sugars or that their A1Cs are not more normal than they were on MDI, you’ve been hanging around in the wrong places!
With the greatest of respect for what you’ve done to help people better control their blood sugars (me included), I’ll wear my pump and have better A1cs until the last place I can wear it is on my big toe! I dare say that most people using a pump would agree.