Insulin pumps – a question of access

Being a teen with type 1 diabetes is hard. Onset and diagnosis often occurs when you are young, but not so young that you don’t remember what it was like without all the pokes and prods and appointments and illness and eternal worries about management. With these memories of ‘normal’ life, combined with teenage issues like hormone changes, increasing appetite, and general pig-headedness, managing diabetes can seem impossible at times, and really bloody hard the rest of the time.

Treatment for type 1 diabetes is injecting artificial insulin frequently, as a diabetic’s pancreas no longer makes insulin. No diet or exercise will cure it, and no combination of coconut oil and flax seed will make it go away. There’s no alternative treatment. Insulin keeps a diabetic alive.

Administering insulin is not a pleasant experience. It’s not a drug that you can swallow with a mouthful of water. It requires subcutaneous injections several times a day. Blood glucose tests, using a finger prick, are also required several times a day and add to the feeling of being a human pin-cushion. Each day requires one or two injections of long-acting insulin, plus an injection of short-acting insulin with each meal, a dose carefully calculated to take into account every gram of carbohydrate in the meal and counter it with the right dose of insulin. It means that meals have to be carefully planned and snacking is right out. It’s a rigid kind of life, one that doesn’t suit the average teen, but it’s what has to be done to stay alive.

There is a newer, more awesome way to treat diabetes, though, that involves much better control of the condition and many fewer injections. Finger pricks don’t go away (yet) but the pile of needles to cart around does. The official name is ‘sub-cutaneous insulin infusions’; regular people call them insulin pumps. They have the potential to change people’s lives.

An insulin pump is a neat little device that clips onto your belt, which controls the amount of insulin that’s being dispensed. It’s connected via a thin tube to a cannula that is inserted under the skin, then stays in for two or three days. One needle, two or three days – that’s a huge improvement to a diabetic’s quality of life. It works a bit differently to the older injection routine, with long-acting insulin dispensed with in favour of a constant background dose of short-acting insulin. It’s much easier to tweak to account for snacks or bigger meals, and it can be adjusted to deal with teenage hormone cycles.

Insulin pumps are pretty amazing, and the change in people’s lives is huge. It gets rid of the embarrassing routine of having to inject in public and the hassle of trying to inject at school, the rigidity of eating patterns and exercise, and much of the worry of managing a difficult condition. It allows diabetic kids and teens to live a much more normal life, and reduces their chances of complications.

In New Zealand, we have about 2,500 under-18s living with type 1 diabetes. Across the country, there are a total of about 60 funded insulin pumps. In the UK, almost 20% of children with type 1 have a pump, and advocacy groups are working to increase that. In the US, the number is up around 35%. Anecdotally, European countries aim to have a pump available to every child diagnosed with type 1. We’re lagging behind. A long way behind.

These are life-changing devices, particularly for young people. They cost around $6,000 each, plus around $2,000 in consumables each year. How many could we fund if we didn’t have a flag referendum? How about if we canned support for Team New Zealand? Hell, we could knock $10,000 off each MP’s pay and more than double our supply of them. We could even steal some from the health budget, as better controlled diabetes now means less serious complications in the future, including savings in kidney, heart, and stroke care. It’s worth finding some room in the budget for them.

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