Gotta disagree with this assessment. If someone's eating a ton of food
and taking a ton of insulin, they put on weight, just the same as someone whose pancreas works. And if Josh were routinely taking enough insulin to stay euglycemic on the Mello Yello diet plan, we'd hear about some scary lows when the megabolus outlasted his bedtime soda.
Insulin pumps are smarter every year, but there's still no fully-closed loop. It's only been a couple of years since the FDA approved automated boluses based on CGM data.
Insulin pumps can make an insulin-dependent diabetic's life simpler, but at a tradeoff. Without a pump, you're riding the ups and downs of multiple daily injections, and keeping that halflife chart in the back of your mind.
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With a pump, rapid-acting insulin takes the place of an injection of long-acting insulin, because of the mechanics of a slow, basal infusion. Pumps have the option of programmable basal rates, so instead of being married to a 24-hour dose of glargine you took in the morning, your basal rate can go down when you're at your active job.
But there's not much difference between a bolus and an injection, other than the device that delivers it. A pump can give more precise doses (percentages of a unit) than a pen or a syringe, and it's easier to press a button than to grab the shooting-up kit, but once it's in the body, insulin doesn't know how it's been delivered.
As for the logistics of pump maintenance,
normal baseline humans cannot interact with durable medical equipment companies without having frustrating, avoidable issues. Polissa has not treated us to any second-hand bitching about prior authorization, order tracking, staying on indefinite hold trying to straighten out an order. No begs about needing cartridges/tubing sets to tide Josh over until something arrives.
Low-functioning Type I diabetics--not the kind of low-functioning who have a caregiver, but homeless/methy/disengaged people--are usually found on multiple daily injections. If you have a pump, you need to be able to maintain, use, and troubleshoot it. The pump needs batteries (or a charge) and you have to be able to refill cartridges, plan ahead so you don't run out of insulin without supplies, disinfect the area you're going to be cannulating. And there's always the risk of DKA if the insulin denatures from trying to coax a cartridge out too long, or if the cannula gets bent (sometimes not detectable until your CBG rises and rises) or if it was just inserted into scar tissue/area of lipodystrophy.
Is my CBG rising and staying high because I fucked up my carb count, because I'm accidentally on my "exercise" basal rate instead of my regular one, because I'm just anxious and it's about to go down again, because I'm getting sick, or is it dead insulin or a busted cannula? If it's time for a new set, do I have enough backups and enough insulin that I can just change it out without worry, or does this mean that every cannula until delivery date now has to last 12 hours longer? If the pump itself craps out, is the emergency Lantus in the fridge still good?
An insulin pump helps manage CBG, but at the cost of the user managing a different set of logistics. I feel like if Josh were using an insulin pump, Polissa wouldn't have been shy about mining all of this for drama.
