Type 1 diabetes
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy. Type 2 diabetes, which is far more common, occurs when the body becomes resistant to the effects of insulin or doesn't make enough insulin.
Various factors may contribute to type 1 diabetes, including genetics and exposure to certain viruses. Although type 1 diabetes typically appears during adolescence, it can develop at any age.
Despite active research, type 1 diabetes has no cure, although it can be managed. With proper treatment, people who have type 1 diabetes can expect to live longer, healthier lives than in the past.
As a type 1 diabetic athlete, I've struggled with the lack of resources for diabetic athletes. Since I've used injections, 2 insulin pumps, and untethered pump therapy, I thought I should share my first hand experience.
I was on MDI(multiple daily injections) for 1 year after I became diabetic when I was 12 years old. I wasn't an athlete at the time, but based on more recent injection use, I can tell you this isn't the ideal therapy.
I started pump therapy when I was 13, about 1 year after becoming diabetic. My first pump was a Medtronic inimed 715 pump. I started Cycling consistently several months later. Just for performance in general, they started me with the standard quick-set infusion sets which go in at at 90 degree angle 6 mm long. While not terrible, I did have problems which became more frequent. The first, which everybody may encounter is the disconnect at the skin site. Its a 45 degree turn to disconnect. However when reconnecting, I often had a hard time because for some reason I couldn't get it to fit back in place properly. It may be fitted too tight or the skin would depress too much creating a indent in the skin. Quite a few times I spent 5-10 minutes reconnecting. Only once or twice did I have to insert a new infusion set.
Second, the insertion device needs to be redesigned. It has two release buttons and if not pushed simultaneously, the needle can go in slightly crooked causing possible pinching problems later. I'm not afraid of needles, but even still the anticipation of the spring release makes me nervous when I insert a new set.
Third, gradually over 18 months I got more blocked infusion sets more frequently. One thing that accounted for it was that I was leaving the sets in for up to 7 days, which is a major problem I later found out. This creates scar tissue, blocks insulin absorption and the end of the tube. It also takes a very long time for scar tissue to heal. Eventually I had to stop using several sites for a few months to all the scars to heal. I was speaking with a rep about infusion sites and he recommended using my stomach. Now I was still using the 90* quick-sets. The first time I used this set in my stomach it jammed on me. I don't think my pump sensed it either. Apparently my body wasn't getting insulin because my blood sugar went up to over 500 and wouldn't come down. Now I has also done a 72 mile bike ride the day before and eaten a lot more carbs than usual, which may have been an issue, but the infusion set certainly played a large role. I went to the hospital for DKA and while there another Medtronic rep came and showed me the silhouette sets that are longer, 17 mm, but go in at a 17-45* angle. I have used those ever since and they have worked quite well, with very few and rare problems. I would say that with the Silhouette sets the Minimed pump is 98% reliable. Now Minimed has teamed up with One Touch glucose meters and they have a wireless connection. When you test your blood sugar, that number automatically gets sent to your pump, so then you can do your correction. Also, they have a continuous glucose monitor system which is another sensor that is placed in your stomach or fatty tissue temporarily that checks your blood glucose every 3-5 minutes. Its a great tool and I think would help control ones blood sugar even better. Unfortunately it's expensive and isn't fully covered by insurance companies.
I started using the OmniPod insulin pump in 2012. Its a much newer pump with a revolutionary design. Instead of being connected with a tube, the pump is tubeless. It has a pod with a 200 ml insulin reservoir and a motor and wireless receiver. It is controlled by a remote that doubles a glucose meter. I got this one because I liked the concept and Team Type 1 Pro cycling was using it. I used it for about 3 months successfully. I liked being able to wear it on my upper arm, about halfway between my elbow and shoulder, I could also put it in the “love handle” areas. Since its tubeless, there are a lot more areas I could utilize. Its definately more bulky and I had to be careful not to bump it hard or rip it off. I tended to forget it was on, possibly because I move it every three days. I often would hit it hard when soaping my body in the shower. Usually it wasnt enough to dislodge it.It worked for about 3 months. Then I started getting a lot of jams. AKA, no insulin delivery. At first it was because I would roll over on it in bed, or lay on my arm with it on, somewhat reasonable stuff. Actually when I got it the Rep said I may have trouble with it because I'm so skinny. I didn't say much to that, but thought her comment a little odd because TT1 used it and they have the same or skinnier body as me. But also I started getting No Deliveries when I would be standing up, or in a position that didn't put any pressure on the site. That was really odd. It came to a point where I wouldn't even make it 24 hours before the pod would jam, often much less,only hours, and many times it would jam during the night. At least once I woke up to my blood sugar above 500. I decided this pump was becoming too unreliable. I stopped using it and went back to my MiniMed pump and leftover supplies. A big complaint I have with the OmniPod is that when it has a no delivery, it deactivates the pod and you have to throw it away and use a new one. Its a waste and expensive, but also inconvenient. With the MiniMed pump, if there's a no delivery, it alerts you, but lets you restart the delivery. I really like the idea of the OmniPod and would like to start using it again. I plan to talk to the reps and try to work with them to try and develop this product better for athletes and skinny people.
The other system I’ve used is the untethered pump program. Untethered is where you use a detachable pump like the Minimed and only connect it for meals and boluses. Simultaneously you are taking long acting insulin shots such as 24 hour Lantus. The advantage to this is your not connected to a tube like the OmniPod. Many people have done it this way. Often not permanently, but as a break from permanent pumping. Its popular during the summer when its hot and people are at the beach and pool a lot and don't want to, or can't wear the pump at all times. This is pretty easy to get fairly accurate within a few days and then you can zero it in from there. I think it works best if you're less active and/or consistent with your exercise activity. The difference from the pump is that you're still receiving the same amount of long acting insulin, whereas with the pump you would be decreasing your basal rate for exercise. If you are an athlete this can be overcome simply by eating more carbohydrates.
Almost everyone will agree that Insulin pumps are the greatest thing for diabetics. In most cases its improved A1C results and makes peoples lives more convenient. At this point I recommend the Medtronic MiniMed pump because it is the more reliable(by far) of the two pumps I’ve tried. Its also the most used pump on the market.
OmniPod Pumps http://www.myomnipod.com/about-omnipod/
Medtronic Minimed Pumps http://www.medtronicdiabetes.com/