singapore health
JAN – FEB 2014
NEWS
03
“Portable pancreas” for better diabetes control A palm-sized pump which administers insulin to diabetics via an infusion set can help reduce episodes of low blood glucose level By Desmond Ng
M
r Wong Leng Hoe, a diabetes patient and user, dubbed it the “portable pancreas”. Worn discreetly on the body, the palm-sized, pager-like insulin pump delivers the hormone round the clock. It mimics closely the normal discharge of insulin by the pancreas to regulate the body’s glucose or sugar level. Insulin is needed to convert carbohydrates into energy, and without it, sugar builds up in the blood, which can lead to serious health problems. Mr Wong, who switched from injections to using the insulin pump in July 2013, carries the device with him 24/7. “I used to forget to inject the insulin – or not do it altogether – when it was inconvenient to do so, like when I was having lunch with clients. “With the pump, I don’t have to excuse myself to go to a quiet place to prepare the insulin and inject myself. I merely press a button to deliver the (higher) dose of insulin needed before a meal. And I don’t have embarrassing blue-black marks on my body because of the injections,” he said.
Fast- or rapid-acting insulin is delivered via an infusion set which includes a short, soft tube, called a cannula, that sits comfortably under the skin of the abdomen. Dr Bee Yong Mong, Consultant, Department of Endocrinology, and Director, Diabetes Centre, Singapore General Hospital , on how the pump administers insulin into patients
Diabetics need to adjust the amount of insulin they use before meals or sports, as their blood sugar levels can go up (after a meal) or down (when exercising). Mr Wong, who is in his 50s, was diagnosed with Type 2 diabetes more than 15 years ago. This form of the disease, also known as adult-onset diabetes, is associated with obesity and an unhealthy lifestyle, unlike Type 1 diabetes where the
Worn discreetly on the body, the pager-like insulin pump delivers the hormone round the clock and mimics closely the normal discharge of insulin by the pancreas to regulate the body’s glucose level.
PhotoS: Alvinn Lim
According to Dr Bee Yong Mong (in blue), patient Wong Leng Hoe’s diabetes was better controlled after a month on the pump.
pancreas isn’t able to produce insulin. Type 1 diabetes is an autoimmune disease and is often diagnosed in childhood. Type 1 diabetics require insulin treatment from the onset of the disease, while treatment for Type 2 involves medication, or insulin injections when the disease progresses and medication is not enough to control the disease. Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin to control the amount of sugar in the blood. According to Dr Bee Yong Mong, Consultant, Department of Endocrinology, Singapore General Hospital (SGH), insulin pump therapy is a good option for people who have poor control over their diabetes. Mr Wong, for instance, struggled to control his diabetes even after starting insulin therapy more than 10 years ago. “Over the years, we’ve had to increase his insulin dosage significantly,” said Dr Bee, who is also Director, Diabetes Centre, SGH. With the pump, “fast- or rapid-acting insulin is delivered via an infusion set which includes a short, soft tube, called a
One-week training before patients start on insulin pump treatment Patient s who opt for the insulin pump treatment are trained for a week by a team comprising a doctor, a dietitian, a diabetes nurse and a representative from the insulin pump supplier. “We will work with the patient to get him acquainted with the equipment, his diet and to improve his knowledge of the insulin pump. The doctor will then decide on the amount of insulin that he should use,” said Dr Bee Yong Mong, Consultant, Department of Endocrinology, and Director, Diabetes Centre, Singapore General Hospital.
cannula, that sits comfortably under the skin of the abdomen,” said Dr Bee. The device pumps out insulin in a steady, measured and continuous dose 24 hours a day (this is known as the basal rate), and is also capable of discharging a surge of the hormone when needed (this is known as the bolus dose). Before a meal, a patient decides how much more insulin he needs based on his blood sugar reading, and presses a button on the pump to push extra insulin units into his body. The extra insulin is needed to account for the carbohydrates consumed, and to bring the patient’s glucose levels back to a specified target range. After a month on the pump, Mr Wong’s diabetes was better controlled. He no longer saw large swings in his blood glucose levels, and he could be more flexible about what and when to eat. Studies elsewhere have shown that patients on insulin pump treatment can achieve better diabetes control and reduce the incidence of hypoglycaemia, a condition where the blood sugar levels are abnormally low, Dr Bee said. When hypoglycaemia occurs, diabetics can lose consciousness if they don’t eat something sweet quickly to raise their glucose levels. Insulin pumps have been in use in Singapore for more than 20 years, but few patients opt for it, mostly because of the cost. The pump is expensive and is not covered by local medical insurance, unlike in the US for instance. Prices range from $2,500 to $9,000 for a pump, and consumables like the > Continued on page 4 ( 华文版本请翻阅至27页 )