From the patient’s perspective, the pump also spares them the need to be injected several times a day, since the device supplies the doses through a catheter that is changed every two or three days.
“Life has turned a lot easier because I don’t have to inject myself with insulin; all I have to do is press buttons,” Londoño says. “There is not as much pain because the pump is already connected to my body.”
Díaz considers the insulin pump “recommendable for all patients, regardless of their age,” because of its benefits. However, he acknowledges that the price can be a problem. The device cost $3,000 to $6,000 and, though many insurance companies cover it at least partially, the patient always has to pay a portion.
Technological advances also help control sugar content. Monitors continuously measure glucose levels and offer automatic measurements every five or 10 minutes. They differ from other portable monitors in that the sensor is in the patient’s body and transmits the collected information to a receptor that stores it. This allows the patient and his medical team to follow the fluctuations of sugar levels in real time.
Doctors believe that in the future, insulin pumps and continuous glucose monitors will function in a coordinated fashion, as with a “bionic pancreas,” in which the insulin doses would be programmed automatically based in measurements performed every minute. In fact, Díaz says that “in Europe there is already a pump of combined sensors that turns itself off if glucose drops lower than a certain level.” This technology has not yet been approved for use in the United States.
Recent developments in controlling sugar levels in the body are now better understood. Dr. Paul Jellinger, endocrinologist of Broward Regional Memorial Hospital and professor of Chronic Medicine at the University of Miami Miller School of Medicine, explains that “for decades we have thought that diabetes control was all about insulin, either supplying it or making the pancreas produce more or making that which is already produced to function better. Yet in the last eight or nine years we have come to realize that the story does not end with insulin and that there are other hormones that play key roles in controlling sugar.”
Recent studies have shown that incretins, a group of hormones secreted throughout the small intestine, play a key role in controlling glucose. They are activated when the individual consumes carbohydrates, stimulating the production of insulin in the pancreas and blocking the production of another hormone, glucagon, which provokes high levels of sugar in the blood.
“Patients with diabetes have high levels of sugar not only due to an insulin deficit but also due to an excess of glucagon,” says Jellinger, adding that incretins go to the core of this problem. Furthermore, incretins have the big advantage of working with sugar levels in the blood. They stop acting after levels reach a normal point, as opposed to other medicines that stimulate insulin production and can generate big swings in glucose levels.
Therapies for diabetes based on incretins seek to elevate GLP-1. This can be done in two ways: through a pill that blocks the hormone absorption, thus promoting insulin production and diminishing glucagon, or through injections of a drug similar to that of GLP-1 but with a delayed effect that allows it to remain in the body longer. The injectable therapy allows larger doses and promotes a sensation of fullness in the stomach, which promotes weight loss in patients.
This type of treatment is only effective in patients with Type 2 diabetes, who produce low levels of insulin. It’s not effective in Type 1 diabetes, in which the pancreas does not produce insulin.
“They are very smart drugs that do what they have to do but then stop,” says Jellinger, who adds that “most of the patients who have tried one of the two forms of therapy based on incretins are happy with the results. The control of diabetes is very effective because they lower the sugar without reaching levels that may be too low.”
“The full story concerning diabetes is not all about insulin. GLP-1 is playing an increasingly important role in this new narrative,” he adds.