I came across a conversation on twitter last week where someone suggested people with insulin pumps are lazy. I questioned myself, am I lazy? The more I thought about it, the more it annoyed me. From my personal experience of living with diabetes, I couldn’t disagree more, and then from a more general perspective I thought these viewpoints are harmful. First, it implies people who do not have perfect control are lazy. Second, if there was a common misconception that people with insulin pumps were lazy, it could potentially lead to people refusing pumps because they don’t want to be perceived as lazy, when their diabetes team thinks they would benefit.
Instead of writing a blog post about my personal experiences of insulin pumps describing how much I appreciate my pump and why I don’t think I’m lazy, I decided I’d let the numbers speak for themselves.
NICE recommends pumps when “HbA1c levels have remained high (that is, at 8.5% [69 mmol/mol] or above) on MDI therapy (including, if appropriate, the use of long-acting insulin analogues) despite a high level of care.” As well as other reasons such as severe hypos and pregnancy. To receive a pump, you have to show a high level of motivation and comply with additional requirements (test four times a day in my clinic) as well as being subject to the clinic’s available resources.
The UK National Diabetes Audit (2015) shows 69.1% of people with type 1 diabetes in England and Wales have a HbA1c of 57mmol/mol or higher. Although it doesn’t specify how many people have a hba1c higher than 69mmol/mol, these numbers suggest quite a lot. If we look at the Scottish Diabetes Survey (2015), 49.8% of people with type 1 diabetes have a HbA1c of 69mmol/mol or higher. It is reasonable to assume approximately half of people with type 1 diabetes meet the initial criteria of a HbA1c equal to 69 mmol/mol or higher.
However, the UK Insulin Pump Audit (2014) estimates only 6% of people with type 1 diabetes have a pump. This is where issues such as motivation and funding play a role. I’m not sure how much each factor (motivation and funding) determines who gets a pump but I’m sure it varies across the UK. The UK Insulin Pump Audit (2014) also states that over 15% of people with type 1 diabetes in Germany and Norway have an insulin pump. Meanwhile, 40% of people in America have an insulin pump. If people with insulin pumps are lazy, are people with diabetes in Germany, Norway and America lazier than the UK?
People with insulin pumps are not lazy, we are just lucky. The UK National Diabetes Audit (2015) reports only 8.7% of people with type 1 diabetes achieve a HbA1c of 48mmol/mol or lower (the new target). I think it is clear that multiple daily injections/current treatment is only working optimally for the few. The rest of us with a HbA1c above 48mmol/mol are not lazy, but we would definitely appreciate a little more help in the form of an insulin pump or any other technology or educational programmes which are available.