TORONTO — When Doug Mumford was diagnosed with Type 1 diabetes at age 18, his doctor was blunt about how trying to staying on top of the disease would alter his life.
“My doctor said: ’I’m sorry to have to tell you this, Doug, but your life is going to be routine from now on,”’ Mumford recalls. “’You’re going to get up at the same time every morning, weekends and weekdays. You’re not going to drink. Every day, you’re going to eat three meals, or maybe six, and they’re going to be the same every time. Maybe not the same, but the same content.’
“’And that’s your life if you want to live very long.”’
Forty-two years later, Mumford is still very much alive and has not developed any of the complications that people with diabetes are prone to — eye disease that can cause blindness, potentially fatal kidney dysfunction, heart attack and stroke, and peripheral nerve damage that can lead to amputation.
An estimated 240,000 Canadians have Type 1 diabetes, an autoimmune disease that destroys the insulin-producing cells in the pancreas.
Over the years, the technology for keeping tabs on blood sugar and ensuring proper levels of daily insulin injections for good glucose control has changed dramatically, says the 60-year-old self-employed Toronto businessman.
“When I was diagnosed, we had no ability to test blood sugar levels at home.
“You had to go to a lab every few months and wait a few days for the results,” he says, explaining that when home glucose testing came along about 30 years ago, it offered a huge improvement for managing diabetes.
“So you could look at your blood sugar and say, ’Whoa, I’m high. I need to take insulin’ or ’I’m low, I better eat something.”’
More improvements followed, including multiple daily injection, or MDI, therapy that provided long-acting and short-acting insulins to better mimic the body’s natural blood-sugar control.
Insulin pens for a dial-a-dose delivery system were offered as a replacement for syringes and needles.
“That was state of the art before the insulin pump came along,” Mumford says of the battery-powered, beeper-sized gadget that is programmed to deliver injections through a tiny tube inserted under the skin, usually in the abdomen.
While the computerized pump was a big leap forward in making life easier for people with diabetes, Mumford said he was never totally satisfied with his ability to control average blood sugar levels over time — the key to staving off diabetic complications and feeling well.
He believes he has that now with the latest innovation in automated insulin delivery, a system that has married the pump to a continuous glucose-monitoring device.
That sensor takes glucose readings every five minutes and wirelessly communicates that information to the pump, allowing users to react to either high or low levels before they become dangerous.
The pump allows long-acting, or basal, insulin to be programmed, says Mumford. “Once you determine what you need, you set the basal dosing by time to match your needs.”
For fast-acting insulin, used to deal with meal-related blood sugar increases, the person can punch in the estimated carbohydrates and the pump will inject the appropriate dose.
An insulin pump costs $6,000 to $7,000, plus about $1,200 a year for pump supplies.
These costs are often covered by private insurance plans and by some provinces. For instance, Ontario covers the cost of pumps for both children and adults, plus $2,400 a year for diabetic supplies, while B.C. and Saskatchewan reimburse the cost of a pump only for children under 18.
Mumford got onto the integrated pump and sensor after taking part in a clinical trial designed to see whether the combination system improved a diabetic’s average blood sugar reading — known as an A1c — over time, compared to diabetics using conventional multiple daily injection therapy.
He was among 485 children and adults with Type 1 diabetes enrolled in the STAR 3 trial at 30 centres in North America, including four in Canada.
“Over the course of a year, we tracked blood-sugar control,” said Dr. Bruce Perkins, an endocrinologist at Toronto General Hospital and principal investigator for that centre’s arm of the trial.
“What we found was that in all subjects there was quite a dramatic improvement in blood sugar control,” he said of the study published last month in the New England Journal of Medicine and primarily funded by U.S.-based Medtronic Inc., manufacturer of the pump-sensor system.
On average, subjects assigned the sensor-augmented pump saw their A1c drop to 7.5 per cent from 8.3, while the average reading in the MDI group drifted down to 8.1 per cent from 8.3.
Perkins said the ideal A1c is below seven per cent, a target met by more than one-third of participants wearing the pump-sensor system, but only 10 to 20 per cent of those on MDI.
“Achieving target blood sugar control in people with Type 1 diabetes is a very difficult task,” he said. “There is definitely benefit.”
Perkins said lowering patients’ blood sugar isn’t that difficult — the more serious problem is making sure blood-sugar levels don’t plunge too low.
Despite the fact the sensor-augmented pump lowered average blood glucose readings, the technology did not increase rates of hypoglycemia, or low blood sugar, which he said can cause seizures, coma and even death.
“Too low a blood sugar is dangerous now, at the moment the blood sugar’s low,” he says. “High blood sugars can make people feel sort of sick, and often not. But what happens is over time they damage the body and cause the (long-term) complications of diabetes.”
While Medtronic is the only company now selling its combination pump and monitoring system in Canada, Perkins believes it’s only a matter of time before pump-makers like Animus and Roche partner with sensor-makers such as Abbott and Dexcom to supply similar incorporated systems.
For Mumford, wearing a pump joined to a sensor has not only improved his health, but has also given him the flexibility he’s been denied most of his life.
“It’s that flexibility to eat and sleep and work and play when you want ... To me, flexibility means freedom, and that’s freedom to live the life I choose to live.”
“I think it’s very hopeful because when you develop diabetes now, you’re not being sentenced to a life of limitations, because the pump, especially combined with the continuous monitoring, really allows you to manage your diabetes within whatever lifestyle you choose.”