Who doesn't sometimes need help navigating life with diabetes? That's why we offer Ask D'Mine, our weekly advice column, hosted by veteran type 1 , diabetes author and educator Wil Dubois.

This week, Wil's setting our minds at ease about some of our most common dreads and fears -- of complications, and potential insulin pump malfunctions.

Yes, anything's possible in the world of diabetes, but Wil wants you to know: nothing's inevitable. So try not to lose any sleep over these fears!

{Got your own questions? Email us at [email protected]}

 

Laura, perhaps no type at all, from California, writes: Help! My beloved partner is scared sick that she is going to die imminently from permanent, irreversible damage due to diabetes. Here's the story: About 18 months ago, she got a blood test showing a glucose level of 140. She instantly changed her entire diet, and lost 120 pounds. But she's absolutely convinced that nothing she's done has made anything any better and that she's doomed to a miserable and early death. She's terrified (to the point of causing anxiety attacks) because she read that type 2 is "an incurable progressive disease that leads to inevitable and devastating complications." You've been through this and know others who have. What can I tell her? Can you offer her some hope?

Innovation 2015

Wil@Ask D'Mine answers: So I would like to know what f***ing idiot wrote that type 2 is "an incurable progressive disease the leads to inevitable and devastating complications" (!). Seriously, I want to know. Because that person needs to be drug by their heels in front of a brick wall, tied to a stake, and shot 100 times with twenty different AK-47 rifles, buried without a gravestone, and their work burned to ashes.

It's. Simply. Not. True. At all.

Your beloved is the victim of some horrible misinformation. On the bright side, this has caused her to make some stellar changes in her life that will pay huge dividends in the long run; but on the dark side, it has no doubt caused her untold and unnecessary pain and suffering.

Here's the truth: Diabetes is harmless... Well, OK, that's not really quite true. And I don't want to be the next persoDSC_0470n facing the AK-47s. What I'm thinking of is a coffee cup I got from Bill Polonsky that says: "News Flash: Well-Managed Diabetes is the leading cause of...Nothing!" His point being: complications are associated with poorly-managed diabetes. In my words, all diabetes does is make the body process sugar poorly. Sugar, if the levels get high enough, is like battery acid in your blood. Over time, left unchecked, high sugar has the power to wreak havoc on your body—the much feared devastating complications. Bluntly put, it's (generally) high blood sugar that's the villain, not diabetes, per se.

Oh, don't get me wrong, the complications are real enough, but they're hardly inevitable. Control the sugar, you're more likely to avoid the complications. It's actually that simple. Even the Diabetes Control and Complications Trial (DCCT) released back in the early 90s showed us the rate is reduced when blood sugars and A1Cs are lower.

Now, it's true that diabetes is progressive. It gets a little worse every day. It takes more effort to control over time, but again, the diabetes does not cause the complications. The sugar does.

And speaking of blood sugar, hers wasn't even all that bad. A 140 is consistent with diabetes...  maybe... but hardly diagnostic for it.

But do you want to know what I think? I think that blood test and the bad info that followed was the best thing that ever happened to your beloved. It scared her into making a major life change that most people are incapable of making. Losing that kind of weight is nothing short of amazing! Oh my God, 120 pounds? That's like 15 bowling balls! That's astounding!

So tell her, the progression of diabetes... yes that's inevitable. Hell, death itself is inevitable because life has a 100% fatality rate. But devastating complications? Inevitable? Bullshit!

There's nothing inevitable about complications. At all.

 

Tom, type 1 from Virginia, writes: I have not read much about the built-in safety features of insulin pumps. In particular, I am terrified of a pump malfunction that would result in the inadvertent delivery of a lethal amount of insulin. If a malfunction occurred with a nearly full reservoir, possibly hundreds of units of insulin could be injected. Some people liken this to having a loaded pistol pointed at a pump user's head 24/7! Are there fail-safe procedures in place that protect against hardware and software malfunctions in insulin pumps? Any reassurance you can provide will help me sleep better at night with my tethered pump.

Wil@Ask D'Mine answers: are there fail-safes built into our pumps to protect us? Hell yeah. By comparison, the safety features and redundancies built into an insulin pump make the Space Shuttle look like a paper airplane, and a nuclear power plant look like a Burger King.

Oh. Wait.

Columbia and Chernobyl come to mind, don't they? So maybe that wasn't the best analogy.

The truth is that insulin pumps fail all the time. But don't freak out on me. That pistol pointed at your head is loaded with blanks. When pumps fail, they tend to crap out and stop delivering insulin. This ends up being an annoyance and an inconvenience on one end of the scale; and a generally slow-motion emergency on the other end of the scale.

What makes a pump potentially dangerous, should it stop working, is that the last drop of insulin that the pump pumped lasts in your body for about four hours, because pumps use fast-acting insulin only. Pumpers don't use the time-released basal insulin. Instead, our basal needs are supplied by a constant drip-drip-drip of fast juice. If the pump goes kaput on you, you're on the road to DKA faster than you are if you were using multiple daily injections. Should this scare you? I don't think so. Hey, skip one Lantus shot and you can be on the same road—type 1s without insulin have a definable, finite lifespan (which I just got a question about, so we'll talk about that next week).

This is why we pumpers are encouraged to test our blood sugar more frequently than other type 1s: for advanced warning of trouble, should it develop. But even if you don't test as much as you should, and should your pump stop, and should you be unaware of it, the symptoms of DKA are kinda hard to miss. Plus, you can travel pretty far down that road before you reach the point of no return.

Actually, thousands of pumps fail every year for various reasons. Generally speaking, when they crap out, a call to the toll-free number on the back of the pump has a replacement headed its way to you in a FedEx box in a matter of hours. Can you live 24 hours without insulin while you wait for a white truck? Probably, but not without getting pretty sick. So you'll need a back-up plan, which usually means going back to shots for one day until the replacement pump arrives.

is-it-safe

A couple of years ago the FDA added up the number of reported incidents involving pumps and put the total at 17,000 over a four-year period, of which 12,000 cases involved "patient injury" and 310 deaths. At that time, 375,000 of us were using pumps. I guess that means your average chance of having a pump problem is at least 4.5%, which is kind of sobering. But on the bright side, your chance of being killed by one of those pump problems is quite low.

Additionally, I should point out that according to a recent FDA study, the main cause of injury (and death) when it comes to pumps is basically pilot error, not problems with the machines themselves. This is probably what's behind the annoying increase in "are you sure" type warning steps in the newer pumps that I ranted about recently. Of course, sometimes a PWD dies wearing a pump and whether or not the pump is to blame is an unknown factor. Suicide by pump also happens—and why not? If you are suicidal and wearing a pump, you have a built-in self-destruct button. Of course, you don't need a pump to do that, you can kill yourself with an insulin pen just as easily.

But I know that what you are worried about is your pump freaking out and overdosing you. Trust me, I've been there myself, and wondering if your pump tried to kill you is scary beyond my ability to describe. That said, death by confirmed pump malfunction leading to an overdose is exceedingly rare. I only know of one case for sure, and while beyond tragic, it should be pointed out that insulin pumps have come a long way since then. In fact, reporting of insulin pump problems is trending downwards. Now anything bad that happens involving a pump is supposed to be reported by pump makers themselves; but that said, J&J got into hot water for deciding not to tell the FDA about pump problems that J&J themselves decided were linked to user errors. Still, we citizens can report trouble, too, and do. So I think the drop in problem reports over the years is because pumps are getting better, rather than because of massive cover-ups on the part of the pump makers.

The modern pump has a gazillion safety features. OK, well, maybe not a gazillion, but thousands. The typical pump conducts something like 15,000 self-checks a day, ranging from software, to electrical flow, to mechanical movements, fluid pressures, and more. They are pretty amazing devices. There are even sensors to monitor the sensors. If you have some time to kill, scroll through this document to get an idea of the things the Feds expect the pump makers to address when it comes to safety features.

Is it possible for a pump to kill you? Sure. But the risk is remote. It's much more likely that the gun to your head will come from a street thug. Or a speeding taxi. Or a rabid bat. Or a short-circuiting iPhone.

Life is a dangerous business.

 

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

 

 
Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.