Implantable
Insulin Pumps.

These are not yet a mainstream diabetic treatment, though they have received the CE mark for approval of sales in Europe. Trials have been done in the US and they are now awaiting FDA approval.

Not only do implantable pumps require approval but also the insulin they use. It is a specially formulated U400 insulin as opposed to the normal U100.

At the moment the only pump available is the Medtronic Diabetes 2007 System.
For reasons I have been unable to ascertain the Infusaid M1000, and the Siemens Promedos 3 are no longer in production.

The disk shaped insulin pump (it has been described as looking like a ice-hockey puck) is surgically implanted under the skin of the abdomen with a catheter inserted into the peritoneum (that is the membrane sac lining the abdominal cavity). It more closely mimics the action of a real pancreas.

The insulin is delivered in short bursts throughout the day into the peritoneal cavity from where it's absorption is rapid and much more predictable than that of subcutaneous injection.

The pump is also able to be programmed to deliver bolus insulin to cover meals.
This is done via a hand held, pager sized, remote control unit called a PPC (personal pump communicator) that sends messages, via wireless connection, in much the same way as those used in external pumps.

The insulin reservoir requires to be filled every two to three months. This is done by injecting a needle through the skin and into the fill port of the pump. There is a negative pressure within the pump that causes the insulin to be drawn from the syringe into the reservoir once the needle is securely connected inside the fill port. This is a safety measure on the newer pumps to prevent some of the problems of refilling that occurred on older models.

Advantages.
1. Better control thus better HbA1c levels and less chance of later diabetic complications.
2. Hypoglycemic episodes are greatly reduced.
3. Quality of everyday life is greatly improved.

Disadvantages.
1. Cost - though this is hard to pin down as yet because these are not really commercially available it has been muted that they will cost in the region of $10,000 to $15,000, plus the price of the initial surgery, any subsequent visits for insulin refills or possible problem rectification and the ongoing cost of the special insulin.

2. They are not really 'do it yourself' devices. They require frequent attention by medical professionals, from the implantation surgery to insulin refill to unclogging of blocked catheters.

3. Possible errors in refilling the pumps, especially the older models. This can lead to one injecting a large quantity of insulin into the peritoneal cavity or, if the needles become dislodged from the port, subcutaneously.

4. Sometimes the insulin settles out and deposits within the pump or catheter and that requires minor surgery to restore proper flow.


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