Counterpoint: Are Insulin Pumps Underutilized in Type 1 Diabetes? No

One of the major goals in the treatment of diabetes is to achieve an HbA1c (A1C) 200,000 worldwide (3). This article will address one specific question, i.e., whether a major effort should be made to increase the number of patients on insulin pumps in order to achieve the above-stated A1C goal. There are several factors that determine plasma glucose concentration. These include 1 ) the carbohydrate composition of food, 2 ) the rate of gastric emptying, 3 ) the rate of glucose absorption, 4 ) the concurrent magnitude of endogenous glucose production, 5 ) the concurrent rate of glucose disposal, 6 ) the diurnal change in insulin sensitivity, 7 ) the activity of counterregulatory hormones, 8 ) the change in the magnitude and type of exercise, and 9 ) the ambient insulin concentration. It is important to note that most of these factors are not directly under the patient’s control. Many of the factors are interrelated, so that altering one may affect the magnitude of the other. Thus, in attempting to normalize plasma …

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