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[IP] Pump/Pregnancy/Israel - Jerusalem Post Article


Glad tidings for pregnant diabetics 


(August 23) - Insulin-dependent (Type I) diabetics are like tightrope 
walkers, balancing themselves between too much glucose and too much 
insulin. Any imbalance can lead to a fall - either fainting or loss of 
consciousness in the short term, and damage to vital organs in the long 

Type-I diabetics suffer from an autoimmune disease in which the islands 
of Langerhans - vital cells in the pancreas - are attacked by the body's 
immune system and stop producing insulin, which metabolizes sugar. 
Testing their blood for glucose and injecting themselves with insulin 
several times a day is an annoying and painful chore, but a 
life-and-death matter. It's especially difficult for children, teenagers 
and pregnant women.

But now, with the availability of the insulin pump, keeping one's sugar 
and insulin in equilibrium is much easier, quicker and much less 
painful. Only about 100 Israelis - of the 10,000 Type-I diabetics in the 
country - are using insulin pumps. In fact, most of the rest of them 
have never heard of the device; and even if they had, it would be too 
expensive for many to purchase.

The insulin pump was invented about a decade ago and first used at Yale 
University in the US. It was about the size of a brick and weighed as 
much; it had to be plugged into an electrical socket each night to be 

But thanks to digital electronics and miniaturization, today there are 
insulin pumps the size of a beeper, worn under the patient's clothing, 
that use three tiny batteries lasting for two months. Today about 50,000 
American diabetics, most with the Type-I form of the disease and the 
rest middle-aged people with the Type-II (non-insulin-dependent) form, 
use the pump, made by the California-based company MiniMed. Others use 
the competing Swiss brand, Tyco.

The device is priced here at about $2,700, and available upon 
recommendation by a diabetes specialist. Only 30 to 50 percent of the 
cost is borne by the health fund - even though improved insulin 
equilibrium greatly reduces the risk of hospitalization and the need for 
major medical care.

Now an obstetrician at Jerusalem's Hadassah-University Hospital with 
expertise in diabetes has apparently become the first in the country to 
fit his pregnant patients with the insulin pump.

Dr. Uriel Elchalal of the Ein Kerem hospital has so far put four women 
through the process of getting used to the device. Three of them have 
produced normal babies, while the fourth is in her seventh month of 

Glucose/insulin imbalance can cause serious damage to the fetus from the 
earliest weeks of pregnancy, Elchalal says.

"It can result in malformation of the various organs and the skeleton, 
and even mental retardation. Thus keeping the pregnant diabetic under 
control is vital for the health of both mother and baby."

About 15 pregnant diabetics are referred to him each year.

After learning about the efficacy of the insulin pump and the great 
benefits it can offer pregnant women, Elchalal contacted Agentek, the 
Tel Aviv representative of MiniMed, which manufactures the most widely 
used and advanced insulin pumps.

The branch, located at the Atidim industrial park, provided a number of 
pumps at a discount, and a donation made it possible to lease them to 
suitable candidates. The health funds, says Agentek's Nitzana Engel, 
cover most (but not all) of the cost of the insulin and disposable 
equipment, which includes glucose testers, tubes, inserters, batteries 
and needles.

The MiniMed pump has a backlit display (so you can see figures even in 
the dark) and four buttons for moving through screens, changing 
parameters and adjusting values. The tiny pump is programmed to deliver 
a basal rate of insulin - a tiny amount issued continuously from the 
device in 1/10 unit increments.

The rate can be increased or decreased depending on the time of day, the 
patient's physical activity and how much and what he eats. Before each 
meal or snack, the user gives himself a specific "bonus dose" of 
insulin; this is based on the size of the meal, specifically the amount 
of carbohydrates.

Because insulin is taken with the food, timing of meals is not as 
important as it is with injections. Meals can usually be delayed or even 
skipped without causing low blood sugar problems, allowing more normal 
daily activity.

The insulin is delivered by the pump through the infusion set, which 
attaches to it. It's a thin tube with a tiny, short cannula at the end. 
The cannula is inserted into tissue in the abdomen, the buttocks or 
thigh with a special tiny needle.

MiniMed's plastic inserter, called the Sof-set, puts the needle in place 
with barely a twinge.

The device is worn round the clock (except for showering and other 
activities, when the tube is disconnected from the pump by a twisting 
action) and replaced every two days, so that no infections develop.

Iris (not her real name), in her 30s and with a 10-year-old son and 
seven-year-old daughter, suddenly contracted Type-I diabetes after her 
daughter was born. She is one of the four Jerusalem-area women who have 
been fitted with an insulin pump. Now in her seventh month of pregnancy, 
she is delighted with it.

"I had thought of not having another child because coping with insulin 
balance was so difficult," she recalls. But she and her husband - both 
university-trained professionals - wanted another baby and hoped the 
pregnancy would proceed well.

She was referred by Prof. Itamar Raz, head of the Israel Diabetes 
Association and a diabetes specialist at Hadassah, to Dr. Elchalal's 
high-risk pregnancy unit. She started using the pump during the early 
stages of pregnancy, and all the many tests she has taken confirm that 
her fetus is completely normal.

She leased the device for $100 a month, and also covers the NIS 300 a 
month (10% of the cost) for disposable equipment that her health fund, 
Meuhedet, doesn't cover. But the expense is worth it, says Iris, as she 
is in optimum equilibrium.

"It's almost like the natural condition of non-diabetics. But it 
requires regular supervision by a doctor and a dietician.

"The amazing thing is that I was a member of all conceivable diabetes 
organizations, but I had never heard of the pump until I met Dr. 
Elchalal," Iris says.

It's also unknown to many physicians: When Iris was an inpatient at 
Hadassah, the doctors and nurses came over to ask what the device was.

The Hadassah physician says he expects insulin pumps will eventually 
become standard equipment for diabetics of all ages, not only those with 
Type I, but also those with Type II, whose pancreases are not destroyed 
but whose sugar metabolism is not balanced.

MiniMed's founder and chief executive officer, Alfred Mann, envisions 
the creation of an "artificial pancreas" as his company's ultimate 

Such a link between insulin pumps and glucose sensors will, if 
successful, "allow people with diabetes to lead essentially normal 
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