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[IP] Research paper - completed

Thanks to everyone who responded to my research paper
inquisitions. Your reponses were of great help to me,
and my paper. 
Since so many of you expressed interest in seeing the
final product, I am including it in this email. I am
turning it in tomorrow, so it is too late to change
anything, but i would like to know what you think.
Please keep in mind that the facts about diabetes and
it's treatment were found from various reference
So here it is- it's fairly long (about 7 pages) so it
might take a few minutes to read. 
Thanks again, Leanna

(sorry that the graphs didn't turn out... there are 3
- two of them just show how humalog and NPH insulin
work over an hourly length of time... the other is a
bar graph showing what different ages of users thought
about their pumps)

Technology - Improvement or Constraint
	Technological advancements have come to be part of
society - the part that most of us thrive on.  In the
area of medicine, however, technology has come to be
more than an additional luxury - it is a necessity. 
Or is it?  There are many opinions about technological
improvement and several factors that must be taken
into consideration when trying to decide whether these
advancements are beneficial or whether they serve as
possible detriments.  The need for insulin, in
whatever form, is an undeniable necessity for type I
diabetics.  As of now, there are two main vehicles in
which diabetics acquire insulin: needles and the
insulin pump.  This paper will show the positive and
negative influence that an insulin pump can play in
the life of a diabetic. 
	Diabetes- what is it?  According to Shin, diabetes is
a "group of conditions in which glucose (sugar) levels
are abnormally high.  Diabetes occurs when the
pancreas stops making enough insulin, which is
necessary for the proper metabolism of digested foods"
(Shin 73).  Insulin is a hormone that is required for
the breakdown of glucose in the blood stream.  Without
insulin, glucose is not broken down, and the sugar
remains in the blood stream until it reaches the
kidneys, when it is expelled through micturition. What
is wrong with this?  Because of the constant high
level of glucose, a diabetic's kidneys have to work
overtime in order to process this - therefore, some of
the complications that diabetics are likely to
experience are kidney damage, loss of limbs, and
diabetic retinopathy- a cause and type of blindness. 
Having good control of blood glucose levels is the
main way to prevent such long-term complications.  
Good control is experienced when one's blood sugar
level reading is between eighty and 120 twenty-four
hours a day.  There is a test available that
endocrinologists use measure a diabetics control,
which is called a glycosilated-hemaglobin A1C. This
test assigns a number to the control the diabetic is
having.  For example, the scale ranges from 0-14.  A
non-diabetic would have a reading from 5-6, which is
where diabetics should strive to stay.  Having a
consistent HGA1C reading in this range (5-6) will
lesson a diabetics risk of long term complications.
A blood sugar level reading is determined by number of
milligrams of sugar per deciliter of blood.  Insulin
makes blood sugar levels go down, while food makes
blood sugar levels go up.  A good outcome may sound
simple to achieve, but in reality, it is not.  After
being diagnosed as diabetic, one must find the precise
balance of food, insulin, and exercise in order to get
the best control possible.  	
	There are several types of insulin available to
diabetics that make this possible - there are two main
types - one type acts as a constant stream - it's
delivery system looks like this:
	Short acting
			          8am     9       10       11     12      1
The second type acts like the graph on the following
                      8am     9       10     11     
12      1       2        3        4        5

*Both graphs depict the action of each type of
insulin- both the short acting Humalog, which quits
working within roughly two hours after taken; and the
long acting, NPH, which does not work for several
hours after taken, peaks five hours after taken, and
then levels off nine hours after taking, until it
eventually quits working altogether.

In order for diabetics to have "good" control, a
combination of these two main types must be achieved. 
It is optimal for a diabetic to have a restrictive
diet, exercise, and daily routine - but that is one of
the hardest things that has to be done.  Eating at the
same time every day, exercising at the same time,
eating the same number of carbohydrates at each meal,
and remembering to take multiple shots daily all give
way to good control.  But, despite following all these
"rules," some diabetics just do not have good control
(Oakley, Pyke, Taylor 87).  If a diabetic wishes to
have a long healthy life, he must follow all these
rules and hope for the best. There has to be a better
way. Is living life on the rigid schedule worth living
at all?  Can diabetes rule a person's life? 
	Yes, diabetes can rule a diabetic's life- but thanks
to the new insulin pump, it does not have to (Shin
92).  This is how pumps work - insulin pumps deliver a
constant stream of insulin. The pump is programmed,
according to the diabetic's individual need, to give
the correct amount of insulin hourly.  This is called
a basal rate.  The pump can be programmed to give a
different amount of insulin every hour - and it
delivers this amount in tenths of a unit.  So a person
requiring one unit an hour will get one tenth of a
unit every six minutes.  An accurate basal rate is
difficult to determine, but it is much easier to
administer than the needle injections because if there
is a problem (when using the pump), the hour in which
the person's blood glucose level goes too high can be
determined, and the problem can be remedied.  When a
person eats a meal, he can program in an insulin
bolus.  This rate again, is different for each person
- what an endocrinologist will usually do, is assign a
unit per carbohydrate ratio.  This way, when a
pump-user wants to eat, he does not have to be
concerned about the time of day that he is eating, or
even what he is eating - a candy bar, despite the fact
that it is rich in fast acting glucose (which is a
no-no for diabetics not using an insulin pump) is able
to be compensated for just the same as, for instance,
an apple is (Shin 93).  
	According to the responses I have gotten from insulin
pump users (found through a pump support web site
(http://www.webmd.com   which led me to a site/club
for people interested in insulin pumps) pump users of
all ages enjoy the flexibility that the pump allows. 
Not having to eat when the clock says it is time, not
having to carry a bottle of insulin around, getting
better control, and being able to live a more active
and fulfilling lifestyle are only some of the perks
that people have mentioned. The following is a graph
that shows the ages of people and the degree to which
how much they enjoy their pump.  

   0-5	    6-10	      11-20     21-40     41-55       
*The vertical numbers represent the following:
5 - Absolutely love the pump
4 - Enjoy the pump, but have had minimal problems with
3 - Could take the pump or leave it
2 - Are experiencing several problems with it
1 - Would like to give it back
The pink bars represent the views of women.  The blue
bars represent the views of men.
The figures that the graph represent are based on the
responses of the people interviewed.

The following section includes quotes from people
interviewed. Before starting to use a pump, one man,
being wary of a pump and after experiencing
complications due to bad control, had a son and
comments "On the day my son was born, upon seeing him
for the first time, I made the decision (to start
using an insulin pump).  Here was a human being whom I
helped bring into the world. He is my and my wife's
responsibility. No longer was I just living for
myself, but for two people."  A child says "I began
pumping to improve quality of life…  I wanted a
childhood with some candy in it, the ability to sleep
late, not have to eat on a schedule, etc."  A woman in
her thirties says "Pump spells one word: Freedom."
Another middle aged pump user says " I didn't want to
consider using a pump because I did not want to be
attached to something. But after starting, I'm amazed
at how stable my blood sugar readings are."  An
elderly gentlemen comments "I resisted going on the
pump for a long time, since I saw it more of a burden
and injections - What a fool I was!"
Despite all of the positive responses, there are
drawbacks to having an insulin pump.  The main problem
that has been brought to my attention by all of the
users are  the hassles that insurance companies put
people through.  According to the individual's
insurance plan, the pump may or may not be covered.
Depending on the model and manufacturer of the pump,
they can cost from as "little" as two thousand dollars
to as much as six thousand dollars.  And that does not
even cover the cost of supplies for the pump, which
can add up to several hundred dollars a month.  Many
people have been fortunate enough to have this cost
covered by insurance, but even those that have had to
pay out of pocket for it see it as a worthwhile
investment.  One lady comments "My insurance was
nothing but trouble and I paid cash for my own pump
and am waiting to get reimbursed $1500.00. I will
believe it when I see it."  But despite this, she
still loves her pump. 
	Another drawback to having a pump is the fact that it
is all electronically run.  Therefore, if the
batteries run out, or if there are other mechanical
problems, the pump user is in trouble (Larkins,
Zimmet, Chisholm 927).  If the pump malfunctions, and
does not give the correct amount of insulin, the user
may not know it for hours, which can cause a person to
go into - DKA (diabetic keto-acidosis).  This causes a
need for hospitalization, and causes damage to the
kidneys each time this acidic balance is not as it
should be.  So although computers run our world, some
people are not comfortable with the fact that they
have to rely on the readings that a machine gives them
as to how much insulin is actually being injected;
they would rather inject insulin using a syringe that
they themselves have filled up in order to physically
see the insulin going in. 
	Despite the problems with insurance, and the lack of
trust of computers, it has been shown that most people
love their pumps regardless.    The use of pump
therapy seems to be most popular with those under the
age of twenty. Children are very active, for the most
part, and many "just want to be kids" and they feel
that they can not do as they please when they are
dependant on the schedule that is required of them
when using the "old" method (Larkins, Zimmet, Chisholm
625).  The parents of these children are ecstatic
about the pump as well. They love them - they no
longer have to deny their children birthday cake at
parties; they no longer have to interrupt school
lunches to administer shots; they can rest easier with
the better control that is provided by the pump. 
Although some children are skeptical of wearing a
"beeper" (which is what the actual pump looks like),
most would not trade it in for the "old life." The
freedom that the pump allows them is unmatchable.
	As for elderly people, many are reluctant to switch. 
They have been doing the same routine for decades, and
see no reason to change.  Many people that were
interviewed have used the line "why fix it if it isn't
broken."  And these people are scared of change.  They
are set in the ways that they were forced to establish
years ago.  But the elderly people that have tried the
pump love it.  They love the flexibility that they
never knew existed.  But for the most part, those over
the age of fifty do not want to try anything new- they
have become accustomed to the pattern and control that
they have established thus far.
	As far as endocrinologists go, many encourage their
patients to use one. They explain the two main options
to their patients (injections and pump therapy), and
let the patient decide - but what patient would turn
down freedom and flexibility? An overwhelming majority
of newly diagnosed diabetics start immediately on the
pump, and are not even aware of the "old" method of
treatment.  Some endocrinologists do not endorse pump
usage - they are determined to achieve good control by
using the old method.  But for the most part,
endocrinologists encourage their patients to try a
pump, because of their high success rate.  
	It is evident that technological advances are
becoming more and more a necessity as opposed to a
luxury.  After switching to an insulin pump, the
thought of going back to the multiple shot-a-day
routine is inconceivable.  The freedom that the pump
allows is unmatchable.  Most people are grateful for
the opportunity to use this advanced treatment for
diabetics.  As of now, implantable pumps are being
researched (Shin 93), but it will be a few more years
before implantable pumps are as common as the external
ones that are available now.  
Insulin Pump.  2 November 1998 <http://www.webmd.com  
Larkin, R.G., Zimmet, P.Z., and Chisholm, D.J., eds. 
Diabetes 1988.  International                         
         	Congress Series 800.  Amsterdam: Excerpta
Media, 1988.
Oaklet, W.G., Pyke, D.A., and Taylor, K.W.  Diabetes
and it's Management.  3rd ed.
	Oxford:  Blackwell Scientific, 1978.
Shin, Linda, ed.  Endocrine and Metabolic Disorders
Sourcebook.  Vol 36.  Health
	Reference Ser.  Michigan: Fredrick G. Ruffner, Jr,


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