An Insulin Pump Helps One Man End His Frequent Glucose Swings
Monte Ransome Johnson, 46, a philosophy professor at the University of California–San Diego who has had type 1 diabetes for 18 years
Steven Edelman, MD, professor of medicine at the University of California–San Diego Veterans Affairs Medical Center and founder and director of the nonprofit Taking Control of Your Diabetes
Monte Ransome Johnson began seeing endocrinologist Steven Edelman, MD, not long after Johnson moved to San Diego in 2006. Edelman, who lives with type 1 himself, is known for his forward-thinking approach to diabetes management and his innovative use of shared medical appointments, during which patients dealing with the same issues can see him together.
Johnson has been part of a group of men with type 1 diabetes for the past six years. Meeting once every three months, members get to know each other and benefit from sharing their experiences.
Over time, Johnson began to notice how much better the men on insulin pumps seemed to be doing compared with those on multiple daily injections, especially when it came to reducing blood glucose swings.
“Monte’s A1C didn’t look too bad before the pump,” says Edelman. But A1C is only an average. Johnson’s CGM data revealed the variation in his levels; they were often higher or lower than he wanted. Combined with his CGM, a pump could help Johnson spend more time in his target range.
Still, Johnson wasn’t convinced. He hated the idea of being attached to a device, so he stuck with what he knew. He’d spent a decade using insulin pens, which he counted as an improvement on his former syringes.
Although the pens were more convenient, their shortcomings were significant. The insulin pens Johnson used didn’t allow him to dose in increments smaller than 1 unit. “He couldn’t respond as well to the readings his CGM was giving him,” says Edelman.
Johnson also had an issue with overcorrecting. He’d react to a low by drinking juice, which often made his blood glucose rise higher than intended. So he’d inject more insulin. Sometimes, because dosing with pens wasn’t as fine-tuned as he needed, he’d take more insulin than required, ending up right where he started: with low blood glucose.
Additionally, there were times he’d forget to bring his insulin with him, or forget how much he’d taken. But the main factor that made him switch to a pump last June was the promise of reducing blood glucose swings. “I’ve come to see injections as not precise enough with dosing,” Johnson says. “It’s too easy to lose track of or forget whether or when injections were taken, and [they were] generally not mimicking the natural function of a pancreas well enough for me.”
In spite of his long-held misgivings about constantly wearing a device on his body, last year he was ready to make the switch from pens. Edelman agreed that using a pump would allow Johnson to benefit more from the CGM he’d had since 2008.
Johnson selected Medtronic’s MiniMed 630G pump. Immediately after switching to it, he gained greater precision with his bolus insulin doses. For example, his pump allows him to give himself 3.3 units of insulin after eating a snack with 33 grams of carb instead of having to choose between 3 and 4 units, as he did with pens. Such fine-tuning helps him avoid blood glucose swings.
Though his pump has a built-in CGM, Johnson has stuck with his Dexcom CGM—he’s had it for years and likes it. The pump and CGM work independently of one other, but he finds that having a pump allows him to make better use of the information he gets from his CGM. The result: He’s more thoughtful in his treatment, adjusting his insulin as needed to meet blood glucose goals.
Being able to adjust his dose during exercise, for example, helps Johnson avoid lows. With the pump, he can reduce his basal rate when he’s going to be physically active for an extended period of time.
Since making the switch to a pump, Johnson has had far fewer blood glucose swings. He’s reminded of those shared medical appointments when he aspired to steady glucose levels like some of the other men. Today, his data looks a lot like the numbers that once inspired him.
Looking to compare insulin pumps and their features? Take a look at our list of available pumps on the market.