Below is the text of a letter I have presented to my GP and other medical staff. It's my first step toward getting an insulin pump.

My research into pump therapy leads me to believe that switching from multiple daily injections to a pump will help me deal with some of the following issues, thereby improving my blood glucose and making me healthier overall while simultaneously giving me a freer lifestyle where I can think about diabetes a bit less.

Hypoglycaemia

I average one hypoglycaemic event every 2 -3 days. To combat this, I have raised my blood glucose target from 5.5. to 6.0 mmol/L. I am very reluctant to target a BG higher than this. I feel terrible if my BGs run over 6 mmol/L consistently: I am lethargic, unable to think, uninterested in my work and projects.

The severity of my hypoglycaemia has increased. When I compared the 30 days 16 October - 15 November 1998 and 1999, I discovered that during both 30 day periods I had 15 hypos. However, during this period in 1998 my most severe hypo was 2.8 mmol/L. During the same period in 1999 I had seven hypos of 2.8 mmol/L or below, including three at 1.8 mmol/L.

Studies demonstrate a decrease in frequency and severity of hypoglycaemia in pump users, so I believe a pump might help me decrease hypoglycaemia and allow me to target my optimal blood glucose of 5.5 mmol/L, which is where I feel best.

Fasting blood sugars

It seems increasingly difficult to achieve good fasting blood sugars. I think this is mainly due to eating too late in the evening and to the variable results I get with short-acting insulin while I'm asleep (see insulin patterns below). Within the period 16 October - 15 November 1999, I had normal fasting blood sugars only seven times out of 30 days.

I am trying to combat this problem by eating smaller amounts of protein in the evening and by ensuring I have no meal insulin in my system when I go to bed. I feel a pump would give me greater flexibility in this area.

Management issues

My insulin regime has interfered with my work. Because I take an injection at 3pm, I have had to leave meetings to take my insulin.

The first suggestion in this case would be to change insulin timing. However, my long-acting insulin regime has been finely adjusted to avoid hypoglycaemia during the night and to deal effectively with the dawn phenomenon.

At present I have four identifiable long-acting insulin patterns (see insulin patterns below). If I were using a pump I would still have to remember when changes in my basal rates were due, but mistakes could be rectified immediately instead of having to wait until the next day.

Because my larger long-acting dose is in the afternoon, I can generally tell by bedtime if I have a deficit/excess of long-acting. At present I have to deal with this the best I can over a day. With a pump I would be able to deal with recognised basal deficits/excesses immediately. This would improve my overall control and give me more flexibility by reducing occasions where I would have to eat to keep my BGs up.

At present I use up to 4 insulins to achieve my targets (Zn, S, H, L). Using a pump would do away with this juggling act because I would use only one insulin. It would also reduce the margin for error.

Despite eating a healthy diet which generally excludes foods that spike my BGs, I meet my BG targets (between 4.4 and 7.8) less than 60% of the time, and I usually meet them less than 50% of the time. I realise these percentages are partly influenced by the fact that I test whenever I think something might be wrong. However, I believe I should be able to improve these results without further restricting my diet. A pump could help me do this.

I would like to point out that my present insulin regime can give me good results if I spend a significant amount of time managing my blood sugar. I think that any other injected regime will require an equal amount of attention. I think a pump will help me reduce the amount of time I spend managing while giving me equal or better BG results.

General health issues

It is my impression that many medical professionals consider a pump a therapy of last resort, when diabetes is completely brittle or when a person is developing complications. These attitudes are perfectly understandable because of the problems with infusion sets, insulin degradation, and DKA in the early 80s when pumps were first introduced. However, all of these issues have been addressed through improved manufacturing processes, changes in the material in infusion sets, and more intensive BG testing regimes. The American Diabetes Association's position statement on Continuous Subcutaneous Insulin Infusion is a good summary of the situation today.

I feel that the pump is the logical therapy progression for me, as I am already on an intensive regime of multiple daily injections. I feel very strongly that I should explore this therapy now, before I go brittle and/or before complications do begin to develop. I am also influenced by the fact that I have never met a person who was ambivalent about her or his pump, and by the fact that people I know who use pumps have reported improvements in other health areas, such as with asthma, skin rashes, eczema, yeast infections, etc. I would like to take advantage of these benefits.

Why I'm a good candidate for pump therapy