In Type 1 diabetes and severe cases of Type 2 diabetes, insulin deficiency is often serious enough to require regular insulin boosts. Singapore General Hospital doctor spoke about the benefits of insulin pump therapy.
Multiple insulin injections were a
part of Mr Char Wei Meng’s daily
routine for the past 30 years.
These injections are necessary as
he has Type 1 diabetes – his body
produces no insulin due to damage
in the pancreas. Insulin is needed to
break down the sugar we consume
Mr Char, 49, a supply planner,
said: “No one wants to have to keep
A year ago, he was introduced to
insulin pump therapy by doctors at
the Singapore General Hospital (SGH) which, among other things,
reduced the need for injections
from up to four times a day to once
every three days.
Hospitals have been offering it to
patients on a larger scale in recent
years, but demand has been slow.
For example, SGH started 30 patients
on the pump in the past two
years and it has 45 pump users now.
This is a mere fraction of the estimated
5 to 10 per cent of more than
400,000 people in Singapore who
have Type 1 diabetes.
At National University Hospital
(NUH), only 13 per cent of paediatric
patients with Type 1 diabetes are
on insulin pump therapy. The insulin
pump is a battery-operated device
about the size of a pager that
contains a syringe-like insulin reservoir
with about three days’ supply.
This supply runs through a tube
into a plastic cannula (a thinner
tube containing a needle) that sits
under the skin, delivering the insulin
continuously into the body.
Diabetes is characterised by high
blood sugar levels that are a result
of the body producing insufficient
insulin. In Type 1 diabetes and
severe cases of the more common
Type 2, the insulin deficiency is
serious enough to require regular
Delivering the insulin to one’s
body is a complicated affair and
Type 1 patients –often diagnosed in
their teens – have to learn to do it
on their own for most of their lives.
Dr Daphne Gardner, a consultant
at SGH’s department of endocrinology,
said: “Insulin delivery has two
components – a background rate
which runs continuously over 24
hours keeping your blood sugar
levels stable, and a bolus dose
which covers insulin requirements
for the food you eat.”
When Mr Char was using an
insulin pen, it meant four injections
a day – once for the background
insulin and thrice for each meal.
With the pen, he said he had to
check the carbohydrate content of
his food and calculate the amount
of insulin needed. If he miscalculated,
more injections would be
needed as corrections.
Mr Char said: “With the pump,
you just need to input the numbers
(such as carbohydrate content and
blood sugar levels) and the device
will give you the estimate for how
much insulin is needed.”
Correcting the dosage is done by
pressing buttons on the device.
Dr Cindy Ho, an associate consultant
at NUH’s division of paediatric
endocrinology, said: “Insulin pump
therapy gives patients the flexibility
to administer the bolus dosage
only when they sit down to eat.
“It allows them to vary their activities
as they can adjust the background
insulin administered on an
The insulin pump can administer
more precise dosages of insulin
than the insulin pen. This means a
lower risk of hypoglycaemia, when
blood sugar levels become dangerously
low, potentially causing
seizures and loss of consciousness.
Despite the significant improvements,
most diabetes patients here
who need insulin replacement are
still on daily injection therapy.
One major obstacle is cost. Dr Ho
said: “The insulin pump itself costs
a few thousand dollars, depending
onthe brand and model.”
Users have to pay for things such
as the tubing and insertion set, and
the insulin supply. Mr Char said his
pump cost close to $6,000.
Patients also need to learn to use
the pump effectively. For example,
changing the insulin supply every
three days is more complicated
than using a pen. And some
patients dislike having the pump
attached to their bodies all day.
But the pump has been a boon for
Mr Char. “The important thing is to
live normally and be happy,” said
the food lover, who is married with
a 12-year-old daughter.
“Putting on the pump is so convenient.
You can eat at any time you
like and, if needed,make the corrections