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June 13, 1980

Pump and Brittle Circumstance

JAMA. 1980;243(22):2331-2332. doi:10.1001/jama.1980.03300480051030

When told that someone we know is equipped with an electronic device, we might guess this to be a Holter monitor, a cardiac pacemaker, a sophisticated hearing aid, a carotid sinus inhibitor, an electrical nerve stimulator for intractable pain, or a respiratory trigger for phrenic nerve paralysis. That the device may be an insulin infusion pump is not likely to enter our minds.

A regulated, continuous insulin infusion pump would respond to an obvious need. Despite many claims to the contrary, insulin-dependent diabetics cannot often, if ever, be properly cared for by diet and conventional depot insulin injections. It is difficult to attain homeostatic balance without feedback information on shifting glycemia in patients who have no appreciable insulin reserve. Homeostasis could be attained only by transplanting a pancreas or grafting pancreatic islets—procedures that would be ideal were it not for scarcity of donors and lifelong problems of immunosuppression.

Less amibitous,