A Crown, Scepter & Insulin Pump The New Miss America, Nicole Johnson, Has Drawn Attention To The Device, Which Frees Diabetics From The Strict Scheduling Of Conventional Insulin Regimens.

Posted: October 05, 1998

Here she comes, Miss America Nicole Johnson, wearing a charcoal-gray MiniMed 507C on her belt.

Or discreetly tucked in the middle of her bra.

Or other places.

``During the pageant, I wore it on the inside of my thigh,'' the 24-year-old brunette confided in an interview last week. ``I told the judges my worst fear was that this pump would slip down my leg.''

We're talking insulin pumps, of course.

The coronation last month of Johnson, a.k.a. Miss Virginia, has thrown a spotlight on diabetes.

Not since Julia Roberts crumpled to the ground in Steel Magnolias have so many people had so many questions about the disease - which pleases Johnson, because she plans to use her reign to raise diabetes awareness. (Miss New York, Deanna Herrera, another insulin-pump wearer, is a kindred crusader.)

Lots of the questions Johnson has inspired are about insulin pumps, a 30-year-old technology that has only recently caught on.

``It has definitely sparked a lot of interest,'' said nurse Jamie Dillinger, 47, of Exton, a diabetes educator who swears by the pump she has used for nearly four years. ``This is good news for the diabetes world because we've been dealing with a lot of barriers.''

To understand those barriers, consider the daily challenge of the nation's 800,000 Type I diabetics. They must constantly monitor their blood sugar and regulate it by adding insulin - the vital hormone their pancreas does not produce. An overdose of insulin or a missed dose can cause life-threatening swings in blood sugar. Over time, fluctuations in blood sugar can lead to blindness, kidney failure, heart disease, amputations.

And here's the worst part: Sleeping late, postponing a meal, vigorous exercise - in short, living a normal life - can trigger damaging fluctuations.

To avoid this, many diabetics become slaves to their disease, adhering to rigid schedules and injecting insulin three, four, even five times a day.

``I stuck myself four or five times a day,'' said Johnson, whose diabetes was diagnosed five years ago. ``I was getting scar tissue. I was feeling depressed, and I thought, `I'm never going to have an iota of freedom.' ''

About a year ago, Johnson found that an insulin pump was the solution. She joined an estimated 45,000 other pump users.

The battery-operated, programmable device sends a low, continuous dose of insulin from what looks like a beeper, through a 24- or 42-inch-long tube, into a needle (called a cannula) inserted in the abdomen, hip or thigh. The user changes the needle site every two to three days to prevent infection.

During sleep - or more intimate bedroom activity - many users simply slip their connected pump under a pillow. They can shower or swim by putting the pump in a water-tight case, or by detaching it for up to 90 minutes. Johnson took hers off during the swimsuit competition.

The pump isn't an artificial pancreas. The diabetic still must draw a drop of blood several times a day to test blood sugar, and program the pump at mealtimes to deliver a surge of insulin matched to the amount of carbohydrates to be consumed.

The pump is also expensive. The $5,000 machine and supplies cost several thousand dollars more each year than multiple daily injections.

But the pump frees the user from the strict scheduling of conventional insulin regimens.

``Diabetes controlled my life,'' Johnson said. ``Now, I control the diabetes.''

Dillinger said her job at Mercy Community Hospital in Havertown was easier thanks to her pump.

``I was teaching diabetes classes and I didn't always have time to eat,'' she recalled. ``When I was taking shots and didn't eat, my blood sugar would drop - and that's a serious situation.''

How serious? Picture Julia Roberts in her role as a diabetic in the beauty parlor, shaking, mumbling, turning pale, nearly passing out.

Although pumps were first used in hospitals more than 30 years ago, only in the past decade or so has the device become ultrasmall and user-friendly. Two manufacturers - MiniMed Inc. and Disetronic Medical Systems USA - sell pumps in this country. (Both have Internet Web sites.)

``When I started on a pump in 1983, it was about four times the size of today's pumps,'' said John Walsh, 51, of San Diego, author of Pumping Insulin, a handbook for pumpers.

Other factors also have boosted pump use.

In 1993, a landmark 10-year-long study proved that strict blood sugar control reduced the complications of diabetes, and that pumps were as effective as multiple daily injections in achieving strict control.

Most health insurers now pay for pumps. However, getting comprehensive coverage for all supplies and equipment remains a problem. That's why Johnson and other advocates are calling for standard, universal coverage of pumps and all diabetic equipment.

Pumps also have spawned accessories and fashions, from color-coordinated belts and spandex thigh wraps to pajamas and boxer shorts with special pockets. An Internet Web site for Unique Pump Accessories of Browns Valley, Calif., founded by pump-user Tamara Norris, advertises a line of ``innovative designs that make wearing a pump fashionable and easy.''

Eventually, technology may improve on the pump. A revolutionary electronic inhaler that would administer aerosol insulin into the lungs, without shots, is being developed jointly by Aradigm Corp. of Hayward, Calif., and a Danish company.

Meanwhile, pump users are pumped up about their pretty poster woman.

``Having a premier figure who . . . is very open about using a pump is tremendous,'' Walsh said.

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