by Dr. Elaine Marie Laforteza
Medical prosthetics, such as insulin pumps, are used to augment the management of chronic illnesses, such as Type 1 diabetes (T1D). In this auto-immune illness, the pancreatic cells which secrete a hormone called insulin (used to regulate blood glucose levels) are incapacitated. Consequently, for those who have T1D, external administration of insulin is needed. Unlike those with Type 2 diabetes, those with T1D always need insulin injections, regardless of how well they maintain their exercise and dietary regimes. For many, insulin injections (from 1 to 5 times a day) is needed. For others, an insulin pump is used to administer insulin in a manner that seeks to mimic a functional, biological pancreas. In this context, an insulin pump can be used to keep those with T1D alive and can improve how diabetes care proceeds.
For instance, in my 22 years of having T1D, I have injected myself with insulin daily to stay alive. In the early years of having the illness, I needed two injections a day. This increased to up to five insulin injections for two years. The toll this took on my body could be evidenced in scars, bruises and fatty lump deposits from where a syringe had punctured my flesh, day in and day out, five times a day. However, after transitioning to insulin pump therapy, I only needed to inject myself once every three days, allowing my flesh more time to heal in between injections. In this case, insulin pump therapy helped the appearance and health of my skin, while also enabling me to feel more empowered in the face of an incurable illness.
This article will explore how insulin pumps are used to augment T1D management. In regards to this, the article also asks broader questions: What happens when insulin pump technologies fail? What are the limits to insulin pump usage?
To start, the insulin pump acts as a replacement for the body’s pancreatic cells that no longer produce insulin. According to the Juvenile Diabetes Research Foundation (JDRF), an insulin pump is “a small computerised device that delivers a slow continuous level of rapid acting insulin throughout the day. It can be programmed to give more or less insulin when and if required. The insulin is delivered through a tiny tube (cannula) under the skin that is changed every three days” (2013). It is in Section C in the Australian Government Prostheses list. Only one AAA battery is needed to power most insulin pumps. Life hangs on the life span of that battery, and if the pump is on low battery, then one’s body is also in danger of shutting down.
There can be other technological limits. For instance, Barnaby Jack, a security researcher, “devised an attack that hijacks nearby insulin pumps, enabling him to surreptitiously deliver fatal doses to diabetic patients who rely on them” (Goodin 2011). In this attack, Jack did not have to physically touch the pump or the person attached to it. Instead, Jack designed software and special antenna to communicate with the radio transmitters contained in some insulin pumps.
There are also more limits to wearing the pump. In my experience, this has ranged from my pump malfunctioning (it kept administering insulin without stopping) to the tubing which connects me to the pump catching on doors and getting tangled up in car seat-belts. In regards to the latter, the way in which I walk into and sit in certain spaces has to be reconfigured in order to account for how well (or not well) the insulin pump can be accommodated. My body thus becomes spatialised in terms of how well my pump can fit into certain spaces without being damaged or without my body feeling any pain from it “getting in the way”.
In this context, while the pump is dominantly used to augment T1D self-care management, it does not erase the reality of having to live with T1D. In terms of my experience, the pump is a harsh reminder of having T1D, but it also signifies the biomedical advances in treatment and how privileged I am to be attached to such a device. Being connected to my pump means being connected to my body by having awareness of it in medical terms (hypoglycaemia, hyperglycaemia, etc.) and in terms of feeling (feeling “low” or feeling “high” in terms of blood glucose levels). Such awareness manifests in how I program information into the pump and is complicated through the paradoxical feelings of safety, annoyance, frustration and inhibition I, and others, feel about being attached to an insulin pump. This intimate connection between myself and my pump blurs the boundary between where I begin and where the pump ends. As the pump acts as the medium through which I deal with my body (and live in my body), I experience it as a part of my body.
At the heart (or pancreas) of this, is a sense of hope that is tinged with frustration. Using a pump is premised on the hope of improving and sustaining a life that is always-already involved with the threat and expectation of diabetes related complications and death. At stake in engaging with such augmentation is the push to understand and make knowable a body that is unknowable, un-mappable, and unpredictable.