A life-changing device for diabetics

In her award-winning essay, young British science writer Jasmin Notarangelo carried out a very personal investigation into a pressing global health issue that affects her family directly.

Jasmin’s essay, about managing Type 1 diabetes, won the 2024 Young Science Writer of the Year award. Here is an edited version of that essay.

I am a teenager whose mother and grandmother both have type 1 diabetes.

It is a disease which cannot be cured, only managed - an autoimmune condition, meaning that the body’s defence system attacks cells in the pancreas. These cells are then damaged and cannot produce insulin - the hormone which helps keep blood sugar levels within a safe range.

In people without diabetes, insulin is released when we eat, preventing our blood sugar levels from going too high. That does not happen to diabetics. Without treatment, their blood sugar can spike - dangerously. Glucose monitors, healthy dietary choices, scheduled exercise, and most importantly insulin injections, are all used to control it.

Insulin injections can be painful. They can cause bruising and a build-up of scar tissue, fat, and protein, which is called lipohypertrophy. As I have seen, these injections can be upsetting and restricting. Diabetics have to have their insulin with them and, for those who have problems with their eyesight, or with their mobility, it can be a struggle to inject.

This is why I believe there is a better, more efficient way to deliver insulin.

The insulin pump is a small device - around the size of a deck of cards - which supplies a continuous flow of longer-acting insulin through a cannula underneath the skin. This device comes in two forms, tubed and tubeless. Tubed pumps last for multiple years, with the insulin supply getting replaced every two to three days.

Tubeless pumps are worn once and a new pump is applied every two to three days. They are changed often to stop the insulin supply running out and to prevent infection.

An advantage of the insulin pump is that it allows increased flexibility for people with unpredictable schedules or who require smaller doses of insulin. This means that people with changing work shifts, who don’t necessarily eat and exercise at set times each day can still have set doses of insulin.

A report by the Australian Institute of Health and Welfare in 2011 says that 86% of survey respondents cited that the insulin pump fits in with their lifestyle much better than injections.

It is also more convenient to change an insulin supply or pump every two or three days, than it is to inject, on average, four times a day.

However, there are disadvantages with pumps, as they are not for everyone. It may be difficult for people with eyesight or mobility problems to change their pump, but this issue is also related to insulin injections. Cannulas can also bend, restricting the flow of insulin, and the pump can sometimes become disconnected from the tubing without the user noticing.

The NHS only offers insulin pumps to those who experience frequent episodes of dangerously low or high blood sugar without warning. These are known as “hypos” or “hypers”. This means that many people choose to self-fund an insulin pump, which typically costs £2,000-£3,000. On top of that, the cost of the equipment needed costs just over £1,000 per year. That is not affordable for many diabetics.

Dr Iain MacLeod., who works as a GP at Prestonpans Group Practice in Scotland told me that insulin pumps had been “life-changing for many patients”.

“I think [they] have been an excellent addition to the range of options available for managing diabetes,” he said.

Dr MacLeod also expressed that pumps “allow more flexibility”, but that they ”are a lot more expensive than standard insulin therapy so, in these times of huge financial pressures within the NHS, it is probably not realistic for all diabetic patients to get the more expensive treatment options.

“If the pump is the best option for a patient, then I would gladly recommend it,” he added.

Insulin pumps are becoming more accessible - and even more fashionable - with companies selling accessories and pouches to protect pumps. I think this is making it easier to live with and accept the reality of the device, which is often life-changing.

I believe it is important for diabetics to have access to whatever treatment options they need to not just manage their condition, but thrive.

Jasmin is from Musselburgh Grammar School, East Lothian and the judges called her essay an “outstanding piece that presented a compelling message about the accessibility of healthcare".

Runners up were Anna Joby, for her essay on light pollution and Lissie Marsh for a piece on the unseen environmental consequences of the overuse of tyres.

The Young Science Writer of the Year Award is organised by the Association of British Science Writers in collaboration with the Royal Institution and with the support of BBC News. Details about how to enter the 2025 competition will be announced in the coming weeks.