Table 2: The self-care status of Patients A and B with respect to the MDI and CSII.
Items CSII MDI
Device Operability Aspect Device Operability The device is difficult to operate. The pump was difficult to use and it takes time to get used to it. It’s easy. Although I sometimes forget to inject myself.
Trouble There is no injection. The tube gets jammed. I’ve never experienced any trouble with it.
Physical Aspect Insertion area You can only insert the device in the abdominal area. It leaves a greater mark as compared to insulin injections. It sometimes gives me a rash. The needle is longer compared to the insulin injections, which makes me nervous. The injection area turns blue. Sometimes I hit a blood vessel.
Injection pain I wouldn’t say it’s extremely painful, but it is uncomfortable. I’m right-handed, so when I inject the insulin into the left side of my abdomen, the angle of the needle slants, creating pain.
HbA1c(NGSP) Once I started using the insulin pump, my HbA1c level stabilized and I could get better control over the blood glucose level. My HbA1c levels were high. I can’t eat during work, and so sometimes I couldn’t inject myself. I didn’t want to inject myself in the toilet, so sometimes I missed injections. That’s why I would get high HbA1c levels.HbA1c.
HbA1c and blood glucose levels After I started using the insulin pump, my HbA1c levels stabilized. However, even with the insulin pump, I keep a careful watch on the amount I eat, as carbohydrates raise the blood glucose level. My blood glucose levels fluctuated considerably. During work, there were many situations where I could not measure my blood glucose levels even though I wanted to. Therefore, I knew when I got hypoglycemia, but when I got hyperglycemia, I would leave it untreated.
Hypoglycemia In the case of the insulin pump, I can insert it slightly and see the situation then work out whether I need more insulin. Regulating levels in this way means that I don’t get as much hypoglycemia. My HbA1c levels were high. I can’t eat during work, and so sometimes I couldn’t inject myself. I didn’t want to inject myself in the toilet, so sometimes I missed injections. That’s why I would get high HbA1c levels.HbA1c.
Daily Living Aspect Cooking It hurts when I press against the cooking table. Not particular.
Cleaning I don’t seem to get tired so easily. I can’t do cleaning in a crouched down position. I get tired easily and I don’t have enough stamina, so I can’t do cleaning without taking breaks.
Child-rearing When I’m carrying my child, his feet sometimes press against the pump, depending on where it is positioned, which makes the pump seem like it is coming loose. Not particular.
Bathing When I bathe, I remove the insulin pump part only. Not particular.
Sleeping The device is an inconvenience, so I move it about unconsciously (move the device while sleeping). Not particular.
Dressing If I don’t wear loose clothing, the insulin pump protrudes. One dresses more lightly in the summer, so my clothing options are especially limited then. Not particular.
Out or Dining in a restaurant CSII does not have the following drawback associated with the MDI. It’s awkward to inject in the presence of people. It’s bothersome to hunt for a suitable place to inject. Sometimes I forget to take my injection kit with me when I go out.
Social Aspect Feel a sense of restriction The presence of the insulin pump bugged me until I got used to it. You have to carry the injection kit with you wherever you go.
Regarding work After switching to the insulin pump, I’ve been able to make progress at work. When at work, I inject myself in the lavatory. If I get hypoglycemia, I wouldn’t be able to work anymore.
Medical cost CSII therapy costs around 15,000 yen a month(the CSII pay medical fees of around 5,000 yen more as compared to those under the MDI). MDI therapy costs around 10,000 yen a month.
Psychological Aspect Body image I have to take certain measures with my clothing so that the insulin pump can’t be seen. I can’t inject myself in the presence of others. I’ve also told my kids never to mention that I use injection.
Sense of burden I don’t have to worry so much about getting hypoglycemia, and the fact that I don’t have to inject myself four or five times a day is a weight off my mind. It was really psychologically stressful knowing you had to inject yourself four or five times a day. My blood glucose levels were unstable, so I sometimes wanted to give up visiting the hospital. My blood glucose levels would fluctuate a lot, and my HbA1c level was high, so I was constantly anxious about controlling them.