The Nature and Meaning of Insulin Pump Use in Emerging Adults With Type 1 Diabetes

Abstract

Objective. The purpose of this study is to investigate the meaning of living with an insulin pump for the management of type 1 diabetes during the period of emerging adulthood. Through a phenomenological narrative, this study contributes to the reflective understanding of the everyday life experiences of this population.Methods. A hermeneutic phenomenological design was used for this study of nine emerging adults (aged 19–24 years). Data were generated through face-to-face interviews and analyzed using the phenomenological approach of Max van Manen.Results. Four themes represent the essence of the day-to-day experiences of these emerging adults: seeking control, becoming responsible, staying connected, and accepting me.Conclusions. An in-depth understanding of the meaning of daily experiences with insulin pump technology has the potential to promote a developmentally appropriate approach to this age-group. The human understanding gained through this study is essential to the development of evidence-based practice guidelines and resources for this vulnerable population.

The process of incorporating insulin pumps into the everyday lives of people with Type 1 diabetes: A critical interpretive synthesis

“…This initial expectation (and potential contradiction) was seen as important to address by all parties (users/parents/HCPs) and perceptions of what the pump could do shaped subsequent expectations of the amount and nature of work required to master living with this new device . Reasons given by people with T1D for wanting to move to CSII from MDI included pursuit of greater stability and control over blood sugar levels, and desire for a more flexible lifestyle . Most users indicated that the new equipment made self‐management easier in terms of work required to balance glucose levels, enabling them greater flexibility in, for example; when/where/how they chose to eat; and undertaking spontaneous activities …”

“…However, improved self‐management and “flexibility” sat in tension with increased expectations to learn new “work”; new skills and adopt new practices associated with a more complex piece of technology . Parents reported “putting their life on hold” while integrating the new tool into management of their child's diabetes.…”

“…Typical daily experiences of CSII were described in dichotomized terms as representing both a shackle and lifeline . For many, the pump was experienced as constraining because it interfered with day‐to‐day life, due to the increased visibility necessitating further work to discretely attach this piece of equipment to the body, and/or the status attributed to a permanent appendage to be worn 24/7 . Physical restrictions were also imposed, which were caused by the bulky nature of the tool and its connecting tubes and alarms.

As a woman, I like tight skirts and dresses, I can't wear that anymore.

…”

“…There were descriptions of persistent aloneness in trying to be “normal,” and trying to hide the equipment from others to achieve this. Many users of CSII expressed feelings of being different from peers, yet wanting to be and feel “normal” When you take it out [the pump] you feel like you're exposing something about yourself for people to, sort of, either, sort of, judge that it's good or bad, in a way, and then I more, sort of, fear someone's reaction.…”

“…Living with diabetes was described as a constant struggle, and the process of self‐management as isolating and lonely, especially when there was a potential for prying or judgement from others . Intimate relations were also discussed with reference to the inevitable awkwardness in explaining the device to a sexual partner, or the contraption getting in the way .…”