An Overview of Insulin Pump Therapy

External insulin pump

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Insulin pump therapy is used by tens of thousands of people of all ages who have diabetes, both type 1 and type 2. Many studies have shown improved glucose management outcomes while using insulin pumps.

While insulin pump therapy does allow for more flexibility in your lifestyle and has the potential to even out the wide blood sugar fluctuations that are often experienced when injecting insulin, it may not be the right choice for every person. Consider the following pros and cons carefully and discuss them with your doctor.

Types of Insulin Pump Therapy

There are several types of insulin pumps on the market today, which primarily differ in how they attach and deliver insulin to the body. All insulin pumps utilize a slow, steady stream of fast- or short-acting basal insulin, also known as "background insulin" with an option to deliver a larger dose of additional insulin (known as a bolus) before/after meals.

Traditional insulin pumps: Consisting of an insulin reservoir and pump, these types of devices connect to the body via tubing and use a cannula to house a needle for insulin delivery. The pump is usually pre-set with your doctor to deliver a specified number of units of insulin, but you can manually adjust and calculate the bolus amount.

Patch insulin pumps: These devices consist of a small reservoir and pump set inside a small case that adheres to the body and delivers insulin without tubes or wires. The insulin delivery and cannula insertion are controlled wirelessly through an external device that lets you calculate and program bolus dosage.

Sensor-Augmented Pumps (SAP): SAPs contain a continuous blood glucose monitor (CGM) along with the insulin pump that allows you to get regular updates on your blood glucose levels without having to perform a fingerprick test several times a day.

Hybrid Closed-Loop: The closest device to an artificial pancreas, closed-loop systems automatically deliver basal insulin based on blood glucose readings from a CGM, approximately every five minutes. They take a lot of the guesswork out of insulin therapy and can alter dosage depending on your personal glucose readings.

Advantages of Insulin Pump Therapy

  • Say bye to syringes: Insulin pumps eliminate the need for insulin injections using a syringe. Instead of giving yourself multiple injections with a syringe every day, you simply reinsert the needle for the insulin pump only once every two to three days.
  • Fewer blood-glucose swings: Since you receive a continuous low dosage of insulin (basal rate) 24 hours a day, you are not prone to the rapid drop in glucose levels that can occur after insulin injections with fast-acting insulin. Using an insulin pump often improves your hemoglobin A1c, a marker of average blood glucose levels over three months, showing that insulin pumps help keep blood glucose within the normal range over a longer period of time.
  • More flexibility: If your schedule causes you to eat at odd times or miss a meal occasionally, you can more easily adjust to these circumstances with a pump. Because pumps use fast-acting insulin, bolus insulin can be given to cover a meal with the simple push of a button.
  • Less hypoglycemia: There are greater risks of hypoglycemia (low blood sugar) with injections because you must take larger doses of insulin at one time. The continuous flow of insulin that a pump provides reduces the risk. This is especially helpful at night when injecting too much insulin could increase the risk of a nocturnal hypoglycemic reaction during sleep.
  • Easier exercise: With an insulin pump in place, you don't have to eat large amounts of carbohydrates before you work out to maintain glucose levels, according to the American Diabetes Association.

Disadvantages of Insulin Pump Therapy

  • Infection risk: If you do not change the insertion site of the cannula (the tube that houses the needle) every two or three days, the risk of infection increases.
  • Checking blood sugar more frequently: This is especially true during the first few months of wearing the pump. Frequent testing is the only way that you can gauge whether your basal rate and bolus are working as planned. If you're using an insulin pump, you should be willing and able to perform a fingerprick blood test to check your glucose a minimum of four times per day. However, some pumps, such as a sensor-augmented pump, have built-in continuous glucose monitors for convenience.
  • It's clunky: When you want to sleep, be active, travel, or get sun at the beach, you may find that being hooked up to the pump can cramp your style and feel bothersome. But remember, you can always disconnect from the pump for short periods without much worry.
  • A greater risk of high glucose levels: Disconnecting from the pump for too long a period or not checking your blood glucose frequently could result in high blood-sugar levels, which could lead to diabetic ketoacidosis.
  • Putting on excess pounds: There is a higher incidence of weight gain when using the pump, even though insulin itself has not been found to cause weight gain.
  • Price: Insulin pumps can be expensive.

Getting Started

Know that using an insulin pump isn't an all-or-nothing proposition. Some children and young adults use a pump during the school year and switch to injections only in the summer. Others use a pump year-round and switch to syringes for travel.

Who Should Use an Insulin Pump?

Insulin pumps aren't the perfect tool for every person with diabetes. Pump therapy should only be used in the following circumstances:

  • You have type 1 diabetes or type 2 diabetes and your body is no longer producing adequate insulin to manage your blood glucose levels.
  • You already take multiple daily self-injections of insulin.
  • You're capable of self-testing your blood sugar a minimum of four times per day.
  • You have adequate vision and hearing to recognize safety alerts and alarms.

It's important to be aware that some insulin pumps are formulated only for adults and not for children. Additionally, be sure to talk to your doctor about the safety of using an insulin pump if you have liver or kidney problems, or are pregnant or breastfeeding. Work with your endocrinologist to find an insulin delivery method that works for you.

Cost

Most insurance companies will cover the cost of insulin pump therapy, but may not completely cover the cost of supplies. A pump can range from $4,000 to $6,000, and supplies can vary anywhere from $100 to $3,000, depending on which supplies are required, and how frequently they're used. Supplies needed include reservoir cartridges, infusion sets, tubing, cannula, batteries, tape or adhesive. Most insurance companies should also cover the cost of a glucose monitor or glucometer to use alongside your insulin pump, as well.

Pump Management Tips

Tuck in the tubes: Insulin tubing can be quite pesky to deal with, especially during sports or sleep. For best results, clip your pump to an undergarment or tuck it inside a small pocket and wear the tubes underneath your clothes so they don't get pulled or tugged accidentally. Another option is to cut a small hole in your pocket so your tubing can fit through. You may also want to use a bit of medical tape to tape tubes to your body for safety if you're going to be really active.

Get disconnected: It also may be wise to disconnect your pump while playing sports, but you'll need to check your glucose before, during, and after your session. You may also need to take a bolus of insulin and have a small snack an hour prior to activity due to the missed basal dose. Work with your doctor to come up with an effective protocol to follow.

Sock it to me: Some users recommend storing the pump inside a baby sock before wearing it under your clothes to protect it from moisture or sweat.

Water-ready: Most pumps aren't fully waterproof but are merely water-resistant, which means you'll need to take off the pump when swimming or bathing.

Power up: Some pumps use batteries while others need to be charged. Be sure to carry extra batteries or your charger whenever you travel away from home.

Regular rotation: Rotating your infusion sites regularly is a necessary part of using an insulin pump, as just with syringe use, pitting or lumps may occur at the insulin delivery site. To safeguard against this, move your infusion site at least one inch from the previous site every two to three days, or otherwise as your doctor recommends.

Wear it out: It's great to feel super comfortable about wearing your pump in public—just know that you may occasionally get questions from people about your pump if it's readily visible. Many might just assume it's a pager or small smartphone. If the idea of answering questions about your condition bothers you, know that most insulin pumps are small enough that you can tuck them away from sight. Many companies sell clips and arm bands so that you can wear your pump discreetly if you so choose.

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