What is insulin pump therapy?

Tens of thousands of people of all ages who have diabetes and must take insulin choose to use insulin pumps instead of relying on multiple daily injections. Numerous studies have shown that the use of insulin pumps to treat both type 1 and type 2 diabetes can improve blood sugar management outcomes.

Insulin pump therapy offers greater flexibility and the potential to eliminate the widespread blood sugar swings that often occur with insulin injections, but it also has potential drawbacks. It’s important to understand both and discuss them with your healthcare provider to determine if it’s right for you.

Types of Insulin Pump Therapy

All insulin pumps deliver slow, steady rapid-acting or short-acting basal insulin, also called “background insulin,” with the option to deliver larger doses of additional insulin (called boluses) before or between meals to correct high blood sugar.

The main difference between these devices is how they attach and deliver insulin to the body.

traditional insulin pump

These devices consist of an insulin reservoir and pump, connected to the body by tubing, and use a cannula to house the needle that injects insulin. The pump is usually pre-set by a healthcare provider to deliver a specified number of insulin units, but can be manually adjusted to calculate the bolus.

patch insulin pump

These devices consist of a small reservoir and pump set inside a small housing that adheres to the body and delivers insulin without the need for tubes or wires. Insulin delivery and cannula insertion are wirelessly controlled via an external device that allows the wearer to calculate and program bolus doses.

Sensor Augmented Pump (SAP)

SAP uses a continuous glucose monitor (CGM) and an insulin pump to regularly update your blood sugar levels, eliminating the need for multiple daily fingertip tests.

Hybrid Closed Loop Pump

The closest device to an artificial pancreas, the closed-loop system automatically delivers basal insulin based on blood glucose readings from the CGM approximately every five minutes. They take a lot of the guesswork out of insulin therapy and can vary dosage based on your personal glucose readings.

What you should know about the different types of insulin

advantage

Insulin pump therapy has several advantages over standard blood glucose monitoring. Here’s why your healthcare provider is worth considering when you’re making your initial diabetes management plan or want to make changes to your current plan.

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  • Syringe free: Insulin pumps eliminate the need to use a syringe to inject insulin. Instead of using a syringe multiple times a day, you can simply reinsert your insulin pump with a new needle every two to three days.
  • Fewer blood sugar swings: Because you are receiving low doses of insulin 24 hours a day (basal rate), you are less likely to experience a rapid drop in glucose levels after injections of rapid-acting insulin. Using an insulin pump often improves your hemoglobin A1C, a marker of average blood sugar levels over three months, indicating that the pump helps keep blood sugar within the normal range for longer periods of time.
  • Increased flexibility: If your schedule forces you to eat at odd times or occasionally miss a meal, you can more easily use the pump to accommodate those situations. Because the pump uses rapid-acting insulin, a bolus of insulin can be used to supplement a meal with the push of a button.
  • Reduced risk of hypoglycemia: The risk of hypoglycemia (low blood sugar) is greater when you get an injection because you have to take a larger dose of insulin at one time. The continuous insulin flow provided by the pump reduces the risk. This is especially helpful at night, when injecting too much insulin may increase the risk of nocturnal hypoglycemia during sleep.
  • Easier exercise: With an insulin pump, you don’t have to eat a lot of carbohydrates to maintain blood sugar levels before a workout. According to the American Diabetes Association, pumps may be a good option for active individuals who benefit from changes in basal heart rate or who pause the pump during exercise.

shortcoming

Aside from the advantages, there are some disadvantages you need to be aware of when deciding whether using an insulin pump is right for you.

  • Risk of infection: If you don’t change the insertion site of the cannula (the tube that holds the needle) every two or three days, you run the risk of infection.
  • Check your blood sugar more frequently: This is especially true during the first few months of wearing the pump. Frequent testing is the only way to measure whether your basal rate and bolus are working as planned. If you use an insulin pump, you should be willing and able to have a fingertip blood test to check your blood sugar at least four times a day. However, for convenience, some pumps (such as sensor-augmented pumps) use a separate continuous glucose monitor.
  • It’s bulky: When you want to sleep, move, travel, or sunbathe at the beach, you may find that connecting to the pump constricts your style and feels cumbersome. Note, however, that you can disconnect the pump for a short period of time without worry. Patch pumps also tend to be less invasive.
  • Increased risk of hyperglycemia: Disconnecting the pump for extended periods of time or checking blood sugar infrequently can lead to hyperglycemia, which can lead to diabetic ketoacidosis.
  • Price: Insulin pumps can be expensive, and insurance may not always cover the cost.
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getting Started

Knowing that using an insulin pump is not an all-or-nothing proposition. Some children and young adults use pumps during the school year and switch to injectables only in the summer. Others use the pump year-round and travel with a syringe instead.

Who should use an insulin pump?

Insulin pumps are not the perfect tool for every person with diabetes, and the decision to use an insulin pump should be based on each individual’s situation, preferences, and needs.

That said, the American Diabetes Association recommends insulin pump therapy for people who meet the following criteria:

  • have type 1 diabetes, type 2 diabetes that requires multiple daily insulin injections to control high blood sugar, or other types of insulin-deficiency diabetes
  • Self-injecting insulin multiple times a day
  • Able to use the device safely on their own or with the help of a caregiver

While some insulin pumps were once formulated for adults only, all insulin pumps on the market today can be used by children. Also, be sure to discuss the safety of using an insulin pump with your healthcare provider if you have liver or kidney problems, or are pregnant or breastfeeding.

cost

Many insurers will cover the cost of insulin pump therapy, but may not be able to fully cover the cost of supplies. Supplies required include reservoirs, infusion sets, tubing, cannulas, batteries, tape or adhesive.

Many insurance companies also cover the cost of a blood glucose monitor or blood glucose meter used with an insulin pump.

Pump management

Once you commit to using an insulin pump, there are ways to make the experience as effective and successful as possible.

stuffed into the tube

Insulin tubes can be difficult to handle, especially during physical activity or sleep. To fix it, clip the pump to your underwear or tuck it into a small pocket, and wear the tube under your clothing so they don’t get tugged or pulled by accident.

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Another option is to cut a small hole in your pocket so your tube can go through. You may also want to use some medical tape to stick the tube to your body before exercising.

Some users recommend storing the pump in a baby sock and tucking it under clothing to keep it from getting wet or sweating.

dealing with exercise and physical activity

While older pumps need to be disconnected before physical activity, newer pumps have a workout mode that no longer recommends turning the pump off if you have an exercise mode.

However, you still need to check your blood sugar before, during, and after exercise or exercise. Since you missed your basal dose, you may also need to take a dose of insulin and a small snack an hour before your activity.

Work with your healthcare provider to develop an effective protocol to follow.

ready to drink

Most pumps are not fully waterproof, but just waterproof, which means you’ll need to remove the pump when swimming or taking a shower.

Charge

Some pumps use batteries, while others require charging. Carry spare batteries or chargers with you when you are away from home.

Rotate the infusion site

This is a necessary part of using an insulin pump because, just like with a syringe, a dimple or lump may appear at the site of insulin delivery. To prevent this from happening, move your infusion site at least an inch away from the previous site every two to three days, or follow your healthcare provider’s recommendations.

wear it out

Wearing your breast pump in public is very comfortable – just know that you may occasionally get questions from people about your breast pump (if it’s easy to see). Many people might think of it as a pager or a small smartphone.

If the thought of answering questions about your condition bothers you, most insulin pumps are small enough that you can hide them out of sight. Many companies sell clips and arm straps, so you can wear the pump discreetly if you want.