More and more people are using insulin pumps to manage their diabetes, drawn by the device's ability to tightly control blood glucose and the flexibility of not having to take multiple daily insulin injections. These advantages were confirmed in a 16-week study of people with diabetes conducted in 2005. Pump users reported a better quality of life and had an average A1C level that was 0.8 percent lower than that of people who injected insulin.
If you have Type 1 diabetes or are among the one-third of people with Type 2 diabetes who require insulin to control glucose levels, you should know whether this option offers advantages for you. Start with the four "Ws" of the insulin pump.
What is a pump?
The pump is a computerized device about the size of a cell phone or pager with a reservoir that holds a two- to three-day supply of insulin. It mimics the human pancreas by continuously delivering a set amount of insulin (in rapid-acting forms Humalog®, Novolog® or Apidra®), called a basal dose. With the aid of a pump, you can keep blood glucose levels within your target range between meals and overnight. However, while the pump is a great technological advance, it's still not smart enough to check blood glucose levels, so you'll need to use a glucose meter along with the pump.
Where is the pump worn?
The pump connects to the body through a thin plastic tube attached to a plastic catheter (called a cannula) that's inserted just below the skin, usually in a fatty area of the abdomen. An inducer needle, which is slightly larger than a regular needle, is used to get the cannula under the skin but is removed once the cannula is in place. The injection site needs to be changed every three days.
The pump itself can be worn comfortably, and fairly inconspicuously, clasped to a waistband, pocket, bra or underwear. Some companies manufacture clothing with pockets to hold the pump.
While you sleep, the pump can be in bed near you, stay under your pillow or be tucked into a pajama pocket. You can even go off the pump for up to an hour while you swim or bathe, though many pumps are waterproof.
Who can pump?
Generally, if you have Type 1 or Type 2 diabetes, have been taking multiple daily insulin injections for at least six months and feel that this treatment pace is interfering with your lifestyle, you may be a good candidate for pump therapy. The pump is appropriate for all age groups-parents can control the pump for a young child and you can't be too old to use the pump as long as your mental status allows you to make correct decisions about insulin delivery.
But insulin pumps aren't for everyone, says Todd Brown, M.D., assistant professor of endocrinology at The Johns Hopkins University School of Medicine. When considering a pump, learn the pros and cons, and then discuss with your doctor or diabetes educator.
Why pump?
"If you are committed to learning to use the pump properly," Brown says, "you can eat when you want and avoid the dangerous consequences of low or elevated blood glucose levels." When you eat, you press a button on the pump to deliver a larger amount of insulin, called a bolus, to make up for the added carbohydrate from your meal. You also take a bolus to treat high blood glucose levels.
You can vary the amount of insulin the pump delivers at different times of the day. For example, you can program less insulin during sleep to prevent glucose levels from dropping too low and causing hypoglycemia. This allows you to sleep late or travel more easily, adds Christine McKinney, a certified diabetes educator at Johns Hopkins. Other benefits, she says, include the ability to deliver precise doses of insulin (up to 5/100 of a unit) and better glycemic control during exercise.
"Most of my patients love using an insulin pump because far fewer injections are necessary," McKinney says. "And they use only one needle, instead of 12, every three days."
Using a pump does require certain skills and you'll need to follow specific instructions to make appropriate adjustments. Here are the most important ones:
- You must train to use the pump. Learning the ins and outs of using a pump can take as long as six months.
- You must think to properly operate the pump—it doesn't work on its own. The pump is like a computer with many advanced functions, not all of which need to be used to obtain its benefits. After training you should feel knowledgeable and comfortable enough to troubleshoot if something goes wrong. If you can easily operate an ATM machine, then you can probably use a pump.
- You must continue to check blood glucose levels. Pump users must learn how to make adjustments in insulin, food and physical activity in response to test results.
- You must diligently rotate the injection site every three days. Pump users are at increased risk for infections, which can seriously affect blood glucose levels.
- You must always carry insulin and needles in case of a pump malfunction. Any interruption in your insulin therapy could lead to dangerously low blood insulin levels and cause a condition called ketoacidosis.
- You may have to consider costs. Pumps can be expensive. Fortunately, many insurance providers will pay at least part of the cost. Be sure to ask about coverage and reimbursement for supplies such as infusion sets, tubing and reservoirs, as well as for the pump itself.
Updated: April 2006
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