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Diabetes Forecast May 2004FOR TYPE 1/TYPE 2 5 Things You Should Know Before PumpingIf you're ready for one, an insulin pump can change your life for the better. Here, the experts help you prepare for the transition.By Terri Kordella Insulin pumps deliver more than insulin. Many people who use them say that pumps also deliver more freedom. Pumps provide you with a small amount of insulin throughout the day (the basal rate) to keep your blood glucose stable. When you eat, you simply press a button or two, and voila, you've given yourself a bolus, a dose of insulin to handle your food. With a pump, you're not tied to a rigid meal schedule, and you have more flexibility regarding your diet. The pump can also help you achieve better control over your diabetes, which lowers your risk of developing complications and makes you feel better. Most people who use an insulin pump say they love it. However, there are responsibilities that come with using an insulin pump. Knowing what they are ahead of time can help you make a smooth transition. 1. It Requires EducationThe pump will be attached to your body through an infusion set. You'll have to learn how to change the infusion set, how to program the pump, and what to do if the infusion set becomes clogged or knocked loose. It's important to understand the mechanics of the pump and how to choose an appropriate site on your body for inserting the infusion set, says Kristi Shaver, RN, BS, CDE, education coordinator, diabetes nurse educator, and pump trainer at the Joslin Diabetes Center in Syracuse, N.Y. "If your pump gets clogged, or you have bad absorption, within three or four hours, your blood glucose can run into the 600s, and you can get into trouble pretty quickly." Clogs (occlusions) are not common, but when they do occur, it's often because the infusion set has been left in the same site for too long. Knowing how to change your infusion set and how often to change it can minimize the risk of clogs in your pump and the resulting high blood glucose. Pump education programs are quite thorough and are designed to help you minimize the risk of such problems, says Carolyn M. Grubb, MA, CDE, RD, LD, nutrition consultant and diabetes educator in Austin, Tex. "Usually, you'll meet with a pump trainer for three or four hours, watch a video, and walk through the steps of programming the pump together," she says. "There might be a checklist for every little thing you have to learn. You might have to take carb-counting classes. You'll need to learn how to balance your insulin with the food you eat and how much you exercise." "Dietary education is huge," Shaver adds. "You'll need to meet with a dietitian and work out a meal plan, whether it's carb-counting or another consistent way of measuring your intake." 2. You'll Still Need Back-Up EquipmentThe best-made plans can go awry, however, and pumps are not foolproof, says Nancy Leggett-Frazier, MSN, RN, CDE, diabetes nurse educator at the East Carolina University Brody School of Medicine and adjunct instructor at the Eastern Carolina University School of Nursing in Greenville, N.C. "You'll need to carry extra supplies with you in case the infusion set gets clogged or the battery dies. Plus, you'll need syringes, back-up insulin, and all of the other stuff that you already take with you to care for your diabetes." 3. You'll Still Have To Check Your Blood Glucose"If you're not willing to check your blood glucose at least four times a day, you won't have a lot of success with a pump," says Leggett-Frazier. "Part of the deal with a pump is that when your blood glucose is not on target, you can make little corrections. You have to check your blood glucose often to see whether you need to correct them." "The pump is not an artificial pancreas," adds Grubb. "Sometimes people talk as though it is, but it doesn't monitor your blood glucose. You're still going to have to measure your blood glucose levels before you take a bolus and keep tabs on your basal rate." Also, many insurance companies require 30 to 60 days of records documenting that you check your blood glucose before they offer coverage, and even then… 4. It's Not CheapMedicare covers insulin pumps and supplies for people with diabetes (both type 1 and type 2) who meet certain eligibility requirements, including those regarding fasting C-peptide levels. If you have private insurance, coverage is determined by your carrier. "Most insurance companies pay for about 80 percent of the cost of a pump and pump supplies, but a pump may cost as much as $6,000," says Leggett-Frazier. A 20-percent copayment on a $6,000 pump would be $1,200. Pump supplies can run anywhere from $60 to $80 a month, and you'll probably have to pay a portion of that out of pocket. "Know ahead of time what your plan covers," says Grubb. "Sometimes there are unpleasant surprises." 5. It Takes Patience At FirstThe pump takes some getting used to, even after you've received the appropriate training. "Even though you can learn how to push the buttons in a few hours, it really takes a few months to get used to using a pump," says Leggett-Frazier. "It's a matter of how your body reacts to the insulin." Shaver agrees. "When you start using a pump, your basal rate and bolus doses are guesstimates," she says. "You learn by trying different things, and you go by experience." Because of the need for fine-tuning, most diabetes centers require that you stay in close contact with your doctor or diabetes educator when you begin using a pump. You should arrange for a way to contact your health care provider as often as you need to at the beginning, as you might need to call him or her as often as once a day for the first week. When you get an insulin pump, the manufacturer will send you plenty of information. Keep all of this information together so you can refer to it quickly and easily. All of the pump companies have toll-free numbers you can call with questions about your pump, and their hotlines are answered by experts who can help you troubleshoot. But It's Worth ItOnce you get the hang of using a pump, chances are your blood glucose control will improve. Better control means a lower risk of developing complications like heart disease, kidney disease, nerve damage, and eye disease. Your quality of life will improve, too. Grubb sums it up: "The benefits of using a pump far outweigh the time and effort it takes to maintain it. You might be surprised at the benefits, and how much better you'll feel." Terri Kordella is associate editor of Diabetes Forecast.
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