Insulin pumps are small computerized devices that deliver insulin in two ways:
- In a steady measured and continuous dose (the "basal" insulin)
- As a surge ("bolus") dose, at your direction, around mealtime.
Doses are delivered through a flexible plastic tube called a catheter. With the aid of a small needle, the catheter is inserted through the skin into the fatty tissue and is taped in place.
The insulin pump is not an artificial pancreas (because you still have to monitor your blood glucose level), but pumps can help some people achieve better control, and many people prefer this continuous system of insulin delivery over injections.
Pumps can be programmed to releases small doses of insulin continuously (basal), or a bolus dose close to mealtime to control the rise in blood glucose after a meal. This delivery system most closely mimics the body's normal release of insulin.
You'll want to check with your insurance carrier before you buy a pump and supplies. Most carriers cover these, but some don't.
Who Should Use a Pump?
Insulin pumps have been used successfully across the age spectrum. Whether or not to use a pump is a personal decision. You can manage your diabetes equally well with pumps or multiple injections, so it comes down to your preference.
Choosing one method over the other is not a lifelong commitment. Some people go on and off their pumps (but this should always be done with instructions from a person’s diabetes care team). Remember that a pump is just a tool—you can reach blood glucose goals with a pump or injections. But here are some things to consider...
Pump Safety is a Commitment
The one absolute requirement for using a pump is that you and/or your caregivers are ready and willing to do what it takes to use the pump safely. Most diabetes providers and insurance companies require that you check your blood glucose at least four times per day before you go on an insulin pump. Checking blood glucose is important because it will warn you if your pump stops working right, or your infusion set stops working. This can cause high blood glucose levels and cause you can go into diabetes ketoacidosis, which is very serious and dangerous. Checking blood glucose levels frequently will alert you to this possibility and will prevent the development of ketones.
A pump might be considered for:
- People who like the idea of a pump. If this is what you want, or you want for your child, and it can be used it safely, then it should be used.
- Active people, who benefit from changes in basal rates or suspending the pump when exercising.
- People who have frequent low blood glucose reactions.
- Anyone who has delays in absorption of food from the stomach (gastroparesis).
- Women planning pregnancy.
- People who want to use the pump’s bolus calculator functions to determine insulin doses.
Other factors to consider:
- The insulin pump doesn’t take away the need to check blood glucose and give insulin before meal.
- There are technical aspects to using a pump—setting it up, putting it in, interacting with it—that are more complicated in some ways than using injections.
- It only gives shorter-acting insulin. If it breaks or falls off, the person wearing it needs to be ready to give insulin by injection any time it is needed.
- It is expensive, so find out which pumps are covered by your insurance and if those pumps meet your needs.
- All pumps are an extra piece of hardware attached to your body, either with tubing or attached to your skin. There are many clever ways to wear pumps, and hide them from view, but they do take a bit of getting used to at first.
The Pump - It’s a Choice
Most people use their pump continuously, but it is not a permanent part of the body. Some kids use it during the school year but not during the summer. Others revert to injections when they go on vacation. Some have issues with their infusion sites, so they go off the pump for a while to let their sites recover. Whatever works to make diabetes treatment easier and better.
There are a number of pumps on the market; research what is best for you/your child. Look at the individual pump company sites and read bloggers who have experience using the pumps. Speak with your diabetes team. Most insurance companies will not pay for a new pump more often than every 4 years, so this is a device you will have for a while. Finally, remember this is not a permanent decision. You can get a pump, wear it, stop wearing it, restart it—whatever works for you. It is an option for treating your diabetes and the choice is yours.
Personal Story from The Type 1 Diabetes Self-Care Manual by Jamie Wood, MD and Anne Peters, MD
Return to Shotsville
I was walking down a very crowded hall in the Humanities building at the University of TN when the wiring in my pump got caught in a door handle and flung off my body. An innocent bystander, hipster-type student, caught it (all UT students are known for their football capabilities whether they play for the team or not). So, here we are in the middle of a busy building on a huge campus of over 27,000 students... Me, tethered to my new best friend, and the hipster, who is basically holding my life in his hands. He said, “Cool beeper.” I said, “Uh, that’s a pump with my medication.” He immediately throws the device back at me as if it were on fire. Apparently he wasn’t comfortable with holding my lifeline (and I hope for the sake of us all he doesn’t end up practicing medicine). Luckily I caught the pump and went on a mini vacation to what I called Shotsville.
Shotsville is great. Being pump-free and untethered made me feel like I owned my body again. That small, vestigial appendage was a source of irritation even if the irritation was more social than physiological. And, really, that’s what I think management with type 1 diabetes has to include: the social ailments. This problem may not be huge but it is legitimate. So, I went on a pump break and then back on to the pump. I have had little difference in A1C and enjoy having the flexibility of therapy and more importantly, the choice.
—Andy Rogers, 28, is pursuing his M.S. in physician assistant studies at Mercer University.