Insulin Pumps: Relief and Choice
For people living with diabetes who are tired of injections, an insulin pump can bring welcomed relief. Insulin pumps are small, computerized devices that deliver insulin in two ways:
- In a steady measured and continuous dose (the "basal" insulin), or
- 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 tube/needle combination is called an infusion set.
The pumps can release small doses of insulin continuously (basal), or a bolus dose close to mealtime to control the rise in blood sugar after a meal. This delivery mimics the body's normal release of insulin.
The insulin pump is not an artificial pancreas (because you still have to monitor your blood sugar level), but researchers are working to create pumps that integrate with continuous glucose monitors (CGMs) to mimic how your pancreas works. Pumps can help some people reach their blood sugar targets and many people prefer this continuous system of insulin delivery over injections.
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 really comes down to your preference.
Remember that a pump is just a tool—you can reach your blood sugar goals with a pump or injections. 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).
Pump safety is a commitment
The one 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. Checking blood sugar is important because it will warn you if your pump stops working right or your infusion set stops working. This can cause high blood sugar levels and cause diabetes ketoacidosis, which is very serious and dangerous. Checking blood sugar levels frequently will alert you to this possibility and will prevent the development of ketones.
A pump may be a good choice for:
- People who like the idea of a pump. If this is what you want, or what 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 sugar 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 sugar.
- 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.
- 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 can be 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.
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 injection sites recover. It’s a choice based on whatever works to make diabetes treatment easier and better.
There are a number of pumps on the market, and it’s important to research what is best for you/your child. Look at the individual pump company sites and read reviews from those who have experience using the pumps. Speak with your diabetes care team about your options, and join the ADA online community and ask for input.