Insulin Pumps

Insulin pumps are tools to deliver insulin that can help some people with diabetes focus more on life than on their diabetes. Using a pump does not mean you can totally forget about your disease, but it may make it easier for you to keep insulin needs in line with your lifestyle. While using an insulin pump, you still need to monitor your diet and exercise levels to prevent weight gain and to keep your blood glucose levels under control.

How It Works

An insulin pump is a small device you wear on your belt, place in your pocket, or hide inconspicuously under your clothes. It delivers rapid-acting insulin directly into your body through a narrow tube that connects your insulin pump to a small internally placed cannula, which allows the insulin to disperse into the subcutaneous layer of your skin. The pump delivers insulin to your body based on the basal rate and bolus dosages you program.

The basal rate is a regularly scheduled insulin administration that helps keep your blood glucose level within your target range overnight and between meals. Your healthcare professional will help you to determine this rate based on your typical daily routine and insulin needs.

In addition, you can program your insulin pump to deliver a bolus dose as needed to prevent sugar spikes from meals or to correct pre-meal glucose levels. Each insulin pump contains a calculator to help you determine the size bolus you need. Calculations of your bolus rely on your pre-meal blood glucose level, the grams of carbohydrates you plan to eat, the basal infusion rate, and any other personalized setting programmed into the pump.

Insulin pumps decrease the number of needle sticks you need to maintain safe glucose levels, but do not eliminate your need for needle sticks completely. The cannula that delivers the insulin under your skin requires insertion using a small needle, which you remove once the cannula is safely in place. You need to repeat this needle stick each time you change the location of your insulin pump, which is typically every three days.

Each time you change your insulin pump’s location, plan to change or refill the insulin reservoir within the pump. The insulin reservoir typically holds between 176 and 315 units of insulin at a time; this varies based on the type of insulin pump you use. How long you can go between reservoir refills or changes depends both on how quickly you use the insulin and on how much the reservoir holds. Some people can go four or more days without worrying about having an adequate amount of insulin, while others need to monitor their reservoir tank daily

Are There Any Risks?

Insulin pumps help keep blood sugar under closer regulation—a fact that causes many people who use them to think they can eat whatever they want. Unfortunately, this often leads to weight gain. Prevent this from happening to you by keeping an eye on both the number of calories you consume and the number of carbohydrates you eat. Failure to follow a healthy, balanced diet increases your risk of fluctuating sugars—even when you use an insulin pump. An unhealthy diet also increases your risk of overeating or giving in to sugar cravings.

Insulin pump tubes and cannulae occasionally become detached from your skin or blocked. If this occurs, ketoacidosis may result—especially if you don’t notice and you fail to get your insulin for two to three hours. Ketoacidosis occurs when you lack the insulin needed to absorb adequate amounts of glucose for energy and the body turns instead to breaking down your fat tissue for energy. Fat breakdown releases an acidic substance called ketone bodies. When ketone bodies build up in your body and ketoacidosis develops, expect to experience dry skin, flushed face, nausea, a fruity scent to your breath, stomach pain, dry mouth, vomiting and rapid breathing.

A failure to change your tubing and cannula every two to three days or a failure to use proper cleansing techniques at the new insertion point may result in the development of an infection. If this occurs, apply a topical antibiotic and contact your doctor to determine if you need an oral antibiotic.

Training to use your insulin pump may require you to spend time in the hospital or at an outpatient care center. The cost of this stay adds to the already high price tag associated with insulin pumps. Insulin pumps alone often cost around $7,000 up front and an additional $1,500 each year in supplies. While your insurance company may cover some of these costs, expect to cover some through your own finances.

Participation in most sports, taking a bath, or going swimming are examples of activities that require you to disconnect your pump. Decrease your risk of developing high blood glucose levels or ketoacidosis by figuring out a system to remind you to hook it back up, such as setting an alarm, using a timer, or listening to the warning sounds from your insulin pump.

What The Expert Says

A review of clinical studies and trials published in the journal Experimental Diabetes Research in May of 2010 explains that several scientific studies have shown continuous subcutaneous insulin infusion (CSII) through an insulin pump helps increase overall glucose control better than multiple daily injections (MDI) of insulin. However, the authors note that in these studies “patients were allowed to choose between CSII and MDI instead of being randomly allocated,” making the results less reliable scientifically than a randomized trial. Similar results were found for insulin pumps supplying straight rapid-acting insulin and those supplying a combination of both rapid-acting insulin and slow-acting insulin.