Insulin Pumps

If you have been diagnosed with diabetes, you may feel overwhelmed by all the new information you have learned and will continue to learn about managing your diabetes. You already know your main goal should be to get your blood glucose (sugar) levels under control in order to increase your chances of a complication-free life.  Many people know this, but need to know how to achieve good diabetes management, while balancing the day-to-day demands of diabetes with other life demands.

An insulin pump can help you manage your diabetes. By using an insulin pump, you can match your insulin to your lifestyle, rather than getting an insulin injection and matching your life to how the insulin is working. When you work closely with your diabetes care team, insulin pumps can help you keep your blood glucose levels within your target ranges.  People of all ages with type 1 diabetes use insulin pumps and people with type 2 diabetes have started to use them as well.

How do insulin pumps work?

Insulin pumps deliver rapid- or short-acting insulin 24 hours a day through a catheter placed under the skin. Your insulin doses are separated into:

• Basal rates
  
• Bolus doses to cover carbohydrate in meals
  
• Correction or supplemental doses
  

Basal insulin is delivered continuously over 24 hours, and keeps your blood glucose levels in range between meals and overnight. Often, you program different amounts of insulin at different times of the day and night.

When you eat, you use buttons on the insulin pump to give additional insulin called a bolus. You take a bolus to cover the carbohydrate in each meal or snack. If you eat more than you planned, you can simply program a larger bolus of insulin to cover it.

You also take a bolus to treat high blood glucose levels. If you have high blood glucose levels before you eat, you give a correction or supplemental bolus of insulin to bring it back to your target range.

Knowing how an insulin pump works is one thing. But you may be wondering where you are supposed to put it. You can buy a pump case or it can be attached to a waistband, pocket, bra, garter belt, sock, or underwear. You can also tuck any excess tubing into the waistband of your underwear or pants.

When you sleep, you could try laying the pump next to you on the bed. You could even try wearing it on a waistband, armband, legband, or clip it to the blanket, sheet, pajamas, stuffed toy, or pillow with a belt clip.

Showering and bathing are other instances when you should know where to put your insulin pump. Although insulin pumps are water resistant, they should not be set directly in the water. Instead, you can disconnect it. All insulin pumps have a disconnect port for activities, such as swimming, bathing, or showering. Some pumps can be placed on the side of the tub, in a shower caddy, or in a soap tray. There are also special cases you can buy. You can hang these cases from your neck or from a shower curtain hook.

No matter what you may think, you can still have fun when you are using an insulin pump. When you exercise or play sports, you can wear a strong elastic waist band with a pump case. You can also wear it on an armband where it is visible. Women can tape the insulin pump to the front of their sports bra. Some coaches do not allow any devices to be worn because getting the pump knocked into you or falling on it can be painful. In this case, you may just need to take the insulin pump off.

When you disconnect your pump, you are stopping all delivery (basal and bolus) by the pump. Here are some important tips to remember when disconnecting your pump.

1. It is important for you to remember that if you stop your pump while it is in the middle of delivering any bolus -- it will NOT be resumed. You may need to program a new one.
   
   
2. Be sure to bolus to cover the basal rate you will miss. If your blood glucose level is under 150, you can wait an hour to bolus.
   
   
3. Do not go longer than one to two hours without any insulin.
   
   
4. Monitor your blood glucose every three to four hours.

Now that you know how the insulin pump works and how to wear it, take a look at some of the facts to see if this is right for you.

Advantages of Using an Insulin Pump

Some advantages of using an insulin pump instead of insulin injections are:

• Using an insulin pump means eliminating individual insulin injections
  
  
• Insulin pumps deliver insulin more accurately than injections
  
  
• Insulin pumps often improve A1C
  
  
• Using an insulin pump usually results in fewer large swings in your blood glucose levels
  
  
• Using an insulin pump makes diabetes management easier – if your glucose level is high or you feel like eating, figure out how much insulin you need and push the little button on the pump
  
  
• Insulin pumps allow you to be flexible about when and what you eat
  
  
• Using an insulin pump can improve your quality of life
  
  
• Using an insulin pump reduces severe low blood glucose episodes
  
  
• Using an insulin pump eliminates unpredictable effects of intermediate- or long-acting insulin
  
  
• Insulin pumps allow you to exercise without having to eat large amounts of carbohydrate

Although there are many good reasons as to why using an insulin pump can be an advantage, there are some disadvantages. 

Disadvantages of Using an Insulin Pump

The disadvantages of using a pump are that it:

• Can cause weight gain
  

• Can cause diabetic ketoacidosis (DKA) if your catheter comes out and you don’t get insulin for hours
  

• Can be expensive
  

• Can be bothersome since you are attached to the pump most of the time
  

• Can require a hospital stay or maybe a full day in the outpatient center to be trained
  

There are pluses and minuses to using a pump. Even though using an insulin pump has disadvantages, most pump users agree the advantages outweigh the disadvantages.

Getting Started

Once you have talked with your diabetes care team and have become comfortable with all of the options on your insulin pump, you and your team will need to do the following in order to get you started.

1. Determine how much insulin to use in the insulin pump by averaging the total units of insulin you use per day for several days. (You may start with about 20% less if you are switching to rapid-acting insulin.)
   
   
2. Divide the total dosage into 40-50% for basal and 50-60% for bolus insulin.
   
   
3. Divide the basal portion by 24 to determine a beginning hourly basal rate.
   
   
4. Then, adjust the hourly basal rate up or down for patterns of highs and lows, such as more insulin for dawn phenomenon and less for daily activity.
   
   
5. Determine a beginning carbohydrate dose (insulin:carb ratio) using the 450 (or 500) rule. Divide by the total units of insulin/day to get the number of grams of carbohydrate covered by one unit of insulin. This dose may be raised or lowered based on your history and how much fast-acting insulin you took in the past.
   
   
6. Determine the dose of insulin to correct high blood glucose with the 1800 (or 1500) rule. Divide 1800 by the total units of insulin/day to see how much one unit of insulin lowers your blood glucose. This dose must be evaluated by your health care team. It is often too high for children or for people who have not had diabetes very long.

It may take several months to get comfortable with the pump. During those first months is the time to adopt some good habits. Here are some tips to help you adjust:

• Take your insulin at a specific time, such as five minutes before you eat, so you don't forget boluses.
  
• When traveling anywhere, bring extra supplies or at least an insulin pen, in case you are unable to use your pump for some reason.
  
• With an insulin pump, when you eat, what you eat, and how much you eat is up to you. You can eat more carbohydrate and still manage your blood glucose, but weight gain can happen. Talk to a dietitian about this when you start on the pump. It's a lot easier to not to gain weight, than it is to lose it after you have already gained it.
  
• When you take the insulin pump off or turn it off, figure out a system to remember to turn it back on. Listen to the alarms on the pump or set a timer!
  
• Make a habit of recording blood glucose checks, carbohydrate amounts, carbohydrate doses, correction doses, and exercise when you do them. It really helps to sit down and look over your blood glucose record at the end of every week (or even every day) to see if you have any problem areas. Reviewing your records is the key to improving blood glucose control.
  
• Your diabetes provider and insulin pump company have record forms, or you can make your own. Just be sure that you have enough room to record everything you need. Keeping daily records is best, but some people find keeping records for two weekdays and one weekend day gives enough information to see the patterns.

This is a lot of information. Fortunately, you don't need to be an expert on insulin pumps overnight. If you are uncertain about anything, you can go to your diabetes care team for help. Everyone learns at a different pace and it is okay if it takes you a while to get the hang of it. In addition, the American Diabetes Association also has resources to help you. Get more information about insulin pumps.