An insulin pump is a small-computerized device about the size of a pager. Much like a cell phone, the pump is battery operated or charged with a cable. The pump has a reservoir that holds insulin. A fine tubing on the underside of the infusion set is inserted into the fatty tissue under the skin and held in place by an adhesive. This allows insulin to flow from the pump into the skin. The abdomen, thighs, and arms are the most common locations for infusion insertion sites. Every 2-3 day's sites must be changed.
The reservoir is filled with the amount of rapid-acting insulin needed over a 2-3 day period. The pump is programmed to continuously deliver insulin over a 24- hour period, closely mimicking a healthy pancreas. Your provider, often working with a certified diabetes educator and/or certified pump trainer determines the programmed settings.
The pump is programmed to deliver basal and bolus insulin. Basal insulin is the “background” insulin infused in small amounts over a 24-hour period. Bolus insulin is mealtime insulin, or insulin needed to cover the carbohydrate eaten at meals and snacks.
Like any other technology devices, there is a range of features available with different insulin pumps.
Insulin pumps are not for everyone; however many people with type 1 diabetes and some with type 2, achieve much better control using a pump. There are many factors to consider when deciding whether a pump is right for you. The first step is to discuss whether you meet the criteria with your health care provider. Next, consider the expense of your current diabetes regimen compared to the cost of switching to a pump. Always have a good understanding from your insurance provider what is covered and what is not, including any deductibles. Coverage will vary among insurance policies. Pumps are usually covered under durable medical equipment. Medicare may pay for pumps and the insulin it uses under durable medical equipment for people that meet certain criteria.
Insulin Pump Advantages:
- Delivery of insulin is more accurate- fewer sudden highs or lows
- More flexibility with eating, meal schedules, and lifestyle
- Ability to change bolus doses depending on the time of day and activity level
- Potential for better diabetes control -lower A1C levels
- Fewer need sticks
- Decreased number of hypoglycemic events (low blood sugar)
- Better control of early morning blood glucose (dawn phenomenon)
- Less hypoglycemic unawareness (no symptoms of low blood glucose)
- Less insulin use than with daily injections
- Helps with gastroparesis (slowed digestion)
- Better control before and during pregnancy
- Potential to decrease long-term complications of diabetes
Insulin Pump Disadvantages:
- Potential diabetic ketoacidosis if insulin delivery is interrupted
- Lipohypertrophy (fatty lumps under the skin) caused by inadequate rotation of infusion sites
- Infusion site reactions
- Having an external device attached 24 hours a day can be challenging
- Cost of pump and supplies
- Learning curve – must be willing to check blood glucose and count carbohydrates
- Requires more initial training and follow-up than insulin injections