Insulin Pumps.
Links to other related pages on our site are:-
Insulin Pump Manufacturers.
Infusion Sets.
Implantable Insulin Pumps.
You can read the article below from the top, or the links below will take you to the section in question.
Terminology.
Before I start to talk about how the insulin pump works or its pros and cons, it may be necessary to explain some of the terms I am going to use. These will seem obvious to a lot of you who have lived with Type 1 diabetes but there are always new folk out there who may not be so familiar with them so bear with me. The explanation may be found by clicking on the highlighted word in the text, or by going to the Glossary of Diabetic Terms for all of them. (Use the back arrow of your browser to return here in either case.)
General Pump Information.
Insulin pumps were first introduced in the early 1970's. These were crude devices compared to the modern ones. They were so big and heavy that they needed to be carried in a backpack. If you want to see what I mean take a look at the pictures on Insulin Pumpers R Us under 'Pump History'.
The size was not the only problem, there were reliability issues as well.
The insulin of the time was not stable and tended to settle out and crystallise in the plastic tubing, causing blockages.
These facts gave pumps a bit of a bad name and although the modern ones have overcome them, being compact, lighter, much more reliable, with stable insulin, either buffered with phosphate, or lispro, which is an insulin analog, and special Teflon tubing, many doctors still remember the bad old days and are reluctant to put their patients on a pump. It can take quite a lot of persistence and good persuasive powers on the part of the diabetic to get agreement for him/her to use a pump.
There are also a lot of misconceptions amongst the general population and, it must be confessed, the diabetic population, about insulin pumps and what they can do.
I hate to be the one to dispel some of the illusions but it has to be said - insulin pumps are NOT the holy grail of diabetic therapy that we are all looking for.
And we literally are looking for that elusive Holy Grail - we want a device that exactly copies a normal pancreas, producing the correct amount of insulin at exactly the right time, all by itself, without any hard work on our part. Insulin pumps as they are at present cannot meet that requirement.
One of the main problems holding back such a device is the insulin itself. Given subcutaneously even rapid acting insulin takes time to be absorbed and usually 'peaks' in 1 to 2 hours and lasts for around 4 to 5 hours, which matches ones food intake reasonably well.
To have the longed for automatic pump we would need an insulin that peaked very fast, in 5 minutes would be good, and lasted for around 10 minutes. That means it could do it's job and leave before the next lot was delivered, otherwise we would have insulin in the system with no food to work on or visa versa.
This would definitely have to be available to pump users only as it would be a disaster for any other form of insulin delivery.
Anyway this is hypothetical as no such insulin exists. We are just going to have to accept that pumps require work on the part of the user.
What pumps do NOT do.
Pumps do not adjust themselves automatically.
It requires you, the user, to make those adjustments, based on the results of your Bg readings and plenty of self - knowledge, i.e. how diet, insulin and exercise work for you.
That is why most doctors will not prescribe a pump until the diabetic has tried multiple dose insulin therapy for some time. They will then have a greater understanding of how their particular system reacts.
Pumps do not monitor your blood glucose levels, that is up to you.
Fingerprick tests are even more important than before as the pump cannot tell if you are hypo or hyper, it just keeps on delivering the insulin as you programmed it to.
Pump are not really less work than insulin injections
but the hard work can be made to fit in better with your normal lifestyle and you may get payback in the form of better control.
HOWEVER.........What they DO do.
Please lets not throw the baby out with the bath water. All this does not mean that pumps are no good.
To the contrary they are fantastic devices despite their limitations and the answer to many Type 1 diabetics prayers. If one cannot have the Holy Grail itself then surely a gold chalice will do!
They give back to many diabetics the control that they so resent losing.
Hey, if you can't have a normal pancreas it is a good second best to be given the chance to act as one, and that is more or less what you've got, as illustrated in the equation below:-
The Pump + The Intelligent User = The Pancreas.
So you carry your pancreas clipped to your belt or down your bra - how many normal folks can get that up close and personal to one of their major organs? Okay, okay, as I have said before, we diabetics need to search out the positives!
Though pumps were once seen as a desperate last resort for those diabetics who could not gain control in any other way they are now becoming the norm for people who want to achieve that control with as little disruption to their daily lives as possible.
More than a million people of all ages world-wide (the youngest is less than a year old) now use diabetic insulin pumps. Though Type 1 diabetics are the main users some Type 2's with advanced diabetes, who require insulin, are using them too.
There's nowt so strange as folk....
I just have to make a comment here on a reaction that some people have made to the subject of diabetic pumps. They felt that these pumps were turning folk into cyborgs (especially when the subject of implantable pumps came up!), that one was being 'kept alive by a machine' and that technology was out of control.
It is all to obvious to me that these people do not suffer from a 'life or death' type chronic disease. One wonders how far their principals would stretch if they were in our situation.
For myself I am prepared to embrace, with both hands, anything that will make my life more worth living.
Once, after my diagnosis, when I was having a really down time and wondering if life was worth living I was given a piece of extremely blunt but never-the-less important advice "Adapt or Die".
I have made a conscious choice to live, and live with as few complications as possible. Thus I will use whatever is out there that makes this possible. If some people don't like it - tough!
It is obvious however, that if you happen to be a technophobic diabetic the pump is not for you!
What exactly is an Insulin Pump?
It is an insulin delivery device, about the size of a credit card, only a lot thicker (think of a mobile phone or a pager).
The 'body' contains a reservoir that holds the insulin, a small pump which delivers the insulin, a battery that operates the pump and a microprocessor that you can program to deliver the insulin when you want it.
Attached to it is the infuser set, which consists of a length of thin plastic tubing with either a needle or soft cannula (piece of tubing) at the end, which is inserted in the subcutaneous tissue and through which the insulin passes.
Pumps are said to be continuous subcutaneous insulin infusion (CSII) devices.
How does the pump work?
The pump is worn permanently, 24/7, it's infuser usually inserted into the abdomen (because, as we known from our injections, this is the place that absorbs insulin the best, and at the most consistent rate).
It can also be inserted into the arm or thigh, but in these places it is usually put directly into a vein. The pump is programmed to deliver insulin to suit each persons individual needs - hence the CSII (continuous subcutaneous insulin infusion).
It constantly delivers a small amount (anywhere from 0.1 to 10 units per hour depending on your program) of fast acting insulin, about every 3 minutes.
This is your basal insulin and it makes up about half of your daily insulin requirement. You can program the rate of flow, so by the simple press of a button you can give yourself more or less insulin to cover changes in your activity levels.
Most modern pumps allow you to store more than one basal program to cope with changes in routine - so you can have one for weekdays and one for weekends or another for sick days or for day shift versus night shift.
When you are going to eat food you program the pump to deliver a bolus dose.
The amount of insulin given is worked out using the carb/insulin ratio. The ability to count carbs is important here folks - get those calculators out or check the online carb counters).
The pump has the advantage over an injection in that, if you decide that that was a really great gooey, carbohydrate loaded pudding and you want a second helping, you can just program a bit more insulin to cover it.
For those who are going to graze over a long period, such as at an event where yummy snacks come round regularly, who are picking from a buffet table over time, suffer from gastroparesis (delayed stomach emptying) or have eaten a high fat meal that tends to delay digestion, the pump can be programmed to deliver the bolus over an extended period.
The bolus is the 'other half' of the insulin you need on a daily basis.
Some pump features.
Especially for parents - some pumps feature tamper-resistance, which allows you, the parent, to enter a program and the child cannot just press buttons and change it.
All pumps will sound an alarm if for some reason the insulin is not being delivered, such as when there is an occlusion (blockage) in the tube or when the batteries run low. They do differ in how long it takes before they sound said alarms.
Most have back-lighting that is useful for situations where there is low light, such as in cinemas and some restaurants.
All have some form of software that allows you to download a history of insulin administration so your health team can work with you to adjust this as necessary.
Most are watertight so do not pack up if they get splashed while you are washing the car, shopping in the rain or having fun at a water park. There are a few that are actually waterproof and claim that you can bath, swim and even scuba dive with them.
Pumps differ in the size of their insulin reservoirs. Some take as much as 300 units, others as little as 170 units.
Which one will suit you depends on the amount of insulin you take. You want one that holds the amount of insulin you will use in three days if that is how often you are going to change your infusion set, then you can both fill the reservoir and change the set at one and the same time - much easier to remember and less fiddling about.
Some pumps allow you to enter the carbs you are going to eat and then automatically work out what your insulin bolus dose should be.
Others let you input your BG result into them and then they work out what insulin to give - great for the mathematically challenged!
One make, the Cozmo, even has an attached Freestyle Flash blood glucose meter.
The market is becoming more competitive and bells and whistles are constantly being added to new models.
One of the latest innovative models on the market, the OmniPod, by Insulet, is totally cordless.
It consists of two parts:-
1. The pod, which contains the insulin and attaches to whatever insertion site you choose, and has a cannula that is automatically inserted upon instructions from the PDM.
2. The hand held PDM (Personal Diabetes Manager) which is the device you program and which sends messages to the pod. It looks a bit like a palm pilot. It also contains a blood glucose meter.
So what pump should you get?
There are a number of factors here that must be considered separately.
Firstly there is the pump itself.
You will need to consider:-
1. The reservoir size.
2. What infusion sets will you be able to use with it.
3. What type of battery does it use - is it easily available.
4. How long does a battery last.
5. How big is the actual pump - what size is okay for you.
6. How easy is it to use - display screen size, back-lighting etc.
7. How much 'waterproofing' do you need - are you an ardent water sport fanatic?
8. Infusion Rate - some infuse faster than others and that can cause stinging.
9. Do you want an attached BG meter.
10. Do you want a remote controller or not.
11. Appearance - can you get it in different colours or attach different covers.
12. How much 'mathematical assistance' would you like.
13. Can you upgrade for free or not.
14. Wireless or not.
Secondly you need to consider how helpful the manufacturers are.
Some offer good customer service, others not so good. The best way to find out about this is to visit the forums and see what other pump users have to say.
Try:-
The site for young adults with diabetes.
Thirdly it is always helpful if your doctor and the rest of your diabetic health care team know something about the pump you are going to use.
I do not mean that you should get a pump you do not care for just because they know about it - it may, as usual, be that they know about it because that is the one the sales rep has pushed.
However, if you have a choice between a couple and they are familiar with one of them I would go with that one as you will then get the best help possible.
This especially applies if it is your first pump as you really need assistance to get your doses right.
Advantages of using a pump.
1.Control of your life.
You can be as spontaneous as you like. You can get up when you want, go to bed when you want, eat when you want, exercise when you want.
You can throw a tantrum or laugh yourself sick and it doesn't matter. In fact you can act just like any normal person.
For folk who really resent having their whole life arraigned around meals, injections and BG levels this can be a real bonus.
2. Flexibility of eating.
You can eat when and what you like. If you do not feel like eating you do not have to force yourself too.
If you want to enjoy a fast food meal with co-workers at the local 'greasy spoon' you can, you just cover with a suitable bolus.
Grazing is covered with a little more basal insulin or repeated small bolus's - it's that easy.
3. Lower insulin doses.
You can adjust your insulin when needed instead of giving a set basal injection and hoping for the best. The less insulin you use the lower your insulin resistance becomes and the less you need....
4. One type of insulin.
Using only short acting insulin for both basal and bolus is great because it is absorbed better. (As previously stated long acting insulin can peak and fall at inconvenient times.)
That leads to more predictable results, less wastage and less chance of injecting the wrong insulin by mistake.
It is easier to work out why there are problems and complications if you only have one type of insulin to consider.
5. Less conspicuous.
Pressing a button is a lot less obvious than filling a syringe and sticking it in oneself. You will not be written off as the local drug addict! Also it eliminates the need to carry syringes and vials around.
6. Less needle 'sticks'.
You only have to insert the infusion set every 3 days or so which is a lot better than giving an injection 4 times a day.
7. Better control.
Dosing is more precise, very small amounts can be given if needed, as little as 0.5 of a unit. Correction for problems can be done immediately, as they occur.
Some folk say that their lost hypo awareness returns when on the pump.
8. By being able to vary the basal rate it is possible to control Dawn Phenomena.
You no longer have to eat pre-bedtime snacks or get up in the middle of the night to take extra insulin.
9. For the mathematically challenged
the pump that works out what insulin to give depending on the carbs entered is a definite plus.
10. Suspension of delivery.
If you have made a mistake and taken too much insulin you can stop the pump from delivering more until things are back to normal. If you have given yourself too much long acting basal insulin via injection there is nothing you can do but wait out the 24 hour period.
Disadvantages of a pump.
1. Being attached.
It is a bit like marriage, you make a commitment to being with your pump 24/7.
You can chose to be separated but that will mean going back to the old ways - in this case multiple injections.
It can take a while to learn how to carry it around inconspicuously and what to do with it while bathing or in bed.
2. Cost.
Pumps are expensive, I have seen prices of $4000 - $7000 quoted for the US and supplies around$1,200 - $3,600 a year.
The batteries do not last very long on some pumps, from only a few days up to 4 weeks. The constant replacement adds up cost wise.
Some insurance companies will cover the cost, especially if your doctor is prepared to write a letter stating that the pump is necessary for you to get better control of your diabetes, thus leading to less complications and therefore less long term cost - with emphasis on the latter of course!
Some, and I believe Medicare is one, will not cover at all. You need to check with your insurance provider before buying an insulin pump,
In the UK £1000-£2000 was quoted for the pump itself and the disposable came to another £120-£180 pounds a year.
The NHS did not used to cover these but since NICE published it's guidance in 2003 you may be able to get one on prescription if you fit the criteria, which are as quoted:-
"Continuous Subcutaneous Insulin Infusion" (CSII or 'insulin pump therapy') is recommended as an option for people with type 1 diabetes provided that:
* Multiple-dose insulin (MDI) therapy (including, where appropriate, the use of insulin glargine) has failed; and
* Those receiving the treatment have the commitment and competence to use the therapy effectively."
3. Increased risk of Diabetic ketoacidosis. (DKA)
This happens when there is no insulin left in the body. The blood sugar level rises rapidly and ketones appear in the urine. It is a life threatening situation.
There has been medical resistance to pumps because of this risk. As pumps only use short acting insulin, which goes away in 3-4 hours there is the worry that if something goes wrong, like the tube becoming blocked, the cannula falling out or the reservoir running out of insulin DKA could develop.
Modern pumps have alarms that sound when these events occur, making them much safer.
Also if you test your Bg levels as you are supposed to you should pick up any changes before they become dangerous. Most diabetics are also aware when their BG's change rapidly to dangerous levels.
4. It is necessary to have a backup in the form of syringes or pens in case of pump malfunction.
Pumps are mechanical devices and as such breakdowns can occur. Some pump 'deals' offer two pumps so that you always have a backup one to hand.
5. Frequent BG testing.
If you thought this was necessary while on injections it is even more imperative with a pump. You need to know whether you have got your programming right.
This is necessary to prevent DKA but most diabetics who are interested in tight control do this anyway, whether on pump, injection or pills.
6. Weight gain.
This generally occurs when the pump is new. It is a result of the euphoria of at last being able to eat anything at any time after living on a strict regime. Most people return to healthier ways once the novelty wears off.
7. Forgetting boluses.
Some people have reported that the pump made their lives so easy they just 'forgot' to give the bolus. It is not something that happens that often but is another reason for frequent testing.
8. Infusion site problems.
Infections at the insertion site are fairly common. Attention needs to be paid to sterility, any infection needs to be treated immediately and site position should be changed with each new insertion.
If you have had a tendency towards staphylococcal skin infections, like boils or dermatitis or have been told at any time that you are a staphylococcal carrier (about 40% of normal healthy people are) then you may be more prone to infected insertion sites.
Some people get scarring at the insertion site. This can affect the absorption of insulin.
It may help to change the site more frequently or to try a different type of infusion set. Thinner people seem to have more trouble with insertion sets than their more padded brethren.
9. Some folk are allergic to the adhesive used
on medical tapes and that can be a problem when you have to keep needles or cannula in place.
I know what I am talking about here as I am one of these people and it is not funny. You come out in an extremely itchy, very virulent red rash in the sharply defined shape of the tape or dressing. You then have to find some other means of keeping the drip or needle or whatever in place.
Sometimes a barrier cream (like 3M's Cavilon ) helps. Then there are the sterile dressings that can be applied to the skin prior to the insertion, like Tegaderm and Smith & Nephew's IV3000.
10. Complicated to set up.
Using a pump is not 'life in easy street'. It takes as much, if more work that any other regime. It requires you to be comfortable with technology as there is a lot of programming that has to be done.
Getting the basal insulin rate right can be difficult to start with and that is central to good control. It takes time, testing, plenty of trial and error and ongoing patience.
The assistance of clued up health practitioners would be a great help but they are not always available.
11. Lack of knowledge.
If you land up in hospital, either as an emergency or as an in-patient, it is very possible that the staff will not know how to deal with your pump. You may find that they want you to go onto injections while they are treating you.
How to wear your pump.
This is something that worries many people, and especially women. Men, as usual, have it easy. They wear these handy garments called trousers that come, not only with multiple pockets but also with waist bands to which pagers, cell phones and insulin pumps can be clipped and go unnoticed.
Women on the other hand would like to occasionally wear a really feminine dress that has nowhere to hide a pin, never mind a pump. Various solutions to the problem have been found, as you will see.
If you have any sort of cleavage and the dress allows it you can tuck the pump down the very centre of your bra. I understand this works better if you wear one of the 'cross your heart' type bras without under wiring.
It is quite easy to get to in this position and hopefully no-one will notice you grovelling down your front if you turn away discretely and face the wall. I am an expert at this as my grandmother taught me at a young age to keep a spare hankie in just that spot "for emergencies my dear".
Warning - it can get quite hot down there if you exercise heavily, i.e. energetic dancing, so beware of overheating your insulin.
If you are wearing a strapless dress and thus a strapless bra you can tuck the pump into the bra on the side under your arm. This takes a bit of getting used to but it does stay there quite well. Some women swear by this position whatever they wear.
There are goodies made that hold the pump in particular places. For instance there is the Leg Thing - a stretchy object like the top of a sock with a pocket in it. You wear it round your calf and the pump is held in by Velcro. Great for slacks and long dresses.
There is a similar Thigh Thing that also has a garter grip that can be used to attach it to your undies. This is a good one for wearing with a dress but try to remember that folk will look at you very strangely if you start reaching up under your dress to adjust your insulin dose!
Some people have trouble getting these 'things' to stay in place but others swear by them. I guess it depends on the shapeliness, or not, of your leg.
Certain pumps come with the option of different colours or changeable covers so you can at least 'colour co-ordinate even if you cannot conceal!
To see a selection of accessories for pumpers go to:-
Angel Bear Pump Stuff Inc. - for children and adults.
Diabetes Mall. - General site.
Pump Pockets. for children and adults.
PumpPack - for children and adults..
Pump Wear Inc. - for children and adults.
Unique Accessories, Inc. Hard to find accessories.
Pump limitations.
You need to protect the pump from extremes of temperature. Insulin does not like getting very hot or very cold. So if you are lying baking yourself on the sunny sands of a tropical beach you need to find somewhere for the pump that is protected and cool. Do not forget that the tubing is full of insulin to and also needs to be out of the direct sun.
Likewise if you are cavorting in the snow don't leave it in an outside pocket, tuck it away where it can keep warm, but not hot.
You also need to keep out water, sand and dust, so if back at that tropical beach it might be an idea to put the pump inside a 'zip lock' plastic bag. Remember to keep it out of the sun or it will sweat within the bag.
What about when you sleep?
You can attach the pump to your pyjamas in some way. If you are handy with a sewing machine, or needle and thread, you could make a special pocket in your pyjamas or nighty that would hold it.
If you are not that domesticated there are some pre-made ones you can buy - see web addresses above - but the choice is limited (no slinky black numbers there!).
You can simply lie it in the bed next to you, place it under your pillow or on the table or floor next to the bed. Fortunately you can get very long plastic tubing, 43inches (110 cm) in length, that gives you plenty of leeway (sort of like giving you enough rope to hang yourself?) .
One question that comes up often is "What about, well, you know, sex?"
You have a choice. You can either find a way to accommodate the pump or you can disconnect it for the duration of the exercise.
The pumps are reasonably robust and resist the occasional trip onto the floor.
If you choose to wear the pump it is a good idea to check afterwards that nothing has become dislodged or that there are no kinks or air bubbles in the tube.
Websites that may be of help to pumpers.
Site for American pumpers.
Site for Canadian pumpers.
Site for UK pumpers.
Site for Australian pumpers.
Site for Danish pumpers.
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