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An external insulin pump is as close a substitute as we have to a working pancreas. It can deliver small amounts of fast acting insulin every few minutes. This is called a basal rate of insulin. Basal insulin is designed to manage the blood sugar steady between meals and during sleep. This is the basal metabolism. Bolus insuin, or insulin given with meals is designed to cover the food eaten. The bolus is adjusted on the amount of carbohydrate, current blood sugar level and other factors.
The pump itself is a beeper size device that contains a cartridge that is filled with one type of insulin, usually Humalog or Novolog. A computer in the pump runs a motor that pushes the insulin out of the cartridge through a tube that runs into the fat of your body. The tube, a catheter, is inserted with a needle. The needle is removed and the small plastic tube is left in the fat. The catheter and tubing needs to be changed and reinserted every three days.
Insulin pumps are ideally suited for a great variety of people. Skills needed to manage the pump successfully include a through grounding in diabetes self management including intensive management using multiple daily injections. Testing the blood sugar six to eight times a day and learning to count carbohydrates to match insulin boluses is essential to successful pumping.
Pros and Cons of pump therapy include:
Pros
- More desirable blood sugar levels and reduction in A1c levels. Although some people, if inadequately trained, may experience an opposite effect with loss of control.
- Fewer episodes of very high and very low blood sugars. By using only one type of insulin there are fewer swings of blood glucose
- A more flexible lifestyle. Pump therapy allows people to sleep in, alter exercise and meal times more easily than some other insulin regimines.
- Precise dosing. Insulin pumps allow alteration of doses much more frequently than multiple injections, most pumps up to 0.01 unit changes.
- Convenience. There is no need for syringes and vials, as the insulin is attached.
- No shots. Multiple daily shots can get burdensome.
- Easy adjustments. Basal rate changes allow the user control to make alterations when life changes.
- Weight control. Often pump therapy eliminates the need for snacking and extra food intake to control hypoglycemia. This can reduce overall weight.
Cons include a learning curve. It is an expensive, technical device that requires ongoing education to learn how to use effectively. The pump is a mechanical device that may fail. It should not replace knowledge of basic diabetes management using syringe and insulin. Skin problems can develop if infusion sets are worn too long or inserted improperly. The absence of a long acting insulin can result in hyperglycemia and ketosis if the pump is not performing correctly.
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