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Pumper's Voice
Pumper’s Voice: A Pumping Primer
Consider the pros, cons and function of insulin infusion pumps

by Gary Scheiner, MS, CDE

More than 100,000 people in the United States use insulin pumps. Why have so many abandoned their trusty syringes and made the switch? And why isn’t everyone using them? Should you consider using one? Nothing sparks more debate among insulin users than the concept of pumps vs. shots.

How does a pump work?

The pump is a beeper-sized device that contains a cartridge filled with fast-acting insulin. It mimics your pancreas by releasing small amounts of rapid-acting insulin every few minutes. This is called basal insulin, and is designed to match the glucose released by the liver, thus keeping the blood sugar level steady between meals and during sleep. When you eat, you program the pump (with the touch of a button) to deliver a larger additional dose of insulin right away. This is called an insulin bolus, and is designed to match the carbohydrate level in the food.

Who should consider a pump?

All of you with Type 1 and those Type 2s who produce little or none of your own insulin can consider a pump. You will need the ability to press a few buttons with confidence, and should be prepared to test blood sugar levels at least four times every day and learn how to count carbohydrates to properly set the bolus levels. You’ll need to keep good written records of blood sugars, insulin doses, the carbohydrates you eat, and physical activity.

You will also need to have adequate insurance to use an insulin pump or be prepared to pay for it yourself; they cost around $6,000, and the supplies that go with them cost $1,000 to $2,000 a year. Luckily, most private medical insurance (including Medicare) now cover them.

Pump pros & cons

Before you jump to the pump, take a look at both the plusses and minuses. Based on my 10 years’ experience using shots, 12 years’ on the pump and feedback from over a thousand patients on both forms of therapy, I present some benefits:

1. More stable blood sugars. Reductions in HbA1c are common in those whose readings are often high on shots. There are also fewer “high to low” and “low to high” swings.

2. Fewer low blood sugars. By using only fast-acting insulin, there is no long-acting insulin peaking when you’re not eating. This makes pump therapy a good choice if you have frequent lows or an inability to detect low blood sugars.

3. A more flexible lifestyle. Raise your hand if you can eat, sleep and exercise at the same times every day. It’s tough, right? The pump lets you choose your own schedule.

4. Dosing accuracy. You’ll get a bolus calculator that helps you determine mealtime doses based on carb intake, blood glucose levels, and the amount of insulin still active from previous boluses.

5. Precise dosing within tenths or twentieths of a unit.

6. Convenience. You don’t have to draw up syringes every time you need insulin; just reach to your side and press a few buttons.

7. No Shots. You change the pump’s infusion set just two or three times a week—no more discomfort from multiple daily insulin injections.

8. Easy adjustments for life’s little circumstances. You can adjust the pump’s basal rate to permit good blood sugar control for things like illness, seasonal sports, restaurant food and menstruation.

9. Weight Control. Eat what and when you choose; snacks are not required when you use a pump.

10. Novelty. The “high-techness” of the pump can add a dimension of excitement and fun to one’s diabetes care.

… and some drawbacks:

1. Cost. Although most insurance plans cover insulin pumps and supplies, there are often
co-pays and deductibles.

2. A learning curve. Don’t expect good control right away. It may take you a few months to get the basal and bolus doses regulated and adjust to using the pump.

3. Inconvenience. Wearing the pump around the clock, even during sleep, can become awkward once in a while.

4. Technical Difficulties. As a mechanical device, pumps are prone to occasional infusion set clogs, power failures, computer glitches and damage due to typical wear and tear.

5. Skin Problems. Your skin can become irritated from the infusion set adhesive.

6. Ketosis. The absence of long-acting insulin with pump use can present a problem if insulin delivery is interrupted for more than a few hours. Very high blood sugar can occur, and ketones may appear in the bloodstream and urine.

7. Infusion Set Changes. You must change your infusion set every couple of days. This 3-10 minute procedure involves numerous steps and can be momentarily painful or traumatic for the novice pump user.

The next step

Discuss this decision with your doctor—it’s an important one for you and your family. If your doctor is not familiar with insulin pumps or dismisses them as being a “waste of time,” consider finding a diabetes specialist who is familiar with pump therapy. Ideally, find a doctor who invites your input and works with diabetes educators who can assist you with your pre-pump education and post-pump blood sugar management. If this is not available to you, feel free to contact my office for additional resources or direct support.

Insulin pump manufacturers and distributors offer information on their web sites so you can learn more as you make your decision. Find out if there are insulin pump support groups in your area; they are excellent forums for meeting pump users and finding out about their experiences.

Editor’s note: Gary Scheiner is a Certified Diabetes Educator with a private practice specializing in intensive diabetes management for children and adults. He has had type 1 diabetes for 22 years and has used an insulin pump for the past 12. He offers his services via phone and the Internet to clients throughout the world. For questions or more information, you may contact him at gary@integrateddiabetes.com, or call 877-735-3648.