Insulin pumps have been available in Canada for the treatment of diabetes since the 1980’s. For some people with type 1 or type 2 diabetes, insulin pumps may be a welcome alternative to needles or pens. Read on to learn more about insulin pumps for diabetes.
What is an insulin pump?
An insulin pump is a small device (about the size of a deck of cards) that is programmed to deliver insulin consistently. You can wear an insulin pump in various places on your body, including clipped to your belt or waistband, tucked in a pocket, bra, or strapped to a pouch on your waist, arm or thigh.
How does an insulin pump work?
An insulin pump is programmed to deliver rapid-acting insulin continuously, which mimics the pancreas’s natural function. It can also be programmed to deliver both basal (background) doses and bolus doses (larger amounts for meals).
Some insulin pumps use tubing to deliver insulin, while others are tubeless and attach directly to the skin. The main components of an insulin pump are:
- Infusion set (for pumps with tubing): The pump connects to the body via an infusion set, which includes a thin plastic tube (called a cannula) inserted under the skin.
- Pods (for tubeless pumps): Tubeless pumps have a pod that is worn directly on the body with adhesive; a remote device controls the pump.
- Basal insulin rate:The pump delivers a continuous, small amount of insulin to maintain background blood sugar levels.
- Bolus doses:Before meals, the user can program the pump to deliver a larger dose of insulin to help control the rise in blood sugar after eating.
- Programming:The pump is programmed to meet the user’s individual needs, including basal rates, bolus amounts and insulin-to-carbohydrate ratios.
- Integration:Some pumps can integrate with a continuous glucose monitor (CGM) to automatically adjust insulin, as needed, based on real-time blood sugar readings.
Who is a good candidate for an insulin pump?
An insulin pump is a good option for people with diabetes ( type 1 or type 2) who find it challenging to reach their target blood sugar range with multiple daily injections, or who have unpredictable schedules or eating habits, or experience frequent low blood sugar reactions. Specifically, here are the types of people with diabetes who would benefit especially from using an insulin pump:
- People with unpredictable schedules or eating habits: Insulin pumps can help with flexibility in meal timing and exercise, which is beneficial for those with variable schedules.
- People who experience frequent low blood sugars (hypoglycemia) or hypoglycemia unawareness: Pumps can help to prevent severe drops in blood sugar.
- People with delays in food absorption (gastroparesis): The extended bolus delivery feature of some pumps can be helpful for people with this condition.
- People who require small doses of insulin: This is particularly important for children with diabetes.
- People who experience the dawn phenomenon: The dawn phenomenon is a large blood sugar rise before waking, which can be managed with an insulin pump.
Benefits and drawbacks of insulin pumps
Insulin pumps have many benefits, as well as some drawbacks, for individuals managing diabetes.
Benefits:
- More precise insulin delivery: Insulin pumps provide continuous delivery of insulin, allowing for finer adjustments based on daily needs. This can lead to better blood sugar control and fewer extreme highs and lows.
- Convenience and flexibility: They allow users to program basal insulin (background insulin) to be delivered continuously and bolus doses when eating without needing to inject manually.
- Improved A1C: Many people see improvements in their A1C because the pump allows for tighter control of insulin, reducing variability in blood sugar levels.
- Small and discreet: Pumps are very small, and many models can be worn discreetly under clothing. This makes them more convenient than injecting insulin.
- Better for people with active lifestyles: Insulin pumps offer flexibility for people with unpredictable work schedules and those who regularly engage in physical activities, as the user can adjust insulin delivery based on eating schedules and activity levels.
- Remote control and enhanced features: Many insulin pumps can be controlled remotely or paired with a CGM for automated adjustments to insulin delivery based on real-time data.
Drawbacks:
- Cost: Insulin pumps are expensive, both for the initial device and ongoing costs for supplies (e.g., infusion sets, reservoirs, etc.). Most provinces and territories in Canada offer financial assistance or coverage for people with type 1 diabetes for insulin pumps and related supplies, but the level of coverage and eligibility may vary by province.
- Complexity: Insulin pumps can be complicated to use, especially for those who are not tech-savvy. There’s a learning curve to programming and troubleshooting the device.
- Risk of technical malfunction: Like any technology, insulin pumps can malfunction. This could lead to missed doses of insulin, insulin overdose, or other issues, which could be dangerous without proper monitoring.
- Site infections: The infusion site (where the insulin is delivered) can become infected or irritated. Regular site rotation and proper hygiene are essential to minimize these risks.
- Frequent maintenance and supplies: The pump requires regular maintenance, such as changing the infusion set, refilling the insulin reservoir, and checking the battery. Running out of supplies or forgetting to replace them can lead to issues with insulin delivery.
Lifestyle considerations regarding insulin pumps
Here are some tips to help manage your daily activities with an insulin pump.
- Everyday wear: You can clip the pump to your pocket, bra, sock, or underwear. You can also tuck any excess tubing into the waistband of your underwear or trousers.
- Sleeping: When you sleep, you can lay the pump next to you on the bed. Or, you could try wearing it on a waistband or armband, or clip it to the blanket, sheet, pajamas, or pillow.
- Bathing and showering: If you have a waterproof pump, you won’t need to disconnect it to bathe or shower. Other insulin pumps may be water resistant, but they should not be placed directly in water. Instead, while showering, you can disconnect it. Disconnecting your pumps for a brief period of time – say, 10 or 15 minutes – shouldn’t pose a problem with your blood sugar.
- Physical activity: The type of sport you’re playing can make a difference to where you wear your insulin pump. You will want to wear it in a place where it is not likely to be bumped or struck by you or a teammate, or where the tubing won’t get snagged. Depending on the sport, thigh and arm bands can be a good option. A popular option for women is to wear the pump in a bra pouch or within a sports bra.
- Intimacy: Many people wonder what – if anything – they should do with their pump while having sex. If you choose to disconnect it, you can be safely away from the pump for 45 minutes to 1 hour. However, remember to reconnect! You can set a reminder alarm on the insulin pump, or on your cell phone. If you leave the pump connected, remember that sex is a form of exercise, so you may need to readjust your insulin dose to prevent hypoglycemia. You can use longer tubing to keep the pump out of the way.
Insulin pumps offer many benefits, including greater blood sugar control, flexibility and convenience. However, there are some drawbacks, including cost, technical challenges and the need for frequent maintenance and monitoring. Deciding whether an insulin pump is the right choice often depends on your preferences, lifestyle and health needs. Speak with your diabetes healthcare team about diabetes management with insulin pumps.
