Insulin Pump Training and Management

What’s an insulin pump?

Many people who have diabetes must take insulin to manage their blood sugar (glucose) level. Insulin is given by an injection into your body with a needle or pen, or from an insulin pump. 

Insulin pumps are small computerized devices that deliver insulin through a thin tube inserted under your skin. They provide a continuous supply of short-acting insulin, helping to improve your glucose levels. They remove the need for long-acting insulin and the need for multiple insulin injections every day.

Choosing the best option — syringe, pen, or pump — depends on your preferences, your individual health care needs, and your lifestyle. Many people use more than one method. An insulin pump can be used continuously, or it can be used along with a syringe or pen. Switching delivery methods will allow infusion sites to heal. Some people prefer using syringe/pens while traveling; others just want a break from the pump. 

How do insulin pumps work?

Insulin pumps mimic how a body without diabetes normally releases a small but steady flow of insulin (basal insulin). The pump can release an extra dose of insulin at mealtimes (bolus insulin) to handle the rising glucose from food you ate. A bolus dose of insulin can lower glucose at other times, too. The pump can be programmed for basal and bolus doses. 

If you’re using an insulin pump, you will need to check your glucose levels at least four times a day. These checks can also be performed by a continuous glucose monitor. The pump uses the information you enter into it about the foods/beverages you consume. It calculates how much insulin you need, and recommends a bolus dose. You must approve the amount before it is delivered. Pumps that get this information from a continuous glucose monitor, can automatically adjust your basal insulin dosages.

About the size of a smartphone, an insulin pump is attached to your body with an infusion set. The infusion set works like an intravenous line. The needle is inside a cannula, a tiny plastic tube placed under the skin. The needle punctures the skin to insert the infusion set. After insertion, the needle is removed and the cannula remains in place. Many pumps have an insertion device that is a push-button, spring-loaded tool to insert the set for you. 

An insulin pump can be worn by attaching to a strap under your clothes, carried in your pocket, attached to your belt, or with an adhesive patch on your arm or stomach.

Are there different types of insulin pumps?

Different manufacturers offer several models of pumps. Pumps are classified into two types: 

• Traditional insulin pumps have a reservoir for insulin, a pump, and an infusion set with tubing to attach it to your body. The pump body has buttons to program insulin delivery. 
• Insulin patch pumps are worn directly on the body. They also have a reservoir, pump and infusion set inside a small case. Patch pumps are controlled wirelessly by a separate device.

Most pumps can connect wirelessly to a blood glucose meter or a continuous glucose monitor. The meter measures glucose using a drop of blood from your fingertip. The continuous glucose monitor is inserted under the skin and monitors glucose continuously. 

Pumps vary by the amount of insulin they can hold, if they have a touch screen, or are waterproof. Safety features include programmable bolus doses, customizable reminders, missed bolus dose alerts, and an alarm to warn of a pump blockage preventing insulin delivery.

What are the advantages of an insulin pump?

Advantages include:

• Fewer needle sticks; pumps only require one stick every few days when the infusion set is changed.
• Better glucose management; pumps deliver insulin more accurately than shots.
• Better A1c levels.
• Fewer blood sugar lows (hypoglycemia).
• Easier dosing for meals and snacks.
• Easier to plan for exercise.
• Better management of high glucose early in the morning.

There are several disadvantages or inconveniences, including: 

• You’ll still need to keep regular injectable insulin on hand in case the pump malfunctions.
• You must enter information into the pump multiple times per day.
• Infusion set must be changed every few days.
• Checking your blood sugar at least four times a day to make sure the pump is operating correctly.
• You’ll need up to a full day of training to learn how to use it. 
• Pump supplies can be expensive. 

What kind of patient does well with an insulin pump?

Insulin pumps are especially helpful for people who:

• Have delays in food absorption from their stomach
• Often forget to take insulin injections
• Frequently have very high or very low glucose levels
• Are very active and need to pause insulin doses during exercise
• Have severe reactions to low glucose
• Have diabetes and are planning a pregnancy
• Are young and have type 1 diabetes, especially children who have trouble adhering to an injection schedule

Who should not wear an insulin pump?

Wearing a pump is a personal choice. It may not improve your glucose control if you are already giving yourself three or more shots a day. A pump may not be the best option if you:

• Don’t like the feeling or responsibility of wearing a device
• Don’t want people to know you have diabetes
• Find the pump’s operation is too complicated or stressful
• Non-adherent with insulin, as only short acting insulin is in the pump
• Don’t want to calculate dosing, carbohydrates, and physical activity

What’s the best insulin pump?

Your choice of an insulin pump depends on what’s most important to you. Your diabetes treatment team can help you decide which one will best meet your needs. 

Think about these questions before you decide on a specific model:

• Which option works best with your lifestyle: traditional, tubeless/wireless, or one with a handheld remote?
• Size of the insulin reservoir — children may need a small reservoir; adults may need a larger one.
• Can the pump deliver small amounts of insulin, for people very sensitive to insulin, or children?
• Do you need a carbohydrate counter of common foods to help you determine your insulin dose?
• Can the pump operate with a glucose meter or continuous glucose monitor?
• Will the pump software work with your mobile phone or laptop device?

Does insurance pay for insulin pumps?

Most health insurance companies cover insulin pumps, or cover only certain brands or types. Medicare will cover it if your doctor says it’s medically necessary. Be sure to check before ordering. If you need help paying for an insulin pump, many pharmaceutical companies offer financial help.

Without insurance, a new insulin pump can cost $6,000. Prices vary depending on the brand, software, extra features, and size of the pump. Batteries, sensors, and other supplies add $3000 to $6000 annually to the purchase price. Most insurance companies will only pay for a replacement pump after four years of use.  

It’s important to find a pump you like and that meets your needs. Most pump manufacturers have a return policy, usually 30 days after the shipping date. Check on your insurance company’s policy on returned devices, and if they’ll reimburse your copay and deductible.

Deciding if an insulin pump can make diabetes management easier, and learning how to use one can be complicated. You need experts to help you make the right decision. Our team of specialists at Inland Endocrine can help you every step of the way, from selecting an insulin pump to learning how to use it. Call for an appointment today.  

References:

WebMD. 2021, Feb. 7. What Are Insulin Pumps?. Retrieved 7-16-2021, {https://www.webmd.com/diabetes/insulin-pump}

Aleppo, G., N.d. Insulin Pump Overview. Endocrineweb. Retrieved 7-16-2021, {https://www.endocrineweb.com/guides/insulin/insulin-pump-overview}

Cleveland Clinic. 2021, March 26. Insulin Pumps. Retrieved 7-16-2021, {https://my.clevelandclinic.org/health/articles/9811-insulin-pumps}
University of California, San Francisco. N.d. Diabetes Education Online. How to Use Your Pump. Retrieved 7-16-2021, https://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-therapies/type-2-pump-rx/how-to-use-your-pump/}