Insulin pumps
What is pump therapy?
Pump therapy is also known as continuous subcutaneous insulin infusion (CSII) and is an alternative way of giving insulin. A pump is a small device which delivers insulin in small frequent “pulses”. Rather than taking your usual 4–5 daily injections, insulin from the pump is delivered through a soft “cannula” which sits just under the skin. This is changed every 2–3 days.
Unlike injections when you have your background or long acting insulin (such as Lantus or Levemir) plus rapid acting insulin for food (such as Novorapid or Humalog), pumps only run on rapid acting insulin. The pump is programmed with a background or “basal” rate, which can be altered every hour to meet your changing insulin needs over the 24 hours. This drips in slowly every few minutes. The pump is also programmed with other information specific to you including you such as your insulin to carbohydrate ratios for your meals and your correction factor.
The pump should be worn at all times however it is recommended to take it off for contact sports, swimming and bathing. It is then important to reconnect after about an hour so that you don’t miss too much insulin.
Having a pump does not mean that you don’t need to do blood sugar testing. It can be more important to test your blood sugars on a pump because you are only running on rapid acting insulin. This means that you are at higher risk of diabetes ketoacidosis or “DKA” if the insulin is not being delivered properly. For example, if your cannula kinks, the insulin will not be delivered effectively and your blood sugar levels can rise very quickly. It is important to keep insulin pens so that if the pump is not working, or you are not sure it is working properly, you can still give insulin.
Pros
- The pump works more like a normal pancreas compared to injections: As the pump is programmed to meet your individual insulin needs, your diabetes control should be optimal on a pump. This should include:
- Less hypoglycaemia
- Reduction in HbA1c
- Fewer fluctuations
- Fewer injections: Your cannula needs changing every 2-3 days. This is instead of taking 4 or more injections per day.
- Increased flexibility with diet: If you want a snack or decide to have some extra food, all you need to do is enter the carbohydrates in to the pump and it will deliver insulin for you.
- Improved quality of life
Cons
- Some people might not like the idea of being connected to a pump for 24 hours a day.
- You are at higher risk of diabetes ketoacidosis or “DKA” because you don’t have any long acting or background insulin. If the insulin is not being delivered properly, blood sugars can rise quickly.
- Requires real commitment to blood glucose testing and CHO counting
Am I suitable?
The National Institute for Clinical Excellence (NICE) provides national guidance and advice to improve healthcare. It outlines who should be considered for pump therapy.
If you are keen to pursue pump therapy, you must be carbohydrate counting. If you are not doing this already, you can arrange to meet with the dietitian to start this process.
Also part of the process is a pump assessment with our clinical psychologist. In this session, you will explore you reasons for wanting a pump and whether it will meet your expectations.
FAQs
Where can I wear my pump?
The pump can be worn on a belt or in a special pouch that can go around you stomach or your leg. Some girls will attach it to their bra.
Where can I put my cannula?
Tummy, buttocks and thigh are the most suitable places to wear an infusion set, but your diabetes team will advise you on the most suitable place which will depend on the childs age.
Will I be able to feel the cannula?
Inserting the cannula can initially feel similar to having an injection. After a few minutes, you shouldn’t notice it anymore.
What do I do when on I’m holiday?
The pump companies have “travel pumps” which you can take on holiday with you as a back up in case you lose it or something happens to it. You need to let them know 6 weeks in advance. If you are on a beach holiday and doing lots of activities such as swimming, you can disconnect yourself from the pump and then reconnect at intervals, check your blood glucose levels and give a correction if required.
Do I have to be attached all the time?
Yes apart from for contact sports, bathing, and swimming.
What if the pump breaks?
Your pump is under warranty for 4 years. After this time you have the option to look again at the pumps on the market and get a new one. If anything goes wrong with your pump during the 4 years, the company will replace it free of charge.
Do I need to insure the pump?
The pump is worth £2,500 so it is important to get this insured. This can easily be added on to house insurance.