Insulin Pump Therapy


 


With increasing frequency, individuals with type 1 diabetes (and, to a lesser extent, type 2 diabetes) are being placed on insulin pump therapy (also called Continuous Subcutaneous Insulin Infusion or CSII for short). Unlike the usual form of intensified management which generally requires injections of insulin between 4 to 6 times per day and uses a combination of rapid or short-acting insulin as well as intermediate-acting insulin or long acting insulin, pump therapy uses only rapid-acting insulin and gives the insulin in tiny doses (called "basal insulin") around the clock. An insulin pump also allows you to give "boluses" (a few extra units of insulin) when you are about to eat.

One advantage of insulin pump therapy (compared to giving yourself multiple daily injections of insulin) is that you will likely achieve better blood glucose control with fewer elevated readings and fewere episodes of hypoglycemia. A huge additional benefit is that the great majority of people with diabetes who go on pump therapy LOVE it and would NEVER go back to conventional injections. The most common comment I hear is: "It's so much more convenient. I wish I had done this sooner!" Note that I do not hear that it is less work (cuz it ain't less work; if anything it's more work).

One potential turn off about being on a pump is that you have to wear it around the clock. Sure, that may sound unpleasant, BUT I must say that these words are seldom spoken by actual pump users; it's pretty well only people that haven't yet tried a pump who voice this concern.

So, if you are considering pump therapy I'd suggest you mull over the following (I'll mention only major points):

The Bad:

  • Pumps have to be worn around the clock (with brief exceptions).
  • Pumps are very expensive (as in thousands of dollars).
  • Pumps are not less work than conventional intensified therapy; they are more work.

 And The Good:

  • You will likely have better blood glucose control (better A1C, fewer highs, fewer lows).
  • Despite the extra work involved, people almost always find pump therapy makes managing diabetes more convenient (easier to bolus for meals and - especially - snacks; much greater flexibility regarding meal timing & exercise, etc)
  • Pumps help avoid inconsistencies in glucose control caused by erratic absorption of typical insulin injections (especially with NPH insulin).

I find that many people who advise me they would like to switch to pump therapy are checking their blood sugars two or three times per day and are not on an optimized, intensive insulin schedule and believe that changing to a pump will, in and of itself improve and stabilize their blood sugar readings. This is FALSE. Switching to a pump does NOT, just by virtue of being on a pump, make things better any more than driving a Porsche rather than a Hyundai makes you a better driver. Indeed, many (but most definitely not all) people with poor control can achieve excellent control WITHOUT a pump if they monitor their blood sugars four or more times per day and are given expert and ongoing instruction about intensified insulin management. Pumps are highly sophisticated computers. Pumps are also STUPID! They only do what they are programmed to do. They do not monitor your blood glucose levels and they do not figure out on their own how much insulin to give you. You have to tell them how much to give you.

The bottom line: If you are on intensified therapy and don't have the blood glucose control that you should, or if you are tired of giving insulin injections four or more times per day, do yourself a favour and consider switching to a pump. For most people with type 1 diabetes - and for many people with type 2 diabetes - it is simply better therapy.

At the risk of sounding corny, I must say that with every smiling face I see on a new pump user; with every "Oh doctor, I should have done this sooner" I hear, I become more and more convinced that pump therapy is the way of the future. Indeed, I am convinced of this.

A very informative article is available at the CDA web site. And a site with lots of links to pump-related sites (including various pump manufacturers) is here.

Pumps can also be used with a glucose sensor. Glucose sensors are part of a continouus glucose monitoring system. This system measures your glucose level under the skin surface (typically, of your abdomen) using a tiny probe that you insert and leave in place for a few days. Your glucose level is then displayed on a pager-size device you wear (or, if you are using a certain type of pump, the result is displayed right on the pump) and, basically, gives you a continuous readout of where your glucose levels are at. Continuous glucose monitoring can also be used if you are not on an insulin pump. There are two continuous glucose monitoring systems available in North America: one is made by Medtronic (picutred on the left below) and one is made by Dexcom (pictured on the right): 

 


Continuous glucose monitoring is a huge advance in the management of type 1 diabetes. In addition to telling you your glucose level (updated every 5 minutes) at any given time, there are also alarms to let you know if you are high or low (especially helpful if you are prone to bad overnight lows) and arrows to tell you if your glucose level is heading up or down. The main downsides to continuous glucose monitoring are the challenges of dealing with technology (including alarms that go off for sometimes questionable reasons resulting in "alarm fatigue") and the signifcant costs involved.

If you are a pump wearer and are looking for accessories (like pants with a hidden pocket to hold your pump), these can be very hard to find. Pump Wear Inc. has some interesting items to help. (I have no financial - or other - relationship with this company and mention this only as a 'for your information;' not as an endorsement).