It's about the size of a beeper and can be worn just about anywhere on your body--in a pocket, inside a bra, even on your back. It holds the promise of better blood sugar control, more flexibility, and less equipment to tote around. But the insulin pump also requires some training on your part.
Insulin pumps deliver fast-acting insulin continuously throughout the day and night using a catheter, and they replace the need for shots. They can deliver the insulin more accurately than injections. Very often, people with diabetes who are on the pump have an improved A1C, and they typically experience fewer big swings in their blood sugar levels than people who take insulin injections.
"Even though we have some very good basal insulins now, there is a distinct advantage of the continuous subcutaneous insulin infusion offered by the pump," says Dr. Randall Urban, professor and chair of internal medicine at the University of Texas Medical Branch at Galveston. The amount of insulin can easily be increased or decreased simply by programming the pump differently.
"The pump gives you a whole other level of control for patients," Urban explains. "The pump can be changed to lower the rate of insulin delivery during exercise. It can be raised back up when you eat."
For families with children who have diabetes, the pump can be a time and sanity saving solution. "You're taking four to six shots a day out of their life," says Dr. Radhika Muzumbar, endocrinologist at Children's Hospital at Montefiore Medical Center. "The pump offers flexibility. If you're taking your child to a party, you can just program the pump and let him have a treat while he's there. And teenagers on the pump can sleep in late, wake up at noon and not have to get up and eat a meal even though they don't feel like it."
Downsides of the Pump?
A person with diabetes still has to test the blood sugar, and the site where the catheter is inserted needs to be changed every two or three days. Pumps are expensive, although they are typically covered by insurance. To be trained to use the pump, sometimes you need to spend a full day or several sessions at an outpatient treatment facility learning how to use it. If the pump malfunctions, or if the catheter comes out and you don't know it, you wouldn't get insulin for hours and are at risk for diabetic ketoacidosis.
However, the companies that make the pumps have strong support systems, Urban says. "My patients have never complained that they didn't get the support they needed when they had a pump malfunction," says Urban.
The big downside for some people with diabetes is that they hate being attached to the pump most of the time. However, if you figure out a place to keep it then this disadvantage may well be outweighed by the many advantages.
Families with young children who have diabetes can be trained so that their child can wear the pump, explains Muzumbar, although a newly diagnosed child would not be put directly on the pump. First, the families are educated about how to care for a child with diabetes. Families meet with the nutritionist and all about carbohydrates and matching insulin to food, she says. They learn to check the blood sugar and give insulin injections.
Only after families become comfortable with the regimen are they ready to consider a pump for their child, Muzumbar says. Pumps for kids have locks on them so kids can't play with them or change the settings. A parent can also change the settings on the pump remotely, Muzumbar explains.
With training and support, the insulin pump could go a long way toward improving both the quality of your life and your blood sugar control. Learning how to use it properly is not rocket science.
As for teens and the pump, some would rather stick with injections because they don't want something hanging off them all the time, Muzumbar explains. "But some teen girls put the pump inside their cleavage," she says. "And some of the pumps are so fancy that teenage girls actually like to show them off."
