Is an Insulin Pump for you?
Firstly, it is important that you do not have unrealistic expectations about Insulin Pump Therapy. The pump does not automatically adjust insulin levels and it does not measure your blood glucose. You have to do this yourself; to make it work, you need to be highly motivated and willing to take on the responsibility of looking after your diabetes on a day-to-day basis.
The pump is not a solution to everyone’s problems but there are many people who may benefit enormously from using an Insulin Pump.
Does your blood glucose control need improving?
If you are having problems achieving your blood glucose targets using an insulin injection regimen, you may wish to consider using an Insulin Pump. Insulin Pump therapy provides the most natural form of insulin treatment and can be tailored especially to meet your own individual needs. Many people suffer from wide swings in blood glucose levels due to unpredictable absorption of insulin (especially longer acting insulin) from the injection site. Only short acting insulin is used with an insulin pump and this is supplied in small quantities throughout the day and night. Insulin delivery via a pump is accurate and reliable.
Do you have problems with hypos?
One of the main drawbacks of tightening up control is an increased risk of hypoglycaemia and some people on insulin injections are prone to sudden or severe hypos. Often, hypos are caused by injected insulin ‘peaking’ at certain times of the day. Sometimes hypos are caused by increased absorption of insulin from its ‘depot’ beneath the skin – this is often in response to exercise. Using an Insulin Pump to provide small amounts of insulin regularly means that these problems are overcome and the risk of hypoglycaemia can be reduced.
Tight control can also reduce the early warning signs of hypoglycaemia. However, Insulin Pump therapy tends to keep blood glucose levels stable and, with slightly higher blood glucose targets, sometimes early warning signs can actually be recovered.
Are you pregnant, or planning a pregnancy?
Tight control is very important for women with diabetes both before and during pregnancy. If you are pregnant, or planning to have a baby then you should consider Insulin Pump Therapy as a means of normalising your blood glucose levels without severely restricting your daily activities.
Do you suffer from the ‘dawn effect’?
Some people have trouble with high blood glucose levels in the morning caused by an increased need for insulin during the early hours. This is very hard to combat with conventional insulin injections without causing hypoglycaemia earlier on in the night. An Insulin Pump can be programmed to deliver more insulin just when the body needs it and this is the most effective way to overcome the problems caused by the ‘dawn effect’.
Do you lead a particularly variable and/or active lifestyle? Are you a shift worker?
If you lead a varied lifestyle, or you are a shift worker, then keeping your blood glucose levels well controlled can be very problematic. Day-to-day changes in mealtimes or activity levels are hard to accommodate with conventional insulin injection therapy. With a pump, however, you are no longer tied to a specific routine and you can take each day as it comes without your control suffering as a result.
Your role in Insulin Pump Therapy
The pump is not a cure for diabetes, in that it doesn’t measure blood glucose levels and then decide how much insulin you need. You will have to perform frequent blood glucose tests and decide on the insulin doses yourself. You will need to learn how to assess the carbohydrate content of different foods in order to give yourself just the right amount of insulin to take care of what you eat. You will also be responsible for changing the infusion set regularly.
Blood glucose monitoring
Blood glucose monitoring is an important part of any insulin therapy; however, in pump therapy frequent testing (generally 4 – 6 times a day) is essential. This is to ensure that your blood glucose levels are well controlled and so that any potential problems are picked up early.
Testing at 2 – 3 am for 2 – 3 days initially then once every couple of weeks is also essential, to make sure that your nighttime insulin supply is right.
Not only will you need to test frequently, you will also need to learn how to use the test results to keep your blood glucose levels well controlled.
Avoiding diabetic ketoacidosis (DKA)
People using insulin injections to control their diabetes usually have some residual insulin lying under the skin. If an injection is delayed or missed this residual insulin helps to prevent diabetic ketoacidosis (DKA) from developing quickly.
If you are using an Insulin Pump, however, and your insulin supply is stopped, you have no reserves to fall back on and your blood glucose levels will rise quickly. If the body is completely deprived of insulin, DKA will develop rapidly and you could be in danger.
Insulin supply from the pump can be interrupted if the infusion set becomes dislodged or blocked – it is your responsibility to be on the lookout for these potential problems. It is wise to carry some spare insulin and a syringe or pen with you, in case you encounter problems with your pump. Keep a spare battery or two handy as well.
Testing blood glucose regularly throughout the day means that high levels can be detected early on. Having been alerted to the problem you can take prompt action before things get serious.
In order to be able to accurately match your bolus insulin doses with the food that you eat you will need to learn how to assess the carbohydrate content of various foods. It may sound like hard work at first, but once you’ve got the hang of it you will be able to glance at a plate of food and quite accurately assess how much carbohydrate is there and how much insulin you will need to ‘cover’ it. Don’t worry – you don’t have to weigh all your food; it is simply a question of educated guesswork. Reference books and food labels will help to guide you.
You will receive training and instruction in how to program the pump and vary both your basal and bolus insulin doses according to your needs. You will need to learn how to calculate your bolus doses to cover the food that you eat and to correct high blood glucose levels. You will also need to know how and when to adjust the basal rate.
Your pump will require very little maintenance. However, you will need to re-fill the reservoir with insulin few days, depending on how much insulin you use. The batteries will probably need changing approximately every 2-3 months.
Changing the infusion set
The infusion set needs to be changed every 2 – 3 days. It should also be changed if you have unexpected or unexplained high blood glucose levels. The insertion site (the place where the needle or cannula is inserted into your body) should be rotated to avoid hardening of the skin in the area. You will need to check the insertion site regularly and make sure that it is not red or inflamed, as these are signs of possible infection.
Following its discovery in the early 1920s, insulin was hailed as a miracle cure for people with diabetes. It certainly made the difference between life and death at the time.
In recent years, however, we have realised that it is more than a question of survival – in order to prevent the long-term complications of diabetes, blood glucose levels need to be tightly controlled. Despite many improvements, injecting insulin still presents a number of problems:-