Heart And Soul Of An Insulin Pump

Paul Schickling, RPh, CDE

My insulin pump is transparent and I can see its heart and watch as the motor delivers my basal and bolus insulin. What I can’t see is just as important. One might say the pump has an electronic “soul”. You still have to guide it along, but most of its functions you do not have to think about. It becomes part of you, and the only evidence it is working is better glucose control.

After wearing his pump for a short time, a client of mine with Type 1 diabetes told me, ” For the first time in my life. I know I will die of something other than diabetes.”

Why would someone want to wear an insulin pump? Is it because it will reduce the incidence of hyperglycemia and hypoglycemia? Or adjust for early morning insulin resistance or improve glucose toxicity in Type 2 patients and improve growth and development in Type 1 patients?

Insulin pumps will allow for more flexible lifestyles, more flexibility in meals, fewer and less severe hypoglycemic reactions, avoidance of unconsciousness in those with hypoglycemic unawareness, more flexibility in exercise, improved control with variable work schedule, and improved quality of life in terms of self-reliance and control. Insulin pumps deliver a steady supply of background insulin (basal) just like the non-diabetic pancreas does. With the help of a dietitian, you will learn how to cover the carbohydrates in your meals (bolus) and you can make corrections for high and low blood sugars. Without a pump its impractical, if not impossible, to give even 1/2 unit for a supplemental bolus.

People with Type 1 diabetes before 1978 did not have the advantage of an insulin pump. Early pumps were too large to carry in your pocket or “hide” in your clothing. The battery of one brand had to be recharged every day. Infusion sets were not designed specifically for insulin pumps and the steel needles were uncomfortable, and site infections were common. The patient was hospitalized to start on a pump.

The Diabetes Control and Complication Trial (DCCT) proved the effectiveness of insulin pumps in reducing HbA1c levels and reducing incidents of severe hypoglycemia by one-seventh, and reducing the incidents of DKA by one-half. One spouse of a Type 1 patient said: “the biggest advantage of my husband’s pump is now I can sleep.”

A survey of new pumpers, suggests it takes from six weeks to three months to adjust to their pump and therefore the patient must understand the advantages and one or two disadvantages of a pump. Patients selection is critical. The patient must want to wear the pump and learn how to fit it into their lifestyle.

Read Pumping Insulin for easy steps on how to succeed with your insulin pump.