What are Insulin Pumps?
Insulin pumps are computerized systems that deliver insulin by two different methods. The first includes through a steady measured continuous dose, referred to as a basal dose. The second method includes delivering insulin by a surge (bolus) dose.1 Doses are delivered by using a catheter with the aid of a needle that is inserted into the skin. You will still need to monitor your blood glucose levels when using an insulin pump. “Pumps can be programmed to releases small doses of insulin continuously (basal), or a bolus dose close to mealtime to control the rise in blood glucose after a meal.”1
How Do Insulin Pumps Work?
“Insulin pumps deliver rapid- or short-acting insulin 24 hours a day through a catheter placed under the skin. Your insulin doses are separated into:
- Basal rates
- Bolus doses to cover carbohydrate in meals
- Correction or supplemental doses
“Basal insulin is delivered continuously over 24 hours, and keeps your blood glucose levels in range between meals and overnight. Often, you program different amounts of insulin at different times of the day and night. When you eat, you use buttons on the insulin pump to give additional insulin called a bolus. You take a bolus to cover the carbohydrate in each meal or snack. If you eat more than you planned, you can simply program a larger bolus of insulin to cover it. You also take a bolus to treat high blood glucose levels. If you have high blood glucose levels before you eat, you give a correction or supplemental bolus of insulin to bring it back to your target range.”2
Who Should Use Insulin Pumps?
Typically an insulin pump is used for people that don’t tolerate insulin injections or who do not want to inject themselves that often. There are other factors that may determine if you want to use an insulin pump and this includes whether you are constantly active, have frequently low sugar levels, or have delay in absorption from food.1
Additional Patient Education
You can buy a pump case or attach it to your underwear, sock, bra, pocket, or belt.2 When you disconnect the pump you are cutting off all basal and bolus insulin.2 You may need to reprogram the pump.2 Also, make sure to use bolus insulin to cover the basal insulin that you may miss if you disconnect your pump. Make sure you don’t go more than four hours without any insulin.2
How to Setup the Insulin Pump
The following are instructions from the American Diabetes Association (ADA) for setting up your pump:3
- “Determine how much insulin to use in the insulin pump by averaging the total units of insulin you use per day for several days. (You may start with about 20% less if you are switching to rapid-acting insulin).”3
- “Divide the total dosage into 40-50% for basal and 50-60% for bolus insulin.”3
- “Divide the basal portion by 24 to determine a beginning hourly basal rate.”3
- “Then, adjust the hourly basal rate up or down for patterns of highs and lows, such as more insulin for dawn phenomenon and less for daily activity.”3
- “Determine a beginning carbohydrate dose (insulin:carb ratio) using the 450 (or 500) rule. Divide by the total units of insulin/day to get the number of grams of carbohydrate covered by one unit of insulin. This dose may be raised or lowered based on your history and how much fast-acting insulin you took in the past.”3
- “Determine the dose of insulin to correct high blood glucose with the 1800 (or 1500) rule. Divide 1800 by the total units of insulin/day to see how much one unit of insulin lowers your blood glucose. This dose must be evaluated by your health care team. It is often too high for children or for people who have not had diabetes very long.”3
Advantages of Insulin Pumps
The following are advantages of using insulin pumps adopted from ADA.4
- Using an insulin pump means eliminating individual insulin injections
- Insulin pumps deliver insulin more accurately than injections
- Insulin pumps often improve A1C
- Using an insulin pump usually results in fewer large swings in your blood glucose levels
- Using an insulin pump makes delivery of bolus insulin easier
- Insulin pumps allow you to be flexible about when and what you eat
- Using an insulin pump reduces severe low blood glucose episodes
- Using an insulin pump eliminates unpredictable effects of intermediate- or long-acting insulin
- Insulin pumps allow you to exercise without having to eat large amounts of carbohydrate
- Insulin pumps. American Diabetes Association. Available from: http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/insulin-pumps.html Accessed November 6, 2018.
- How do insulin pumps work? American Diabetes Association. Available from: http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/how-do-insulin-pumps-work.html Accessed November 6, 2018.
- Getting started with an insulin pump. American Diabetes Association. Available from: http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/getting-started.html Accessed November 6, 2018.
- Advantages of using an insulin pump. American Diabetes Association. Available from: http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/advantages-of-using-an-insulin-pump.html Accessed November 6, 2018.
- Heinemann, L., Fleming, G. A., Petrie, J. R., Holl, R. W., Bergenstal, R. M., & Peters, A. L. (2015). Insulin pump risks and benefits: a clinical appraisal of pump safety standards, adverse event reporting, and research needs: a joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diabetes care, 38(4), 716-722. Available from https://care.diabetesjournals.org/content/38/4/716 Accessed November 6, 2018.