use the same site for the infusion set repeatedly, you can get scar tissue and an increase in fatty tissue buildup (called lipohypertrophy).
Infusion Set Issues
The probability of your infusion set falling out or being jarred from the site can be minimized with good habits. Using appropriate taping techniques and changing your infusion set regularly can help avert problems. To be safe, you need to keep extra pump supplies with you at school or work, and have an insulin pen or syringe available so you never have to compromise your safety and health.
Missing Boluses
Some people forget to bolus with meals or to correct hyperglycemia. If you regularly miss or skip taking a bolus for food, then your A1C will increase. The good news is that many pumps have alarms that you can set to remind you to test or take a bolus at certain times; an example might be to set a bolus alarm to remind you at lunchtime to check your glucose and take your bolus insulin. You can also set the alarm on your phone or watch to remind you about boluses.
Weight Gain
Some people gain weight due to the ease of dosing insulin. But the pump doesn’t add excess calories to your meal plan—only you can do that. Remember your meal plan, and schedule a meeting with a registered dietitian if you’re having trouble following your healthy eating plan.
Cost
The insulin pump itself, plus the supplies (e.g., infusion sets, insulin reservoirs, tapes), have a cost. Most insurance companies cover insulin pump therapy, minus your deductible. It is important for you to find out what you will have to pay out of pocket for insulin pump therapy before you make the transition.
Summing Up the Disadvantages
These disadvantages usually become less significant as time passes and as you become more familiar with the pump. As your knowledge and experiences grow, you will be able to adapt to the pump and make it work for you. Insulin pumps can be a great tool for diabetes management and can mean better glucose control and fewer complications.
WHAT MAKES YOU A GOOD PUMP CANDIDATE?
Before anyone can take on an insulin pump, he or she needs to understand what the pump can do and how it works, be realistic about his or her capabilities, and know a good deal about diabetes management. Your diabetes team may be very enthusiastic about pump therapy for you, but are you ready for it? What do you need to do to be considered ready for an insulin pump?
• Realistic expectations. The pump is not an artificial pancreas. It doesn’t cure diabetes. It cannot correct anything on its own. This is true even if you have a sensor and use CGM. You must be committed to being very active in your diabetes—and pump—management. Successful management takes time, good habits, dedication, hard work, and commitment.
• No coercion. No one should be forced to get an insulin pump, including young children. Although a pump can motivate someone to participate in his or her diabetes management, this cannot be the primary reason to get a child or teen an insulin pump.
• Participation of others. No one can manage diabetes alone. Children, teens, and young adults need someone—a family member or a friend—who understands diabetes, insulin pumps, and diabetes emergencies.
• Sufficient diabetes knowledge. To succeed with pump therapy, it is important to understand the following concepts: basal/bolus therapy, your diabetes meal plan, carbohydrate counting, avoiding and treating hyperglycemia, and sick-day management. Gaining skills and knowledge should be your goal.
• Awareness of financial responsibilities. Find out exactly what your insurance will cover and what you will have to pay out of pocket. This is vital information.
• Sufficient glucose monitoring. The only way to effectively use an insulin pump is to check your glucose frequently and take action based on the glucose levels. Many health care providers and insurance carriers require proof of four or more glucose checks a day for at least 60 days before they will authorize you to get a pump. Without adequate glucose monitoring, pump therapy is less likely to be successful.
IF YOU’RE READY FOR AN INSULIN PUMP, HERE’S WHAT’S NEXT…
Your physician has to prescribe the insulin pump, and your insurance company will have to review and approve the claim. Your pump will be shipped to you or your health care professional. You will be given instructions on how to start learning about your new device.
If you are ready for an insulin pump and are confident that you meet the requirements listed above, then you’ll need to work with your diabetes team to determine which pump you should get.
Which Pump?
Different companies make different pumps. Although these different pumps are fundamentally similar, each individual pump has its own distinguishing features. Likewise, different pump manufacturers provide different services. Discuss the available options with your diabetes team, research them on the Internet, read the product brochures, talk to people who use pumps, and learn as much as possible. Decide what features or services are important to you. Once you have made your choice, work with your diabetes team, the insulin pump company, and a pump trainer to make your new journey successful and enjoyable.
When to Start Pump Therapy
There is no right or wrong time to start insulin pump therapy. It is becoming more common for people to begin pump therapy early in the course of their diabetes, while others wait for some time. Some decide to get an insulin pump only after they have had a problem, like severe hypoglycemia, or a complication. Sometimes the diabetes team is pushing for pump therapy; other times, team members are reluctant. Some health care providers are more willing to use pumps, and others have very strict criteria for who they think is a good candidate.
At the present time, pump therapy is usually considered to be the next step after MDI. If your diabetes center uses MDI at the time of the diagnosis of diabetes, it might only take weeks or months to switch to a pump. If your diabetes center starts people on one to three shots per day in a fixed regimen, then you likely have to go to MDI and then to a pump. This could take months or years.
Is there an advantage to starting insulin pump therapy earlier rather than later? Perhaps, but we don’t really know for sure. However, studies are underway to determine if more intensive management at diagnosis is beneficial.
Pump Training
Before you have your in-person pump training, do some research. Most companies have some easy online learning that will help you become familiar with how your pump operates. Your pump trainer will be certified in all of the features of your insulin pump and will verify that you know how to operate it. You will go through all the steps of setting up the pump, filling the reservoir, priming and inserting your infusion set, and practicing as many times as you need until you are comfortable and confident with the pump. There are online tools, instructional videos, and booklets to give you further guidance after training.
Data Management with Computer Programs
You can upload the information stored in your insulin pump to a computer program, which is either supplied by the manufacturer of your pump or available from another company. The program will allow you to store and upload information, such
