insulin correction (sensitivity) factors.
Insulin pump: A small, programmable, battery-powered device worn externally that delivers insulin in tiny continuous amounts (basal doses) and in larger amounts for meals or hyperglycemia (bolus doses). The pump is attached to the patient by either an infusion set consisting of long, thin flexible tubing with a catheter (or needle) on the end that is inserted subcutaneously into the patient, OR, a tubing-free (“patch”) pump is directly attached to the patient with a subcutaneous needle-inserted catheter and self-adhesive tape. The user programs and operates the pump or the pump’s remote control device to deliver insulin doses that match individual needs. An insulin pump does not automatically calculate the amount of insulin needed; patients and healthcare professionals work together to calculate the patient’s daily insulin amounts, and the pump is then programmed by the patient to deliver insulin based on the person’s specific requirements.
Benefits
For People with Type 1 Diabetes
• Improves glycemic control by delivering an individualized basal rate supplemented with bolus doses to match the patient’s intake and correct any hyperglycemia. Erratic glucose fluctuations can potentially be reduced.
• Offers precise dosage delivery in basal rates as low as 0.025 units/h and bolus doses in exact whole, tenth, and twentieth-unit doses.
• Can manage the dawn phenomenon by delivering a higher basal rate during the dawn hours.
• Can control glucose during and after exercise by delivering a lower basal rate.
• Has the potential to decrease the risk of hypoglycemia by allowing patients to individualize insulin doses to match their requirements hour by hour.
• May lessen or reverse hypoglycemia unawareness by decreasing the incidence of hypoglycemia.
• Allows incremental, precise doses to match growth spurts in children and adolescents and to manage people who are insulin sensitive.
• Improves management of patients with gastroparesis by adding the option of splitting and/or extending bolus delivery over time to match delayed absorption of nutrients.
• Can match delayed gastric emptying observed with the use of pramlintide, or with the consumption of high-fat foods, by extending bolus delivery over time.
• Eliminates the frequency and inconvenience of multiple daily injections (MDI).
• Increases lifestyle flexibility by allowing the person to eat at desired intervals instead of matching food intake to injection therapy insulin peak times.
• Improves well-being and quality of life by providing freedom in school, work, exercise, and leisure-time schedule variations.
• Allows for easier weight loss. With individualized dosing, the pump patient is not “chasing insulin” with additional food. Additionally, with decreased incidence of hypoglycemia, caloric intake to treat hypoglycemia is reduced.
For People with Type 2 Diabetes
• Allows the attainment and maintenance of improved glycemic control
• Eliminates the frequency and inconvenience of MDI.
• Increases lifestyle flexibility by allowing the person to eat at desired intervals instead of matching food intake to injection therapy insulin peak times.
• Improves well-being and quality of life by providing freedom in school, work, exercise, and leisure-time schedule variations.
• Allows for easier weight loss. With individualized dosing, the pump patient is not “chasing insulin” with additional food. Additionally, with the potential decreased incidence of hypoglycemia, caloric intake to treat hypoglycemia is reduced.
For Women Who Are Pregnant or Planning Pregnancy
• Mimics normal physiology with individualized precise dosage delivery.
• Has the potential to decrease pre- and postprandial glucose (PPG) excursions.
• May potentially reduce the risk of hypoglycemia.
• Improves the management of morning sickness by eliminating the need to eat on rising: a correctly calculated basal rate maintains euglycemia.
• Allows for easier achievement of recommended blood glucose goals.
• May potentially reduce postprandial hyperglycemia due to the delayed. gastric emptying of normal pregnancy as well as gastropathy with the use of the extended or combination bolus feature.
Myths
| Patient | Healthcare Professional |
| The pump calculates and delivers all my insulin doses automatically | The pump calculates all the required insulin doses automatically |
| No more SMBG | Any patient can use a pump |
| Can eat whenever I want without planning | Less emphasis on meal planning |
| Can eat as much as I want | Not useful in type 2 diabetes |
| Too expensive | Too expensive |
| Too much trouble | Too complicated for most people |
| Can’t wear it during exercise, swimming, or intimacy | Can’t wear it during exercise, swimming, or intimacy |
| Can eliminate low and high glucose levels | Can eliminate low and high glucose levels |
| I can lose weight quickly by skipping meals | Will cause weight gain because most patients will start eating more, since they only have to press a button to deliver insulin instead of taking injections |
| Children won’t like wearing a pump | Too risky for children to use |
| Can learn how to use a pump in just a few minutes, since I’m very tech-savvy | A pump company representative gets the patient ready and calculates the patient’s starting basal rate(s), insulin-to-carbohydrate ratio(s) (ICR), blood glucose goals, and correction (sensitivity) factor(s) as part of the pump training |
The pre-pump and ongoing education and skills training in pump use provided by the healthcare professional are crucial in correcting any misconceptions the patient may have about pump therapy and, even more important, in guiding the patient as s/he develops pump skills. The truth about pump therapy is that the greater the patient’s effort and the greater the support and access to skills training, the greater the chance that therapy will succeed. Healthcare professionals as well as patients need to understand the implications of pump therapy, including both benefits and challenges.
Challenges
Pump therapy is not without some challenges and risks, although a patient with motivation, pre-pump training, and ongoing pump education can tackle practically any drawback. However, inattention to problems can create life-threatening circumstances. Weigh these challenges and risks against the benefits.
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