Understanding Insulin Pumps

Many people with type 2 diabetes will require insulin at some point in time. Insulin remains the fastest way to lower blood sugar levels. The type of insulin and number of insulin injections given each day will vary depending on a person’s glycemic control. Insulin therapy is often started with a long acting insulin (Lantus or Levemir), given one time a day, and then may eventually be transitioned to multiple daily injections (MDI) of both long acting insulin and rapid acting insulin (Humalog, Novolog, or Apidra). An insulin pump may be a consideration for those people on MDI therapy.

An insulin pump is a small mechanical device that is worn externally and is roughly the size of a deck of cards. It contains a small motor that allows for the precise delivery of insulin 24 hours a day. Insulin is infused under the skin through a cannula (small tube) that is connected to an insulin reservoir inside the pump. The infusion set (cannula and tubing) needs to be changed every 2 to 3 days.

Insulin pumps only use rapid acting insulin. Rapid acting insulin is given in small doses around the clock. This insulin acts as basal (background) insulin, which takes the place of long acting insulin. Rapid acting insulin is also given as a bolus (a quick release of insulin), which is used to cover carbohydrates at meals and snacks and to lower high blood glucose readings.

What are some of the advantages of wearing an insulin pump?

• Improved blood sugar control (reducing the risk of long-term complications)
• Reduced frequency and severity of hypoglycemia
• More precise insulin delivery
• Better management of the dawn phenomenon (high blood sugars in the early morning hours from increased hormone levels)
• Weight loss may be easier (although initial weight gain from improved glycemic control may occur)

What are some of the disadvantages of wearing an insulin pump?

• Being connected to an insulin pump is a constant reminder of diabetes
• Increased risk of diabetic ketoacidosis (if insulin delivery is interrupted diabetic ketoacidosis can develop within hours)
• Expense
• Mechanical failure
• Skin infections

Where do I wear an insulin pump?

• A pump can be worn anywhere an insulin injection is given (abdomen, buttocks, back of arm, and thighs)

What necessary qualities should a candidate for an insulin pump have?

• Adequate diabetes knowledge
• Motivated to improve glucose control
• Willingness to do at least 4 blood sugar checks every day
• Family and friend support
• Realistic expectations
• Good problem solving skills
• Ability to count carbohydrates

If you are interested in a particular insulin pump, you can learn more by contacting that pump company directly and having a local representative demonstrate their product. A pump representative can set you up with a saline pump trial to assist you in making your decision. A pump trial gives you the chance to wear an insulin pump with saline (salt water) infusing instead of insulin to see how you feel about being connected to the device.

Once you have chosen the pump you would like and have the go ahead from your doctor a letter of medical necessity is sent to your insurer. This letter helps you get insurance approval. It is important to have a clear understanding of your insurance coverage prior to starting on an insulin pump. You will want to know what is covered and what amount of out of pocket expenses you can expect to have on a monthly basis.

To learn more about insulin pumps currently on the market you can review the following consumer report.