In this section, you will find answers to these frequently asked questions:
- Which pump is the best?
- Does the pump know my sugar level and automatically deliver the right amount of insulin?
- Do I have to be attached to the pump all the time?
- What type of insulin is used in an insulin pump?
- Should I go on the pump?
- How much time and effort commitment does pump therapy require?
- What expectations should I have?
- What skills will I need to use pump therapy?
- What’s so great about the pump?
- What’s not so great about the pump?
- What should be considered when choosing an insulin pump?
- What Is The UCSF Diabetes Teaching Center Pump Start Process?
Most pumps have similar features, but they’re all a little different. No one pump is best.
No! At this time, insulin pumps cannot measure glucose levels and cannot automatically deliver the right amount of insulin.
It is possible to temporarily disconnect yourself from the pump, but not for very long. If you are disconnected for more than an hour, you may need to replace your missed insulin. Once again, speak with your doctor about specific recommendations. It is important to assess the entire picture.
Insulin pumps use rapid-acting insulins such as lispro, aspart and glulisine. Because the pump delivers tiny amounts of insulin every few minutes, longer-acting insulins are not necessary.
Insulin pumps can greatly benefit people with diabetes. However, not everyone with diabetes is a good pump candidate. Psychological readiness and physiological needs vary with individuals and need to be considered.
Starting pump therapy requires commitment. It is not unusual to check blood sugars 8-12 times per day in the beginning of pump therapy to assess basal and bolus insulin needs. This often means lots of interruptions during the workday and during family time. It also means disturbing your sleep in order to take blood sugar readings in the middle of the night. Think about your schedule and commitments. Talk to your family for support. Plan ahead.
Make sure you have realistic goals on what pump therapy can achieve. It takes a lot of work with injections to achieve the best glucose control. The same is true with an insulin pump. Pump therapy does not automatically fix a problem. It takes time and effort. However, the pump does provide more tools to help.
- A thorough understanding of diabetes self-management skills:
You should understand insulin action, carbohydrate counting and how to treat high and low blood sugars.
- Manual dexterity:
Manual dexterity is necessary to load or fill an insulin cartridge and depress buttons on the pump for technical functions. Severe limitations from hand arthritis or neuropathy may hinder this.
People with vision impairment should carefully evaluate which pumps may be the most helpful for them. Pump features such as screen size, screen contrast, size of letters and numbers, audio functions, alerts, alarms, and backlighting should all be assessed.
The list is an important one, in large part because pumps provide more precise and tailored insulin delivery. As a result, they offer greater lifestyle flexibility. Tailored insulin delivery can help:
- The “dawn phenomenon” – by matching your early-morning increase in insulin resistance, so you avoid high blood sugar.
- Post-meal glucose rise from slowly digested foods or gastroparesis (Combination and extended meal boluses extend insulin delivery).
- Shift workers by adjusting the basal rates to your varying work schedule
- Frequent travelers by adjusting the basal and bolus rate to your travel schedule and time zone changes
- Prevent low blood sugars during physical activity and exercise by use of temporary basal insulin rate settings
- Extremely insulin sensitive people by delivering small doses of insulin
There are downsides to any therapy, and the insulin pump is no exception.
- Wearing it can be unsettling
Most of the time, you’ll be wearing your pump on your body, clipped to your waistband or in your pocket. Fortunately, many accessories are available to make wearing the pump discreet and convenient.
Insulin pumps cost thousands of dollars. Insurance coverage for insulin pumps varies. Some companies will cover all of the cost, while others may cover only half. Some might also pay for only certain brands. Don’t forget to factor in the cost of disposable items, such as cartridge syringes, infusion sets and skin preparation items.
- Higher risk for ketoacidosis
There is a greater risk for ketoacidosis in pump therapy, because long-acting insulin is not used. Because of this, high levels of ketones may develop when there is not enough insulin in the bloodstream. This can happen if there is air in the tubing, a bad infusion set, insertion site infection, or if the insulin pump is disconnected for too long. See also Ketones and pump therapy. As a result, ketoacid levels rise, which can lead to diabetic coma.
- Risk of infusion site infection
Infections can occur if an infusion set is left in for too long. To lessen your chance of infection, change the set as directed by your doctor or pump educator. It is also crucial to wash your hands and the site properly in order to reduce chances of infection. See also Infusion set tips.
The following list may seem formidable and long, but keep in mind that not all of it may apply to you. Discuss which features and elements are most relevant to your care with your doctor.
- Weight, size and color of pump
- Lowest basal rate delivery
- Amount of insulin a cartridge can hold (e.g. 160 units or 200 units or 300 units of insulin)
- Number of different background, or basal, insulin patterns available (e.g. weekday, weekend, night shift, exercise day, day of week, etc.)
- Insulin-to-carbohydrate ratio program feature
- Insulin-sensitivity factor and target glucose features
- Number of different customized bolus programs available – for example: breakfast, lunch, dinner, pizza, use of pramlintide, etc.
- Nutritional information
- Insulin-on-board feature
- Types of alarms and alerts
- Waterproof, watertight, or water-resistant
- Ease of use – programming, delivering a bolus, navigating program menus
- Infusion set compatibility – brand-specific (proprietary) or universal
- Customer service – technical support, clinical support, warranty, trial period, upgrades, cost of upgrade
- Future features of upgrades
- Software programs
- Blood glucose meter link
- Continuous glucose sensor link
- Local insulin pump workshops or classes available
- Doctors’ and pump educators’ familiarity with the pump you select. Some health care providers are only familiar with one brand of pump.
UCSF insulin pump start process
Our program consists of 3 components:
- getting ready to go on the pump – timeline is 2 to 3 months or more
- starting on the pump – you will attend two ½ day classes
- follow up – timeline is 2 to 4 weeks
- meet with pump educator
- choose your pump
- verify insurance coverage
- make appointments with the pump team:
- RN – 3 to 6 visits or more to verify self-management strategies. The last appointment must be within 4 weeks of starting the pump. Prior diabetes comprehensive diabetes management education is required and may include the Diabetes Teaching Center Insulin Workshop
- RD – 1 to 3 visits or more for carbohydrate counting
- MD – 2 to 3 visits or more to maximize glucose control on injections and determine future pump settings. The last appointment must be within 4 weeks of starting the pump
- Pump educator – 2 to 4 visits or more to learn technical use of the pump and infusion set insertion
- Manufacturer’s Pump Trainer – 1 visit approximately 1 week prior to your class to learn how to operate your pump and go on a trial of saline in the pump.
You will attend an insulin pump start class on two consecutive mornings taught by certified diabetes educators. This is when you will start pumping insulin.
Make appointments with pump team
- MD – 2 to 5 visits or more
- RN – 2 to 4 visits or more
- RD – 0 to 2 visits or more
Once you are given the dates for your pump class be sure to schedule your pump team follow up appointments.
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