Insulin Pumps and Continuous Glucose Monitoring. Francine R. Kaufman

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.

GETTING AN INSULIN PUMP

      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 as number of insulin doses delivered, pump settings, glucose values, carbohydrates consumed, infusion set changes, pump suspends, and more. These data management programs then display data in pie charts, tables, graphs, and percentages above and below target range. The ability to transfer this data and analyze it with the software can help you improve your diabetes care by making it easier to detect trends and patterns that may require attention.

      CHAPTER REVIEW

      • An insulin pump is a small machine that continuously delivers insulin.

      Pumps come in two varieties: durable and patch.

      • There are many advantages to insulin pump therapy. The advantages of delivering basal insulin with a pump include multiple basal rates, temporary basal rates, multiple basal patterns, and precise insulin delivery. Boluses can be given to cover food, to correct an elevated glucose level, or both. This gives you flexibility.

      • The disadvantages include the risk of DKA, the issues of being attached to a device that reminds you about diabetes and might be visible to others, issues with your skin and with infusion sets, missed boluses because diabetes management becomes more automatic, and cost.

      • Pump users should have these qualities: realistic expectations, ability to participate with others in their diabetes care, sufficient diabetes knowledge, willingness to monitor glucose effectively, desire to use an insulin pump, and an understanding of the costs of the device.

      • You need to decide which pump to use, and getting properly trained is critical.

SECTION 2: THE NITTY-GRITTY

CHAPTER 3 HOW DOES MY PUMP WORK?

      IN THIS CHAPTER

       • The Parts of the Pump

       • Pump Functions

       • Uploading and Record Keeping

       • Patch Pumps and Pumps in the Future

THE PARTS OF THE PUMP

      Although it’s only about the size of a deck of cards, an insulin pump is an impressive, complicated device that contains many components and can perform many different functions. There are two kinds of pumps: durable and patch.

      Durable pumps are designed to last many years. They are made of a hard plastic case with buttons, a front screen, a battery compartment with a screw on top, and a space for the reservoir that will be filled with insulin. Clips can be attached to the outer surface so you can place the pump on a belt or waistband. There is a sticker on the pump that has some useful information: the serial number, model and type, company phone numbers, and other general information. At the base of the reservoir shaft is a computer-controlled mechanical plunger that can deliver incredibly small amounts of insulin.

      Patch pumps are worn directly on the body. The pod component attaches to the body and has the insulin reservoir and motor inside. It is controlled by a separate controller or personal digital assistant (PDA).

      Reservoir

      The reservoir comes empty. There is a needle attachment that is used to draw insulin from the insulin vial into the reservoir. The needle is detached once the correct amount of insulin is drawn up; the correct amount