Insulin pumps for diabetes patients

Insulin Pumps

An insulin pump is a small device that delivers only rapid-acting insulin via a tiny plastic tube that is placed into the skin and stays connected to your body all the time.

From Kids Health: Insulin Pumps

Facts about insulin pumps:

• The pump placement site on the body needs to be changed every two to three days.

• The pump can be disconnected for short stretches, including bathing, but not for longer stretches because children with type 1 diabetes need insulin all the time.

• Blood sugars still need to be checked four to six times per day, as the pump does not monitor blood sugar. This is also true with continuous glucose monitoring, or sensor devices.

• It is important to remember that children on insulin pump therapy still need to have syringes and understand how to calculate insulin doses for times when the pump isn’t working or the child is ill with ketones.

• Insurance often guides which pump manufacturers a child has access to, but all pumps work with the same basic design, delivering rapid-acting insulin based on basal rates, carbohydrate ratio and correction factor settings that are inputted by the family.

How does the pump deliver insulin?

• Basal: The pump delivers a small amount of insulin continuously to keep glucose levels in the target range when no food is eaten. This is instead of long-acting insulin such as glargine (lantus) that is given to children on injection therapy.

• Bolus: The pump delivers short-acting insulin (examples: lispro, aspart, apidra) delivered over a short period of time, multiple times a day to provide insulin for carbohydrates eaten as well as correction insulin for high blood sugars.

Why should I consider an insulin pump?

• Choosing between insulin delivery options is a family choice. The pump, just like a syringe or an insulin pen, is only a tool to deliver insulin into your body. It works well for some families but not for others.

• Some families find that the pump can be more flexible in your meal times and exercise and social routines because you can deliver very small amounts of insulin, rather than only half or whole units.

• Other families like the freedom from taking out needles in public places and prefer the pump technology, which is familiar in the world of advancing gadgets, phones and mobile technology.

What are some risks and downsides to an insulin pump?

• Cost. Insulin pumps cost around $7,000 plus the cost of supplies.

• Pumps only delivery rapid-acting insulin, so if the pump has an issue, the tiny plastic tube (catheter) gets bent, or ketones are building up, diabetic ketoacidosis (DKA) can develop quickly, To avoid this, patients on pumps need to be excellent at checking blood sugars regularly, and more frequently if blood sugars start to trend up.

• Infections and poor insulin delivery are possible if you do not move the pump site between a variety of spots.

• Like any technology, there are problems that unexpectedly come up and the pump can stop working. Families have to be ready to switch back to syringes at all times.

Troubleshooting an insulin pump

If you aren't sure if your pump has been working, it's often safest to switch to basal and bolus insulin by injection while troubleshooting as follows:

Check infusion set/pod

• Detached?

• Blood in tubing or insertion site?

• Can you smell insulin?

• Same site for more than 3 days?

• Scar tissue at site?

• Kinked catheter?

• Is area of insertion red, swollen, painful, leaking or wet?

Check tubing

• Loose connections (site or reservoir)?

• Is tubing damaged, cut or knotted?

• Visible air space (will appear as a line in tubing) in tubing or reservoir? (note:. ~1 inch of tubing = 0.3–0.5 units of insulin)

Check your pump/device

• Pump on suspend?

• Any error messages or alarms?

• Missed bolus?

• Out of insulin?

• Forgot to prime the tubing or catheter?

• Battery/Power full?

• Settings/date/time correct?

Check insulin

• Expiration date?

• Insulin storage concern (temperature, etc)?

When in doubt… change it out!

• Infusion set catheters may become kinked. Changing the infusion set is the only way to know if this is the problem.

Recheck

• If pump issues do not resolve with change of infusion set and reservoir, there may be an issue with the pump.

• Switch to basal and bolus insulin by injection

• Call pump company

• Switch to basal and bolus insulin by injection

• Call diabetes team for help with dosing and to make them aware.

What is the next step?

1. Talk as a family about the pros and cons of pump therapy in your own life.

2. Call the Pediatric Diabetes Clinic to set up a time to talk about pumps with our team.

3. Check with insurance about what is covered.

Remember

A pump doesn’t work on its own. An insulin pump is simply a tool that delivers insulin. Just like syringes and pens, pumps only work well if you keep up with checking blood sugars, giving insulin, and making adjustments to your insulin plan regularly.