About Insulin Pumps   Frank Barnhill M.D.
 

This handout is not only intended for those using insulin pumps to improve control of their diabetes, but should also be used by family and friends who wish to learn more about continuous percutaneous insulin infusion.

In this handout we will cover the reasons for insulin pump therapy, the types of pumps available, general use of pumps, side effects of using pumps and the problems that can arise from improper or inefficient use.

Insulin pumps are designed to allow a diabetic person to achieve as normal as possible blood sugar control by simulating the body’s normal pancreatic function. Your body normally maintains blood sugars within a narrow range of 80 to 104, because the pancreas produces and secretes or adds insulin to your bloodstream continuously in what is called the basal state. After meals and during the release of certain hormones, your pancreas also adds (boluses) additional insulin to the blood stream to compensate for higher blood glucoses.

For one reason or another, insulin production, secretion or interaction with body muscle and fat is impaired in the diabetic person. Almost all persons who develop diabetes under age 21 will require insulin and up to 40% of those older than 21 will eventually need supplemental insulin as their pancreas stops working.

The advantages of using an insulin pump are:

More individual control over your life and control of your weight

No need for multiple daily injections, so more freedom to choose when and where you bolus insulin or check finger stick blood sugars

You can delay, advance, or even skip meals, as you desire

No embarrassment from having to inject insulin in public

More predictable absorption of insulin and the resultant blood sugars

So, most persons require less insulin in a 24-hour period

Fewer episodes of hypoglycemia or low blood sugar

Freedom to eat smaller, larger, more frequent, less frequent, earlier, later or higher calorie meals because you can bolus or infuse less or more insulin as needed at the touch of a button.

Allows you to exercise or sleep without the fear of hypoglycemia that occurs more often with multiple daily insulin injections 

Ability to reverse insulin reactions or low blood sugars by decreasing the pump output or removing the catheter

This is especially convenient when you are sick with a fever, vomiting or diarrhea.

And of course the most important benefit of pump therapy is being able to keep your blood sugar in the normal range (90 to 120 with a hemoglobin A1C of 7 or less).

This benefit decreases your risk of the complications of diabetes such as blindness, kidney, heart and vascular disease significantly, as persistently elevated blood sugars can damage all of these body organs.

The disadvantages of insulin pump therapy:

Some people just can’t stand the thought of wearing a machine under their clothing or on a belt

Insulin pumps are designed to deliver a continuous amount of insulin under your skin through plastic tubing called a catheter. This tubing will need to be changed every three days to avoid skin irritation and infection or abscess formation.

There is a higher risk of diabetic ketoacidosis or high ketone concentrations in your blood stream if you do not receive insulin for 3 or 4 hours without injecting additional amounts. Without continuous infusion, you literally “run” out of insulin in a couple of hours.

This situation usually arises because of pump failure from dead batteries, a stopped up catheter, the catheter being pulled loose, and the skin around the catheter not absorbing insulin because of scarring or infection.

You must check finger stick blood sugars at least three times a day to help set and maintain basal infusion rates. It is important to assess both fasting and two hour after meal (postprandial) blood sugars in order to lessen your risk of the complications of diabetes.

Your goal in insulin pump therapy should be to achieve a 2-hour postprandial blood sugar of 160 or less until you get really good using your boluses to control your blood glucose. Eventually, we hope you will strive to have 2-hour postprandial glucoses in the 120 to 140 ranges and still avoid hypoglycemia or insulin reactions.

If you have questions about setting your individual goals, please do not hesitate to ask!

drhuggiebear, drhuggiebear.com and contained materials are the copyrighted and/or registered properties of Frank Barnhill, M.D. and may not be reproduced for profit without the express written permission of the author.  All materials may be photocopied in whole for educational use.  For information please contact us at drfrank@drhuggiebear.com.