Is the Pump Right for You?
Only you and your diabetes team can determine the best way to manage your diabetes. However, if the flexibility of the pump is appealing to you, consider the points below. This section also includes another list of questions that you can use to talk to your physician or diabetes team about going on pump therapy.
Who is a candidate for the pump?
- People who take insulin
- People who have frequent problems with low or high blood sugar
- People who have difficulty maintaining control over their blood sugar despite their best efforts
- Women who are pregnant or are planning to get pregnant
- People who travel frequently or have unpredictable schedules
- People who play sports or are regularly active (i.e., runners, hikers, bicyclists, skaters, etc.)
- Teenagers undergoing physical changes
- People who are very motivated to maintain tight control
- People who want the most control over their schedule
Questions to ask your diabetes team when considering the pump
- What are the benefits of the pump therapy vs. shots?
- How do I determine the amount of insulin to use with a pump?
- How often will I need to test my blood sugars?
- What effect will continuous insulin have on my diet and exercise?
- What kind of education or training is involved?
- What features should I look for in a pump?
- What's involved in switching from shots to the pump?
- What have been your other patients' experiences on the pump?
Why Consider a Pump?
- Improved Control. Near-normal blood sugars mean better health, a chance to avoid complications and prolong life. Pump users almost always report better control with a pump than they were able to achieve using multiple daily injections. They typically report less hypoglycemia, due to both the predictable action of short acting insulin and the ability to control precisely the amount of insulin injected.
A recent study demonstrated that insulin pumps are better than multiple daily injections for adolescents. Many people feel that pumps are better for everyone who uses insulin.
- Flexibility. Another strong reason to consider an insulin pump is flexibility. Since insulin pumps deliver only short-acting insulin, you are freed from the need to eat at specific times to cover longer-acting insulin that you injected hours before. You are able to sleep late without worrying about your blood sugars going high because you have basal insulin continuously infused by the pump. Parents need not worry about kids who are picky eaters, since there is no long-acting insulin to cause hypoglycemia -- you bolus to cover whatever is eaten, after it is eaten (when using Humalog or NovoLog in the pump).
With a pump, you're down to one "injection" (the infusion set insertion, which is typically painless with an automatic insertion device) every two or three days. Plus, your insulin is always with you.
- Precision. Pumps deliver insulin much more precisely and accurately than anyone can with a syringe or pen injector. And because you can use an auto-insertion device and infusion set, you get consistent insertion depth for more predictable absorption. Pumps typically can deliver insulin in 0.1 unit increments (some pumps even provide 0.05 unit dosing). Such precision is not possible with today's commercially available insulin syringes or pens.
Arguments Against a Pump
- Some people can gain almost the same level of flexibility provided by a pump when using multiple daily injections of UltraLente or Lantus for basal coverage, and Humalog or NovoLog for pre-meal boluses. Some people refer to this regimen as the poor-man's pump. While Lantus makes it even easier to use injections to mimic the benefits of a pump, the pump lets you cover rising insulin needs early in the morning, while Lantus cannot. And Lantus can't be mixed with shorter-acting insulin, so you'll need to take faster-acting insulin injections at meal times to maintain good control. The result is that you take several shots a day.
- There is no backup long-acting insulin in your body. If the pump ever stops working, or the infusion set becomes blocked, and you aren't aware of it, your blood sugar will rise quickly. Within hours, you could be producing ketones. A recent study demonstrated that extra care was needed when using an insulin pump with Humalog. So you must remain vigilant, paying special attention to pump alarms and instructions for use. And you must check your blood sugars frequently - the more often the better. Be prepared to test a minimum of four times a day. Many pump users test 10 times a day or more.
- Sports, bathing and intimacy require a little more thought. However, pump makers provide a way to disconnect the pump from the infusion set and reattach it without removing the infusion set from your body.
- People who are extremely active -- like professional athletes, firefighters or police officers -- may feel that their occupations or hobbies might make pump therapy more challenging than injection therapy. Nevertheless, there are many people pursuing such careers and athletic goals who all enjoy the added flexibility, convenience and control their pumps deliver.
The Bottom Line
Pump therapy represents the best that medical science has to offer for controlling type 1 diabetes. Pump therapy may also be useful for some patients with gestational diabetes and with Type 2 diabetes.
Pumps make it easier to achieve tight control than injections because of the more predictable nature of using only short-acting insulin. Pumps also provide a level of schedule freedom that you simply can't get with injection therapy. For anyone who is having difficulty controlling blood sugars due to unpredictable schedules, pumps can often help make a huge difference. For example, pumps can allow teens to sleep late without risking hyperglycemia.
For people who count carbohydrates and calculate bolus amounts, pumps offer freedom to eat on their schedule, not the schedule dictated by long-acting insulin. Pumps have been even successfully used on very young children, including toddlers and infants.