Is Pumping for You?

Stephanie Schwartz
RN, MPH, CDE Diabetes Nurse Specialist

Jeff Hitchcock
Editor, Children with Diabetes

September 1999

www.childrenwithdiabetes.com

Why People Choose Pumps

The first insulin pumps were large, bulky, and difficult to use. People who used them were extremely motivated to control their diabetes. Today, insulin pumps are about the size of a pager.

A freer lifestyle

Normal blood sugars

Fexlibility in meal timing and size

AMIGO Insulin Pump By Nipro

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Why People Choose Pumps

Pump users typically use Humalog, a very fast acting insulin. Using only Humalog helps increase the predictability of insulin action, which helps pump users live more ative lifestyles with reduced risk of hypoglycemia.

Ability to exercise without losing control Control while travelling Erratic schedules

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Why People Choose Pumps

Insulin pumps represent the state of the art in treatment for people with Type 1 diabetes. Many people with Type 2 and Gestational diabetes also use insulin pumps to achieve the best possible control.

Membership in a community of forward-thinking, health-conscious people Peace of mind

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Why Healthcare Providers Recommend Pumps

Talk with your diabetes team about pump therapy. Support for pumps varies, and you might need to work with your team to convince them of the benefits of insulin pump therapy.

To prevent, delay, or reverse complications To manage the dawn phenomenon To reduce wide blood sugar fluctuations

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Why Healthcare Providers Recommend Pumps

Teenagers and pumps go well together. The changing schedules of teens are easier to manage using insulin pump therapy, and teens gain confidence in themselves as they learn that diabetes doesnt prevent them from leading a normal life.

To improve control during growth spurts of adolescence To counteract insulin resistance

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Frequenty Asked Questions

Older kids and adults must decide for themselves about using pump therapy. For younger kids, parents decide. Regardless of age, the benefits apply.

Who would benefit from a pump?

People who want better control
People who want more flexibility in their lifestyle People who are willing to take on more responsibility

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Frequenty Asked Questions

The benefits of using a pump come with the added responsibility of frequent blood sugar monitoring and carbohydrate counting.

What do I have to do if I decide to use an insulin pump?

Check blood sugars at least 4 times a day, every day Learn how to adjust insulin doses based on such things as activity and meal size Count carbohydrates

Check out Carbohydrate Counting at http://www.childrenwithdiabetes.com/d_08_d00.htm

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Frequenty Asked Questions

For teens, one of the greatest benefits of using the pump is the ability to sleep late. Once you have your basal rates figured out, you can sleep as late as you want, without worrying about needing to get up and eat or take an insulin shot.

Can I sleep in and vary the times that I get up each morning?
Yes! Since your body is getting insulin all the time, there is less worry about sleeping in. The pump can be adjusted to give the right amount of insulin to stay in control even when sleeping late.

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Frequently Asked Questions

Today, people with diabetes are taught that they can eat whatever they want, as long as they cover the food with the right amount of insulin. Pump users carry their insulin with them in the pump, making it easy to eat what they want, when they want.

Can I eat whatever I want?

The pump gives you the ability to give the right amounts of insulin at the right times for the for food you you are eating. It is still important to maintain a healthy meal plan based on the Food Guide Pyramid whether you have diabetes or not.

Check out the Food Guide Pyramid at http://www.childrenwithdiabetes.com/d_08_800.htm

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Attitudes and Attributes for Successful Pump Use

Kids who successfully use a pump are selfmotivated and have a mature approach to caring for their diabetes. Theyre also comfortable with having diabetes and arent bothered by wearing a pump.

Self-motivation

Maturity
Acceptance of diabetes Ability to problem solve

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Self-motivation

Frequent blood sugar monitoring is important when using a pump, especially if you use Humalog. An interruption in insulin delivery can quickly lead to very high blood sugars and even DKA.

Must be willing to learn and accept responsibility for pump use, trouble shooting, and self-care behaviors Must perform frequent blood glucose monitoring

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Selt-motivation

People who use insulin pumps are generally highly motivated to achieve the best control they can. They are attentive to variations in their daily lives that affect their diabetes care and make adjustments as needed.

Must follow recommendations for safe pump use Must pay attention to aspects of daily life which affect the insulin regimen and the needed adjustments

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Self-motivation

Its a good idea to keep a diabetes diary to help you identify reasons for high and low blood sugars. You can help prevent future problems if you know the reasons for highs and lows.

Must anticipate insulin needs as circumstances change Must evaluation actions taken and problem-solve

Must agree to follow-up schedule for phone calls and appointments

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Maturity

Parents of young kids with diabetes are responsible for their childrens diabetes care, whether their kids are on injections or use a pump.

Maturity is a more important determinant of pump success than age Insulin pumps have been used successfully in all age groups, including infants and toddlers

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Acceptance of diabetes

Nicole Johnson, Miss America 1999, wears an insulin pump. Her confidence has helped show everyone that having diabetes and wearing an insulin pump need not prevent anyone from reaching their dream.

Wearing a pump is a visible sign that you have diabetes People who havent accepted diabetes may feel uncomfortable making this outward statement

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Ability to Problem-Solve

While a problem with an infusion set is not common, it does happen and you need to be prepared. Always keep a extra insulin and syringes (or a pen) around in case of a pump problem.

Pump users must be capable of learning how to trouble-shoot by adjusting insulin dosages, and problem-solve when theres a problem with the pump or infusion set

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Ability to Problem-Solve

If youre a little rusty on carb counting or adjusting insulin, schedule some extra time with your diabetes team before you start on the pump so youre ready to go when your pump arrives.

Must have a working knowledge of

Pump use
Carbohydrate counting The meaning of blood glucose levels Insulin adjustments

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Ability to Problem-Solve

People who dont monitor their blood sugar arent good candidates for pump therapy. Many pump users check their blood sugar six or eight times a day.

Frequent blood glucose monitoring is an essential element of effective pump therapy Common sense and ability to follow directions are a must!

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Ability to Problem-Solve

Since pump users take extra insulin for all food eaten (the bolus), they need to understand the relationship between the amount of food eaten and the amount of insulin to inject. This is the insulin-tocarb ratio.

Must be able to determine the relationship between aspects of the treatment regimen
Insulin and food Exercise and blood sugar levels

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Ability to Problem-Solve

Once youve determined a reason for a high or low blood sugar, you can change your pumps insulin delivery to accommodate your needs.

Must be able to determine the relationship between actions and results Must be willing to change behaviors (actions) based on the the evaluation of results

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Expectations about Pumps

While the pump may represent the state-ofthe-art in insulin therapy, it is not a cure and it doesnt elininate highs and lows. Understanding that can help make pump therapy successful.

It is important to have realistic expectations about pump therapy Unrealistic expectations will lead to frustration and discontinuation of pump therapy Realistic expectations can become the foundation for setting and attaining treatment goals

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Expectations about Pumps

Adjusting to pump therapy is a lot like adjusting to diabetes. You need to relearn a lot of things. But the benefits of pump therapy make it worth the effort.

Realistic
I need 3-6 months to adjust to pump therapy

Unrealistic
Pump therapy is easy; Ill adjust immediately

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Expectations about Pumps

Many people feel better when they use a pump. However, a pump isnt a cure, and you still need to test your blood sugar and program the pump to deliver insulin when you want it to.

Realistic
I will feel better on pump therapy

Unrealistic
The insulin pump will cure my diabetes

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Expectations about Pumps

A pump man help you achieve better blood glucose control, but youll still have highs and lows.

Realistic
I will have better blood glucose control

Unrealistic
I will have perfect blood glucose control

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Expectations about Pumps

Frequent blood glucose testing is essential for pump users. But if youre considering pump therapy, youre probably already testing frequently because you want to keep your blood sugars as close to normal as possible.

Realistic
I will have to check my blood sugar at least four times a day

Unrealistic
I wont have to check my blood sugar on a regular basis

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Things to Think About

There are many pump accessories that allow you to wear a pump just about anywhere. If you choose to wear it so it can be seen, most people think youre wearing a pager.

Body image
Some people are concerned about wearing a pump because they feel it may cause prospective partners to view their body or health status negatively

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Things to Think About

Some people prefer not to be tethered to a mechanical device, and for these people, pump therapy is not a good choice.

Dependence on a mechanical device

Some people prefer not to depend on a mechanical device to maintain their health

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Things to Think About

Kids and young adults who have grown up with computers and video games will feel comfortable using the pump. Older adults might be a little apprehensive, but will quickly learn how to manage their pump.

Trust and control

It may take some time for a pump user to trust their ability to manage their diabetes using a more complex treatment plan

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Advantages of Insulin Pump Use

Because of the predictable nature of using only short acting insulin, pump users are often able to reduce the frequency and severity of lows.

Tight control while minimizing risk of low blood sugar

You can carefully target insulin delivery to match insulin need

Check out Insuin Pump Questions and Answers at http://www.childrenwithdiabetes.com/dteam/d_0d_0l1.htm#Pumps

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Advantages of Insulin Pump Use

By using only shortacting insulin, pump users free themselves from the burden of eating when their long-acting insulin demands.

Insulin pumps are predictable because they administer only shortacting insulin
Humalog and Regular insulin have a more predictable absorption pattern than NPH, Lente, and Ultralente. This unpredictable absorption accounts for a great deal of the variability in blood sugar control.

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Advantages of Insulin Pump Use

You can program your pump to vary the insulin delivery every hour, so you can adapt insulin delivery to your life, not the other way around.

Insulin pumps are extremely flexible

Everyones insulins requirements are different in terms of how much is needed when. The pumps allows of almost an infinite number of variations in the insulin regimen without adding more shots.

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Advantages of Insulin Pump Use

Todays pumps are high-tech precision instruments. Pumps deliver insulin more accurately than any human could.

Insulin pumps are very accurate

Insulin pumps deliver exactly as much insulin as you tell them to. There is no need to try to measure exactly how much is in the syringe. The more variable blood sugars are, the more important this becomes.

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Advantages of Insulin Pump Use

The ability of a pump to deliver very small amounts of insulin precisely allows pump users to make corrections to high blood sugars with ease.

Insulin pumps are very precise

An insulin pump can deliver extremely small doses of insulin (0.1 Unit). Try doing this with a syringe!

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Financial Considerations

Both Disetronic and MiniMed have experience working with insurance companies to gain coverage. Be sure to work with your pump company.

Insulin pumps are more expensive than multiple injections Candidates for pump therapy need to have adequate financial resources Most health insurers will reimburse for the costs associated with pump therapy if there is documentation that it is medically necessary

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Contraindications

Inserting a pump infusion set is different from injecting insulin. Kids who use pumps should numb their skin with EMLA or ELA-Max before inserting a set.

Lack of consistent blood glucose testing (less than 4 times a day) Unwillingness to calculate meal dosages

Intense fear of needles or pain

Extreme concern about hiding the pump from others

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Contraindications

Because pumps use only short acting insulin, problems with the pump can quickly turn into serious health problems. Pump users must therefore be more attentive to their diabetes care than injecton users.

Poor compliance with treatment plan or scheduled visits Unwillingness to disclose diabetes to others

Severe and unstable psychiatric conditions

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Pumps in Kids

If you have questions about pump therapy for your child, visit the Parents or Pump Users chat rooms at the Children with Diabetes web site. Youll find other parents and pump users who can answer your questions.

Kids of any age should have the option of pump therapy provided:
There is adequate support from the diabetes team There are adequate financial resources The child is capable of pump selfmanagement OR Parent is willing to accept responsibility for pump management

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Summary

Pump therapy is the best that medicine can offer for people with Type 1 diabetes. In the future, we may see pumps tied to automatic glucose sensors in a kind of mechanical pancreas.

Insulin pump therapy can be viewed as the ultimate level of diabetes selfcare

Check out Pump Users Chat Room at http://www.childrenwithdiabetes.com/chat/

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