Q: My father is a diabetic and has been self-injecting for more years than I can remember. My next door neighbor, however, tells me she has an insulin pump which eliminates needles and syringes. Can you tell me what this is all about?
A: Surprisingly, insulin pumps have been in existence for about 30 years now and are growing in popularity because of their ease of use. There are several manufacturers and the devices, much like a new style automobile, offer easy-to-use instructions and more options than ever before. The pump actually helps a diabetic manage insulin levels, blood glucose and carbohydrates with less effort than ever before.
The pump is small — about the size of a deck of cards or pager. Its purpose is to store and deliver insulin. It is carried in a pocket or worn on a belt to allow for a constant flow of rapid acting insulin that is released into the body through a catheter (a small tube) inserted under the skin of the abdomen) and taped in place. The unit works 24 hours a day based on a plan the diabetic programs into the unit. Further, the user is able to change the amount of insulin administered. For example, between meals and while sleeping, a small amount of insulin is delivered to the body so blood sugar levels can remain within the desired range. This is referred to as a ‘basal rate’. Then when food is consumed, a bolus dose of insulin can be programmed into the pump, with the calculation based on the grams of carbohydrates consumed. While this may sound rather confusing, a physician will help determine dosing amounts based on sugar levels, the time of day, the amount of activity encountered, and insulin needs.
An insulin pump requires monitoring, for lack of another word, by the user who must fill the insulin reservoir periodically and to alternate the location of the pump every two to three days in order to avoid infection. The user has to understand how to manage activity levels and to count carbohydrates so a determination can be made as to how much insulin will be required at meal times.
The pump mimics the methods by which a healthy pancreas releases insulin to the body. Interestingly, while the pump eliminates finger pricking and injecting, studies vary on whether the pump actually provides better control than multiple daily injections. Monitoring of blood sugars by the user must be done at least four times each day. Any necessary adjustments to dosing again depends on food intake and the amount of exercise a person performs. During times of bathing or showering, the pump must be disconnected so the protective tape that holds it in place will not loosen and dislodge the cannula, after which the pump is re-applied. However, the needle is left in place and protected, meaning the patient only has to change it every few days.
