Contributor: Shannon Knapp, BSN, RN, CDE
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If you have diabetes, you may be curious about insulin pumps, which deliver rapid-acting insulin as both a small, steady flow 24 hours a day (basal) and a larger surge for meals, snacks, and high blood sugars (bolus).
The good news is that there is a lot of information available about insulin pumps. Also, many hospitals, including Cleveland Clinic, have classes for people who are considering them.
Here’s how an insulin pump works: The device, which is about the size of a small cell phone, provides insulin through a small flexible tube called a cannula. The cannula is part of a tubing set called an infusion set. It is inserted under the skin using a needle, which is then removed — leaving only the cannula.
Do some research and talk to your doctor if you are considering a pump because there are both pros and cons to using one. Here’s a rundown on advantages and disadvantages:
What are the advantages of insulin pumps?
- You don’t have to give yourself as many injections. For people who require three to four insulin injections each day, using a pump can be a big benefit. With an insulin pump, you’ll only need a “stick” once every two to three days for infusion site changes
- A pump provides a very accurate delivery of insulin. This helps improve blood sugar control for people who have a hard time keeping it regulated. Some pumps have the ability to fine tune dosing to 0.001 of a unit!
- Those who use an insulin pump often have improved A1C levels. (The A1C test helps gauge how well you’re managing your diabetes.) This is usually the result of more accurate and consistent delivery of insulin.
- You may have more flexibility with your diet if you use an insulin pump. For example, eating five or six small meals a day can be inconvenient for people taking injections. Some insulin users avoid this meal plan because it would require an injection for every meal that includes carbs. But with a pump, dosing for meals is done by pressing buttons on the pump, making it much easier to adapt the necessary insulin dosing to a meal plan that fits your lifestyle.
- Exercise can be easier to manage with a pump. Have you ever had to eat right before exercising to prevent a low blood sugar? In most cases, that is because your long-acting insulin continues to work during exercise. On a pump, you can turn down the basal insulin before, during, and/or after exercise to help prevent a low.
- It can help if your schedule makes regular injections more challenging, such as an especially busy workday, working third-shift, or having a shift that changes regularly.
What are the disadvantages of insulin pumps?
Although pumps have many benefits, they aren’t for everyone. Consider the following:
- A pump is not a “set it and forget it” type of device. Pumps require a lot of regular user input. Pump users enter information into the pump all day long, including blood sugar numbers and carb grams eaten. And every three days, it is up to the pump user to change his/her tubing and insert a new infusion set.
- Insulin pumps require at least four blood sugar checks per day. This frequent blood sugar monitoring is necessary to verify that the pump is delivering insulin as expected.
- Using a pump does not mean you don’t have to carry diabetes supplies around with you anymore. Not only do pump users have to bring their blood sugar monitor with them, but they also must have a pump emergency kit with them at all times in the event of things like pump malfunctions or problems with the tubing.
- When transitioning from injections to a pump, there are usually multiple visits required with your healthcare team even before you start the pump. These visits help to prepare you and are crucial to your success on the pump, but may take several weeks or months to complete.
- Although most insurance companies will cover pumps, your copay could be more expensive than injections. Check with your insurer to see if it covers pump therapy and what your copay would be.
- Some people gain weight after starting a pump. Remember that pump benefit of added flexibility in the diet? Sure, pressing a button on a pump makes it easier to take insulin for a snack, but if those snacks are extra calories in your diet, they can lead to weight gain.
- With insulin pumps there is a higher risk of diabetic ketoacidosis, or DKA, a potentially dangerous condition where a lack of insulin causes the body to break down fat for energy. This can happen any time there is a blockage in the flow of insulin from the pump. Luckily, doing frequent blood sugar checks and carrying a pump emergency kit can greatly decrease the risk of DKA.
- Though pumps are convenient, some people don’t like being attached to one; some people also just don’t like the idea of having a device that remains with them 24 hours a day.
The more you know about pumps, the easier it will be to decide if an insulin pump is right for you. Schedule a visit with your doctor or diabetes educator to learn more.