Insulin Pump Therapy

Using An Insulin Pump

This section will take a look at some of the things you need to know about using a pump, including those everyday tasks involved in taking better control of your blood sugar.

Overview of Basal Rates and Boluses
In a person without diabetes, the pancreas releases small amounts of insulin that allow the body to use blood sugar for energy. This sugar comes from the food you have eaten. The pancreas releases a larger amount of insulin with meals to maintain normal blood sugar levels. Insulin pumps are designed to mimic this process through the use of “basal rates” and “bolus” doses.

The first type of insulin delivery, the basal rate, is also referred to as “background insulin.” It’s the insulin your body needs between meals and while you sleep. Your basal rate is the amount of insulin that the pump delivers automatically, at regular intervals, and in very tiny increments — such as 1/10th of a unit. When you go on a pump, your diabetes team will help you determine how much basal insulin to program. You may have many different basal rates depending on your changing needs. Each rate is programmed into your pump, and you can switch rates by pressing a few buttons. For example, your body may require a lower basal rate (i.e., less insulin) in the afternoon when you play sports. Yet, in the morning, you may require a higher basal rate (i.e., more insulin) if you’re sitting in the classroom. Many pumps let you store more than one basal program to accommodate different kinds of days. For example, you could have one program for school days and another for weekends when you sleep in.

With the Pump,
You Take Insulin When You Need It.

Before each meal or snack, you will give yourself a bolus dose by telling the pump to deliver insulin to match the size and content of the meal, taking into special consideration the amount of carbohydrates you are eating. Since the insulin is taken with your meals, you can eat when you want and when you want. You don’t have to live your life according to the peaking of long acting insulin like NPH. Meals can even be delayed or skipped altogether, which can give you additional flexibility in your schedule.

Living with the Pump Every Day
Even though the pump is a very sophisticated insulin delivery tool, it’s easy to use, even for kids. The following will give you an idea of daily maintenance and care, including the steps you need to take to ensure the best blood sugar control.

Pump Power
Many pumps use “watch-like” batteries for power, although some pumps use AAA batteries, which you can find almost anywhere. Most pumps have alerts to tell you when the battery is low.

Infusion Set
The infusion set is the flexible tubing connecting you to the pump, which ends in the tiny, soft, “needle” or cannula that you place under your skin, on your abdomen, thighs or buttocks. You change the infusion set, according to the manufacturer’s FDA-directed guidelines, every two to three days. (See Wearing Your Pump for more details on your infusion set.) Some infusion sets have an automatic insertion device that can make it easier to insert the set.

Insulin cartridge
Inside the pump, a small cartridge holds your supply of insulin. It’s like a syringe, and it fits into its own compartment inside your pump. You change this cartridge when it runs low on insulin. Some pumps can automatically detect when your insulin volume is low. Most pumps hold about 300 units of insulin, but the Medtronic MiniMed Paradigm holds 170 units. Consider how much insulin you use each day when you’re looking at which pump might be best for you.

When you’re on the pump, you will press a few buttons when you eat to deliver your bolus dose. The amount of the bolus is based on the amount of carbohydrates in your meal. Your diabetes team will teach you how to determine the right amount to bolus for a given amount of carbohydrates.

You can either detach from your pump during exercise or use a specific basal rate for activities that might cause your blood sugar to go low. (See Life on a Pump for more information about playing sports on the pump.) Pumps can make sports easier compared with shots, because you can lower the amount of insulin afterwards easily by adjusting the basal rates.

Blood Sugar Testing
Whether you’re on shots or the pump, you should test your blood sugar a minimum of four times each day. Many people who use a pump test much more often — some ten times per day or more. The reason is that the more you know about your blood sugars, the more you can do to keep them as close to normal as possible — which leads to better health. Ideally, you should test your blood sugars when you wake up, eat lunch and dinner, and go to bed.

One of the most frequently asked questions about the pump is how you can sleep with it comfortably. The answer is, pump users usually find it is easier than they expected. People leave it the nightstand, under their pillow, even in a pajama pocket. Another consideration with sleeping is your basal rate. Your diabetes team will work with you to figure a specific amount of insulin for overnight. This will help reduce low or high blood sugars in the morning (“Dawn Phenomenon”). More normal overnight blood sugars should also help you sleep better, so that you can wake up feeling better than when you were on shots.

What if the tube gets blocked? What if I drop my pump? What if I press the wrong button and give myself too much insulin? Pumps are designed to be durable enough to withstand regular abuse associated with everyday living. Some pumps are also waterproof. Safety is of primary concern, so there are many alerts to tell you when batteries need to be changed or if there is something blocking
the tube.

There are watertight pumps available today that make it possible to swim or bathe while wearing a pump. Because you wear the  pump every day, pumps are designed to be splash proof and may even be dunked for a few seconds without damage. Some are even waterproof. So don’t worry about removing your pump to wash the car or for the log ride at an amusement park. To shower or take a bath, you can easily disconnect the pump at the end of the tubing, leaving the cannula in place.