Living with diabetes blog

Insulin pumps: Explore the pros and cons

By Nancy Klobassa Davidson, R.N. and Peggy Moreland, R.N. September 13, 2011

Are you considering the use of an insulin pump? More and more people with type 1 diabetes and insulin-dependent type 2 diabetes are wearing insulin pumps. Insulin pumps deliver rapid-acting insulin 24 hours a day.

Insulin pumps deliver insulin in three ways:

  • Basal rate. The insulin pump delivers small hourly increments of rapid- or short-acting insulin over a 24-hour period. The basal rate replaces a long-acting insulin injection and accounts for approximately 50 percent of a person's total daily insulin requirement.
  • Boluses. These insulin injections are required to cover carbohydrates eaten at meals.
  • Correction. A correction is used to adjust the pre-meal insulin bolus for glucose values outside of the blood glucose target range.

Benefits of insulin pumps
Insulin pumps can:

  • Improve blood glucose control by delivering individualized basal rates
  • Eliminate inconvenience of multiple daily injections
  • Increase lifestyle conveniences — you have more flexibility about when and what you eat
  • Offer precise dosage delivery in basal rates as low as 0.025 units per hour and bolus rates of 0.1 unit doses
  • Allow temporary basal rates
  • Deliver a special meal bolus to match the delays in the absorption of certain foods
  • Usually result in fewer large swings in your blood glucose levels
  • Reduce frequency of hypoglycemia

Disadvantages of insulin pumps
On the flip side, an insulin pump:

  • Can malfunction, delivering too much or too little insulin
  • Increases risk of diabetes ketoacidosis — the pump uses only rapid-acting insulin, and if insulin delivery is disrupted for any reason, your blood glucose will rise rapidly putting you at risk of ketoacidosis
  • May be expensive — costing around $7000 for the pump itself, with supplies costing about $1500 a year
  • Is attached to you all day every day
  • Won't take care of all your blood glucose problems — you'll still need to test your blood sugar before meals and at bedtime, and the person using the insulin pump will continue to give a bolus before meals

Most insulin pump users would agree that the advantages far outweigh the disadvantages. My two sons with diabetes both use insulin pumps and wouldn't have it any other way. If you're considering an insulin pump, you must currently be on a multiple daily insulin dose program, be experienced in carbohydrate counting, and test your blood sugar at least four times a day. A good candidate for an insulin pump must also be able to understand and work with mechanical devices or computers. Please discuss with your diabetes care team if insulin pumps interest you.

Peggy

Sep. 13, 2011