Insulin pumps are innovative portable devices that deliver small amounts of insulin into your body twenty-four hours a day. Insulin pumps can help you control your diabetes, reduce the risk of complications and enjoy an active and fulfilling life.
What is an insulin pump?
An insulin pump is a battery-powered appliance designed to deliver insulin into your bloodstream around the clock. The insulin supply includes basal or background insulin and boluses of insulin around mealtimes. You can modify the insulin supply to match the carbohydrates in your diet, your exercise, and your body’s needs.
An insulin pump more closely replicates your body’s natural insulin release. It offers greater lifestyle flexibility; you don’t have to stick to a rigid food schedule. With a pump, you should also experience fewer hypos, and your blood glucose levels should be more stable.
How does an insulin pump work?
An insulin pump is attached to your body; it uses battery power to drive a stream of insulin under your skin and into your bloodstream. The pump has a reservoir that you fill with insulin. You attach the insulin pump to your body by a narrow tube called a cannula. The device inserts the cannula into the layer of fat under your skin; then, the pump drives insulin from the reservoir through the cannula and into your body. You will need to change the cannula regularly to prevent infections and blockages.
You programme the insulin pump to deliver a steady stream of background or basal insulin. When you have a meal or a snack, you should count the carbohydrates in your food, then add a bolus of insulin using the pump. You should wear the pump at all times to ensure your body has the insulin it needs, only removing it for a short time to swim or shower.
Adults and children living with diabetes can use insulin pumps. They are very useful for people with type 1 diabetes because they have no natural insulin production. However, people with very poorly controlled type 2 diabetes may also benefit from a pump. An insulin pump is particularly helpful if you have brittle diabetes, if you need to give multiple daily doses of insulin and still have uncontrolled hypers and hypos, or if you want your diabetes to better fit around your life.
Types of insulin pumps
Pump technology is constantly evolving, and there are many different types available. Your diabetes team should help you find the best pump to suit your needs and your lifestyle. Pumps vary in tube and cannula design, colour, size of insulin reservoir, battery life, screen size, features and type. Types of insulin pumps include:
Tethered or line pumps attach to your body by an infusion set- a fine, flexible tube connected to the cannula. You carry the pump in a pocket, on a belt or a band around your body. Smart pumps are controlled by remote devices or through a smartphone app, allowing you to programme the pump and administer boluses of insulin easily. You should change the cannula and pump position every two or three days to prevent rashes, infection and lipohypertrophy.
A patch pump attaches directly onto your body at the position of the cannula. You control the pump using a remote control that you can carry separately. Instead of just changing the cannula, you should regularly change the whole device.
The OmniPod pump is a waterproof, wireless and tubeless patch pump. It connects directly to the skin without tubes and communicates wirelessly with a remote touchscreen Personal Diabetes Manager that programmes and controls insulin delivery.
Insulin pumps with integrated CGMs
Some of the newest pumps allow direct interaction with a continuous glucose monitor, enabling some devices to respond to hypos by stopping the insulin supply. Examples of pumps with this integrated technology include the Medtronic MiniMed 640G and the Medtronic MiniMed Paradigm Veo.
A closed-loop system is also known as an artificial pancreas. The intelligent systems use a smartphone app to automatically adjust the dose on your insulin pump according to the readings from an implanted glucose monitor. The CamAPS® FX is a closed-loop system that runs on Android devices. Closed-loop insulin systems can offer better diabetes control, a reduced HbA1c and fewer hypos and hypers.
Insulin pump therapy
Insulin pump therapy can revolutionise your life. You can control your diabetes instead of letting it control you. However, you will need to learn how to count the carbohydrates in your diet, calculate your insulin needs, and learn how to programme and use the pump safely and effectively.
Glucose monitoring with an insulin pump
It’s essential to continue monitoring your blood glucose levels to identify any hypos and hypers and calculate what insulin you need. You’ll need to finger prick even with an insulin pump. However, some pumps integrate with a continuous glucose monitor, or you could use a closed-loop system with an implanted glucose monitor if you prefer less frequent finger-pricking.
Carb counting and insulin pumps
Carbohydrate counting is a way to match your insulin needs with the number of carbs in your diet. Carbohydrates in your food and drink are broken down into glucose; that’s the same for carbs in sugar, bread, pasta and carrots. Equal quantities of carbohydrates will raise your blood glucose level by the same amount. By counting the carbohydrates, you can work out how much insulin you will need before a meal. Your diabetes team will help you work out the number of insulin units you’ll need for every 10g of carbohydrate so that you can work out the correct bolus dose of insulin to programme with your meal.
Carb counting sounds confusing, but it gets easier with practice. Initially, you’ll need to weigh and measure your foods. Very quickly, you’ll be able to look at a plate and tot up the carbs in your head.
If you calculate the carbs and give the correct bolus insulin dose, you can improve your diabetes control, reduce hypos and hypers and protect your future health.
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Carol Willis - Diabetes Clinic Facilitator
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