Type 1 Diabetes: Insulin Pump Therapy

By Gabrielle Kaplan-Mayer

For years, the 3.7 million people worldwide who depend on insulin to survive had no choice but to take daily insulin injections—sometimes up to ten a day. Today, those same people are offered a technology that allows them to replace the daily regimen of shots with a continuous flow of insulin in their bodies, through a “pump.” In addition to not having to endure the pain and inconvenience that multiple daily injections can sometimes cause, pump users have more control of their insulin flow than do people taking injections. With just the press of a button, a pump user can stop or cut down the flow of insulin, as needed.

First introduced in the 1970s, today's pumps are small, sleek, and safe machines, about the size of a beeper or smaller. Just like a pancreas, an insulin pump releases small, continuous amounts of insulin into the bloodstream. In pump terminology, this is known as "basal" insulin. And, just as a pancreas produces insulin quickly to counteract carbohydrate intake, an insulin pump allows its wearer to dial in additional insulin to cover the amount of carbohydrates ingested or to correct an abnormally high blood glucose level. This insulin is known as a "bolus" of insulin. The combination of correct basal insulin rates with additional bolusing allows the person with diabetes to achieve the closest thing possible to a functioning pancreas.

With over thirty years of technology behind them, today's insulin pumps contain tiny computers, and run on batteries. They are extremely safe, comfortable and easy to wear. (In fact, dLifeTV co-host Nicole Johnson Baker, wore her pump throughout the Miss America competition.) Insulin is delivered through a thin tube that is connected both to the pump and to the person wearing the pump, through a needle or catheter, placed under the skin. The tubing needs to be changed every 2-3 days, meaning the user only needs to feel a needle that often. Most pump users connect at the abdomen, although others use thighs, hips, upper buttocks, or even arms. The tube can be easily detached for some activities, such as showering, that are easier to do without the pump on. Many pumps are water resistant, allowing the pump user to stay attached while swimming if desired.

Insulin pumps allow their users to continue any physical activity they're involved in – they don't inhibit sports, recreation, work or sex. In fact, because the pump user is able to lower the basal insulin rate during exercise or other activities that normally lower blood sugar, he/she will generally experience fewer hypoglycemic episodes.

There are many different reasons to choose pump therapy over multiple injection therapy and the following are some of the most important reasons to consider this choice. Talk with your endocrinologist or certified diabetes educator if you think the pump might be right for you.

Poor glucose control (high A1c values).
At the June 2002 meeting of the American Diabetes Association, three studies demonstrated that pump therapy is the most effective way to maintain tight blood sugar control. If you are struggling to keep your sugars within a healthy range, the continuous flow of insulin that a pump offers may help you regulate your blood sugar control.

Frequent and/or nightly hypoglycemia.
One of the biggest advantages of pump therapy is that you can adjust your basal rates for different times of the day. You may need more insulin during the evenings, and less while you sleep, or the reverse. By working with your doctor to establish your basal rates, you can avoid taking too much insulin and will never have to worry about insulin “peaks.” These factors help many people avoid frequent lows.

Desire for a flexible lifestyle (sleeping late, skipping meals, etc.).
Once basal rates are set correctly, you never have to eat to match your insulin again. If you want to skip a meal, you can. If you need to eat dinner at different times because of your work schedule, you can. If you need to postpone a meal, you need not rush to eat a snack. Pump therapy allows people with diabetes to make the same lifestyle choices as people without diabetes.

Planned or existing pregnancy.
Pump therapy is the preferred insulin therapy for women with type 1 who want to get pregnant. A pump allows the wearer to easily make the necessary insulin adjustments that the different stages of pregnancy require. If a woman is experiencing morning sickness, a pump allows her to give small boluses based on the amount of food she is able to keep down. The ability to give precise dosing, down to fractions of a unit of insulin, also allow her to keep her blood sugars in the very tight range that pregnancy demands.

Better weight management and control with exercise.
Again, pump therapy means never having to eat to feed your insulin or having to take a snack so that you don’t get low while working out. Rather, the fine tuning that a pump allows means that you can adjust your basal rates as you take in fewer calories and lose weight, all while maintaining tight blood sugar control.

If your curiosity is piqued, learn all that you can about the pump. Seek out a local pump therapy support group or look online for groups of pumpers who can share their experience firsthand.

Gabrielle Kaplan-Mayer is the author of Insulin Pump Therapy Demystified, available at http://www.insulinpumpbook.com/.