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Are You Ready to Switch to an Insulin Pump?

Everything you need to know to make the transition

With Kathleen Wyne MD

More and more people with diabetes are switching from self-administered injections several times per day to a pump that supplies a continuous delivery of short-acting insulin. 

If you have diabetes, you already know the time and energy that goes into keeping your blood sugar levels in check. (In type 1 diabetes, the body doesn’t produce the insulin that helps it use glucose for energy. In type 2 diabetes you do produce insulin, but it’s either not enough, or it’s not being used effectively.)

For some people with type 2 diabetes, insulin therapy via injections, inhaled insulin, or a pump – in addition to diet and exercise – may be needed. If you're considering trying a insulin pump for the first time, here’s what you should know.

What is an insulin pump?

A pump is a small, computerized device that is attached to your body and delivers insulin continuously (basal) and when you eat (bolus) through a catheter under the skin. Some pumps use a pod attached to the skin via a tube, with a small device that you program and carry around with you, while some are wireless. Each pump is programmed according to your needs, but most can also be configured using a bolus calculator when you’re eating, so that you can receive the right amount of insulin. This is often used in addition to a Continuous Glucose Monitor (CGM).

An insulin pump uses rapid-acting glucose, which is dispersed as you need it, mimicking how a pancreas would behave. Pumps are always evolving, according to Janet Zappe RN, Certified Diabetes Care and Education Specialist. “Today, two of the three pumps can communicate with a sensor to adjust insulin flow on demand. This is a major advancement.”

Who should use an insulin pump?

Successful disease management is all about finding what works for you – as decided by you and your healthcare team. This process can take some time – and it can also be a bit daunting. But you are not alone, and you have options.

You may be interested in using an insulin pump rather than injections for a variety of reasons. Maybe it’s the convenience, a fear of needles, or because you believe it’ll help to better stabilize your blood sugar.

According to University of Michigan Health, “Using an insulin pump can keep your blood sugar at a more constant level so you don't have as many big swings. People who use pumps have fewer problems with very low blood sugar.”

For many patients, it’s simply because they want to inject less. According to Zappe, “A person transitioning is typically injecting four to eight times a day. More, if they like to snack or are pregnant. An insulin pump is usually one physical injection every three days compared to 12 to 24 injections. They have their insulin on them so they can be more spontaneous in what they eat.”

Although there are plenty of great reasons to transition to a pump, it’s an entirely individual decision – and it requires some getting used to it. Here's how to know if a pump is right for you.

You feel ready to make the transition. According to endocrinologist Kathleen Wyne MD of Ohio State University Wexner Medical Center, making this decision is really up to the patient in most situations. “We take the approach that the only criteria to start the process to a pump is for the patient to want to do it,” she says. “But we ask them to learn all the options to make an educated decision of which pump and/or CGM they want.”

You're invested in learning about which kind of pump or monitor you need. The decision must be made carefully, as each person has a unique health situation, says Wyne. Someone who takes very high doses of insulin will need a pump with a cartridge that can be changed every three days, versus every 30 hours, for example. 

Wyne recommends patients ask their doctors for assistance in learning about pump options rather than simply asking their doctor to choose for them, and be an active part of the decision-making process.

You have a firm understanding of diabetes and your own management needs. Wyne says it’s important for patients to be closely assessed to see if they have the skills needed to succeed with a pump. These include:

  • Carb counting, which can be an obstacle for patients who think it’s too tedious
  • Understanding the rationale for pre-bolus, or taking insulin at a set time before eating
  • Learning how to troubleshoot highs, lows, and symptoms of diabetic ketoacidosis, which occurs when the body begins breaking down fat too quickly, causing blood to become acidic

You know how to work the pump and how to fix any issues that arise. You’ll need training on:

  • How to fill the pump’s reservoir where it stores the insulin
  • Selecting where to attach the pump as it can feel bulky 
  • Changing the infusion set 
  • Turning it off
  • Calculating dosages 
  • Preparing for any cases where the pump doesn’t work (such as common examples like heat souring insulin, or your tube getting air bubbles)

Your healthcare team will go over all of this with you, although many patients recommend also turning to support communities on social media and watching other patient's videos on how they do it as well.

Insulin pump obstacles and barriers

Emotions understandably play a role in the decision to move to a pump, so it’s important to take stock of how it may affect you mentally and emotionally.

Some people with diabetes say that being tethered to a device can make them feel scared, mechanical, embarrassed if others see it, or too often reminded of their disease. 

While Zappe acknowledges the complicated decision-making process that goes into whether or not to try a pump, she says they are simply one tool to help you stay healthy.

For this reason, it’s important that you're honest with yourself about your disease (which can be hard!) and about the transition. It might be uncomfortable at first, but it will help you advocate for yourself in the long-term. 

“They need to be in a comfortable place with their diabetes in that they are ready to move to a different approach with different daily tasks,” Wyne says. “There is more work on the transition, but once you have learned all the tasks, it may seem like less work in the end.”

Another barrier? Money. “A pump can cost $10,000,” Zappe says. “If insurance covers 80/20, the person still has a $2,000 expense just for the pump. Day-to-day supplies also add up.” 

Other options 

Wyne says, “Some people who choose to start with CGM do not proceed on to a pump, as the info from the CGM can be enough for them to stabilize glucose trends. Many people are opting for a smart pen and CGM instead.”

A smart pen provides an injection, but it can also keep track of your meals, bolus, and dosages.

But that’s not all. “With the new analog insulins, inhaled insulin, faster acting insulins, and CGM, many people can gain the level of control without needing the increased flexibility of the pump,” says Zappe.

What do people with diabetes think of the pump?

Emily Brimmer, who has lived with diabetes for over 25 years, says she’s tried the pump twice. The first time, she removed it because she was a dancer and the pump wasn’t leotard-friendly. She later went back onto the pump.

“About 5 years later, with really no improvement in my glucose levels, my doctor thought it might be the right time to try again, and it was definitely a different and better experience,” Brimmer says. “I was on just a pump alone for the first 12 or so years and have been using it in tandem with a Continuous Glucose Monitor (CGM), which was a huge game changer."

She says her transition wasn’t exactly easy, though. The first time, she felt a bit of fear. The second time, she says, “I had a better idea of what I was getting into, but it's still definitely weird getting used to having something attached to you all the time.”

It also had an impact on her dating life because the pump was visible. “In that sense, it was actually a really great catalyst for me embracing the fact that I was a diabetic. And even though that's not something I look at as a positive, being open with it makes it easier to be at peace with it to a certain extent.” 

Brimmer says that patients should know that a pump is not a silver bullet. “It’s just as much about what you put into it. I've learned certain tricks along the way, and there's a lot, like with all things diabetes, that is going to depend on the individual.”

For example, she says, “The first time your tubing gets caught on something and pulls out it is a huge bummer, but then you find ways to make sure it's always tucked in. You'll also find the best place for you to keep your pump.”

In the end, Brimmer thinks that patients who want to make it work will see its benefits. “Overall, I would say the patients most likely to be successful are those that are willing to be proactive.”

Continue Reading
How Do I Use an Insulin Pump?