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To Pump or Not to Pump - Part 1

Provided by the Diabetes Research Institute's Education Center

As you know, type 1 diabetes requires lifelong replacement of insulin to provide what the body’s insulin-producing cells (beta cells) no longer make.  Anyone living with type 1 diabetes can tell you how frustrating and difficult this can be.  Although most people understand that insulin helps to use the glucose (sugars found in food) for energy when you eat, they don’t realize that people without diabetes secrete insulin all day long.  There are 2 components to insulin replacement: 

  1. Bolus insulin that is given before meals so that the glucose from food can be utilized for energy
  2. Basal insulin that keeps blood sugars in the normal range when food is not being eaten; in people without diabetes this “background” of insulin fluctuates up and down as more or less insulin is needed to keep the blood sugar stable.

Typically, this requires that rapid-acting insulin (Novolog, Humalog, Apidra, or Regular Insulin) is given before the meal to match the amount of food being eaten PLUS an insulin that is longer-acting to provide the background needed to keep the blood sugar normal when the person is not eating (Lantus, Levemir, NPH).  If you are doing the math in your head, you can see that to replace insulin as close to a non-diabetic person as you can that you will need three to five separate injections per day to accomplish this.

Example:

Another option for the physiologic replacement of insulin (this is just a fancy way of saying that you are replacing insulin as close to the way the body does as you can!) is to use an insulin pump.

The way that an insulin pump mimics the normal workings of the pancreas is to use only rapid acting insulin.  The insulin is loaded into the reservoir of the pump and then the computer portion of the pump is programmed to deliver small amounts of rapid acting insulin all day long to create the “background” or basal insulin; this replaces the long-acting insulin you were taking.  Before meals you will press a button to deliver a “bolus” (big squirt of insulin); this replaces your pre-meal injections.

Who is a good pump candidate?

Anyone wanting better blood glucose control with added freedom and flexibility is a good pump candidate!  However, there are a few criteria that your health care team will want to be sure you match:

Desire:  The best pump candidates are people who WANT to be on a pump.  A parent or spouse may feel that the pump is the answer for their child or partner but if that person is resistant to it, success is unlikely to be achieved.

Realistic Expectations:  People who think the pump is going to take all their “troubles” away are poor pump candidates.  Although in the end, pump therapy can give you greater freedom and flexibility, the time you put into learning about the pump AND good diabetes self-management skills at the beginning will actually create more work for you.  Going on the pump is often a catalyst for people to learn self-management skills that they didn’t learn before and that is good but you won’t just put it on and find that all your diabetes-related issues go away.

Be willing to test at least four times per day or wear a continuous glucose monitor: Most health care professionals will require that people who want to go on pump therapy are also willing to do blood glucose testing at least four times per day.  Anyone who doesn’t test is certainly at greater risk for problems like undetected hypoglycemia and DKA.   Your health care provider would not want to give you a device that could potentially add to that risk if you are not assessing your blood sugars frequently. You can’t assess and use good judgment if you don’t have any blood sugars to guide you!!! 

Make sure the timing is right:  Be sure when you start pump therapy that you have the time to devote to it and to learning more about diabetes self-management.  Do not start pump therapy if you are over committed at work or school and don’t have time to learn how to properly use it and don’t have time to do all of the testing and assessing that starting a pump successfully requires.  Some doctors want their patients to have diabetes for a certain amount of time (six months or a year) before they are willing to start pump therapy.  The rationale for this approach is to give the person time to really learn about diabetes and time for the physician to assess the person’s capabilities. This is not our philosophy, we prefer to assess each person individually; some people are ready very early in diagnosis and some are poor candidates many years after initial diagnosis.  An arbitrary rule to wait may lead to frustration in people who could really benefit by starting their life with diabetes by using advanced technology and more advanced diabetes self-management education.

The pump is an amazing, wonderful tool that can certainly enhance your life with diabetes and can help you to get better blood glucose control while also experiencing greater freedom and flexibility.

However, without education and personal motivation, the pump by itself will not guarantee good blood glucose control.  It is the time and work that the “pumper” puts into it that creates success.

At Diabetes Research Institute, located at the University of Miami, we have an advanced program called “Mastering Your Diabetes” that, over a four-day period, teaches you to “think like a pancreas.”  It will help optimize your diabetes control with or without a pump.  If you want to learn some advanced techniques in diabetes self-management this is the course for you! 

Stay tuned for Part 2 in the next issue of PEP Talk!!!

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